Day shift: Seven calls; two assisted-only; the rest went by ambulance.
Stats: 1 Head Injury; 2 Chest pain; 1 EP fit; 1 Anaphylaxis; 1 RTC with minor injury; 1 Electric shock.
I was five minutes ahead of the ambulance when I arrived at my first call of the morning, a 55 year-old man who was unconscious in his hostel bedroom. The staff was waiting and the bed had been lifted up against the wall ‘for his own safety’, bizarrely. Maybe they’ve had a rash of incidents in which beds were used as weapons.
The large, naked man was in the recovery position and not quite unconscious because every time I tried to carry out my obs, he’d move and attempt to stand up, only to fall back into a slump again. His breathing was noisy and he was bleeding from a mouth injury, indicative of a seizure, although the staff stated he wasn’t epileptic and they hadn’t seen him fit. Nevertheless, he was an alcoholic, so fitting would have become part of his medical history sooner or later (or now in fact).
He also had a head injury and that concerned me because, fit or not, the cranial defect would contribute to his behaviour and possibly exacerbate his problem. When the crew arrived I was struggling to keep control of him, even with the help of a large member of the hostel staff. Moving him out of the small room in the chair was going to be highly risky and the thought crossed my mind that it might be easier (and safer) to have him put to sleep by a Delta Alpha. It’s been done before and I’m sure it’ll be done again. He was combative and moved spontaneously, so he would unbalance us on the narrow stairs we had to manoeuvre him down. Oh, and when I say put to sleep I don’t been permanently to sleep…
While we mulled over a plan for his removal to hospital he became less irritated and seemed to be recovering a little, so things were going to be easier for us...well, for the crew – they were the ones who would carry him. We used this window of opportunity and got him out of the building. He was still an awkward, dangerous cargo to take down those stairs but my colleagues did a great job and soon enough he was breathing fresh air – as were we all.
Pharmacists, surprisingly, will not always give drugs in an emergency. My next call to a chemist on Oxford Street was for a 61 year-old man with a history of heart bypass who was complaining of chest pain. The pharmacist was with him and she made a couple of comments to me about how long they’d been waiting for an ambulance. ‘Twenty minutes we’ve been here’ she said, repeatedly. I’d only just received this call (and I try not to stop and do a bit of shopping during my emergency calls as I feel this would be unprofessional and make me rush to buy something on impulse without thinking the cost/quality/value principles through), so I explained that I had only taken five minutes to get to her.
I ventured to ask her if she’d given GTN or aspirin (the patient had forgotten to bring his GTN spray) and she told me she hadn’t. There really is no reason for her not to have done so but I know that a lot of pharmacists are not keen to get involved in case they get sued or struck off. Amendments in the law allow for some drugs, including GTN and Aspirin to be given in emergencies, even by a suitably trained member of the public if the patient agrees and needs it in an emergency.
The crew took the man away (I gave the necessary drugs) and the pharmacist went about her business – I don’t think she was impressed with us.
A 21 year-old epileptic man who had a fit at University was recovering when I arrived, so he declined to go to hospital. Fair enough.
My next chest pain call was for a 48 year-old man who was led from the bus by one of the inspectors at the terminus. Chest pain patients shouldn’t be walked at all if possible and I found the fact that I’d been called to attend the man on a bus, only to find him sitting on a park bench, more than a little disturbing. I asked why he’d been moved and the inspector (who is first aid qualified) told me that he thought it would be good for him to ‘get some air’. Who is teaching these people? I’ve even heard of an organisation that is telling qualified first aiders they cannot give an Epipen to an anaphylactic. This is rubbish. Anyone can give an Epipen in an emergency – if you don’t, someone will die. Maybe these instructors should read the HSE guidelines before they train first aiders.
Anyway, this patient had also forgotten his GTN, so he needed to borrow some of mine. Then he was taken away by the crew and I decided to move away from the terminus to do my paperwork. I was facing the wrong way on a bus lane with nowhere to go but forward to the lights – I couldn’t turn around, so I put my lights on and slowly made my way and was immediately obstructed by a bus coming in to the terminus. I hoped he would let me pass but he didn’t. For some reason, he took umbrage to the fact that I was driving the wrong way so he just sat in front of me and forced me to veer around to his right, further obscuring my vision of the road and making things a lot riskier for me and pedestrians. I have no idea why we get such little respect. If I’d been driving a police car I can almost guarantee his attitude would have been different. For a few seconds it looked like a stand-off between two gunfighters – a large red one and a small, yellow (and therefore less appealing to viewers) one.
An Austrian language student (learning English incidentally) ate a peanut and had a massive allergic reaction. The 12 year-old knew she was anaphylactic but didn’t know she’d eaten the nut. She didn’t have her Epipen and so I gave her an injection of adrenaline as soon as I saw her puffed up face, bulging eyes and scared face. Her wheezy breathing was caused by a ‘fat tongue’ and ongoing occlusion of the pharynx – a recipe for death if not dealt with quickly. A speedy decision to administer adrenaline increases the efficacy of the drug in these circumstances.
By the time the crew took her into the ambulance, she was feeling and looking a lot healthier.
The crew and an off-duty police officer were on scene and dealing with a 24 year-old woman who’d been hit by a motorcycle. She had a minor cut to the chin but was a bit shaken up, as you can imagine. I stuck around to se if I could be of any use and found that I couldn’t, so I left them to it.
If you aren’t an electrician, don’t try to mend live electrical fixtures – you are likely to get a shock. Like the 22 year-old smiley-faced amateur electrician who wanted fix the light switch at work. The live wire gave him a jolt and he was left with a flash burn (not a penetrating burn) on his palm. After an hour, he developed a tachycardia and set off to the nearest walk-in centre for advice. We were called and I found him sitting up, happy as Larry (whoever he is), with a healthy ECG and a settling heart rate. I thought a 12 lead wouldn’t go amiss and advised him to go with the crew anyway. I also advised him not to play with stuff he didn’t understand – wise words from someone who used to install electrical sockets and connect them with a live circuit. Wise words from someone who’d had a few shocks himself. Still, isn’t teaching all about learning in the first place?