Oi!

I was late posting the latest from my run of earlies because of this...

A young female driver piled into the back of me as I waited for the car in front of me to pull in and park. All I saw was a blur in my rear-view mirror, her face (closeup) and then there was an almighty bang. My car was thrown forward but I managed to stop it hitting anything else. She had been travelling at speed but hadn't seen that I was stationary - or she was distracted (she had a friend in the car with her).

Her car was much worse off, the entire front of it was demolished but that probably saved her life, she should have been thrown through her windscreen and into the back seat of mine, such was the force.

I have lots of experience with the aftermath of accidents like this but virtually no experience of being in one, so it was quite a shock. Of course, I made sure nobody was hurt and luckily, nobody was.

The irony is that the young lady is insured by one of the most annoying statistically-skewed (and possibly sexist) companies around...Sheila's Wheels!

I can't get the stupid song out of my head now...

Sick in the heart

Nine emergency calls and one running call. One false alarm, two conveyed (including the running call) and seven required an ambulance.

I nearly drove past my first patient of the morning, a 42 year-old man with chest pain. He was sitting in one of those little alcoves (can’t think of a better name) on London Bridge. I almost drove past but I didn’t because he looked so obviously in distress. He was very pale, diaphoretic and had that look of deep concern for himself. Real illness is obvious.

He was on his way to work when he passed out on the tube train. He recovered and made his way across the bridge but suddenly felt unwell again. Chest pain began to develop and he felt sick and faint. He didn’t pass out on me but he had a damned good try. Ironically, he felt better standing up, despite my advice that he should sit down.

The motorcycle responder arrived to help and I could hear the ambulance a short distance away. I’m sure the MC paramedic thought the same as I did; this guy was going to suspend on us. He didn’t though and the crew arrived and took him aboard. He was given everything he needed to help him through this event – courtesy, comfort, dignity and respect. He also got pain relief. He had kidney problems so morphine wasn’t an option – entonox was provided instead.

My next call was for a 19 year-old female having an asthma attack. Her inhaler had failed to provide relief, so she was taken to the ambulance, which had arrived on scene at the same time as me, to be nebulised. She worked in a casino. I’ve never seen the back end of a casino...it’s like Fort Knox (I’ve never seen Fort Knox either)...so much door security...so many doors. I’m willing to bet banks are less secure.

Then off to the north for a male in his fifties who was found lying in a garden with his face ‘covered in dried blood’. When I got there a neighbour, who had spotted him and made the call, described him and said he had wandered off. It sounded very much like a local alcoholic had planted himself on someone’s posh lawn for a few hours and had been caught. These tidy neighbourhoods cannot abide the stench of the street in their territory, so who do they call?

999...Trampbusters!

I carried out an area search and sure enough, around the corner I found him sitting on the pavement of the high street. He smiled and waved at me and I poodled over to chat to him. His face had a few bruises on it and he had a swollen eye – there was no dried blood. He told me he had been given a “good kicking” the night before. This is common and it didn’t surprise me; he probably offended a comrade.

He told me he didn’t want an ambulance (so I cancelled it) and he didn’t need my help, so I prepared to leave him alone. I gave him directions to the tube station, which I thought he should know and bid him farewell...until next time that is.

He wasn’t rude, he didn’t swear and he had his lunch in a plastic bag; apples, sandwiches and cake...no booze. It was probably too early in the day for him.

My next call threw me a spanner. A 78 year-old male was having an ‘asthma attack’, according to my MDT. When I got there I was shown in by his very worried wife. He was sitting on the edge of his bed, leaning forward (this is what severe DIB makes you do), gasping for air. He couldn’t complete a sentence and he looked exhausted. His blue ventolin inhaler was next to him.

He told me that he was asthmatic and that he had suddenly developed DIB. His inhaler had brought no relief and he was getting worse. His sats were very low (89%) and when I listened to his chest I could hear a familiar high pitched wheeze on both sides. I could hear nothing else, just a wheeze. He also had a niggling non-radiating chest pain. He described this as just like an asthma attack for him.

I looked at him again and there was something wrong with the picture. He was sweating profusely. I asked about other medical conditions but didn’t get a clear answer from him or his wife (I think they were both too panicky). I was still focussed on his asthma and prepared a nebuliser for him. The crew arrived as I put this on and we took him straight to the ambulance.

He was still very sweaty and the salbutamol I had given brought no relief, so I asked the crew to give him Atrovent (the 2nd line drug). I was going through the drug regimen for asthma but my inner voice was telling me it wasn’t asthma. I considered something else; congestive heart failure, (CHF). I listened to the patient’s chest again but all I could hear was a wheeze. I asked the EMT to listen so that I had a second opinion but he heard nothing else. The added sound I was listening for was a crackling or bubbling sound that would indicate fluid in the lungs – a sign of possible heart failure. I needed something to go on before I made a decision to give this patient a drug he quite possibly didn’t even need. He could still have been having a severe asthma attack, notwithstanding the chest pain.

I had checked the man’s ankles but there was no swelling. Then I asked again about his medical history and his wife told me he had high blood pressure. I asked what medicine he was on for it but she couldn’t name it and started rooting around in her bag for it but time was running out.

I could stay on scene in the back of ambulance and wait for a 12-lead ECG. I could cannulate this patient and give him Frusemide, which would deal with the symptoms he was experiencing if my hunch was correct or I could let the crew get him to hospital now. The hospital was three minutes up the road and it would take me that time to prepare and administer the drug, so I decided to leave him alone. I discussed this with him and told him what the options were – he agreed that it was best to get going.

When he got into resus, the doctors were no wiser and continued the treatment for DIB related to asthma. I left after twenty minutes, just as an x-ray was being set up. This would confirm CHF if that was indeed the problem.

If you don’t eat for days on end, your body will start to rebel – especially if you are elderly. I was asked to attend a 70 Year-old woman who hadn’t eaten for three days. An ambulance had been called for her because she felt dizzy and generally unwell. She had lived a healthy life until now but had lost her appetite recently, resulting in her three day fast. She told me that she vomited when she ate, so she didn’t bother trying. She was quite pale and very tired looking. I think that despite her years of good health, something sinister may have caught up with her. She went to hospital.

Then I had to deal with an extremely distraught (and badly behaved) woman at an embassy building. She and her husband had allegedly been given bad news about their immigration status and she had reacted by stripping off to her underwear, tearing her wig from her head and throwing herself wildly about the floor, screaming and wailing. I’m not the world’s most patient person for this kind of display.

The ambulance had been called on the basis of her having ‘chest pain’ but she had nothing of the sort. She was hyperventilating and stressing while reeling around on the floor like a mad woman. Her husband did nothing to help and communication was impossible. Her screams were so loud and piercing at times that I had to plug my ears with my fingers until she reduced the volume. I got kicked and slapped by her as I tried to keep her calm.

When the crew arrived, they spent a lot of time just settling her (when the husband was taken out of the room, she calmed down) but I couldn’t help thinking what a waste of emergency resources this was. She had no illness and her immigration status would not improve because we were there. I sympathised to some extent but then I remembered my last seriously ill patient and even that connection evaporated. I’m not a social worker and I wouldn’t be good as one either; everyone has problems...everyone. Most people stand alone and deal with them.

The police had been called for this job and when I got outside there were armed cops at the door and up the street, which had been closed off. They thought it was a siege! One of these police officers had even drawn his hand gun as he approached the area. It was a Wild West farce brought about by a single irrational woman.

My next call took me back into the West End for a 23 year-old who had fainted. She was lying on the floor of her office and a colleague was standing next to her. She had felt faint but hadn't actually passed out. I could see that she was stressed and that there was probably more to this than she would tell me (there usually is), so I coaxed her to sit up, chatted with her and cancelled the ambulance, telling her that I could take her and her friend in the car, which would be less stressful. She was happy for me to do that.

When she got to hospital, she looked just as depressed as when I met her. She was wary of everyone and everything that was being done to her (I didn’t carry out a BM because she was clearly frightened). When her mother arrived and I showed her where her daughter was, I was almost physically swept aside. I felt like a servant delivering a package. Some people still don’t get the whole mutual respect thing.

A smelly call for a 35 year-old alcoholic at a hostel. He had been lying in his own filth for days and the staff just wanted him out. They claimed he was having a fit but this was news to him and his mates. He didn’t appear to be recovering from a seizure at all, he just looked drunk. He smelled drunk but all the other smells soon put that into perspective. At first the gag reflex kicks in but then you recover...looking away for a few seconds and reminding yourself that you have no choice but to deal with it is the only true way to cope.

As we stood him up (the crew were on scene with me) the inevitable happened; his trousers fell down, exposing him to the entire room (they never have underwear on). So, we pulled them up, secured them and took him into the ambulance, where my part in the drama ended, thank God.

My last call of the day was a real drama. I was asked to proceed with caution to a collapsed male. The police had cordoned off the area in which he was lying because of a separate incident – a suspect rucksack. I had to enter the cordoned area and, with the help of a police officer, deal with the man on the ground.

He was, of course, drunk. He was Estonian and again my Russian/Estonian failed me miserably, so we had to revert to broken English and drunken insults (mainly from him I should add). We got him up and walking, with reasonable force (support) until he was clear of the cordon. He wasn’t happy at all to have his beloved bottle of alcohol left behind and kept trying to breach the cordon to get back to it. Eventually he capitulated and slunk off beyond the watching crowds.

I stayed on scene at the request of the police and Control advised me that an ambulance was on its way. When it arrived I told the crew that the ‘patient’ had gone and they stuck around in case they were needed.

A rucksack had been thrown to the ground by someone who had then run off, causing a panic and the evacuation of the buildings in the surrounding area. Police had arrived with bomb disposal units and a cordon had been placed around the area, just off Piccadilly. We watched as the remote controlled robot went around the corner to investigate the suspicious bag. A controlled explosion was to be carried out and I waited for it because I had never seen or heard one of these. The police told me it would be a ‘pop’ and I felt a little disappointed but when it went off it was no pop...it was a huge bag. I thought a device had exploded. We could feel the blast wave hit us from the next street. I was impressed and deaf.

At the same moment, a man had been coming out of one of the buildings in the cordoned area (he obviously didn’t take it seriously and had stayed behind to finish his work off before leaving). When the explosion took place he legged it around the corner and hid. He must have thought it was for real.

When the dust had settled someone’s personal belongings were strewn all over the buildings and shops in the street where the bag had been left. I was told that this is becoming common; individuals are leaving bags and packages around just to see this happen. Meanwhile, a real threat will go unchecked thanks to these idiots. I wouldn’t be surprised if they become Youtube video favourites.

I was late now, so I made my way back through the horrible traffic to my base station. On the way, just at the end of Westminster Bridge, I came across an accident, so I stopped to help. A young girl had been knocked off her bicycle and injured her face. She had lost a tooth on the road (she was looking for it when I stopped) and had a deep cut to the bottom of her chin, which would need stitches. I offered to take her to hospital – St. Thomas’ is literally across the road and she was happy to get checked out and treated.

Unfortunately for her the hospital was very busy and she looked a little less happy when I left her sitting in the reception area waiting to be seen...in about three hours. Oops.

During my shift I returned to the hospital where the ‘asthmatic’ man had been taken and was told that he had improved on nebulisers but then deteriorated again. It wasn’t until all else had been tried that he had been given Frusemide, which immediately helped. He went up to Intensive Care in a stable condition. I also learned that the medicine his wife was trying to find was Frusemide – he was already on it but hadn’t taken it.

The man from a few days ago who had been taken to hospital with what I suspected to be a bleed in his brain had suffered a subarachnoid haemorrhage – he was transferred to the National. I don’t know if he survived.

I have written about the great politics out there when it comes to paramedics and the ‘stay and play’ decisions we can make but nothing should ever be done that isn’t in the best interests of the patient. The past few days have shown me that some of my decisions will leave me with a bad feeling. I will wonder whether I made the right choice. I will worry about whether using my skills or not using them would amount to a dereliction of duty and thus negligence. Then I remind myself that I’m not the only one living with these stresses...every other medical professional is doing the same and I’m guessing it doesn’t matter how many years you’ve got in, the feeling is still the same. Doubt is part of the curve.

Be safe.

Sick in the head 2

Giant inflatable man does somersault.

Ten emergency calls; one assisted only and nine taken by ambulance, including one gone before arrival and one running call.

An 18 month-old girl who woke up with DIB which lasted for 20 minutes was as right as rain by the time I arrived. She was happy, active and breathing perfectly well. That’s not to say that she didn’t have ‘an episode’, however but her mother was extremely apologetic for “wasting our time” nonetheless.

I didn’t see it that way. Her daughter may well be asthmatic or have had DIB due to an underlying illness or infection, so I stuck around and did a few checks, including temperature, to be on the safe side. Mum didn’t want to take her to hospital and the little girl looked absolutely fine, so I advised the parents (dad was there too) to take her to the G.P. at the first opportunity and to keep an eye on her until then.

The crew arrived within a few minutes of me but there was nothing for them to do; my form was completed and a copy was handed to mum, duly signed.

I noticed (as did the crew) how dusty the hallway up to the flat was, due to ongoing renovation works just outside their door. The dust caught in my throat a few times and I could see how it could irritate a small child’s delicate airways. This was mentioned to the parents and I left the scene with a “thank you” floating in the air. I don’t hear it much, so I may as well savour it.

After that I was sent to a 47 year-old female epileptic who ‘felt funny’ after taking her meds. This was my second call in the same area. There was a shortage of vehicles and staff today, so I found myself in unfamiliar territory for the first part of the day.

The woman was sitting in her front room and her husband, who seemed strangely distant and unconcerned, wandered about in other areas of the flat. She seemed fine; she had claimed DIB but I found nothing but a slight wheeze when I listened to her chest – even that seemed forced to me. She looked depressed and I think that was where the real problem lay. The crew took her to hospital and her husband remained where he was – there was no acknowledgement either way. I found that depressing in itself.

I greened up to be called back into the area I had just left for a 67 year-old female with ‘breathing problems’. The crew turned up at the same time as I did and I followed them to the patient. He was sitting on his sofa in a room full of medicines – the shelves were organised and neat but crammed full of drugs. It looked like a pharmacy.

He was a dialysis patient and he wasn’t very specific about why he needed an ambulance – he just felt ill. This is fair enough. When you are already being treated for serious illness and you have to take that many drugs to get through the day, we’re not going to argue with you if you feel ill. We’re going to believe you.

My next call took me back into W1 for a '40 year-old male, sick person – status unknown'. He had been found collapsed in a small garden area by the police but had been taken by an ambulance before I got on scene. Control had no idea that he was gone because the MDT on the ambulance was sending the wrong status back to them. As far as they were concerned, the crew were still on scene. I was on scene and, unless they were invisible, they had left. No police, no patient, no ambulance.

I let Control know about this and trundled up to the hospital to double check. Sure enough, the crew were there and so was the patient. I knew him; he was a regular caller and his ‘collapse’ was probably due to the fact that he was drunk.

I get lost when I am asked to travel into the City – too many dead ends and narrow street. This call was for a 25 year-old male who had collapsed and become unconscious on a tube train. He lay there motionless and, although his eyes were wide open and he blinked when I tested his response by brushing a finger across his eyelashes, he did nothing else. He was breathing, had a good pulse and I couldn’t smell alcohol. His pupils were dilated, so drugs use was unlikely (not impossible, just unlikely).

I spoke to him and tried various tactics to find out if he was faking but he didn’t react. Neither did he flinch when I did his BM, which was normal. He didn’t seem to have any reason to be lying there. I started another line of questioning, away from possible medical problems and got him to blink once for ‘yes’ and twice for ‘no’. The crew had arrived by this time and I had gained permission, via eye-blinking, to look in his bag for ID and any evidence of a medical problem.

I asked him if he had psychiatric problems and he blinked once, so I asked him if he took anti-depressants because this was ringing a bell in my head. I had been called to a woman who would not respond and just sat in a chair in her front room – she too had psychiatric problems and was currently on anti-depressants. It was impossible to do anything for her because she just could not communicate (or didn’t want to). She, just like my patient in the tube train, suffered from cataplexy.

After I had sorted that out and he confirmed by blinking (he must have sighed with relief inside after I had badgered him with a hundred irrelevant questions) we got him into the ambulance. His limbs were stiff but they eventually relaxed and before he was taken away he was beginning to talk again. It was an interesting little job.

A 48 year-old with ‘flu-like symptoms’ and DIB next. When I got on scene, the little street had been emptied because a fire alarm had been activated. Everyone was standing across the road waiting for the Fire Service to appear and switch the noise off; everyone except me and the crew, who had just landed and were making their way inside the building where the screaming sirens were sounding.

I went in a few seconds behind them and found the crew standing over a fair-sized man who was flat on the floor of his little bedroom (he lived in a hostel). The noise was loud and piercing and there was always the possibility of a real fire, so the paramedic suggested getting him out first. I helped the crew to get him to the ambulance – he was very hot to touch and probably had a fever but I left the ambulance crew to do the rest; it’s too busy today for me to hang around at jobs.

The fire service showed up a little while later (funny, they’re usually so prompt) and I watched as they went inside the building and deactivated the cacophonous signals. Hearing was restored…not by much in my case.

Back into W1 for a 25 year-old female who had fainted at her place of work. She lay on the floor, surrounded by her fashionable work colleagues but she was fully conscious and on her way to recovery. She was French but able to communicate with me and I found out she had a magnesium deficiency and this is why she sometimes passes out. She will be fine and I got out of the crew’s way after a few minutes, during which I tried my French out and decided the patient’s English was good enough, so no need for me to try to impress anyone only for it to backfire when I say something completely stupid.

Another confused communication on my next call. I was sent to Kings Cross station for a drunken male who had fallen and sustained a head injury but my navigation system insisted I went to Euston (not far up the road). Even though the address I had clearly stated Kings Cross, I drove into Euston anyway. A member of staff was waiting for me and had his radio to his mouth. I knew that this was the right place and I began to get my bits and pieces out of the car.

“You have two patients who have fallen on the escalators”, said the man with the radio

“You mean one and he’s drunk, right?” I replied

“Nope.”

“??”

“Two elderly folk. They fell on the escalators. One has a broken arm I think”

I got on the radio to Control and told them I was at the wrong job. Apparently, this one was just being handled for despatch and the other was waiting for my arrival!

I was able to get them swapped and it was lucky that nobody was critically ill or injured during this delay. It was nobody’s fault – just one of those things.

I went in to the station and found my two patients. They were both in their 70’s and the woman had lost her balance on the way up the escalators. She had tumbled backwards, knocking her husband down and taking him with her. They both fell to the bottom. She had a grazed elbow and he had a possibly broken humerus. They were Australian, so hard as nails...hardly a moan between them.

When the crew arrived to take them to hospital, they were still in good spirits and I was considering emigration.

After that call the heaven’s opened up. The rain had been standing off all day but now every cloud with a silver lining was tipping its weight onto the streets. Driving became dangerous and as I waited at the station, I wondered how long it would be before the first RTC came in.

It took three minutes.

A taxi had hit a pedestrian as he crossed a busy road. The MDT comment read ‘bone sticking out of leg’ and I thought of the rain getting into the wound and how complicated this might be.

I arrived to find a young man on the ground with the taxi driver and a passer-by attending to him. He was fully conscious and the first thing he said was that it was his own fault – he had walked out in front of the cabbie without looking. He was hit at 30 mph and thrown onto the bonnet of the vehicle. Now he had pain in his left thigh. The taxi driver was fretting about this. I could see a lump at the top of his leg but no evidence of bleeding – even in the torrential rain.

I controlled his neck as other resources arrived; a motorcycle responder, followed by the ambulance and I asked for the leg to be checked. The man wanted to get up – he wanted to take his jeans off so that we could examine him but that’s not how it’s done unfortunately. His jeans were cut and his leg was examined. No injury was found. The bulge at the top of his leg was a wallet inside his pocket.

It looked like he had been lucky and had escaped injury but he was collared and immobilised as a precaution. In a short time he was on his way to hospital.

The police weren’t on scene and should have been, so I stayed where I was and got Control to remind them that an accident had taken place. The taxi driver was still worrying about the young man’s condition, even though I had reassured him many times. He told me later that when it had happened, he had looked on in horror as the passer-by had felt around the ‘broken leg’, saying that it felt like a bone was sticking out. He had turned his back and said “I don’t want to see that”. He had felt physically ill. In the same sentence he told me how much he wanted to join the ambulance service.

The police turned up (well, a motorcycle solo and two PCSO’s) and they had all been told that the RTC involved life-threatening injuries. They had obviously been given the old call details. We all stood around in the rain for a few minutes discussing communication problems until I got fed up being wet.

My last call of the shift was another one of those decision-making jobs. The call description stated that I was going to a 36 year-old male with DIB and difficulty speaking, elaborating that ‘the patient will not say why he wants an ambulance’. The truth is, he couldn’t say why.

I arrived at a decent hotel to find a crew on scene with the man. He was sitting in a chair, smartly dressed and with his business colleagues waiting anxiously outside. I was shown a note on which several lines of incomprehensible statements were written. At first, it looked like an attempt at a suicide note by someone who is very mentally unstable but I looked at the man and it didn’t make sense.

The attendant was going through his normal obs routine and the man was trying to answer his questions. He had great difficulty finishing them and I wondered why that was. He had complained of a headache and had no DIB, although his ability to speak was clearly impaired. Either that or his English wasn’t good. I discovered the man was Swedish but had lived in the UK for years. I asked that a colleague try to communicate with him in his own language but that made no difference to his struggle.

This man was having a CVA or had suffered a TIA; whatever it was there was a possibility of devastating deterioration if we didn’t get him to hospital now. I asked the crew to forget about the twelve lead ECG and anything that might delay his transport to resus, where he needed to be. We could have spent another ten minutes on scene gathering more clinical data but if he was bleeding inside his head that time would not have been pertinent, so off we all went, straight to A&E - four minutes away.

Yesterday sharpened my judgment about making the right choice for the patient. Today I had no doubt that what I did was correct. Tomorrow would challenge me yet again.

Be safe.

Sick in the head

The National Gallery in Trafalgar Square.

Eight emergency calls; one refused, one conveyed and six taken by ambulance.

It’s been a week in which I’ve had to make decisions and hope that I got it right...for the patient and for my career. All paramedics are registered and personally accountable for their actions. Any detrimental decisions which lead to harm or death can lead to prosecution at worst or being struck from the register – that would mean the end of a career for most of us.

Over the next few shifts I was called to medical emergencies that required the right decision to be made. The outcome for the patient depended on it. I can tell you that I questioned and doubted myself throughout this set of shifts. I depended on colleagues and peers to help me resolve my inner conflicts. There isn’t a paramedic out there who can say s/he hasn’t done the same from time to time.

All the Zafiras were off the road today, so I was assigned an Astra – they are small and crowded inside but they are fast. Unfortunately, as soon as I started it up the engine began clicking strangely. I took if off the road and commandeered a brand new Zafira - it was sitting in the garage, all shiny and bright and the Station Officer offered it.

Once I had swapped all the equipment over I got myself out on the road. For the rest of the shift I would be worrying about that ominous burning smell you get with new engines. Of course, as usual, the thing had no guts when it came to power from a standing start; 0 - 60 in a month.

My first call of the day was for a 44 year-old man who had collapsed with chest pain on the stairs at a bank. He was very big and reluctant to move from his position on the floor (lying down) to one where his pain may be relieved a little (sitting up). He barely communicated to me and moaned with discomfort every few seconds. When asked to identify where the pain was in his body, he pointed more to his upper abdomen than to his chest. The pain also radiated, according to the patient, across his abdomen to his right side. This didn’t seem cardiac-related to me but I gave him GTN and aspirin anyway.

When the crew arrived, we had to lift him on the chair down a flight of stairs to the street. He was extremely heavy and I don’t lift patients much now that I'm on the car – the exercise did me good but I was sweating horribly into my stab vest after it and that's not comfortable at all.

His ECG appeared to show a prolonged Q-T interval but nothing else. He had also just been given a prescription for antacid medicine because he had a history of stomach problems – this is probably what was troubling him now but considering his likely QT history, he went to hospital just in case.

A tall and extremely agitated man who had collapsed on the street after taking a drug was taken to the ambulance by the crew, who arrived on scene when I did. I wasn’t required for this one. At first it looked like he was going to be trouble and the police had him ‘surrounded’ as he lay on the pavement protesting. A little crowd of tourists had created a self-imposed cordon a few metres away – I knew they were tourists because Londoners wouldn’t have bothered and would have walked on by regardless.

Later, I was sitting on stand-by at Trafalgar Square when a man came running up to the car and asked me to help an elderly man who had collapsed inside the National Gallery. I called it in because, although the staff had called 999, I had yet to receive the CAD. I ran in with him and found the gentleman on the floor, his wife standing near him and the Gallery staff helping out.

It took all of 30 seconds and a failed FAST test to conclude that he had suffered a stroke. His left side was useless; no movement, no sensation. He was confused and weak. It was decision time. With acute CVA the right thing to do is to take the patient directly to the most appropriate care centre – in this case, the National, Queen’s Square. The crew had arrived by now and a few seconds were spent debating whether the National would take the patient; the hospital is so busy that there was always a chance of being turned away. If we got this wrong, there would be a delay in treatment.

I called Control for advice as the patient was taken to the ambulance and made confortable. I was then able to pass the information I had onto the crew paramedic. They were to go to the National and Control would pre-alert. I went with them in the car and the patient was taken straight to scan.

This was a simple decision to make and every crew knows where the best treatment centres are for various conditions – it wasn’t this one that gnawed at me.

After a short rest I was off to deal with a 63 year-old who had slipped and twisted his knee, causing a dislocation. He was lying on the pavement at a pedestrian crossing – people were continuing to cross regardless, of course, but a few good colleagues of his stood around to protect him from being knocked and tripped over. He was in quite a lot of pain but was also embarrassed to be where he was.

A Team Leader was already on scene when I arrived and the ambulance showed up a few seconds after I did, so he was quickly splinted and moved to a more private area for treatment. Traffic was building up behind the emergency vehicles, so it was important to get going as soon as possible. Some drivers have very limited patience, regardless of what we are dealing with.

A 15 year-old ballet dancer with an allergic reaction turned out to be an emotional young girl (possibly with a crush on her dance teacher). As soon as he was there she decided not to go to hospital, despite telling me and the crew that she would – she had eaten a chocolate biscuit, which may have contained nuts and had felt sick and dizzy afterwards. She had experienced a tingling sensation on her tongue and that’s what prompted the 999 call. She had no history of anaphylaxis and this seemed like a very local reaction to me but we were willing to get her checked out at hospital, just in case.

Her teacher's presence made her smile, when none of us could so she changed her mind. I got the in loco parentis signature I needed and she got the attention she needed. Hopefully she’ll stay off the chocolate biscuits.

When I got back to Central London, I was called to a 40 year-old man who was ‘fitting’. I got on scene within two minutes and was shown up to the third floor via some very narrow wooden steps to a lobby area. I could hear the first aider shouting the man’s name over and over again, so I knew I was dealing with an unconscious patient.

He was slouched in a chair, unresponsive and with a noisy airway. He was gasping sporadically and I could see that he was in serious trouble. It all looked terribly familiar to me. I had just started my primary survey when the crew arrived. Together, we made his airway safe and began to investigate possibilities for his current condition, which was not improving.

He had no history of epilepsy as far as his work colleagues were concerned, although they admitted they didn’t know him all that well. His pupils were pin-point, so Narcan was given just in case but I was convinced he was having a completely different kind of crisis and my colleagues suspected it too. In the past few months I had separately treated a child and a woman with a very similar clinical presentation; sudden collapse and apparent seizure, agonal breathing, and a high BM ( I have yet to find anything useful to explain this but I’m guessing that the condition influences glucose release – I wouldn’t mind an expert opinion). In each case, an intracranial bleed was the culprit. Now I was looking at the same thing and I was pretty damned sure of it.

By the time we began the slow and very precarious descent down the stairs with this heavy man, we were supporting his breathing with a Bag-Valve-Mask. He was deteriorating.

There was a problem, however. Do we transport him directly to the National, where his condition could be quickly diagnosed and treated, or do we take him to the nearest A&E where a resus team would be able to stabilise him? If we sent him further than he needed to go and we were wrong, then it could cost him his life – if we took him to the nearest hospital, he would at least get everything done before being transferred to the appropriate care centre. It wasn’t my call now but I could see both sides of the debate; it was a tricky one and the right decision had to be made for the sake of the patient.

He was taken to the nearest hospital. His condition was time-critical.

It was almost time for me to return to my base station. It was almost home time and I was drained. Unfortunately Control had other ideas and sent me in the opposite direction for 2 miles for an 85 year-old with DIB who had refused an ambulance earlier in the day, only to find an ambulance on scene when I arrived. I was not required. Arrrgh!!

On the way back I spotted a man dressed in canvas clothing and a cloth cap standing in the street playing a penny whistle. He was playing it well but the bottle of red wine at his feet must have put people off (or diminished their sympathy for him) because nobody contributed to his cap. He tried harder and gave a cheeky wink to the ladies passing by – they ignored him and he shook his head in defeat. He’ll pack up and go home as penniless as he had started.

I was almost there...almost at the threshold of going home when I received a call to a 60 year-old having ‘dizzy spells’. He wasn’t critical and had a history of this, so I took him to hospital myself. By the time I had booked him in and returned to base I was on overtime that I hadn’t elected to do.

Spare a thought for us as you clock off exactly on time every day. We can get called out at one minute to going home time and there’s not a lot we can do about it.

Be safe.

Chivalry

Eight emergencies; all taken by ambulance.

A fairly quiet day. The sun shone and I got some reading in, which made a change. Later in the day I sat on stand-by at Trafalgar Square and watched an excellent performance by this steel band. I love that sound anyway (always reminds me of sunny weather) but these kids were playing those metal bins with so much passion and expertise that I almost believed I was listening to a recording.

Hawk man was around earlier too but he was having a bit of trouble with his bird. The predator had flown onto the roof of the National Gallery to scare off the seagulls - many of them were still circling around screaming their beaks off – and was intent on staying there, regardless of the man’s desperate efforts to entice him down with some sort of colourful plastic lure which he held in his heavily gloved hand. I didn’t blame the bird to be honest – what he was offering was far less attractive than a good chunky seagull.

Anyway, a few hours into my shift and I’m off to a 35 year-old male who had overdosed on GHB at a club. A crew arrived just ahead of me (I had been sent a long way) and I asked if I was required. They didn’t think so but I hovered until I got a thumbs-up from my colleague and off I went, back to my area.

Then to an 88 year-old male who was ‘blacking out’, according to the carer who met me when I arrived on scene. I didn’t sense any real concern from the carer but the man was lying across his bed, looking very unwell. He also smelled of old urine, so what the carer was actually doing to ‘care’ for him I don’t know. He was taken to hospital by the ambulance crew after my obs were completed. He was a bit confused and obviously worried about his new habit of falling down without warning.

Across the bridge and south for a 45 year-old woman who was fitting at a railway station. Her son was with her and a couple of bystanders had been helping before I arrived. They told me that she had been fitting on the pavement for less than a minute. Both were French and spoke little English. As you know, my French is rusty at best but I got a few details and communicated a little bit back. The woman was conscious but confused. Her son said she was epileptic but the woman didn’t know if she was or not. The problem I had was that she either didn’t know because she was confused (as a result of fitting) or the language barrier had mixed the messages and one or neither had understood me.

In the end, the rail staff produced a fluent French-speaking lady who helped out. The crew arrived and order was restored. I will, at some point, go over my French and take lessons. I might be too old for this language lark though.

As I raced to my next call, which had come in as a 27 year-old male with chest pain, I nearly got T-boned by another car as it cut across a junction. I was visible and had my noise and lights on, so he had no excuse. Luckily I was going at a speed that enabled me to get around him but it was close. There’s not much I can do if some idiot wants to keep driving towards me and I have little room to manoeuvre. Sometimes I feel I’m pushing my luck.

The chest pain turned out to be abdominal pain and it probably wasn’t serious. The guy had been in pain for about 30 minutes and had a history of it. He had been drinking all the day yesterday and watching cricket in the sun. The staff of the underground station had called us because the patient couldn’t walk. It’s possible that he was dehydrated – he may even have a little stone in his kidney.

Then I met an honest-to-God salt of the Earth type. He was up on the tenth floor of a block of flats. I walked in as the door was opened by an elderly lady who could barely stand up and was guided to him. He was sitting on the sofa and he looked up at me and smiled.

“Allo son, sorry to waste your time” he said, “but I’ve got this pain and I really didn’t want to trouble ya...I tried to get the papers up to ‘er but the pain wouldn’t stop”

He was an East London man, the real deal Cockney and he was experiencing chest pain. He had cardiac problems and a history of hypertension. The woman wasn’t his wife (as I had assumed), it was a friend of his that he runs errands for “on account of ‘er not being able to get arand”.

He had been collecting the lady’s newspaper, as was his daily routine, when the pain started. It got worse but he said “I was determined to get the paper to her”. He collapsed on her sofa and she called an ambulance. Now she sat across from us, concern etched on her face.

I carried out my obs and included an ECG. He was persistently bradycardic, diaphoretic and the pain lingered but did not increase. His blood pressure was good though, so I gave him GTN and aspirin and chatted with him until I could see a change in his demeanour. I asked him how the pain was now and he said that it was much better.

I continued to get to know him over the next few minutes until the ambulance crew arrived. The man had been a soldier and had fought during the Normandy landings. He told me that his unit had lost 800 men in one hour of fighting; I have no idea how that must have been but I was looking at a man who had been through that and was now sitting on a sofa with angina, worrying more about taking care of his lady friend who was “a diamond”.

We got him into the ambulance (it took a bit of persuasion to convince him that he needed to go in the chair) and before I left to get on with my paperwork, he chatted some more and referred to me by name. I had only told him my name once, as I do with all my patients, so I was surprised that he had remembered it. I also liked him because he called me ‘son’ – made me feel young ;-)

A long run from E1 to SE1 for an 82 year-old male who was fitting. An ambulance pulled in ahead of me and I went up to see the patient with the crew. He was in bed, surrounded by his family and he was shivering. He hadn’t been fitting; he had a chest infection and was running a temperature. He hadn’t seen his doctor about it and now he was feeling rough. I was on scene only because the crew were both EMT’s and for fitting a paramedic has to be present in case drugs are required but it was clear that I was surplus to requirements and so I checked with the attendant and left.

At Victoria I found myself looking at a familiar face. He was an alcoholic who frequently found himself on police cell floors, pretending to be unconscious. When he is ‘woken up’ he hurls abuse and becomes violent. I’ve seen him being pinned to the floor by as many as four police officers. He has no respect and he has no intention of getting any. Two PCSO’s were with him because he had told them he was a diabetic and had forgotten/lost his insulin. This was rubbish, of course, he had no other condition than alcoholism and a bad attitude.

I cancelled the ambulance because he was fully conscious and refusing any attempt on my part to get basic obs., including a BM. He was sitting in a corner, outside a Baker’s shop and I realised that the proprietor had probably called the police just to get rid of him. He wasn’t the best advertising they could wish for.

He is a young, wirey man and he can change from reasonable to aggressive in a split second, so I was being very careful not to say the wrong thing. The PCSO’s were trying to persuade him to comply but he just wasn’t interested – he made a few sexist remarks, designed for the attention of the female PCSO but they were largely ignored.

I gave it twenty minutes and three attempts but he refused each time; the intonation and volume of his voice changed and I knew a fourth request was going to end in tears. I left him with the PCSO’s and they probably spent the rest of their shift trying to move him.

Finally, a 45 year-old male who was sitting in a car in north London. He was dizzy and vomiting. Every time he moved he threw up violently – there was no chest pain, nor any other symptom. He was a big man with a history of hypertension. His lady companion (she insisted they were long-standing friends only) was by his side. She was extremely concerned about him and I found it difficult to get a clear two-way conversation going with him because every time I asked a question, she would interject then put her fingers to her lips and stare apologetically. She kept doing it though, so I guess she was nervous and worried.

The man had to be carefully moved from the driver’s seat of his car to the ambulance when it arrived. He was sick a few times on the way but again, no other symptoms. I have seen this before and I am not convinced that there is a cardiac origin. I’ve seen it as vertigo. Any movement of the head caused a spinning sensation, leading to vomiting. It’s a very uncomfortable experience.

He refused an anti-emetic (the hospital was only a few minutes away anyway) and said he felt a little better once he was stable on the trolley bed. His friend, who was still flapping a little, told me that she had known him for years and that they went places together and did all sorts of things over the years. I had a sense of a mutually plutonic relationship that had become a real and very solid friendship over time. It seemed to me that, no matter what the man had asked of her, she would have been willing to do it for the love of him.

Be safe.

Kerb judgment

Nine emergencies; one deceased, one assisted only, one conveyed and six taken by ambulance.

I spent the first part of my shift talking to a dead man. He was sitting in a chair in his front room, a half-opened nebuliser in his hands and cans of beer strewn around the floor – one of which was waiting to be opened. It never will be – not by him anyway.

The 68 year-old had been found by a caring neighbour who regularly visits to give him his breakfast. He had let himself in to find his charge sitting upright, as if watching the garden through his patio doors. He was asthmatic and had emphysema. He had a home oxygen system and a portable, mains-powered nebuliser compressor. I’m telling you this because a tragedy seems to have occurred in the early hours. His power had gone off because his meter needed credit. Nobody is sure when it happened but the sequence of events looked to me thus: Breathlessness and a tightening chest. He reaches for his nebuliser, switches on his portaneb, prepares to load his nebuliser with salbutamol...then the power fails. Everything stops and he dies – out of breath.

Now that may all seem melodramatic but I can’t figure out many other likely scenarios from the evidence, I suppose he could have died before the power went off and was just too late to help himself. Whatever happened, he went very quickly, peacefully and in the middle of trying to save his own life.

He has no living relatives and few friends but he was an avid collector of models (cars mainly); he had hundreds of them around him. He probably liked his own company.

As I sat there, I went through what might have happened with him (I always chat to the dead when it is appropriate - you never know) and the police arrived to take over. Then an inconvenient and rather embarrassing thing happened – my service mobile phone rang. That in itself is no big deal but I hadn’t realised (and how could I?) that the ring tone had been reset by someone to one of those feature sounds. I sat there, police in attendance and the man’s friend just outside the door, with the sound of a rooster calling in the room. I wasn’t amused (although I'm certain some of you are smiling right now) and I don’t think I even looked up as I reached for the phone and took the call.

I left the scene after I had completed the necessary Recognition of Life Extinct (ROLE) form. I then returned to my base station to replenish some kit and to change that stupid rooster sound to a normal ringing tone.

Soon, I was on the road again and I wandered into my usual area, just in time to be called to a fast-food restaurant to attend to an unconscious male. The call description stated that staff thought he might be drunk or on drugs and I was willing to bet on one, the other or both.

Sure enough I arrived to an empty welcome and had to walk around the place looking for my patient. No member of staff even tried to help me out - they were all too busy selling burgers. I went downstairs and there he was (at least I made an educated guess that it was him), sitting at one of the tables, leaning drunkenly to the right. He was a young man and he looked scarred and beaten by life, so I was being very careful with my approach.

He was conscious and not very interested in being helped. He didn’t want an ambulance; he just wanted to be left alone. This is where we find ourselves in a no-man’s land, professionally speaking. It’s really not our job to turf people out of public places and yet the Manager, who turned up eventually to watch, expected me to do just that. The crew turned up and I felt a bit better about my odds but I was still unwilling to do anything other than treat the man if he needed it. He didn’t – he made that clear.

The crew walked out with him after a few minutes though. I talked him into at least leaving the premises (at least I think I did, or he may have been persuaded by common sense) and my two colleagues walked with him until he was in the street again. The idea was that he would get checked over and a decision about a trip to hospital could be made if necessary. He changed his mind, however and I watched him refuse all treatment and stagger off, almost re-entering the premises he had just left.

I think I handled him the right way because when he stood up to go, he verbally threatened the Manager, who had been the only person to talk down to him. I thought he was going to throw a punch at him and it shook the man a little; he looked frightened. It wasn’t a pleasant exchange at all. Earlier he had bragged about how much he fought and that he had been banned from Croydon. I tried to look impressed ‘cos I’ve no idea how to get banned from an entire town.

A long trip south followed for a 26 year-old who was vomiting and ‘can’t wake up’. My mind automatically assumed alcohol-related for this one but I was wrong. The young guy actually looked ill. He hadn’t been drinking or taking drugs but he lay in his bed, barely able to open his eyes, shivering and suffering from abdominal pains. I hadn’t got started on obs when the crew arrived, so I let them get on with it – the man needed to go to hospital. A doctor needed to look at him, so the less delay the better.

My next call brought me back to my own area and to an unconscious 25 year-old. He was found by an off-duty police officer, curled up in a corner at a busy tube station. I had to keep pinching his shoulder for a long time to get him to respond. I could smell the alcohol from him, so I had a reasonable suspicion that he was sleeping it off. Eventually, he came to and looked around in a daze. He was American and he thought he was in Chicago. He was genuinely shocked to be in London. He didn’t know where he was, where he stayed, what he had been doing last night or what day it was today.

I noticed a bruise on his forehead and it looked like he had been hit but I also noticed a wad of £50 notes hanging from his pocket, along with his wallet. I pointed these things out to the police officer. I don’t think he was mugged, I think he got so drunk that he fell over and hit his head. He was now concussed and, quite frankly, lucky to be in possession of his cash and wallet at all. He must have lain there all night and nobody took a blind bit of notice. Sometimes Londoners are a saving grace.

There was nothing else wrong with this man; he recovered from his ‘unconscious’ state and I found no abnormalities with his vital signs. His BM was good and he had no other injuries. I was literally a spit from the hospital (if you are a great spitter and can lob saliva half a mile), so I cancelled the ambulance and took him myself in the car. When we got to hospital, he was just as confused as ever.

“I can’t believe I’m in England, man. This is England, right?”

No rest today (they tried to send me on my break twice but I got called) and so the next job came in immediately after I ‘greened’ up. This one was for a 60 year-old man who was feeling weak and suffering abdo pains at a swimming pool. The staff members who met me were worried that he may be having a heart attack – I know this because I could see it on their faces but also because they had their defibrillator up and ready to go. Nothing like being prepared.

He sat in their first aid room, clearly in some pain. He had been swimming and felt the sharp pain start but had ignored it, assuming it was cramp. He carried on swimming until he could go no further and the pain stopped him. He admitted that he had probably overdone it.

His obs were good and the pain was in a very specific place, so it’s possible he had torn a muscle or suffered a hernia. I don’t think he was having a cardiac problem but it can never be ruled out (until it is ruled out, of course), so he was going to be moved by chair and have an ECG done. The crew arrived and did just that. They gave me a copy of the ECG and, apart from the expected anomalies given his age (he was actually 70 odd but didn’t look it), there was nothing remarkable on the strip. The crew took him to hospital and gave him something for the pain.

For some reason my kerb-hugging parking, which is usually good, was rubbish today. I thought it was the way the mirrors were set, so I adjusted them but time and time again I parked up, got out, did my job and returned to find that I had left about a mile of space between the wheels and the kerb – okay, not a mile but a fair bit. It was starting to get embarrassing by the end of the shift. I've been driving (and parking) for over twenty five years - what's this all about?

I returned to Trafalgar Square to meet my buddy for the next few hours – the journalist from Radio 4. I was a bit nervous about how it would all go but she turned out to be friendly and easy to talk to. We have to be very careful what we say to the media when we are on-duty; it’s a different matter when you are expressing a personal opinion (say, in a blog) but I have to watch for press minefields when I am working. I could get sacked if I don’t.

During the few hours of my interview, I received two calls and she came along for the ride (with LAS permission, of course). My first call was for a 28 year-old pregnant lady who felt dizzy in a coffee shop. A crew was on scene just ahead of me and so I wasn’t required. The next call was to another coffee shop (the same chain ironically) at a different location. This time it was for a man with DIB and asthma. Two Cycle Response Unit colleagues were arriving when I pulled up, so they joined me as I assessed the patient.

The man had chest pain, not DIB and was extremely anxious. His partner was with him and he confirmed that he was prone to stress. My worst jokes came out for him and he appreciated them (I think). A patient with chest pain needs tons of reassurance, not a dead-pan face and a sober attitude. Not that I clown around, of course, that’s way too far down the line. Most of my colleagues have a great sense of humour around ill patients (where appropriate) and I have seen it work wonders.

It was raining heavily when the ambulance crew arrived to take the man to hospital. His pain had eased and I am sure he had nothing but stress to blame for it but the doctors will confirm that.

My Radio 4 adventure ended after that call and I went back to work alone after chatting with my CRU colleagues and grabbing a quick (and free) cappuccino during paperwork time.

I got a few cancelled calls after that, including one which sent me to SE1 from W1 just to be cancelled on arrival. It was getting dangerous driving in the torrential rain, especially when no other driver seemed to see me coming and I had to use brakes and steering in slick conditions to avoid them. My top speed in the rain is probably 40 mph...on the straight.

A 26 year-old female with severe abdo pain and a history of cysts was my next patient. She had been waiting with her husband at a bus stop for a while before I arrived – not because I took my time but because there were no ambulances available due to the high call volume. She could barely stand up and wasn’t willing to move much. Her face told me she was in genuine pain and I hoped an ambulance would come soon.

There was a drunken man sitting on the same bench with her. His head was down and he was drooling a stream of saliva (or something nastier) down to the ground. He wasn’t moving much and he had his trusty cans of lager at his side, should he feel the need for a break. Ironically, another drunken man sidled up to him, looked at me, then back at him, back at me, rolled his eyes to heaven and showed me a face full of disgust. Mr. Bean couldn’t have created the comedy that I was watching now. I might write another book entitled ‘Drunks are funny’.

When an ambulance did arrive, some ten minutes later, the crew told me that they were on a different call. They had already stopped though and this was getting awkward. The woman’s husband would not be pleased if this ambulance went away again, so I asked what they were going to and they told me it was a probable ETOH, lying in a doorway. The crew agreed to help the lady and I called Control to see if we could swap the jobs. They obliged after I explained the need to treat this patient for her pain and the awkward situation we now found ourselves in.

I gave her morphine for her pain and went with the crew to hospital. It took ten minutes to treat and convey her. She had waited almost an hour.

My last call of the shift (and I was glad it was over) was for a 41 year-old homeless alcoholic who had been found semi-conscious and coughing up blood. He was lying on the steps of a church that gives refuge to the local alcoholics and drug addicts. The Parish takes responsibility for feeding them, clothing them to some extent and giving them a place to lie down.

I knew this man. He had been a patient of mine last year and he was drunk and abusive. Now he was too ill to care. He was still drunk and he was lying in his own filth. There was an eye-stinging smell of urine about him and I had to hold my breath several times to deal with it but he wasn’t well and his body needed to go to hospital, even if his soul was meant for somewhere else.

His friends were deeply concerned about him and I think they are used to being ignored and vilified because one of them said:

“We are good people but we are alcoholics”

It stopped me in my tracks. I could hear her in my head saying ‘we get treated like crap all day, so please don’t do it now’. I had no intention of treating them any less than anyone else.

As I left they thanked me and the crew, who had taken the sick man to the ambulance. The woman shouted out that she didn’t know what else to do and that she was sorry she called us but...

“I didn’t want to wake him up dead”

Be safe.

The publicity machine

I will be posting my next few days worth on Sunday or Monday folks. I've been busy and here's why...

Someone from Radio 4 conducted an on-the-job interview with me about the blog and the book (and the high number of drink-related stuff we deal with). You can hear it on "Broadcast House" at 9am tomorrow (Sunday) - on the radio (obviously) or online...

http://www.bbc.co.uk/radio4/news/bh/

I'm a bit apprehensive because I have given up my name and now my voice will be bandied about. At least you will be able to hear me talk through some of the blog just like I think it when I write it up :-)

So I wouldn't mind your opinions on how this works out because I'm sure, in the run up to the book launch, I will get a lot more of this stuff to do and I find that prospect a bit unnerving.

Speak to you all again soon.

Xf

Humid

Ten emergency calls; one running call, one treated at scene, one conveyed and the others went by ambulance. There were five cancelled calls tonight, most of them were sending me up to 4 miles away and one of them was for a ‘rash all over body’.

A beautifully still, peaceful and humid night; not the chaotic traffic-filled melee that is Friday and Saturday night in Central London. The downpours of the past few weeks have gone and its hot – the dead air is making my uniform uncomfortable to wear so I hope I don’t have to go underground during my shift. Its hotter than Hell down there.

A friend of mine met me for a coffee at the station and chatted to a few of my colleagues while I tended to the car and completed my VDI. I needed the distraction to be honest, so it was nice to have company for a short time before things started moving. Most of my calls were going to be a distance tonight.

My first trek was into the west for a 90 year-old male who had fallen. He crawled to his front door and lay there complaining of feeling ‘weird’. His neighbours were concerned for him and there was a strong smell of smoke coming from his flat, although a few people had investigated it and found nothing seriously wrong. His smoke detector was beeping away periodically and that meant the battery was going. If he did have a fire in that place, he wouldn’t wake up to know about it, so I asked one of the kind neighbours to sort it out for him and I know it will be done.

Meanwhile, the man didn’t appear to have any real physical injuries but he was very confused. The bottom line is he shouldn’t be living alone in the flat anymore. The crew arrived and I set off for my next call after my paperwork was completed.

In a very posh part of west one I found myself leaning on the doorbell of a woman who was ‘having a coughing fit’. She was asthmatic and when I got to the front door I could hear her – she had one of those annoying persistent dry coughs that eventually hurt the diaphragm. I get that myself whenever I have had a chest infection and some people are prone to longer recovery times than others. It is more delicate if you have asthma though, so I nebulised her and this brought some relief. She developed a sense of humour (I think she called me a dirty rotten liar when I got a detail wrong during my handover to the crew) so I knew she wasn’t too bad in herself. Just that damned cough. I told her she was just trying to get attention from her neighbours. She went to hospital but there will be very little they can do for her, the cough will have to clear up on its own.

Back into my neck of the woods for a 19 year-old female with abdo pain, ? cause. She wouldn’t sit down and relax for me and insisted on standing in the hall with her entire clan gathered around her. None of my investigative questions were answered positively enough for me to identify a probable cause for her pain and it was difficult to get her to comply with the crew’s directions when they arrived. Eventually, she sat down and tried some entonox to ease her pain. Her family had spilled into the street and were talking to her (and one another) in their own language. I find this a little annoying. I think its bad manners when we are trying to get answers and a three way conversation spins away into two languages, neither of which is intended for your ears. Something could be said that is relevant to the patient’s condition and unless I learn Urdu or Hindi very fast I won’t know what it is.

I had a fairly long rest after this. I think I got through an hour without a single call. I sat in the car on stand-by at Leicester Square and Trafalgar Square – my two usual haunts. My street-bound friend ‘Mike’ no longer sleeps in his usual place at the Odeon Cinema because the Casino has arrived and he has been turfed out – he doesn’t add class to the place I guess. It’s a shame because he slept every night for years in that doorway and never bothered anyone. He was always gone by 6am.

I went back to my home station, had a cup of coffee and, two sips later, got called to a head injury. A man had fallen from a railing into the road; smacking his head on the tarmac and splitting it open. He was drunk and lay in his own blood until a passing driver noticed him and called an ambulance. The police were on scene when I arrived and had put him into the recovery position (incidentally, there is no reason to do this if he is conscious – it’s best if he is left still). There was a large pool of blood where he landed and a good deal of the stuff on his clothing but his wounds were not too bad. The only concern I had was that his scalp moved a little too much when I felt around the large bump on his head. Then there was the possibility of a neck injury, never to be ruled out, especially when the patient is too drunk to complain.

When the crew arrived, we collared and scooped him. I’m pretty sure he is neurologically sound but that sloppy scalp of his means that he may have a cracked skull, so a thorough check needs to be carried out at hospital. Unhappy bus drivers were queuing up because we had blocked the road to deal with this patient. I didn’t feel sorry for them because they are only too happy when we dash out to remove the drunks from their seats. Fair, don’t you think?

As I was attempting to escape to a cooler place I was ‘attacked’ by a hysterical Brazilian woman who banged on my window and begged me to go to her boyfriend’s aid. I was at Trafalgar Square and he had been set upon by a few men that he apparently knew. They had punched and kicked him to the ground. I did notice him lying in a heap when I passed and had slowed down but I tend to mind my own business so I didn’t stop - then she came running after me and I knew I would be dealing with something. I thought he had been stabbed and was bleeding to death. Her behaviour was very dramatic. Brazilians are very passionate people, so I guess they also overdo it when they are a little emotional. Maybe you know better – I’ve only met a few.

I checked him out and called it in as a running call. I asked for an ambulance just in case and the police were also sent. The man had a jaw injury but it wasn’t significant – he had been punched once or twice around the face and kicked while he was down. He was a big, strong guy, so he could absorb the blows. His girlfriend was embarrassing him I think. I had to tell her several times to stop screaming in my ear. I don’t think she could help herself because she would stop at my request, apologise then start all over again when anyone else spoke to her. I got it, the police got it, the ambulance crew got it and a few random strangers got it. It was almost funny.

In the end, he refused to go to hospital and the whole thing turned out to be an expensive exercise for non-Brazilian taxpayers.

Another asthmatic to treat but this time she was so confident in her condition that she walked out of the hotel to meet me. The crew had arrived at the same time, so I handed her over immediately. She was nebulised but her condition was so mild it amounted to no more than a tickly chest. She never carried her asthma inhaler and felt that this was the worst ‘attack’ she had ever experienced. Luckily, she understood how mild it was after twenty minutes and returned to her room all the happier.

I had another annoying language-barrier encounter in a casino later on. A Chinese man had fallen (twice), cutting his head and hurting his wrist. He was slumped against a wall and I tried again and again to establish what was wrong with him but he either didn’t understand or wasn’t able to speak. I asked for someone to translate but she turned out to be worse and a conversation flowed between the two in Mandarin but never reached me in English. When it did, there was confusion over what I had asked in the first place.

The next translator I got was no better and used broken phrases that made no sense, so I had to try and put them together to work out the man’s current condition – he looked spaced out. Eventually I established that he had low blood pressure problems and had collapsed a few times like this in the past. He didn’t have any serious injuries as far as I could work out but he still needed to go to hospital.

The crew arrived amid the confused conversation and took him out to the ambulance. I sat in the car and reflected on my mood. I realised very quickly that I had been a little unreasonable with the patient. I had been short with the Casino staff and the second translator (who turned out to be his wife). It occurred to me that I was tired and my behaviour was deteriorating. I needed to be less involved in the heat of the moment and unemotional about language barriers and difficult patients.

I went for a caffeine shot and sorted myself out.

At 5am I sat in Leicester Square watching passing prostitutes harassing lone young men and a young boy, wrapped in a blue blanket begging with a polystyrene cup. It was very still out there and what little life went by was tired and ragged. I felt the same. I need a holiday.

I raced to a 75 year-old male who had been robbed and was now suffering chest pain and DIB. I arrived to find he had fled the scene as soon as he spotted the police. I thought this was strange and we did an area search. We found him across the road, shouting at the ambulance crew who had been assigned as they tried to drive to the call location. I drove over to where he was and told the crew I would deal with this myself. I knew we were having our time wasted and the crew were happy enough to leave it to me.

The man was ranting at us (the police officers and me) and it looked like he was just going to give them a statement about his alleged robbery and leave it at that. He told me his chest pain had gone away and that we had taken so long to get to him he had got better. We took precisely four minutes to get to him.

I was just about to leave when he approached the car, told me the police were useless and laughing at him and demanded that I take him to hospital. He usually went private but he didn’t mind slumming it in a NHS place this once. I was mildly amused.

I was even more amused when he told me his chauffeur had been given the night off and that he was worth millions and had gambled £10,000 that night in the Casino. He was dressed in a dirty pair of jeans and a ragged T-shirt. I couldn’t see past his demeanour to a point where he hunted grouse during the week.

I took him to hospital and he talked incessantly. He didn’t stop. He made no sense half the time and used racist, sexist and other-ist comments. The nurse thought he might have a psychiatric condition. I couldn’t agree quick enough.

Nobody seemed to know who he was but when I went to book him in the receptionist recognised his name instantly and told me all about him. He wasn’t rich, he didn’t have a chauffeur and he didn’t visit casinos. He hadn’t been robbed either. He was Bi-Polar.

He had been entertaining, I have to say and he helped change my mood from the little sulk I was in earlier on. He reminded me that I was seen once by different patients, not many times by one.

My next call was to a 30 year-old homeless man who was ‘not alert’. He was cold and fed up, so he got an ambulance and a warm bed for the night. On Sunday nights its easier to find a place for an unfortunate soul to rest his head.

My last call of the shift was for a male who had been stabbed. I got the call as I pulled up to my base station, expecting to go home shortly afterwards. I got on scene but couldn’t see any police. I moved slowly around the estate and kept my eyes peeled. At the back of the estate I saw three police vehicles and a couple of officers standing over the body of a man. I jumped out of the car, grabbed my stuff and went over to them.

The man was a drug addict and he had been stabbed once in the back. The wound had stopped bleeding and, luckily for him, didn’t appear to penetrate his lung. In fact, it looked like it had been deflected by his shoulder blade. He writhed and cried out in pain though and it was very difficult to keep him still. The police helped by holding him down while I pressed a dressing over the wound.

The crew arrived soon after and the man slumped into ‘unconsciousness’. He wasn’t really, his girlfriend had arrived after hearing him cry out for her (so had most of the neighbours) and he was faking the loss of consciousness for dramatic effect. We woke him up and took him to the ambulance. I noticed he had tattoos all over his torso, most of them were crudely done but one of them stood out and epitomised this stabbing victim’s natural inclination to lower level society. It read F*** OFF.



Be safe.

A Paramedic's Diary - THE BOOK

Right folks. TPD is being published in book form and will be out in October this year. The publisher, Monday Books, have already gone ahead with the pre-press stuff and you can find it on Amazon.co.uk, Play.com and Waterstones.co.uk (as well as other places I believe), where it can be pre-ordered if you are inclined to buy.

The title is 'A Paramedic's Diary - Life and Death in London' and the cover is yet to be confirmed, so I would like your feedback on it when you see it. You will also discover my name, of course...

The intention of the book is to reach a wider audience (and it doesn't hurt the finances either I have to say) it is NOT intended to glorify the job I do or to patronise patients or colleagues. It is about what I do and will serve as a record of my career. I have been published before but this is the first time I have written a book of this kind, so I am hoping it will all go well.

For the record, although my bosses know about this blog and the book, the London Ambulance Service is not officially involved in any way. The book is therefore a biographical work and nothing more. I will, of course, have added stories that I have never posted, as well as expanded thoughts and views.

:-)

Psychiatric city

You can get a free meal if you give your self to Jesus. But only on the odd Saturday night.

Twelve emergency calls (more than 4,000 Service wide). Six required assistance only, one was a false alarm and the rest needed an ambulance.

Saturday nights are a chore for every emergency service but when the streets begin to clear of the merry and colourful people of London, there is a hard core of stragglers that draw attention to themselves. They aren’t noticeable because they cause trouble; they stand out because they behave abnormally. I don’t know if they are always there when other people disappear or if they come out in the wee small hours just to wander the town. London’s mentally ill make up a small but fairly significant number of the individuals I watch as I sit on stand-by. Some of them are drunk as well as disturbed. Some of them are dangerous. Some are my patients.

I went up to the fourth floor of a grubby block of flats to lift a drunken ex-boxer to his feet. He had fallen and his care worker couldn’t, wouldn’t or wasn’t allowed to pick him up. He had been told to stay at home because he is normally ‘unsteady’ on his feet. The reality is that he will never be steady on his feet because he is an alcoholic.

I remonstrated with him to begin with because he was aggressive. He didn’t like my tone (to be honest I can sometimes be a little abrasive when I am dealing with people who just don’t want me there) but we settled on a compromise and agreed to work with one another to get him into his flat. He didn’t want to go to hospital, so at least he wasn’t going to need an ambulance and he wouldn’t be wasting some nurse’s time.

I picked him up after checking that he had no injuries. His nose gave his past profession away; it was flattened and spread across his face. He looked like he had been handy in his youth, so I was being careful not to antagonise him too much – even an alcoholic ex-pugilist could take a fairly accurate swing.

We staggered into his flat (so now I looked drunk too, we could have been buddies) and I sat him in his chair. The home he lived in was a war zone. I can’t fathom how some people survive in the squalid conditions they live in – brought about by their own hand I should add.

I chatted with him and he gave me an uneven, gappy smile as I left the place. His care worker stuck around for a few more minutes then I watched her escape to a social life as I sat in the car doing my paperwork. All was well with his world again. He had fags and booze.

From that place I went into Theatreland to rescue a woman who had fainted as a result of the heat. The older theatres can become stifling when the weather is warm and the woman, who was 50 years-old, collapsed during a show. I walked into the bar area where she was recovering and there was a bunch of 'animals' standing in a circle rehearsing their next scene. It was bizarre. You can go ahead and guess the show if you like, my patient won't mind.

The woman was recovering well but it was still hot where she sat, so I took her into the fresh air, along with her two daughters and a member of staff who had initially come to her aid. The cooler evening air did her a world of good and she got her colour back. Her obs were normal (and had been since I arrived) and she didn’t want (or need) to go to hospital. I let her get better and chatted to them all until she was ready to get a cab back to her hotel. She signed my magic form and off she went.

Control dragged me 3.5 miles south for a 19 year-old female who was fitting. The journey seemed to take a long time and I realised I had no idea where I was after ten minutes. I ended up in a large estate of grey-brick blocks of flats, crammed full of newly housed immigrants and the less fortunate of society. I worked my way up to the zillionth floor (I’ve used millionth before and I don’t want to be seen to exaggerate) and into a horrible little flat. I was shown in by a dark skinned woman and led to a bedroom where another dark-skinned woman was lying on a filthy mattress on the floor. She wouldn’t look at me when I spoke and was doing the dramatic act. I have seen this many times and I have no patience for it, I have never pretended to have time for it.

All her obs were normal and I wasn’t in the least surprised. As soon as I told her this and asked her why she thought she needed an ambulance she began to ‘convulse’. She was faking it big time. Her movements were so controlled and violent that she nearly injured me as I tried to hold her down. I told her to stop the act and she did. Then she asked me why I was even there if I thought she was alright. Good question. She became rude and annoying and I left, telling her many, many female friends (what was this place?) that she was being emotional and that there was nothing medically wrong with her. I considered her mental state and left the scene. I could hear shouting all the way out but I don't know if any of it was directed at me.

On my way back to my own area I was asked to attend another fitting female. This one was only 15 years-old and had been drinking, according to her friends. I never got to speak to her directly because when I showed up, along with the police and an ambulance, she had run off. Apparently she was scared that her parents might find out about the alcohol. We looked around for her but none of us, including and especially the police, were fussed about pinning down some stupid teenager who wanted to waste our collective time, so we left her to it, wherever she was hiding.

Some call descriptions make me look twice at the screen. This one, ’23 year-old female, can’t stand up, ? cause’ and located right outside a bar nearly had me in stitches. I rolled towards it thinking that someone was joking. It wasn’t until the update appeared informing me that it was ‘not related to alcohol’ that my smirk was wiped off. I couldn’t say it was EOC’s fault then.

The young Italian woman had collapsed (fainted) whilst having a drink or two with her friends. They were all quite pleasant and I had nothing to do but obs. She was fully recovered and a little embarrassed and I know that’s not fatal. When I left, the bar manager asked me if I wanted a drink, which was considerate of him. He got me a coke and I stood there drinking it but I felt too awkward, so I left it on a table. I was the only one dressed in unfashionable green.

A few minutes later I was at the scene of a 40 year-old Polish, homeless alcoholic who had fallen onto steps as he made his way to his usual bed for the night. His nose was pulped and there was a bit of blood around. He had been sleeping with a bloody face and another homeless alcoholic had spotted him and called us. He will be okay and the ambulance crew took him off to get cleaned up but I felt sorry for the people who were going to arrive for work on Monday to a blood-stained entrance.

I went back into the West End and immediately got caught in heavy traffic. I was trapped and I got a call (of course) so had to book a delay because I was going nowhere. It was 1am.

The journey took ten minutes, the distance was one mile and the patient was hyperventilating. She was asthmatic and had taken her ventolin inhaler but with no relief. That was because she wasn’t having an asthma attack.

I sat with her and her boyfriend and a rather over-friendly female friend while she recovered. It took a mere ten minutes to work that trick and she was quite happy when I left her.

I got my break about now but I can’t remember that one either!

A drunken Polish man on a bus (what is going on?) in Trafalgar Square next. He was easy to wake up. I just walked onto the bus – the bendy variety – shook him hard, shouted and he opened his eyes. He smiled and nodded. The bus driver didn’t even know I had arrived.

The man had a very heavy bag with him and when the police arrived, after I had walked him off the bus, they had a look inside. He was carrying large books and cans of deodorant. He was a nice smelling, Polish bookworm. He probably had a degree. Or he was a library thief.

My next stop was a local club where I found my patient, a 24 year-old female, lying unconscious with her huge boyfriend crying and wailing over her. He was holding her like she was dead. I thought the whole thing was rather over the top but I didn’t know him and he may well have just been the emotional type. In any case, his girlfriend was very much alive, very drunk and very unconscious as a result. The ambulance was delayed on this call, so I started fluids on scene. A voice in my ear asked if I needed any help and I looked up to see a young Asian woman who announced that she was a qualified dentist. She was also drunk, so I wasn’t about to let her get near my patient’s teeth – that’s what she meant, right?

After a long wait, during which the unconscious girl recovered a little, the crew arrived to take her away. The boyfirend had resumed his crying.

Back to base for a cup of coffee and then on to a stabbing at a club in Victoria. Actually, the patient, a 32 year-old female hadn’t been stabbed at all and I was being diverted to her from a fight which had taken place around the corner. An ambulance crew were already sorting that one out and I found myself sitting at a bus stop with a crying Eritrean woman, a police officer and three students who just wanted to know that she was alright. I thanked them for their help and they had a group hug before leaving. Strange.

The woman was homeless and very sad about her situation. She was very meek and to me she seemed too vulnerable to be out on the streets. I agreed to take her back to the hospital that she had been in earlier today (when she claimed she had been stabbed) and I could only think of ‘vulnerable adult’ as a reasonable excuse for doing this. I couldn’t just leave her where she was and the police officer was hoping I’d make a decision – so I did.

I took her back to hospital myself but the reception for her wasn’t warm. The nurse wasn’t too pleased to see her again because there was nothing wrong with her. I told her that I felt she was vulnerable and that this was a place of safety for her. I also pointed out that we bring plenty of drunken frequent flyers in and that she, at least, wasn’t drunk...or smelly.

She got a cubicle and a bed.

While I was there I saw that armed police had set up guard points at the entrance and exit to resus. This usually means that someone has been shot. I was told later that there had been a double shooting in south London and that one of the victims had died. There was the usual gang of friends hanging around outside, waiting to hear the prognosis for their injured mate. This has become a sick routine now.

My next call was to a petrol station where a 35 year-old man had been assaulted. He had a head injury and was quite aggressive. His little gang of mates were also a bit rowdy and they jostled the police as they tried to argue their point, whatever that was. All of these men were Somali and this appeared to be some kind of inside fight but I was told later that he had been hit over the head with an iron bar and a litter bin after telling another driver off for not having car insurance. It mattered that much to him apparently. Nobody believed this story of course, least of all the police.

My last call was to a night club where a 22 year-old female had collapsed. This was given as a Red1, with ‘life status questionable’ stuck on the screen. This produces a long sigh.

She was, of course, drunk as a skunk. She was also not very helpful and didn’t appreciate the pain I produced to get her to sit up and pay attention. She was far too heavy for me to consider playing ‘carry the rag doll’ with. She came to her senses (what little she had), stood up, with support from two of the door staff and wobbled her way to the exit with her stunned (and sober) friend. A taxi was hailed but he tried to escape when he saw what he was being asked to deliver home – mini-cab drivers are too fussy these days, don’t you think?

The door staff collared the driver before he could make good his U-turn and bundled the ungrateful woman into the back seat. Poured is the word I’m looking for.

Be safe.

Floppy

Eleven emergencies; Two assisted but not conveyed, one running call, one not required and eight taken by ambulance (including the running call). Three cancelled calls and a few quid earned for the LAS through ambulance requests for drunks.

First night of my three-night run and it starts immediately with a 20 year-old male ‘fitting’ at an underground station. He was lying on the platform, surrounded by underground staff and an off-duty nurse and doctor (I don’t know if they were a couple, fellow passengers or were on their way to an ‘off-duty medical professionals’ seminar). There was a crew with me; they arrived on scene just after I did, so there was little point in taking the lead as they would be conveying the patient, so I helped out with the basic obs and treatment.

The man had apparently collapsed and had a fit while waiting for a train – when his BM was checked it was 1.8 so that was probably the reason for his seizure. He was completely out of it and quite combatant so the possibility of him eating anything given to him was slight. We gave him an injection of Glucagon and waited. In the interim we had a quick look in his bag for evidence of diabetes and found his insulin and two bottles of Lucozade. I had already asked a member of staff to get something sweet for him to eat and he returned with a Mars bar (one of those double things that con you into thinking you are eating half the amount of chocolate but you end up eating both bits and therefore it’s the same as eating a giant bar – damn you Mars).

The man was recovering well and ten minutes into his treatment he was able to start chomping down on the chocolate and drinking the Lucozade. I nearly lost my fingers during the chomping phase. He still needed to go to hospital and we helped him out to the ambulance, although he was initially reluctant. He had fitted, so a proper check in A&E was in order, just to be on the safe side.

I went back to the car with Lucozade-sticky gloves and the other half of the Mars bar. He didn’t eat it and he didn’t want it – I asked him twice.

So I ate it.

What? Why are you looking at me like that?

From there I was sent a little further north to a suicidal 20 year-old who had taken an overdose. She hadn’t called; the 999 had been made by someone else who didn’t live at the address. I arrived and knocked on the door. There was no reply. I knocked again - still no reply. I was beginning to think that a bit of breaking and entering was required.

I peered through the letterbox and caught sight of movement and a door opening just in front of me. I shouted “ambulance” into the hallway and a young man jumped from behind the door. He had been in the toilet and was startled by my voice as he came out. He opened the door and gave me a blank look. It was clear he had no idea why I was there.

“Did someone call an ambulance from this address?” I asked

“No, I don’t think so”, he replied

“Is this number 20?” I have to tell you that I began to doubt that this was the right address. I’ve made this mistake a couple of times over the years; misread the number on the screen and gone to the wrong house – or street.

He scooted upstairs while I waited at the door – I didn’t want to be rude and barge in. In a few seconds he was back down, pale as a sheet, with another young man – also quite pale and I was ushered upstairs to a young girl’s bedroom.

The girl was slumped against the wardrobe, empty blister packs and pills scattered around her. She was incoherent and vague, although conscious and breathing, thankfully. I asked her what had happened but I couldn’t make out a single word she said. I only got her name by looking at the label on the pill packets. She had downed two bottles of wine with a cocktail of anti-depressants, sleeping tablets, antibiotics and (ironically) Pro-Plus. Her two friends (they all shared the house together) had no idea that she had done this and that an ambulance had been called. Luckily, she had been on the ‘phone to someone (I’m guessing an ex-boyfriend) and confessed her intentions, so he had made the call for her, although I noticed he remained absent from the scene.

The crew arrived shortly after I began my obs and my colleague found a suicide note, scribbled and almost illegible, on the dresser unit. I hadn’t noticed it but then I was kinda busy propping her up and keeping her awake...and desperately trying to understand her words. The crew had no better luck than me – they couldn’t understand a word she said either.

She was taken to hospital in a hurry (she had ingested over fifty pills) and I watched as the medical team attempted to communicate with her. She had tried this before; she had attempted to slash her wrists. Unfortunately, she had cut way too high up on her arm to have any more of an effect than scarring. She was crying out for something and if only we could hear what she was saying, she might get the help she needs.

Just up the road I attended an assault. A sixteen year-old boy had been set upon by a group of teenagers and kicked, punched and stamped on. I think stamping on someone’s head is the most hateful and disgusting form of assault. It really shows what kind of man (or woman) you are when you need to do that to someone.

He had run home after making the call on his mobile and I arrived to find him sitting with his family in the kitchen of their flat. He had a broken nose, a bloody face and a very clear boot print on his head. It had been a vicious attack and he was lucky to be conscious.

The crew had arrived at the same time as I did, so he was quickly taken to the ambulance for a proper examination. The police showed up as we were walking him out of his flat. He’ll be fine but his bent nose will be a permanent reminder of his violent encounter.

I managed to get back into the West End to witness a gang of up to fifty roller-bladers whooping and singing their way down the middle of the roads around Covent Garden. The first time I saw this lot a few of you educated me about the fact that they are organised and do this regularly – for fun and exercise. It looks fun but I wonder if I will be getting a call to a RTC involving a car and ten ‘bladers’, mown down by a blind and ignorant driver. Or a pedestrian with roller scars on the face and body.

I went into Soho to attend a 35 year-old man who had fallen and cut his hand on glass. In fact, when I got there I discovered that he was a homeless man who had been assaulted (allegedly) and now lay on the pavement with a deep cut on his calf muscle. His ulcer had been ripped open and there was a good deal of blood around – and he was HIV+ (the police on scene told me).

I cautiously dressed the wound and listened to him rant about being set upon for no reason then I called Control and asked them to inform the crew about his HIV status. He was stable and the blood loss wasn’t critical, although it looked dramatic, spilled as it was in large puddles on the pavement, much to the fascination (and disgust) of the passing public.

I ordered up some boiling water from a nearby pub to flush the blood away with (it disinfects and it was all I had to work with) and completed my obs as the patient became less aggressive. Then he refused to go to hospital. I tried several times to persuade him and the police had a go too but he was adamant. He told me that he didn’t care anymore and that he just wanted to crawl into a corner and die. He said his life was worthless now. I couldn’t say anything to make any difference so I gave up the fight to get him to go. I cancelled the ambulance and he got up and staggered off. I left the scene when I had completely cleaned up the blood spills. One day I will see him again.

Off to the east for a hyperventilating female who didn’t need my help and was happy to sit in the ambulance for twenty minutes with her happy friend. She went back to her house (friend in tow) after ‘treatment’. I chatted to them, had a laugh and sat in the car ‘til I was the only one left.

A call for a 62 year-old with chest pain and unstable angina turned out to be a frequent flyer that I hadn’t personally dealt with for some months. I recognised him as soon as he came out of the phone box. He was still on the line with the LAS call taker, so I asked him to come out of the box and told the call-taker that I had arrived and was dealing.

This man is very aggressive and demanding. He had no chest pain and claimed he needed his prescription re-filled. He wanted to be taken to the Royal Free hospital, which is out of my area. He was very loud and in my face for most of the conversation ‘til I cancelled the ambulance and told him to get a bus to the hospital of his choice. He wasn’t happy.

I know I had a short break at some point but I can’t remember it.

Soon enough I was off to a train station for a ‘20 year-old male - unconscious’. I arrived to a lengthy report given to me by a random young man who had helped out when the guy had collapsed. There was also a PCSO present and he tried to give me details as well. I noted the young man was more interested in chatting up the two girlfriends of the unconscious (drunken) man on the ground.

“Thank God you were here to help us”, they said

“That’s okay. I’m like that, I help everyone”, he replied

I thought I was in a B movie.

I waited 30 minutes for an ambulance. It was extremely busy tonight and drunks were not being given priority. The unconscious man was completely out and I had him up on fluids and packaged to go by the time a crew got to me. He was now cold but responsive (a little fluid through the veins will usually wake them up). By the time he was being loaded into the ambulance, he was aware of his situation and embarrassed by it.

During that job my car was attacked by a loony drunkard who decided it wasn’t a good enough ambulance for his fallen comrade. Then he turned on me. The attending PCSO’s made short shrift of moving him along.

Another ‘drunk on a bus’ call – except there were two of them! I went aboard and picked on the smaller of the two but he lashed out at me almost straight away. I avoided a punch to the face by inches. I went over to his mate, who was lying in between the seats on the floor. He was no better. I threatened the smaller guy with the police if they didn’t get off the bus (I had stopped saying please and sir) and this seemed to have an effect. He got up and began to rouse his rather large slumbering mate. They were both Polish (and I wasn’t shocked to hear that) and he told me that his large friend was ex-special forces. Uh-oh.

It took five minutes and a really good kick (from his mate, not me) to get Mr. Special forces up off the floor. He rose to his six foot or so and glared at me as he was led from the bus. I let him have a bit of space. I’m nice like that.

The crew arrived as they left the bus and the police never came.

Meanwhile, in Leicester Square, I was asked to help with a drunken female who had gone off the rails by mixing booze with her antibiotics. She was unwilling to co-operate and vomited frequently in the direction of my boots. Her gang of concerned friends became a real pain as they jostled and harried me about the delay in getting an ambulance to her. I had another half hour wait.

Just after that job, I was sent around the corner (or bend, depending on your perspective) to a hyperventilating man in the midst of a panic attack for no reason other than ‘he is sensitive’. There was a tired looking PC with him and we both sat patiently calming him down until the ambulance arrived and took him away.

My shift ended with a horrible call. A two year-old was having a fit and there were no ambulances available to deal yet, so I was on my own with this one. Usually these things turn out to be nothing more than febrile episodes but not this time.

I couldn’t find the address (it was one of those estates where nothing makes sense) and I asked for the caller to wave out the window or signal somehow. I was told that someone would meet me outside, so I drove in the general direction of the block of flats and saw a large African woman running towards me – with a fitting child in her arms. This, I didn’t need.

I pulled over and immediately took the child from her. I had no choice but to lay the little girl on the back seat of the car and I knew I was going to have to treat her there. This was not good. Never, ever bring your critically ill child to us – we will come to you.

The girl was still fitting and had been for half an hour. There was no ambulance yet and I quickly called Control and asked them to direct the crew to my exact location while the mother stripped off the child’s nappy and clothing at my request. I have to say that I wouldn’t have been as calm as this lady appeared to be. She either didn’t know just how bad things were or she had supreme confidence that I could fix it.

I gave the child rectal diazepam without delay. Her temperature and BM were normal but her sats were plummeting (currently below 85%). I gave her oxygen and thought about my next move, which had to be decisive – there was no time to lose here. She had no medical history for epilepsy, so the cause of her fit was unknown, although I did notice how loose and foul smelling the contents of her soiled nappy were.

As I mulled over the next move (whether to take the child myself or not) the ambulance arrived but not at my location – they were across the street. I grabbed the child and ran to the vehicle before the crew had time to get out. I explained the situation, gave my initial obs and told the paramedic that I had given diazepam. The three of us then got to work in earnest. I put a line in and a second set of obs were completed. Why this child was fitting was still a mystery.

During the second set of obs, she stopped fitting but her breathing became progressively depressed. I was concerned about the effect the diazepam may be having, so I let the crew get on with it and I prepared to follow in the car. Meanwhile, the mother had disappeared back to the flat. She hadn’t asked what was happening and she didn’t seem concerned in my opinion. The crew couldn’t wait for her, so I got her into the back of the car (when I had tracked her down) and took her to hospital, travelling behind the ambulance all the way.

The child had deteriorated when we arrived; the attendant was ‘bagging’ her to support her breathing when the trolley bed was taken out. This concerned me. I followed them into Resus and watched as the paediatric team worked on her, continually supporting her airway and breathing. She was floppy. Her eyes were open but she wasn’t there.

I handed my report over and left to go back to my base station. My shift was ending in 20 minutes but I was in no mood for another ‘routine’ job. I asked the crew who had helped me to let me know how the little girl got on (if she survived or not is what I meant) and gave the paramedic my mobile number. He promised he would let me know the next day.

I went home shattered after that job and I mulled it over all through my ‘sleep’.

I got a call from the paramedic the next day as promised. The little girl pulled through. She had an infection and this had caused the fit. The diazepam had nothing to do with her respiratory change.

Be safe.