Sunday, 2 November 2008

Cold and wet

Day shift: Six calls; one declined after treatment; the others by ambulance.

Stats: 1 eTOH; 2 EP Fit; 1 RTC with leg injury; 1 Near drowning; 1 DIB.

A bag was found in our station bin this morning. It was discovered by the rubbish men (refuse technicians or whatever the PC term is). Inside was some clothing and an ID for a Clinical Pharmacologist from UCL. How it got there is a mystery but only two theories for its presence hold water as far as I’m concerned. The young man was either robbed and it was dumped there, or he got so drunk the night before that it was abandoned. Cynical of me I know but my world doesn’t offer much else in the way of explanation. Needless to say we will be trying to reunite the bag with its owner.

And so a Saturday morning, freezing with the start of true winter, opens with a call to a 70 year-old man who has collapsed outside his hostel. I know this place well and none of us particularly enjoy coming here. The old man was drunk and had just returned from a morning shopping trip in which he purchased breakfast – a bottle of cider. He is, of course, an alcoholic and somehow he’d lost his balance and fallen, giving himself a minor head injury. His trousers were half way down his legs, revealing his naked behind as I approached – it was his introduction to me.

The man has no medical problems but it’s impossible to completely rule out a non-alcohol related reason for a fall like this, especially as he obviously made it to the shop and most of the way back without toppling. Could it be that the very anticipation of a drink made him walk too fast for his aged legs? He had to go to hospital regardless of my theories and suppositions because his habitual drunken state would mask any problem related to his head injury or a medical cause for it.

His undignified transfer (trousers around his ankles) to the ambulance from the street was witnessed by the hostel staff and everyone else who just happened to have business in the area at that time in the morning. He was helpless despite the help offered by the crew. Beyond help is probably more accurate.

My first of two EP fits was a 45 year-old man who collapsed in a shop. His groceries were all over the floor and he was recovering when I arrived, although he was still a bit confused. He confirmed his condition and was taken to the ambulance and off to hospital. I managed to gather his shopping together and the kind staff allowed me to take it to the patient even though he hadn’t yet paid for it, so I felt like a shoplifter as I left.

My second fit was a 38 year-old man who fell down a few stairs at work in front of his colleagues. He was unconscious when I got to him and there was a little blood coming from his mouth (this is common). He regained consciousness over the next few minutes with oxygen and, although he remained vague and restless for a while longer, he began to recover to the point where he understood what was going on. He told me he was prone to have more than one fit at a time and so I put a line in just in case. There’s no point in getting caught out. The crew arrived soon after and he was taken away. His colleagues looked very relieved. I think they thought the worst. Until I could establish that he was epileptic, which none of them knew for sure, I too, was concerned.

A minor RTC in Central London next. The relentless cold rain was bound to throw up more than a few of these today. A young woman fell off her moped when the vehicle lost traction on a slippery drain as she rode along the busy road. She had leg pain and the police and a passing ambulance crew were on scene when I got there, so she was already being taken care of. I helped her up and into the ambulance for further checks. The low speed and low height of her fall meant she probably had no more than a bruised knee. She was lucky not to have fallen in front of a bus.

This is the season for suicide and my next call, to a male who’d jumped from Blackfriars Bridge, had been fished out of the river by the RNLI. My MRU buddy, the one I seem to always get tough jobs with, told me that he’d been taken further up river to the lifeboat station because he was dead. Normally, we are asked for an opinion first, so that seemed very strange. Nevertheless, off we went in search of our supposedly dead patient.

When I arrived at the station, my colleague was already inside and I made my way down the slippery jetty and into the small floating cabin that serves as a first aid room for the RNLI and river police. I could see a man lying on his back on the bed and I noticed that his chest was rising. So, not dead then.

A lifeboat man had dragged the suicidal man from the river after he was spotted floating face down under the bridge. He wasn’t breathing and his rescuer, a man called Paul Ward, began resuscitating him. By the time he’d reached the station, his charge was breathing again and conscious. So all our efforts were now concentrated on keeping him that way. He was re-heated (his temperature had plummeted and couldn’t be read on our thermometers) with blankets and warmed IV fluids. I’d already cut away all of his wet clothing to accommodate the process and now we waited for his body temperature to rise and for his vital signs to normalise.

Meanwhile, two officers and an ambulance arrived and a plan was prepared for his removal. The deck and walkway of the lifeboat station is very hazardous when wet and I’ve tackled it more than once with patients (dead and alive). The risk of slipping is high, so we needed all hands to remove our patient to the safety of the ambulance.

It took almost half an hour for the man’s body heat to recover to normal; two bags of warm fluid and loads of blankets did the trick. His vital signs were good and he was making sense, although his ambition to die had been thwarted, it seemed he regretted trying. Apparently he had mental health issues and woman problems.

I’ve named Paul with his permission because these men and women don’t get enough recognition for the job they do. The majority of recoveries from the river will be dead and there’s never any thanks for that I guess but when they do save a life, it seems to be seen as part of their function and that’s it. I shook the man’s hand, thanked him myself and introduced him properly to the patient, informing him that he now knew the person who’d saved his life. I don’t know if he’ll ever visit Paul and his colleagues to say thanks personally but at least the job was done in part and by proxy.

I ended the shift with a call to an underground station for a 58 year-old man with DIB. I arrived to find him wheezing dramatically but still able to talk to me in full sentences. His wife and friends were with him and he told me he had a history of MI. He had no chest pain and this event had been triggered by a skateboarding teen who’d whipped past him on the platform, giving him a fright. He may have been bumped by the wheeled maniac and it looked to me like he was just winded. He requested (and got) oxygen and within two minutes was fully recovered and declining further aid.

I cancelled the ambulance and walked down the platform after bidding them farewell and an enjoyable evening. A female member of the underground staff squared up to the male staff member who’d led me to the patient and demanded to know why there was such confusion over the location given to me when I arrived. I hadn’t noticed any problems but I left them arguing at full volume as I made my way back to fresh air.

‘I told you where to send him!’

‘No you didn’t’

‘Oh, yes I did!’

‘No you didn’t’

Christmas has come early...

Be safe.

1 comment:

Feathers said...

Do not know what to say, just wanted to comment on the guy called Paul who helped to save the man's life, hopefully in time he will thank him. Very moving.

We have a bridge near us, famous for suicides, straight onto a road, hundreds went over during the years. Local business man/firm paid for steel erecting fencing all the way along,(council did not do anything about it) big bridge as well, made so people would find it impossible to climb over, after the suicides got so stopped it all. Only the odd one now as it is difficult to climb over. At his height could be 2/3 a week more, people did not survive the fall.