Something and nothing

I wanted to go to this but I couldn't find it...

Ten emergencies. One taken to work by request, one assisted-only and eight taken by ambulance to hospital.

An early call for a 34 year-old man who had fainted and made his way to a hospital when he recovered. The hospital has no A&E department, so I was asked to attend and I found him sitting in the reception area looking very pale and tired. He had no significant medical history but he hadn't completely got over passing out and still felt dizzy whenever he stood up.

The crew arrived soon after I had started my obs and he was taken to another hospital for further investigation.

My next call, for a 25 year-old female with dizziness and chest tightness was easy - there was a crew on scene when I arrived, so I wasn't required.

Another faint, this time a 33 year-old female who was on her way to work when she collapsed at a tube station. She had fully recovered by the time I got to her and she insisted that she didn't need to go to hospital. She hadn't been sleeping well and was packed to go on a weekend break after work, so she was probably just exhausted. I gave her a lift to work and she seemed right as rain when she got out of the car, wheeling her suitcase along the road to her office.

A local job at an address just around the corner (literally) from a hospital next. A 50 year-old male had called to say he had collapsed outside his flat. After that there was no communication with him; he wouldn't answer his 'phone. Calls like this can be nonsense or they can turn out to be serious, so the crew and I stood outside the locked street door and buzzed every flat until we got an answer.

'London Ambulance, can you let us in please?'

'No', said the woman's voice

'We have an emergency call to this building and need to get in'

Nothing. Then a click. She had hung up.

We tried that buzzer again and again while we waited for the key holder to arrive but the woman refused to reply. She wouldn't even come to her window to look out onto the street and verify who we were!

Eventually, we gained entry when the key holder (who arrived without his key) let us in using a free code. A woman from the same department arrived just as we let ourselves in and made our way to the lift - fully equipped for a possible resuscitation.

'Do you know this man?' I asked the woman

'Yes, he has health issues', she replied

I thought I recognised the tone of her answer.

'Is he an alcoholic?' I ventured

'I think so’, she said

I could almost predict what we were going to see from then on.

The lift shuddered to the relevant floor and the doors opened. We could all smell the booze. We walked to the corridor where the flat was located and he was lying on the floor outside his flat, unlit cigarette in hand and cans of lager strewn around him. He was the perfect patient.

'What's wrong with you?' we asked when we got close

'I'm locked out' he replied

I left the crew to deal with him and made my way back. The lift door had a child's boot print on the doors, almost as if s/he had walked up the length of it. 'Spiderkid, Spiderkid....'

Paying your taxes means you can rely on a swift and altogether over-the-top response if you give the wrong details to the call taker. My next patient was a 54 year-old female who had called us claiming chest pain. She was at work and we descended on her in full force; me, the motorcycle response unit and an ambulance crew. Turns out she had back pain. Not chest pain, back pain. Even I find it embarrassing when we overload a job like that.

A young panicky male next. He was at work too but for some reason collapsed in a heap of emotional hyperventilation before his day had even started. I had to extract him from his cuddling colleagues to calm him down - he was soaking up too much sympathy. He recovered in the ambulance and went back into work. He had done it before and he will do it again.

The next call reminded me never to be complacent about patients, regardless of how they look and act. A 45 year-old male with severe DIB outside a hostel had me reeling a little from the smell of him. He was not well toilet trained and had been sleeping in his own filth for days. He stood outside the building gasping for air and, incidentally, gasping on a cigarette. He begged for something to help him breathe but he refused to put his fag out, so I couldn't give him oxygen.

He had been hit by a car the previous week and sustained a shoulder injury. He had been discharged from hospital and limped around for days doing drugs and smoking cigarettes (and not washing at all). Now he was struggling to breathe and he wasn't acting. He stopped smoking after my tenth request, which was firmer than the previous nine. He chucked the ciggie, staggered forward and complained of a sharp pain in his chest. His colour wasn't good but then it's difficult to assess with someone whose lifestyle drains energy from every cell in their body.

The ambulance arrived as I gave him that much needed oxygen and he was transferred on shaky legs and a walking stick as swiftly as physically possible. A proper check was carried out and he was taken to hospital, which was literally one minute along the road. His sats had never improved above the high 80's without oxygen, so we were taking him seriously, despite all appearances.

I left the hospital as soon as the crew delivered the patient because I had another call to attend but I learned later that he had been diagnosed as having a pulmonary embolism (PE) - a potentially life-threatening problem. It probably developed after his accident; it could have sat in one of his large veins as a thrombus before tearing off into his circulation (embolism) until it found an artery too narrow to squeeze through. By chance, that happened to be an artery in his lung (pulmonary). Thank God for two lungs then, eh?

A 23 year-old female who was reportedly suffering a panic attack and had pins and needles in her arms may in fact have been having an allergic reaction. She had a swollen tongue and a rash developing on her neck. She scratched her way through my initial obs as she sat in the staff office of a tube station - she was also tearful and very worried about 'not being able to breathe properly'. Needless to say she was taken to hospital quickly - just in case.

After a lull I visited a 12 year-old boy with severe physical disabilities that I had treated three years ago. He is prone to epileptic fits and the last one I dealt with was extreme - he needed airway support all the way to hospital. This time his fitting was bad but his airway was patent. He recognised me through the seizure and was able to communicate with his eyes. I gave him a top up of diazepam (his mother had already given him some but with no effect) and when the crew arrived we bundled him out of the house and into the ambulance. I grabbed his favourite soft toy for him but it got left behind somehow in the mad dash to move him before he deteriorated. Poor mite.

Finally, a 48 year-old female who fainted twice in quick succession. The call originally came through as a single fainting episode in a bar and it was cancelled because she recovered on scene. However, I received it again because she had fainted a second time.

When I got on scene, she was recovering but very pale and unsure. Her BP was lousy, so I got her to lie down while I tested it again in a supine position - it had improved to around normal. The woman had no relevant medical history and she had been very tired and stressed recently but I was concerned that I may be missing something, given her age, her BP and her propensity for multiple faints. She was continually hypotensive when upright, so it was prudent to keep her flat and I asked for an ECG to be carried out when the crew arrived.

Her ECG seemed to be normal but her BP continued to stay low whenever she was upright. She went to hospital and I hope she recovered without further drama. It was probably nothing more than the effect of a combination of stress and lack of sleep but I'm not willing to testify to that.

Be safe.

Torrential

Eleven emergency calls; two assist-only. All the others went to hospital by ambulance.

Yet another rainy shift – some of the downpours were just mean. I’m beginning to feel like I’m back home in Scotland!

Every now and then I get a call to assist a crew with a ‘heavy’ patient. This rarely means well-built. My first call of the morning was to a 74 year-old man who was lying on the floor after having suffered a stroke. The crew were already on scene and simply wanted an extra pair of hands to lift the patient into the ambulance.

When I arrived, the crew were attending to the man’s needs (oxygen, etc) and I helped them move him onto the chair. I had come up some steep stairs to his bedroom, where he had been found lying on the floor with a weakened left side. The man knew he had suffered a stroke so it was important to keep him calm and reassured whilst we carefully carried his large frame down those narrow steps and out to the ambulance.

An ECG showed he had Left Bundle Branch Block (LBBB) and possibly Atrial Fibrillation (AF) but determining that is difficult when the patient is shivering and you can’t get a clean reading but it is quite common and likely to have been the cause of his stroke. With this in mind he was taken quickly to hospital.

A 25 year-old who had collapsed and become unconscious in an underground station was my next patient. She was almost fully recovered when I got to her and it sounded, from the short history I was able to take prior to the crew arriving, like she had a touch of food poisoning. She had been ill before she set off for work. It may have been wise of her to stay in bed and call in sick.

After a short break, during which the rain fell relentlessly, I was sent to a 23 year-old man who had collapsed. He had vomited on the floor of his office and I remember looking at the carpet and thinking his little pool of sick was going to leave a nasty stain when it dried fully. His colleagues were concerned about him so I guess cleaning the mess up wasn’t their priority.

I examined him as he lay on the floor; his blood pressure was low – it fell even lower when he was moved to a less supine position. Postural hypotension can be a clue to numerous possible diseases and conditions but it is fairly common and can lead to no pertinent diagnosis whatsoever except that the person became ‘vasovagal’. Until recently I treated such attacks, especially in younger people, as no more than a simple faint and either left them where they had recovered or took them to hospital if their condition hadn’t improved or they had refused to go. However, recent research into sudden adult death suggests that it is prudent for pre-hospital professionals to thoroughly examine unexplained faints in young people, especially after stress or exercise. This means an ECG for every one of them.

Considering how many faints we attend every day, this may seem unnecessarily time-consuming but the thinking behind the research is that some of those young people who have died may have been saved if a heart defect had been detected earlier. In my opinion ten minutes on an ambulance having an ECG carried out is not a problem – a decision can still be made about conveying to hospital and the person concerned may still refuse to go but at least there will be a record of examination should things go wrong.

A simple trip and fall next; a 70 year-old tourist who missed the kerb and stumbled into the road. He had suffered no more than a few grazes but he had a pacemaker, so we checked it for functionality on the ECG. It was working just fine as far as we could see. The crew completed their checks and let him and his wife carry on their day.

I had numerous cancellations after my break then I was sent to the north for a 46 year-old male ‘passed out in street, now nauseous’. The rain was still hitting the ground hard as I stood banging on the front door of the address with the crew, who had arrived with me. The patient refused to answer (or couldn’t). I called Control and asked them to ring the patient back but the number rang unanswered. We were beginning to look like wet door-to-door salesmen for the NHS and continued to try until eventually it opened and the patient walked out, bothering not a jot that we had been stood there for ten minutes waiting for him.

He was an alcoholic and had been out drinking when he felt dizzy and collapsed. He made his way home and called an ambulance because he now felt sick. I left him with the crew and made my way back to familiar territory.

I didn’t get far though. My next call took me all the way into N7 for a fitting 20 year-old male. The ambulance arrived as I pulled up in front of the address and I went in with them to see if I could be of any help, especially as I had just driven all this way.

The man was standing in a classroom where he had been taking an exam. He is a known epileptic and had suddenly had a fit, causing his tutor to run for help. He was recovering now but he kept clearing his throat in a loud and exaggerated manner; it sounded like a seal crying. This may have been his usual post ictal behaviour but it was quite unusual and strange to watch. Every now and then he would punctuate the noise with a coughed up blob of phlegm. I left him to the crew and made my way, once again, back to my own area.

The radio had been going on about blue skies in the afternoon with 20 degree temperatures but this hadn’t transpired. It was grey and raining still. The wind had changed and made the weathermen look like idiots – the tourists had relied on these weather reports and as I watched the soaking, plastic-covered foreigners board their open-top buses I remembered how brave we tend to become on holiday. Appreciation for fine art suddenly increases too; the National Gallery hosts a swell of extra bodies when the torrents begin.

I was sitting on stand-by watching the wet world go by when I got a call to Piccadilly Circus. A 60 year-old male had severe DIB and had collapsed. On my way there, an update advised me that he had ‘? Asthma’. The call had come from the police and they were on scene when I arrived. I expected to see an elderly gentleman but I didn’t. I was greeted by a wailing gang of teenage German tourists, one of whom had suffered a panic attack and begun to hyperventilate. By the time I arrived his fingers had gone numb and he was worrying about the loss of feeling around his mouth. I explained that it was perfectly normal and that he should try to relax.

His English was weak and he was distracted by his friends – the young girls were crying and trying to hug him. They were all about 16 years old and there was no supervising adult on scene (although he had been called and was on his way). I was being manhandled by weeping youngsters who thought their world was ending.

I took the young man away from the hysterical little crowd and sat him in the car until he calmed down, a process that began almost as soon as he lost sight of his highly-strung friends. The police officers joined me in the car too because they were getting soaked through and hadn’t brought their jackets out.

The crew arrived and took the young man into the ambulance to fully recover and await the arrival of the adult in charge. He won’t be going to hospital. Meanwhile, the police asked me if they were needed any longer because they had a prisoner in the van across the road and really should be going now. I found that amusing and agreed they should get on with their arrest.

Scotland Yard next for a 25 year-old male who had been working below a large, heavy shutter door when it collapsed and almost crushed him. Luckily he dodged it but his hand got caught by a very nasty cog (see photo) which tore through it. The police, who are always nearby, attended and there was a large dressing on the wound when I arrived. I had a look at it, saw how deep it was and covered it over again. He had been very lucky – the door could have killed him. He got away with the hand injury and a good old fashioned fright.

We often get calls to doctor’s surgeries – sometimes the patient had been well treated and is ready to go to hospital with a full history and two sets of obs and sometimes we find a chest pain sitting out in reception. This time we found a 66 year-old who had fitted, sitting in the doctor’s office, unaware that we had been called and not quite sure that he needed to go to hospital at all. He was very pale and sweaty and at times he seemed non-responsive and distant (absent) when I spoke to him but I couldn’t say for sure if that was his normal behaviour or, as an alcoholic, he was the worse for wear but the doctor was insistent that he had fitted and was ‘not himself’, so I treated him accordingly.

The crew were with me and all I needed to do was assist but the patient disagreed with the diagnosis I think.

My quickest response of the day took me across the road and all of 30 seconds for a 50 year-old man who was ‘collapsing’ on a station concourse. He had been seen staggering around and collapsing every now and then. This was brought to the attention of rail staff and police who called an ambulance whilst they located him and sat him in a chair. I was met at the entrance to the station and told that the man was ‘probably drunk’, although I could smell very little alcohol on his breath when I examined him. He had lost bladder control and his BP was very high. His verbal responses were extremely slurred and nonsensical, so he was either stupidly drunk or he had possibly suffered a stroke. There was something about him that led me to believe the latter and when the crew arrived, my colleagues seemed to agree.

My last call of the shift was for a 70 year-old female who was dizzy and vomiting. She was in a hotel room and had already been seen by a doctor who gave her an anti-emetic to stop her being sick. She had called an ambulance because the drug hadn’t worked and every time she moved the room began to spin, making her vomit. Initially I thought she may be suffering from vertigo and asked her about possible recent ear infections and other relative disorders but she had no suggestive medical history.

The crew arrived and took her to the ambulance while I packed up and made my way back to base to go home. My bags had soaked and dried several times today and now there was a musty damp smell around them. I’ll need to air them out before I start work again tomorrow...don't want the customers complaining.

Be safe.

Waterworld

Twelve emergencies; two assist-only and ten went by ambulance.

It was raining when I started my first of three early shifts. It was still raining after my first coffee and had settled to grey drizzle by the time my first call came in. Predictably, as in most days of adverse weather, it was a RTC. This one involved a 34 year-old female who had fallen from her moped on a busy road in rush hour.
She had a suspected broken arm, probably the distal end of her Humerus (known as the funny bone), but she didn't seem amused at all. I put a sling on her after removing 3 coats and a jumper (it was wet but it wasn't that cold!). Of course, the removal of each layer caused her some pain and discomfort but short of cutting through them, which would have been a tad over the top, we both had to grin and bear it - mainly her.

Over on the east side I found myself on my knees in a puddle for a 55 year-old man who had collapsed and had a ‘? Fit’ after a spontaneous nosebleed. After a few minutes and a few pertinent questions, it became clear that he was an alcoholic and had probably fallen earlier (and damaged his nose) before collapsing with a bloody nose on the road, where bystanders had witnessed him having a seizure.

There was a wee bit of over-resourcing on this job; myself, two ambulances and a motorcycle solo – not to mention the police, who were already on scene. The patient was recovering and smelled of alcohol. He didn’t deny being an alcoholic but he was taken to hospital for further checks anyway.

Next, a 46 year-old male who had fainted at work. The ambulance was already on scene so I wasn’t required. This was followed by a call for a 37 year-old female who was suffering severe back pains at her workplace. Her pain was located mainly around the right lumbar area, directly above her kidney, so there was a good chance, judging by her description of the pain and the intensity of it that she had renal colic. I sympathised with her – it’s one of the worst pains to suffer, short of toothache. I hate toothache.

It was still raining when I saw her off to the ambulance.

I got a call to attend a doctor’s surgery for a 24 year-old female who had been suffering intermittent SOB over the past four days. The doctor had given the woman salbutamol and called us because there seemed to be no reason for this sudden problem.

I asked her about her medical history but there was nothing significant to report – meanwhile her kids are standing in the little treatment room with her, they didn’t seemed too concerned. Mum was breathing with long expiratory intervals, which tends to indicate the need to ‘dump’ excess carbon dioxide from the body. A CO2 monitor was put on in the ambulance and sure enough she was producing long, shallow plateaus. She had been hyperventilating, that’s all. Now whether this was due to stress, panic or the aspirin she had taken a few days earlier ( I gleaned this from her during our chat), just prior to the beginning of these attacks, I don’t know but I’m willing to bet nobody will get to the bottom of it all and she will recover fully in time.

When the police call for us, we give their calls a priority response, generally speaking, but we rely on their good judgment in deciding whether an emergency ambulance is required or not. My next call took me four miles south for a 70 year-old male with a ‘cut finger’. That was it. No other issues or complications. The call was categorized as a red3, a Category ‘A’ emergency. The FRU Control desk even called me to apologise for sending me on this journey, which involved a long and tricky drive in wet and extremely windy conditions through some heavy traffic.

When I got on scene there was already an ambulance crew dealing with the patient, a man who was nowhere near 70 years of age and who was nowhere near death’s door, with his bandaged finger in the air. The ambulance paramedic was already ‘chatting’ to the two PCSO’s who had called this in. He was discussing the very real problem of sapping our resources for a walk-in A&E job. I stood there doing nothing as the patient passed me on his way to the ambulance. He sucked his teeth and said ‘ambulance’ in a sing-song voice. Interesting.

Just for good measure another FRU showed up for this call.

On my way back I received a call for an 80 year-old man who had collapsed and stopped breathing briefly, before recovering. He was in fact 90 years old and was a retired cardiologist whose GP had recently doubled his dose of beta-blockers as a ‘prophylaxis’. I found this odd as increasing such a drug will increase the likelihood of faint due to a drop in blood pressure but maybe that’s the thing to do – increase the drug based on the possibility that a more problematic condition (such as hypertension) may get worse in the near future; one evil over another. Perhaps a doctor out there can enlighten me please.

The patient was an extremely pleasant man and was surrounded by retired colleagues – they were all at a get-together lunch in a sports ground. One of his friends was a surgeon for decades before bowing out.

When I examined him I found nothing amiss – in fact, he was in very good shape for a man of his age. He had no medical problems except for slight hypertension, which at 90 years is to be expected. He also had a specific heart problem called right bundle branch block (RBBB) but this wouldn’t impair his ability to live a normal life and he was well aware of that, being ‘in the trade’ so to speak.

He had fully recovered from his faint (the fact that he was seen to have stopped breathing was never convincingly argued) and I walked him down to the waiting ambulance, where a thorough check up was carried out, including an ECG which clearly showed his RBBB but nothing else of note. He refused to go to hospital and I have to say I wasn’t concerned about him, neither were his friends and the attending crew agreed.

Nice man. It was a pleasure to chat to him.

Next up, an RTC involving a young female. She walked into the path of a car on a busy road and put a bulls-eye in the windscreen with her head. There was a crew on scene when I arrived and so I assisted with the care of this patient. The motorcycle solo arrived to add a pair of hands and together we collared, blocked and scooped her – all good practice and all precautionary. She had no neurological deficit and complained of no significant pain but it’s not a good idea to presume too much and give the all-clear when the windscreen says different.

It was raining hard when I did that job.

Then, after a short break, I was sent miles away to an unfamiliar part of London for a 32 year-old diabetic who was confused. The call came from a doctor’s surgery but it wasn’t until I got to the address that I realised the patient wasn’t actually in the surgery. He was at home and the place I had arrived at wasn’t the most obvious surgery-type building, so it threw me. The ambulance arrived while I was circling the neighbourhood wondering where this surgery was!

I didn’t get to treat this patient; the crew went in instead. It was still raining.

On my way back I witnessed a bizarre arrest (not the cardiac kind) in Trafalgar Square. There was a police van Parked up and inside were about eight or nine fully suited up riot police with helmets on their heads and (strangely) balaclava-type covers over their faces so that only their eyes could be seen. They were all fairly big guys and looked quite menacing.

Three of them jumped out of the van and ran down the steps, returning a few seconds later with a handcuffed young man in their collective grips. He was about 5’10” and they towered over him at more than 6 feet to a man. I thought it was some kind of rehearsal or an anti-terrorism snatch squad. Then I went to a call at Baker Street tube station and saw a LOT of police around. Only then did I learn there was a football match on at Wembley; England v Germany. The police had been out all day arresting potential trouble-makers before they could set off for the game and stir things up (the trouble-makers, not the police). I think they cover their faces because some of them work undercover but I’m not sure. One of my police readers will tell me no doubt.

Oh and the call to Baker Street was for a 65 year-old tourist who was vomiting and had DIB. The crew arrived just in front of me so I wasn’t required.

My next RTC (and I knew there would be a few in this lousy weather) involved a car and a motorcycle. A 45 year-old male was sitting on the pavement after having been knocked off his motorbike by a car. He had a leg injury and the crew were, once again, on scene with me, so they dealt with it. It was too wet to stand around looking interested…it was still raining hard.

As I sat in the car (dry and warm) doing my paperwork, a young woman crossed the road ahead of me. She was talking on her mobile ‘phone and didn’t see that the lights were not in her favour. A taxi almost knocked her down – he had to slam on his brakes and skid to a halt, inches from her. She let out a quick scream, stepped back then carried on her conversation as if nothing had happened. I wonder what her friend on the other end of the ‘phone thought?

My last call of the shift was a replacement job. I was already running on an amber call for a minor problem (backache I think) when I was cancelled for a higher priority call – a Red2. It was for a 6 year-old boy who had been run down by a car. The vehicle had gone over his legs. This was serious.

It was still raining and visibility was poor so the journey was horrendous, especially in the heavy traffic.

When I got on scene the police were already there and all the traffic had slowed to a crawl leading up to the scene (rubber-neckers and traffic control) but I couldn’t see a body on the ground, which is what I expected. Instead I was directed to a stationary car. I could hear a young child’s screams coming from inside. There was nobody with him; he was sitting in the back seat, screaming in pain and virtually all alone. For some reason his parents were standing away from him on the pavement. There was no attempt from either of them to comfort him at all. The only person who was near him was the plain-clothes police officer who had been driving the car that hit him – the very car he was now sitting in!

I examined him but could find no obvious visible injury. HEMS had been activated for this and I was tempted to cancel them but as I chewed it over they flew overhead, so I thought they might as well join me. This young boy was in obvious pain but had no obvious injury. He kept referring to his upper leg and I tried to piece together what had happened. The first thing I asked out loud when I saw him was ‘who moved him?’

Apparently, the boy had run in front of the unmarked police car and it had swerved to avoid him. It clipped him and he tumbled under the rear of the vehicle. His leg was trapped by the rear wheel which went over it. The officer said he clearly heard the sound of it being crushed. I had to believe him.

Then, despite the officer’s protestations and attempts to stop him, the father picked the child up and started running around the road, shaking him as if he didn’t know what else to do. This couldn’t have made things any better for the child. The mother, who had been down the road and had seen it all happen, ran up to them and started clobbering the dad with an umbrella. I find this behaviour seriously flawed. Maybe one of my psychologist readers can explain these actions for me.

As a parent I would NOT have moved him and I would NOT allow anyone to take me away from him. I wouldn’t have concerned myself with who was to blame and dole out the punishment on the spot and I certainly wouldn’t have stood on the pavement listening to his screams of agony without an emotion. This, of course, is my own opinion and some of you might have different parenting methods or opinions on how people deal with their emotions but I am long enough in the tooth to spot the difference between concern and apparent indifference. I just couldn’t believe it.

The boy had either sustained a potentially life-threatening injury (a fractured femur) or his leg had somehow managed to survive the weight of a car – I don’t know. HEMS arrived and the doctor had a look at him. He was just as concerned as me but couldn’t identify an injury either.

With kids the risk of missing something significant because they seem stable is very high. They compensate extremely well with dangerous internal injuries before any signs appear and by that time it could be too late. Just getting him to hospital on blue lights and factoring in the mechanism is a life-saving move and that’s exactly what we did.

I still find myself amazed and shocked by the behaviour of certain groups of people (God knows, I daren’t specify any particular group in case I’m branded a racist) when it comes to the health and welfare of their children. There is either a cultural behaviour that I am unaware of and need to be told about or there are some very stupid parents out there. I go for the latter until I’m told otherwise.

It was still raining when I went home.

Be safe.

Coming to an ambulance near you...

For the past year I have been involved in research into the effects of respirator equipment on paramedics when they carry out advanced care. To some of you this may be an irrelevance but I have taken an interest in this alongside a few others on the basis that, sooner or later, we are going to be tested.

At the moment there is no protection for frontline staff if a chemical, biological or nuclear weapon is detonated. We do, of course, have the LFB and our own HART teams but they won't necessarily be on scene at the moment we are expected to go underground or into a building after an attack. On 7/7 crews were taken underground to rescue the injured and dying before the risk of possible further attack, or even the nature of the bombs used, was fully assessed.

Of course, the practicalities of immediate care will always make 'safety first' an unreliable modus operandi so it is important that we have the following in place:

1. Fully operational, thoroughly tested and effective communications equipment.

2. Personal protection equipment that includes a respirator mask.

The research is ongoing and to date my colleagues and I have produced one published paper, with two or three more to come soon.

Personally, I don't feel protected enough to deal with the threat posed by possible future non-conventional attacks. I am perfectly willing to go anywhere I am asked to save lives but I would like to live to go home afterwards.

Xf

Chronic

St. Paul's at sunrise.

Nine emergencies; one taken by police, one assist-only and taken home, one running call, one conveyed and the rest went by ambulance.

A miserable rainy day in London. When the sun did pop out the tourists filled the streets and public places, in some locations so much so that moving on foot was just as bad as driving on the roads.

After a quiet start I was sent to deal with a 47 year-old suffering chest pains in his hotel room. He was on a ‘plane when it started twelve hours before but he chose to ignore it. His wife looked fed up with his stubborn behaviour, citing the fact that he never goes to see a doctor about anything. His history of gastric problems gave rise to the possibility that he wasn’t in any danger – he had taken something for a stomach problem but there was no relief. However, his familial history of heart attack (his father had suffered an MI and died) meant that a cardiac problem could not (and should not) be ruled out.

I gave him GTN and aspirin and the GTN gave him a headache, which is to be expected. A little oxygen sorted that out for him and then he was packed off to hospital. Although his ECG was fairly normal, there were anomalies and I don’t trust anomalies (or any other sea creature :-))

My next trip out was to see a 61 year-old lady with emphysema who was experiencing SOB. There’s not much I can do for patients like this, apart from increase their oxygen and give them a bronchodilator (Salbutamol).

When I arrived she was struggling to breathe and looked as if she was on her last legs but 5mg of Salbutamol through a nebuliser and ten minutes later she was improving. She was even able to manage a smile and a full sentence after that. Of course, she went to hospital for further treatment and more definitive care but she will be back home tomorrow with the same problem. It will eventually kill her.

An Italian lady fell on the escalator at a tube station then felt dizzy and sick when she stood up again. Her family were with her and they were concerned because she suffered from vertigo and they didn’t know if she was having an attack or if she had a more serious problem because of the fall. I examined her and suggested that after the fall, she felt faint and nothing more. Her BP was a little low and she was steady enough on her feet, so her long-term condition probably wasn’t the culprit but it couldn’t be ruled out, so she was taken to hospital by ambulance, family in tow. This either added something to their day out or completely ruined it.

A short spell on station was followed by a call to a 69 year-old gentleman with asbestosis who had chest pain. He also had a recent chest infection, unrelated to his disease but such complications can indicate a progression and need to be monitored, so he needed to go to hospital for further investigation.

Then a strange call which took me to an underground station in the City for a '20 year-old male, fallen from bike, arm injuries'. I was fully expecting an outdoor job this time but when I pulled up on scene a member of staff was waiting at the entrance to take me inside.

‘I thought he fell off a bike’, I said

‘Yes, a couple of days ago’, the LU man replied, ‘he has terrible cuts to his arm. Very deep.’

He went on to tell me that they (the London Underground staff) thought they knew him from last year and that there was something strange about him. I felt they were cautioning me to be careful with him, as if he would be some kind of threat.

I went into the office where he was being ‘treated’ and found a man in his thirties sitting on a chair with large and very deep cuts to his arms. I recognised two things immediately about this man: he was a drug addict (his arms were covered in tell-tale punctures) and he was a self-harmer (the wounds were obviously self-inflicted – the depth and direction of them gave that away).

The wounds were old and purulent - both were badly infected. It was possible to smell rotten flesh if you got close enough, as I had to. He had cut himself and left the wounds to fester. To be honest, if you are going to kill yourself, make sure the wounds do the job quickly; don’t leave them to get infected and hope that death will come easily – it won’t.

I asked him when he had last taken drugs and he confirmed that he had taken heroin that morning. He also told me that his leg was painful as the result of a DVT he had been living with for days. I examined it and there was little doubt that he was telling the truth; his leg was badly swollen and very hot to touch. He needed treatment.

The man was very depressed and had given his ‘fallen off a bike’ story to the staff just to get an ambulance. He is probably well known to some of my colleagues but as this is out of my area for the most part, I didn’t recognise him and so he could take advantage of that I guess.

There were no ambulances available for this call and I had to decide what to do. I asked him if he was able to walk to the car and offered to take him to hospital myself. He agreed and I let Control know of my decision. I really didn’t want to be standing here for another 20 or 30 minutes with this man, I had nothing to offer him. His depression made me feel depressed. He reminded me of the devastation that drugs wreak – the hole is even deeper than the one in which alcoholics find themselves.

I took him to hospital and there was no pity for him there. I walked him to a seat where he would wait and wait until a doctor finally got round to him. I had dressed his awful wounds but his soul was lost and beyond repair unless he got a miracle. I left him sitting there with his head bowed and an empty stare in his eyes. He is 38 years old; he probably won’t see 40.

I sat on stand-by at Leicester Square for a while after that job. The police were also hanging around and a couple of Officers approached me and asked if I would examine a female drug addict who had been found on the floor of the ladies toilets. I sat her in the car and she was obviously out of it. Her obs were normal and she said she had just wanted to go to sleep. I told her not to sleep in public places and to go and find somewhere hidden so that people didn’t call ambulances all day long for her.

She wandered off to find somewhere and I got on with my shift.

Another chest pain call took me south for a 79 year-old with dementia. She was generally unwell and had recently been diagnosed with a chest infection. She referred to pain in her chest and it was pretty central, so nothing could be ruled out and the fact that her lungs sounded clear indicated that the antibiotics she had been given had probably done their job. She could have another infection though, possibly a UTI, so a trip to hospital was advisable.

Her son, who was present, wasn’t happy about this because she had allegedly been treated quite badly, in his opinion, the last time she went. My colleagues and I spent some time persuading him that it was the right thing to do. I suggested a full set of obs, including an ECG, at her bedside before finalising the decision. He seemed happy to have that done.

Her obs were normal, apart from her ECG, which wasn’t, so I used this and the chest pain she was complaining of to finally persuade him to let her go to hospital. One thing I have learned in this job about patient relatives is that the surest way to get a letter of complaint is to ignore their concerns.

I popped into a shop on the way back from this job. I needed chocolate and something to drink. On my way out an American asked the shop owner if he had any breast milk. He repeated his request and when told no left saying ‘nobody in this country has breast milk for sale’. It reminded me of the ‘bitty’ sketches in Little Britain.

I went back to my station and read the paper. I came across an article about an 80 year-old man who planned a fake wake for himself. He even had a coffin put in his front room and planned to lie in it while his ‘mourners’ enjoyed his posthumous hospitality. Unfortunately and with greatest irony, he died of a heart attack the evening before the occasion he had planned so painstakingly.

Then a red1 for a 'male lying in street, life status unknown'. This translates to 'drunk' most of the time. The category wouldn't be so high if people were brave enough to see if the person is breathing.

Sure enough, when I got to him, he was drunk and asleep on the pavement. He was also Russian and aggressive. I left him to the crew when they took over. The police were going to arrange his removal.

On my way back to base I was given my last job of the shift. A 78 year-old lady was having a panic attack and couldn’t move her muscles to get down stairs.

I went into a smart house in a smart neighbourhood and she was at the top of a winding staircase, clinging to a cabinet. Her friend was with her but couldn’t get her to come down stairs, no matter what she said or did. The clinging woman confessed to me that she was agoraphobic and that she simply couldn’t move once she approached the stairs. I cancelled the ambulance and calmed her down. I walked her to the top of the stairs and slowly, carefully and with conversation as a distraction, walked her to the bottom. It took five minutes.

Normally she comes and goes by taxi but she was too scared to travel that way to get home, so I offered to take her myself. I called it in as a ‘home by request’ and took her the mile or so back to where she lived. She was very grateful and almost fully recovered from her fright. I felt useful and it put a smile back on my face to be going home with.

However, I got back to my base station late and discovered that a very good friend and colleague, someone I’ve known for almost fifteen years, had suffered a stroke and was seriously ill in hospital. My thoughts are with him and his family.

Be safe.

Mechanisms

Twelve emergencies; one assist-only, two refused and nine taken by ambulance.

Mechanisms. I’ve used the word many times throughout this diary. The word describes the causes for injury. For example, if someone falls 20 feet onto concrete, the mechanisms for injury include the height, the landing surface (and its ability to absorb energy) and the person’s body and state of health, among other things. If you were to show a REAL interest and it was relevant, you might also look at objects on the way down, the weather and other things that may influence injury but we rarely have time to be that scientific about it.

Medical emergencies also have mechanisms; the pills a person takes or doesn’t take, the state of a person’s heart when they have chest pain, etc. Every tell-tale sign or symptom is a lead to a potential mechanism.

My first call of the day was to a 33 year-old man who had come off his bicycle at speed while going downhill. A wall had abruptly stopped him and he had gone over the top of his handlebars at around 30 mph. Now he was sitting on a step outside his home with a friend a few hours after the incident. He had decided it wasn’t worth an ambulance at the time and had simply hobbled home.

His main complaint was that he felt dizzy and faint. He also had severe pain in his shoulder and ribs on the same side (the side he had landed on). He had a tender spot on his cervical spine at the level of his mid-neck. His breathing was rapid and his BP was low. He hadn’t been knocked out and there was no visible bleeding. The mechanisms, however, suggested a possible neck injury, a possible fracture to his upper arm and ribs and the possibility of an internal bleed. So, he was treated for all of those.

I asked him to lie flat on the ground (which helped him feel less faint) and held his head so that he couldn’t move his neck. The ambulance arrived at that moment and I explained the situation to the crew. The man was immobilised on an orthopaedic stretcher (a scoop) and taken to hospital for further investigation. His mate was left behind wondering what the hell had just happened.

My next call was to a 20 year-old female with a history of anaemia who now felt dizzy and complained of her ‘throat swelling’. I couldn’t work out whether she had eaten something and was now having a mild reaction or she was relating two different problems to me; her anaemia-induced dizziness and the fact that she had reacted to something. When I carried out my obs, she seemed absolutely fine and had no history for anaphylaxis. The call had come in as a ‘DIB’ but she was having no difficulty with her breathing at all.

She was taken to hospital anyway. If she had reacted to something it was possible she could relapse.

Choking children present one of the worst scenarios for us. This call was for a one year-old boy who was ‘choking and vomiting’. I arrived with the ambulance at my heels and we all entered a small, dimly-lit flat together. Inside a woman was sitting with a child in her arms. He looked perfectly happy and was active and playful. I asked if this was the child who was choking and she said 'yes'.

On the bed, there was a little mound of vomited food and an benign object that caused the whole panic in the first place. It was a large, badly cut piece of apple. Apples are notorious for causing choking in small children, they get stuck in their little windpipes and are difficult to get back out again. In this case, the child had vomited in distress and the apple core had been forced out with the pressure.

I checked the child over and could find no reason to take him to hospital; he had cleared the obstruction himself and was now fully recovered. I asked the mum if she was happy to keep him at home and she said she was.

‘Can I still feed him?’ she asked

‘Well, yes but I wouldn’t advise anything but liquids at the moment.’ I replied

Let’s not tempt fate, eh?

I was sent to an underground station for a 32 year-old man who had collapsed and was vomiting. He was, of course, extremely drunk. He was taking a cocktail of drugs for gout and back problems, none of which deterred him from downing as much alcohol as his body could possibly hold – ‘I think I’m an alcoholic’, he said apologetically. I agreed with him.

The crew arrived and a chair was wheeled out for him.

Meanwhile, the beautiful people of London were hurrying past us in their suits and dresses, on their way to happier places where people don’t lie in their own vomit until well after chucking out time. The man painted a pathetic picture of his future history and everyone passing him knew it, judging by the looks of pity and disgust he was receiving...or maybe they were looking at the men in green.

No break yet and off to see a 27 year-old male suffering abdominal pains at home. He had a history of Hep B and was complaining of a burning pain in his stomach. It could have been an isolated gastric problem and nothing more but he had taken an antacid with no relief and had not vomited or experienced heartburn prior to it. His medical history meant that he could suffer all sorts of complications arising from liver disease and there was a palpable lump on his abdomen, directly above that organ, so he went to hospital for further investigation.

I got back to my home station for a cuppa and a short rest before being sent up north for a 25 year-old man who had allegedly been pushed down a flight of stairs by the doormen at a club. I couldn’t find the place because I had an approximate location on my navigation system, so I tail-gated a police van that I felt sure was running to the same call. Of course, I ran the risk of ending up miles from the job but I was willing to take it. Luckily, they pulled up in front of the club I was heading to.

There was an ambulance already on scene and I wasn’t required. The young man was conscious, alert and appeared to have no significant injury, regardless of the fact (which couldn’t be proven) that he had been pushed down stairs.

Back in Leicester Square I found myself hovering over yet another drunken female who had vomited all over her clothes and for whom all glamour and excitement of the evening out had evaporated. She was in a mess but insisted she was alright. A police officer stood over her and was ‘guarding’ her when I arrived. She had a low temperature and a low BM (although she wasn’t known to be diabetic) but this combination is common when too much alcohol is taken.

The crew arrived and swept her off the pavement and into the ambulance. She would spend the night in hospital, vomiting and crying about the injustice of it all.

My next call, immediately after this one, was to a collapsed female. I was being directed to a bus stop at the Aldwych. This strangely shaped road runs straight until you get toward The Strand, where it becomes an arch before straightening out again. It reminds me of an aneurysm.

There are a LOT of bus stops in this road and, although I was given the bus stop number, I couldn’t see it for...buses. So, I had to crawl from one to the other. Then I was waved down by a young lad who was sitting with a seemingly collapsed person next to him. He was holding this person up. I stopped, got out of the car and approached him but he gave me a stupid grin that warned me I had been set up.

‘Did you call an ambulance?’ I said

‘No, but my mate is drunk’, he replied

‘Why did you wave at me to stop?’

‘I was just saying hello’

Arrgh!!!

So, I started the whole search all over again until I met up with the assigned ambulance crew and we searched together. Eventually, a windmill directed us to a collapsed woman, lying in her own vomit. She had been drinking all night and couldn’t get home without falling down. Her ‘friends’ had abandoned her to this fate.

A noisy basement club in Soho next for a 19 year-old pregnant girl who fainted. The noise and heat were incredible in the pits of this place, so I wasn’t surprised she had passed out. She refused to go to hospital and promised me she would see her GP in the morning. She signed my form and I watched her make her way home with her boyfriend.

I stopped at a shop to get something to eat and was accosted by a lunatic who demanded I call the police or he was going to beat people up. He was threatening two of the staff from the shop I had entered. He seemed to mean business, so I asked for police to attend and waited in case he decided to make real his threat. In the end, he was all talk and no action. The police arrived and calmed him down.

I got a break after this and made my way to sanity and a cup of coffee (and a sandwich...and chocolate). There was nobody else on station; it’s still busy out there and the ambulance crews are working flat out, mainly to recover the human detritus produced by alcohol.

My next call was for a 30 year-old male with ‘cuts to arms and neck, ? cause’. It was an amber, so I had plenty of time to get there but when I arrived I found a young man collapsed on the floor of a petrol station with two very obvious and very deep stab wounds to his arm. He also had nicks in his neck where attempts had been made to stab him in the throat. One of the fingers of his hand had been sliced open, probably as he tried to defend himself, and he had a bloody mouth, where he had been punched or kicked.

He was stable at the moment and his obs were normal but he said that he had been attacked by two or three men at a club and couldn’t remember what happened. He had probably been knocked out, so there was always the possibility of hidden injuries, including a head injury. Young people tend to cope well with injury until the last possible moment, and then their compensatory mechanisms fail. I wasn’t prepared to take that risk with him, so when the crew arrived, I had him ‘blued’ into hospital.

A rude 26 year-old next – she stormed off as I tried to help her in the early hours of the morning. Her boyfriend had called an ambulance because she had collapsed in a drunken heap at a train station. She wasn’t happy with him but took it out on me instead. She didn’t care a jot who I was, what I represented or why I was there.

My shift ended with a ‘not required’ when I arrived on scene for an 82 year-old with DIB. The crew were there and I could go home, so I did.

Be safe.

A hard act to follow

An Australian paramedic sent me this article. I thought you'd like to read it.

Who would do this? Step into a stranger's emergency and all its bloody detail, breaching the sanctity of someone else's home at their lowest point, knowing that all those people clamouring around as you work are relying on you to produce a miracle?
Who would willingly set out for work each day expecting that at least once, and probably several times on that single shift, you’ll be the first point of help in someone else’s disaster?
Even by the most conservative estimate, Paul Featherstone has done this close to 10,000 times over the course of his 35-year career as an ambulance officer.

In an industry that is largely underpaid and under-recognised, Featherstone is Australia’s best known paramedic. He is the man who comforted Stuart Diver through those terrible hours in which he lay entombed by the landslide in Thredbo in 1997. And last year, 925 metres underground, he was part of a team who talked miners Todd Russell and Brant Webb through the psychological nightmare of their entrapment until they were finally freed from deep inside the Beaconsfield mine.

At 57, Featherstone has been a crucial figure in some of the country’s most notable rescues, from the Granville train disaster to major bushfires and floods. Yet what he remembers most are the private tragedies. Of all the dramas that he has tried to salve, the domestic shootings, heart attacks, industrial accidents, car crashes, even being attacked by someone wielding a knife, it’s the very old and the very young whose impact has proven to be most enduring.

What does he remember? Returning from holidays years ago with his wife and kids, towing the family boat along a busy highway and right up to a terrible accident. A family car had collided with a truck and gone over a guard rail, sliding down an embankment and coming to rest on its roof. He remembers scrambling down to the car, realising that a family just like his own had been suddenly struck by tragedy. “I can still see the car, unsecured and moving (on its roof) and inside were a number of children all pretty much deceased, except one who had primitive breathing, just gasping for air. There was no way you could get to her.”

He remembers the tragedies of elderly people, too: “Eighty-year-olds, they’ve been married 60 years, and there’s a frantic phone call and of course when we arrive there he couldn’t wake his partner up and there’s just total disbelief that she has gone after all those years.”

Stepping into such intensely personal dramas was not something Featherstone had ever contemplated, even in early adulthood. Trained as a toolmaker, he first saw emergency services working together up close when he witnessed an industrial accident. “There was a young fella, he got his arm caught in a conveyor belt. It was one storey up and you could just see his feet hanging in the air and hear him screaming … We couldn’t do anything except shut the machine down and wait for the emergency services personnel to come,” he says. “When I saw these guys doing this at the top end of human life, I thought it would probably be interesting to have a shot at it.”

With an interest in medicine, he opted to join the ambulance service, and in 1976 was one of the first paramedics to graduate in NSW. Having since conceived and developed the service’s Special Casualty Access Team, which attends emergencies in a variety of hazardous situations, Featherstone has been trained in everything from canyoning and caving to hostage survival and mountaineering, and these days spends much of his time as a helicopter rescue paramedic.

But when it comes to what he’s known for – being one of the best listeners in the nation – there has been no formal training. What he has learnt about people, and how best to help them emotionally, comes from years of working on the street.

“At the end of the day it’s all about human faces,” he says. “We’re dealing with the highest end of the human element. Even if it’s not life and death it’s still injury, it’s still pain, it’s still psychological torment for people. A man who has a heart attack at home and he’s the breadwinner and all of a sudden he’s got these guys coming in and sticking monitors on him and putting lines in him and they’re saying: ‘I’m sorry, mister, but it looks like you’ve had a heart attack’ – all of a sudden he’s going through his head: ‘How am I going to pay the bills? I’m not going to be able to be the man that I was.’ The exacting science is knowing what drugs to give him. But the human value stuff is the art form.”

And it’s one that Featherstone has crafted well. Todd Russell, who was trapped underground for 14 days, says: “For us to be able to communicate with him, day in, day out – and he was putting it into our terms rather than a doctor or a paramedic’s terms – it helped us immensely. He gave us the confidence to find our way through it.”

But there’s also an element of intuition to what Featherstone does, a sixth sense that he says comes with working so closely with colleagues over so many years and at such high risk. And these are the people who inspire him – quiet achievers like his workmates, who spend their days achieving extraordinary feats with little acclaim, but always with the hope of a happy ending. “You do have to care,” he says. “I think most people do. I think there is more good in the world than bad; we just hear a lot of the bad. I think people don’t know what they are capable of in bad situations.”

Ultimately it is humanity – his own, and that of others – that sustains Featherstone. As he says: “The reason you’re doing it is because you’ve got to remember that the most important thing we’ve got in the world is life.”

The Australian newspaper- Fiona Harari

And don't worry, the posts are coming. I'm busy editing for the book and it's costing me my eyesight.

Be safe.

Question answered

Thanks for all your replies to the last posting. I will continue as I have been doing as it is clear the vast majority of you prefer it.

In answer to the queries set in the many comments I received (including by email); the glossary (TPD Glossary), which you can find on the left hand bar, will explain all the terms I use in this blog. Remember this isn't written just for medically minded people.

TPD is written to include the jargon and some of the technical terms because that's how we speak and the diary wouldn't reflect my job if it wasn't included. The glossary is designed to familiarise you with these terms so that you can 'translate' as you read. Many of you will already have become familiar with most of these terms now, I'm guessing.

Cutting down the postings so that only a few calls are written in would probably ruin the timeline, although I'll be careful about repeating too many 'drunk' jobs where possible but I also think that those REAL jobs that come along will catch you out when you have become used to my routine, just as they do for me and my colleagues. That, I think, gives you the feeling of 'being there'.

Once again, thanks for the feedback.

Verbal diarrhoea

During a discussion in which the readership numbers for this blog were being discussed, it was suggested that my postings may be a little too long. I am a prolific writer and can churn out between 1500 and 2500 words every time I 're-live' my shift for you. The AOL blog started out as a sort of 'highlights of my day', which meant that my postings were shorter (500 to 1,000 words) and therefore more frequent.

If the majority of blog readers are put off by long postings and prefer to 'dip in and out' for shorter entries then it may be beneficial to revert back to my original style; shorter postings written more frequently (daily).

I would, of course, continue to write ALL of my day's work down so that readers would experience it with me but I could publish the full version in a book for a more leisurely read.

I'd like your views on this.

Xf

Hot & bothered

Twelve emergency calls. Four assist-only, one false alarm, one refused and one hoax. The others went by ambulance.

I probably watched more people (men) urinate in the street tonight than on any single shift.

Did I mention how hot it was down in the underground system? My first call was to a 35 year-old female having an epileptic fit on the platform of one of these hell holes. She was so near the edge that there was a real risk of her, or me, falling onto the track.

She had suddenly collapsed and started fitting with brief pauses and seizures in repeating cycles; never a good thing. I had already established from her friend that she was epileptic and that she had been drinking so when the crew arrived I prepared to give her diazepam. Trains were still coming into the platform and people were running and shuffling all around us. Even with the help of the staff there was little we could do, short of closing down the entire platform. We dragged her further away from the edge because every time she fitted she moved perilously near to it. It was too dangerous to lift and move her just yet, so I tried to gain IV access for the drug I was going to administer but her vein was thin and useless. I tried again elsewhere but with no better luck, so I was left with the only option open - rectal administration. In such a public place it's not a choice I make initially but I had run out of immediate options and something had to be done about her condition. She had oxygen and her airway was clear but she would be impossible to move safely.

We got the staff and a few of her friends to create a 'sheet wall' around us while I administered the drug. She seemed to settle down after a few minutes and we prepared to move her but then she had another violent seizure, so another 5mg of diazepam was administered. She settled again and we decided it was time to go. She was put into a chair, strapped down as securely as possible and wheeled all the way up to ground level. She fitted twice more on the way up, the second time slipping dangerously out of the chair at the top of some steps. The stretcher was brought to her and we moved her swiftly onto it and into the ambulance. I left my car at the station and joined the attendant in the back of the ambulance with the patient.

During the trip to hospital, I attempted once more to gain IV access. She was fitting again. I still had no luck, even with the smallest needle. I had to administer more rectal diazepam. Despite this, she fitted twice more on the way to hospital.

When we arrived she had settled down. All her obs were settling and she went into Resus in a more stable condition...the diazepam had finally worked.

I thought I might be losing my touch - I had tried three times to get a cannula in and failed but when I went back into Resus twenty minutes later, she had two inserted - one in her neck and one in her ankle, that's how difficult her veins were.

I was sweating through my shirt after that job. I had to throw my stab vest off in the ambulance because I felt so uncomfortable - the thing doesn't allow your body to breathe and hot, sticky environments are the worst places for high-exertion jobs.

I went back to my base station to replenish my drugs and cool down a bit, then I was off to a police station to aid a woman who had fainted in the front office area. She had been waiting for news of her newly-arrested son and the stress had been too much for her. She had a few family members with her and they explained that the boy had never done anything wrong in his life and that this was the first time any member of the family had been in a police cell. I felt sorry for the patient and I stayed until she felt ‘normal’ again; she didn’t want to go to hospital.

Another ‘unconscious thru drink’ call sent me to Soho where a young man greeted me by vomiting in the direction of my boots as I approached him. His sober(ish) friends were apologetic and the man on the ground looked up and realised what was going on. He was embarrassed that an ambulance had been called – he had passed out momentarily but was fully recovered now, albeit too drunk to think straight. He could, however, walk fairly straight and with assistance from his gang of mates, he made his way home without the help of the NHS.

My next patient was also very drunk but he too realised that an ambulance was probably over the top. He was in a tube station (thankfully in the ticket hall) and his friends had called us because he had cut his thumb, seen the blood (a mere trickle) and promptly passed out. I have to tell you that I have more personal experience of men fainting than women – especially at the sight of blood. Even when I teach first aid, every now and then a male student will faint at the very mention of the stuff.

He went home with his buddies and all was well with my shift so far.

Then I got a call while driving around the West End for a 35 year-old male ‘fitting’. I couldn’t find him at first and the person who had made the call didn’t make themselves known, so I drove into the street and looked around for someone fitting. All I could see was a thin, drunken man sitting in a doorway eating a pizza. I had seen him earlier in the night and thought his behaviour was strange. He had one of those extreme twitches where he almost throws a punch. If anyone got close enough during one of those reactions, they were going to get clobbered...by accident of course.

So, there he was, sitting on the step, twitching away, minding his own business. That’s when I realised the ‘patient’ had to be him. I got out of the car, approached him and asked him if he had called us. He looked up, eventually, (the pizza was just too good) and shook his head. Then he mumbled incoherently. I nodded sagely, although I had no clue what he had said. It bought me time to retreat.

I called it in and as I was speaking on the radio a young girl approached the car with the ‘I have just dialled 999’ look on her face.

“Did you call an ambulance?” I asked

“Yes” she replied

“For someone who is fitting?”

“Yes”

“But he isn’t. He just twitches and he’s eating a pizza.”

“I know but I couldn’t get in.”

She had seen the man sitting on the step twitching away and had called us because she was too scared to pass him on her way into the building where she lived. I know she may have been nervous about him but come on, he was eating a pizza. How many random assaults have taken place during the act of eating a pizza?

I walked her to the step and around the man sitting on it. He took the hint after that and moved along, deeply offended that anyone would think the worst of him. I watched him go, twitching and eating.

Just around the corner my next patient stood on the pavement, waiting for me to rescue him. He was a 20 year-old complaining of ‘cold sweats, sore tonsils and pain in the neck’. Hmm. Just for good measure and a guaranteed emergency response, the word ‘chest pain’ had been added. Everybody knows how to play the system these days.

He was a tall, healthy looking young man and he had a viral infection - I would put money on it. I had to stop myself from getting too wound up about his stupidity. Personally, I would be highly embarrassed if an ambulance came for me just because I had a cold...and before anyone goes on about tonsillitis, I know all about it and I know it can become complicated but I also know a healthy person with a mild infection when I see one. I knew that if I sent him on his way by bus he would end up dramatising the whole thing and complaining to his local MP, so I took him to hospital myself. I literally taxied him to the A&E door. I’ll keep you posted on his condition if you want...

A 50 year-old diabetic man whose confusion and lack of co-ordination was causing a good citizen enough concern to dial 999 turned out to be a drunken diabetic who couldn’t walk or find his way home because he was full of alcohol. His BM was normal. The crew had no choice but to take him to a place of safety. He would have generated calls all night otherwise.

Later on in the night I was sent to a collapsed male who was lying in the street. This usually means he is too drunk to move any further. It always amazes me the distance people achieve before suddenly becoming too drunk to move another inch. They must get drunker the further away from the pub they get. Or they get weaker the closer to home they get.

Anyway, there he was, lying on the pavement area in front of a shop. I approached, shook, pinched and eventually got him to open his eyes and look at me. He spat something in Russian and I continued my vocal onslaught until he began to move. Using words like ‘police’ and ‘arrest’ normally provoke a reaction with East European drunks – they fear the police but they generally have zero respect for the ambulance service – they know we have no real power to do anything. Not that there’s a lot the police can do either but it’s always good to have something in the armoury.

Unfortunately he was stubborn and wouldn’t budge. My ploy was failing.

A few likely looking guys were hanging around shouting at him and generally provoking him while I tried to make him get up and go home. This was making the situation less stable for me and there was no ambulance on scene yet. I asked the trouble makers to leave but they hovered around behind me, so I kept myself alert.

Eventually I got the man to stand up as the ambulance arrived but he ignored the crew and they accepted his ignorance as a refusal. I found myself back where I was at the beginning – he lay down, refusing to move and I waited in the car until police arrived to move him along. If I drove off and left him there I would be called back again and again.

The shop owner obviously had enough of this and he stormed out of the premises and immediately began to provoke the man on the ground. This developed very quickly into a stand-up scuffle. I got out of the car and tried to calm them down but I was in the middle of two fairly large men and my voice wasn’t being heard at all. They were shouting at each other and the drunken Russian was gripping the shop owner's arm so tightly it was causing him a lot of pain. That didn’t stop him from threatening him to his face, however. It was clear that someone was going to get hit soon. I asked Control for urgent police assistance because the other men were starting to get involved and I could see it all blowing up. Luckily a passing police unit stopped and the officers quickly dragged the protagonists off each other. The other men disappeared around the corner.

The drunken man was sent on his way and he staggered unevenly down the road and into the dimly lit narrows of Covent Garden. He will stop somewhere, lay down and if someone sees him, another ambulance will be called. On and on it goes.

I had always thought that sooner or later one of those pedicabs that work around Central London is going to be involved in an accident. This was my first call to one but it wasn’t the ‘driver’ who was to blame, it was his passenger, a 40 year-old New Zealander. She was so drunk that she decided to skip the cab in the middle of the road – she threw herself off the back and into the path of traffic, smashing her head on the ground and giving herself an injury that bled a decent amount, not to mention a massive headache in the morning. At first she was compliant and friendly but when the crew arrived she became abusive and stormed off the ambulance, despite her just-as-drunk friends insisting that she behave herself. There is no behaving with alcohol.

Then she tried to get back on the ambulance and the crew were more than a little bemused. She had a scalp injury but there was no way of knowing if she had a more significant problem because she was so drunk. Head injuries and drink do not mix well.

A passing patrol of armed cops sorted the antipodean group out and sent them on their way. She had refused and was frankly too much to handle. Zero tolerance.

The wee small hours is when we get our ‘drunk on a bus’ type calls and sure enough, at about 5am, I was activated with an ambulance to an ‘unconscious male, ?cause’. I boarded the bus with my colleagues and there he was, in the usual place at the back. He was slumped on the back seats and there was a large stain of dried vomit next to him, soaked right into the fabric where some poor commuter will sit in the morning. If only you knew what went on at night, poor commuter.

We got him to open his eyes but he refused to budge. The police arrived and they soon had him on the move but when he got outside he stood with his hands behind his back, preparing to be cuffed. It was an almost instinctive move; he had obviously done this so many times that it had become second nature. At the sight of the police, assume the position. Just how guilty can a person become?

He wasn’t arrested of course, this is the UK and technically he hadn’t done anything illegal, so he was taken to hospital to sleep it off instead. Liberal values cost us a fortune.

Near the end of my shift I got a wakeup call. I met a 36 year-old Iranian man who had been tortured in his home country, simply for objecting to the regime. He had been thrown from a fifth floor window, breaking his legs, pelvis and arms only to be sent to prison and tortured further after a seven month stay in hospital. I can’t imagine the feelings he must have endured as he lay on his hospital bed, knowing his fate.

Now he needed an ambulance for a headache. He calls us a lot apparently; the crew knew him from previous times. He is so depressed and scared that the smallest thing is now too much for him to cope with and he needs help and reassurance. I felt terribly sorry for him. Nothing brings you back to Earth quicker than the sight of a broken man.

Just as I made my way back at the end of my shift I was asked to ‘investigate’ an abandoned call. I arrived at a posh block of flats and the security staff told me that they thought they knew who was making the calls (I was the second ambulance in an hour) but couldn’t prove it. I helped them out by asking Control to confirm the source telephone number. An ambulance arrived behind me and I told them it was a false alarm and explained what the security man had said. The crew agreed to take the job and let me get home, which was very nice of them.

Now I was tired; I had dealt with a genuine emergency and worked my way through the usual run of drunken calls to find myself watching the inside of my eyelids close on another night shift. I’m on earlies next and the sun is coming back.

Be safe.

Melting snowballs

Nine emergency calls and one running call. One assisted only, one refused and one conveyed (the running call). Seven went to hospital by ambulance.

The shift kicked off with a call to an unconscious male. The call had come from someone who could see the man lying on the road but would not go out to see if he was okay. We get a lot of calls like that.

When I arrived I found him lying in a car park space. He was sleeping; just another homeless person trying to get a kip but unable to because everyone who sees him thinks he's dead...or worse, undesirable.

I woke the poor bloke up and asked him to find another bed. I felt sorry for him because he looked so tired. He is a Big Issue seller (I saw his ID) and it must be hard work to stand around all day trying to sell a copy or two to make ends meet. Most of these people are dead on their feet by evening time. Next time you see someone selling the Big Issue, buy one. Then leave him/her alone when you see him/her sleeping in a doorway (or parking space).

As I left the scene, I saw a woman's head pop back inside a window just above me. She had been watching all the time and had probably been the person who rang in. Show yourself.

A 28 year-old who felt faint at an underground station next. The crew had arrived at the same time as I did so I wasn't really needed but I went down for a nosey anyway. It was extremely hot down there.

She was okay, just weak. The poor crew had to carry her all the way up to the top because she claimed she couldn't walk. I have to say I think she was being a bit unfair on those two guys. She could have walked if she'd tried. Oh and I did offer to help.

Another tube station call - this one immediately after the first and I was only a few metres away from it when I got it (makes Orcon look good) - on scene within one minute :-)

This lady was drunk. She was so drunk in fact that no amount of induced pain would make her react. It wasn't until her gag reflex was tested with an oropharyngeal airway that she responded...and even that took some time. Getting so drunk you lose your gag reflex is a very stupid thing to do.

Her Portuguese friend was translating from Italian, spoken by the station staff member (he couldn't speak Portuguese but the girl spoke Italian). Oh, it’s all too confusing these days.

Anyway, we managed to get her to stand up and walk with support until we got her to the last escalator where, at the very top, she decided to pass out again. We almost fell into a heap on the floor. Her landing was clumsy and undignified and she was told in no uncertain terms to behave and keep her eyes open. Alcohol makes you selfish - she didn't care about the possible injuries she could have caused if that fall had happened half way up the escalator. Obrigado indeed.

As I was returning to my standby point I was sent back to Regent Street, where I had been earlier, to deal with a RTC involving a motorcyclist and a taxi. As I pulled up on scene I had a bit of a flashback. This is almost exactly where the hit and run had taken place earlier this year and more ironically the same FRU colleague was attending to the patient who was lying on the ground, his bike smashed and leaking petrol and oil on the road.

There was a group of noisy and boisterous individuals, mainly kids, milling around my colleague as he tried to render aid to the injured man. I shooed them away but they didn’t go far and were all standing in the middle of this busy London Street. The traffic had halted on one side but not the other. This was a dangerous scene and the crowd were a little hostile - a couple of them were arguing viciously with each other. One young lad was taking photographs as we tried to deal with the patient. I moved him away and he got abusive - he must have been 14 years old. It was all getting stupid.

I called for the police and the Fire Service (we would need to make the petrol and oil safe) and I could hear LAS sirens approaching, so I knew the ambulance was on its way too.

Eventually we had control of the scene and the police turned up to deal with trouble-makers and the traffic. The injured man had slammed into a taxi and was now complaining of pain in his leg. He didn't seem to have any life-threatening injuries but he was collared, immobilised and given pain relief nevertheless. He had hit the taxi at speed, with no braking so there was the possibility of hidden injuries which could manifest later on.

As I played my small part in this incident, I noticed the taxi driver (whose cab had been hit by the motorcyclist) standing at a distance, watching us. He had that familiar worried frown on his face; the one that portrays personal guilt (even though, from the story, it sounds like it wasn’t his fault at all). I asked him to talk to the police about what had happened but I realise now that I didn’t ask him if he was okay. I felt a bit guilty about that myself.

I spoke to my colleague later on about the Regent Street hit and run. I told him that I had been trying to get information about the young woman’s fate after we had rushed her to hospital that horrible morning a few months ago. I was surprised when he told me that he had followed it up directly and found out that the girl had survived. Not only that but she went home within five weeks of the incident. Considering the extent of her facial injuries that day, I was very happy to hear it.

I made my way back to the Wild West End and cut through Trafalgar Square to look in on the many people who choose to sleep on the grassy areas at night. I was just about to set off when one of the roller-bladers who frequent the Square approached the car. He asked me to look at one of his friends who had fallen badly and hurt her wrist. I went over to a tall (well her blades made her look tall) young Russian girl who was nursing her left arm. She was in some discomfort and I asked her what had happened. She told me she had fallen backward awkwardly and now she had a lot of pain in her arm.

Her wrist was swollen and very tender to touch. It looked a little deformed over the ulna and I suggested that she may have broken it but that I would take her to hospital to get it checked. She was very upset and began to cry. Although I sympathised, I found it ironic that she felt so emotional about it – she must have known the risks she took every time she put on her wheeled boots.

I called it in and took her and a friend to A&E as promised.

Somewhere in the next few hours I got a break and a well deserved cup of coffee...

Then I was sent to the north for a collapsed 35 year-old male. A gentleman with a private ambulance had been flagged down to help the man, who had been seen lying on the ground by several passers-by. He was in the recovery position and some obs were being taken.

The man looked agitated. He was conscious but he looked as if he had a neuro-physical problem – something that was causing myoclonus; possibly MS. He couldn’t communicate clearly either, his speech was badly slurred but he hadn’t suffered a stroke – he confirmed that he was normally like this. Although he gave me his date of birth, he wouldn’t tell me anything about what had happened and why he was on the pavement.

There were two police officers on scene with us and they had even less success getting information but he had said something earlier about being attacked and kicked around the head and body. He kept referring to his ribcage and guarded it with his hand. I had a look but could see nothing significant – no marks, no bruising. It was a strange call.

The ambulance arrived after twenty minutes and the crew took the man inside for further checks. All his obs were normal and he didn’t appear to have any injuries. He still wouldn’t tell anyone what had happened and we only got his name and address through an ID check with the police. I left the crew with that little mystery and headed back to my own area.

Calls to police station cells are never any fun. I found myself inside one of these small, smelly places in the early hours, asking a man to confirm whether or not he had swallowed a number of ‘wraps’ containing cocaine. He had told the police earlier that he had removed them from his storage place (his anus) and swallowed them in his cell. Considering how long it had been since he had allegedly done this, I found it incredible that he was still breathing, never mind making any sense when he spoke. He was a very angry man and refused all help from me (and my colleagues, who arrived as I stood there listening to him). We got his recent life story and the police got loads of abuse. A fairly balanced call, I thought.

When I went to deal with a 35 year-old male with DIB, I got a surprise. I opened the callbox in which the man stood waiting for me and saw that it was a frequent flyer that I’d not laid eyes on for some months now. He is an annoying and persistent problem. He claims chest pain when he has none and is verbally abusive if challenged about his behaviour. Most of the hospitals know him and few tolerate him. I handed him over to the crew as soon as they arrived. My colleague referred to him (as we all do) by one of his names – he uses up to three different names in an attempt to disguise who he is.

My next call was to a hostel in south London for a 23 year-old female who had overdosed on a heroin and cocaine mix (known as a snowball). She had paid £35 for this single hit and I was about to ruin her day by reversing it with one injection of Naloxone. She was too groggy and her breathing was depressed, so she needed it. We took her to hospital and she stormed out with her boyfriend as soon as she ‘recovered’. Not a happy bunny.

Finally, a 34 year-old with chest pain who walked to the car when I arrived. I got him to sit down on a bench while he explained that he had gastric problems and that the pain felt similar to past episodes. He had no cardiac problems and was usually healthy; his obs said the same. When the ambulance arrived, he was swiftly taken to hospital – you can never be too sure.

I was cancelled no fewer than ten times tonight as I set off on calls. The new version of FRED that has been rolled out is even more frustrating than the old one. If it was a real person, he’d be taken aside and beaten up by now. Some shifts are all about rapid response and very little to do with pre-hospital care. I did nothing important tonight – I didn’t save, or contribute to the saving of a life (unless you count the overdose girl) and I used few skills. It was a routine night and my ‘rapid response’ technique has sharpened to a point where I am highly tuned to one probable outcome for any call. Cancellation.

Be safe.

Hoax

Seven emergencies; two hoax calls, one assisted only and one standby. The rest went by ambulance.

Sheila's Wheels called me. I thought at first they had seen the blog and were about to complain but it was just to see if I needed anything after my accident. The 'Sheila' was actually very nice and kept asking if I had been hurt. She told me not to hesitate if I developed any neck pain or other problems. I wonder if there's a commission system for such claims. I certainly wouldn't lie about an injury because, at the very least, it would affect the young lady's insurance premium when she renews. I'm sure she is in enough trouble already now that she has made a claim.

It also occurred to me how easy it was to fall into the 'where's there's a blame, there's a claim' culture. So many people are getting rich at the expense of a few unfortunates. Some of those who do make a claim are no doubt genuine cases but how many have been enticed to say the word 'whiplash' at the behest of an insurance company? I'd only have to lie about neck pain and I could pay off some of my debts. I won't though because it's not me and never will be.

I didn't start my duties 'til just after 9pm. More than two hours were spent moving from one car to another because of confusion about who was assigned to what vehicle and where the keys were to the one I was given. I swapped a lot of equipment from one car to another, then another only to find out that the keys for the first vehicle had turned up. So, I moved everything back again. I was dehydrated at the end of it all. Who needs the gym?

First call of the shift and it's a hoax. Someone has been making calls every night over the past week from the same call boxes. He simply hangs up. On the single occasion that he called the police, he ranted abuse at them.

When the next call came in I was asked to scoot to the location and try and catch him in the act. Then the police could be called to arrest him. When I got there he was gone (having a bright yellow car isn't always an advantage). He was close by though because the call had only just been made, so I stuck around.

A gang of police officers came up to the car and asked if I had seen him yet. They had all been sent to track this guy down (there were six of them). While I was describing how I had just missed him a familiar shape walked into view. It was someone I have had a lot of trouble with in the past - he has attacked me with a bottle, threatened me and generally been unpleasant. I'll call him MD and I'm sure that any LAS bod from central who are reading this will know who exactly I'm describing.

The police formed a little circle around him and asked him about the calls. He denied everything of course but he is a practised liar. He has been calling us out for imaginary problems (and some that he has staged for impact) for years. I have known him for two years and I remember how gullible I was when I first came across him. I can say without much fear of reprisal that he is a time waster of the highest order. He is also dangerous.

This man contributes nothing to society. He costs the tax payer tens of thousands of pounds every year with his antics and he is known by almost every crew and almost every cop in this part of London. There seems to be nothing we can do about him. An ASBO has been suggested and it may well be that he has had one but it won't stop him. I think he wants to go back to prison.

Anyway, the police couldn't prove he was the hoax caller, so they had to let him go. As soon as they were gone, he made threatening gestures at me while I sat in the car doing my paperwork. I moved along to somewhere else. It was the wise thing to do.

It felt like a Friday night out there; so many drunken people spilling out of bars and clubs in the middle of the week. My next two calls were for 'collapsed' males, one of whom was so out of it he could barely see. His friends became aggressive when I tried to help. He had collapsed outside a tube station and his mates, who were French, started in on me. I was threatened in French by a tall, skinny guy and he was getting kinda close, so I told him to back off and said I could understand everything he had said to me. I did, in fact.

Meanwhile, his other mate (an Israeli) would not stop talking at me and prodding me for no reason. Enough was enough; I asked for the police. When they arrived they dragged every one of the drunk man's friends off him and let me get close enough to start my obs. The crew had arrived by now and it was decided just to get him into the ambulance where it was safer. I left them to it.

Around the corner another male had collapsed. A 40 year-old man in a suit and a decent pair of shoes lay motionless on the ground. Two doormen from Stringfellows were watching him and told me he had just fallen down and stopped moving. I was glad to have them behind me - they were big guys and I knew that, at the first sign of trouble, they would wade in.

The man was easily roused and I explained that he was lying on the pavement.

"Do you need an ambulance?" I asked

"Yes" he said

Why?" I asked

"You just told me that you have no medical problems and that you are just drunk"

Then he mumbled stuff I couldn't decipher because I haven't learned to speak drunk yet.

The crew arrived (they had parked down the road a little because they thought this was a no-trace...so did I at first) and I let them finish what I had started. I had him sitting up with his eyes open and they got him to his feet and on the way to a taxi. He'll probably fall down or be found 'unconscious' on a bus in someone else's territory.

Meanwhile, the hoaxer had been making a few more calls and the police had arrested someone in the callbox where one or two of the calls had originated. It's unlikely it was the real culprit because I believe it was MD and no other. Nobody hates us more than he does.

After my break I was asked to investigate a call which had originated from a callbox in the same area that the hoaxer was haunting. This 999 plea was for a 35 year-old male who had been stabbed in the chest. There had been a lot of stabbings all over London tonight, including at least one fatality but because we had been running around in circles for this caller, it was up to me to decide whether or not it was genuine.

Control advised me to "be careful". I put the eyes into the back of my head.

On scene and a few telephone boxes later but no sign of a stabbing victim. Usually there is a degree of panic - people shouting and screaming, that sort of thing but nothing seemed out of the ordinary. I reported back to Control and told them I would do a quick area search but, in the meantime, perhaps it would be best to cancel the ambulance (someone may get stabbed for real somewhere else). I had just completed that call when a small group of police officers (they were all running about in gangs tonight) approached the car and told me that a man had been stabbed and was in another street. Uh oh. Then the man appeared from the shadows. He had a bloodied shirt wrapped around his chest.

I advised Control and the ambulance was updated. The crew arrived as I was calming the man down. He had a single stab wound to his chest; it had penetrated but didn't look too deep. He had no breathing problems and he seemed in good shape, considering.

He was taken to the ambulance for a thorough check and then transported to hospital. Allegedly, he had been set upon by three black men wearing hoodies. They had dragged him into an alley and demanded his ipod. He had refused, so one of them pulled up his shirt and deliberately stabbed him in the chest with a screwdriver (or similar instrument). It sounded like a cold-bloodied and callous attack, more to do with the rite of passage earned through stabbing someone (anyone) than through material gain. This is far more common than you'd think.

He will survive because the assailant was clumsy. If the wound had gone deeper, it would have penetrated his lung and collapsed it. His life would then be in danger. Surviving the assault was more luck than chance.

I rolled down toward Leicester Square to do my paperwork and a cordon had appeared. There were police vehicles building up in the area and I thought it might have something to do with the stabbing. Then I thought it was all a bit too much for that. My DSO turned up and he explained that a suspicious package had been found.

The cordon quickly began to fill up; 5 Fire engines, 2 HART vehicles, myself and the DSO and at least a dozen police vehicles, not including the dog handlers and bomb disposal unit. It was 4.30am and the whole area around Leicester Square was closed off. It was eerily quiet and for a while there was a little sea of blue lights.

I waited on standby with the DSO and my colleagues from the HART teams until the all-clear was given. The culprit had been caught and arrested and the 'bomb' turned out to be nothing of importance (a bag with some bottles of liquid I believe).

I got a real sense of just how seriously these suspect devices are taken. It wouldn't take much to bring Central London to a halt without even planting a real device.

Finally, I get back to my base station only to be pulled out with ten minutes to go. Luckily, it’s a job just around the corner, ‘60 year-old male fallen from bike, head injury’. Well, he had grazes to his face after he went over the handlebars of his bike. He was lying on the ground with a couple of people around him to help out. One man in particular seemed a little over zealous and before I knew what was going on he had got someone to ‘phone for the police. The police weren’t interested – it was a simple accident, so I took the ‘phone and told them all was well...

I cleaned the man up, listened to how he came to land on the ground so hard (his front brakes seized) and offered him up to the ambulance crew when they arrived. It was going home time and my eyes were stinging with tiredness. It all starts again tonight...

Be safe.