Friday, 14 November 2008

System abuse

Night shift: Eight calls; one assisted-only; seven by ambulance.

Stats: 1 RTC with leg injury; 1 RTC with head injury; 1 Chest pain; 2 eTOH; 2 EP fit; 1 Fall with head injury.

It’s raining and it’s dark and the RTC’s start coming in thick and fast; forty across London within the first hour of my shift. I got two of them.

A 6 year-old Arabic boy is hit at low speed by a bus as it pulls in at a stop and a fight breaks out between the father and the bus driver. I get updated on the way that there is a problem and that I should be cautious when I approach but the police are on scene when I arrive and a CRU colleague is attending to the little boy’s cuts and bruises (to his leg). I walk up to him and ask what I can do to help and behind me a little war breaks out.

A relative (probably the father) is punching and pushing the bus driver. A lot of shouting is going on and I try to calm them down. The police are busily cordoning off the area and one of the officers is helping my colleague so I decide the role reversal needs to be checked – I ask the officer to go and contain the situation because it threatens to spill onto us all. Then I take his place.

The child isn’t seriously hurt but the cut leg is obviously upsetting for him and the family’s aggressive reaction to the accident is heightening his emotions. None of us are helped by the fact that no English is being spoken and attempts to communicate calm and reason are being thwarted by a language barrier.

When the crew arrive the violence has subsided and been replaced by a threatening atmosphere – like an evening on the North Korean border. We scoop the child up and get him into the ambulance. HEMS are on scene, even though they were cancelled but they decide they have nothing to contribute to such a minor injury. The ambulance clears the scene and I hail a cab for the rest of the large family so that they can go to hospital with him. Then I clear off too.

The next RTC, as if on cue, involved a car and a cyclist – not a happy combination. This time I arrive to find another kind of confusion. A colleague is rendering aid to the cyclist, who is standing up and seems confused and bewildered. My colleague tells me that he is single (has no crew mate), despite the fact that an ambulance is on scene. So, he’s not actually in commission for this call; he just happened to be passing by on his way back from re-fuelling the vehicle.

I watch the behaviour of the woman who’s been hit and decide she has a head injury. I can’t see it – all she has is a small bruise on her cheek – but she is not behaving normally and I’ve seen a lot of this brain-insult associated irrationality, known simply as cerebral irritability.

HEMS arrive just as I escort the young woman (probably in her early twenties) to the ambulance. The doctors are surprised to see me again and a short exchange takes place in which the notion of following each other around all night becomes plausible. They are in a gang of four tonight; two doctors, a paramedic and an observer. A gaggle of HEMS.

The young woman’s behaviour becomes more and more unstable as the team attempt to calm her. She refuses to get into the ambulance, so spends a lot of time sitting on the step with a doctor chatting to her and trying to treat her. She’s resisting his attempts to cannulate her. ‘I just want to go home’, she cries as the needle enters her arm. She’s clearly scared but she’s also confused and doesn’t actually know what’s happened to her.

There is a contra-flow cycle lane on this busy road and it’s one of the most ludicrously dangerous ideas I’ve ever seen. Drivers must look both ways when turning left or right at the junction...not only on the road but as they cross the cycle lane. It’s an unnatural and difficult to remember action – it goes against the brain’s driver-training functions and it’s clear the thing was dreamed up by a non-car driver.

The cyclist was hit as the car drove across the lane and into the side street. He probably wasn’t looking both ways or his mind was confused by the need to do so as the rain fell and the light faded. Driving conditions are bad enough tonight without the added danger of a moronic contra-system. She was probably hit hard because the car hadn’t braked...or she had simply slammed into the side of him and gone over the bonnet. Whatever had taken place, her head had hit the ground and her helmet had flown off. At the very least she is now concussed. At most she is bleeding inside that little dome of hers.

Once she is calmed and on the trolley bed (she fought a bit and struggled against the oxygen mask) the doctors decide she needs to be managed properly, so they are going to put her to sleep. Another ambulance, with a crew, are on scene now and there are enough of us to help with this. More cops and brought in and the entire road is closed off because we have to do this out in the street – our new vehicles don’t allow for the trolley bed to move to the middle of the floor so that we can get all the way around it.

I rope in a few volunteers to act as umbrella holders because the rain is now falling quite hard. We have no umbrella but we have a sheet and it can be stretched overhead as the work goes on underneath it.

The girl is brought out and she is tearful but calm. All the equipment for RSI has been laid out on the road and one of the crew has been assigned the job of applying cricoid pressure as the tube goes into her throat. She knows nothing about this and she lies there, looking up at the sheet overhead, wondering what’s going on. ‘What are you going to do to me?’ she asks the doctor. ‘We’re going to get you to hospital’, he calmly replies.

A few seconds later and she’s asleep... a few seconds more and she’s paralysed and unable to breathe for herself. The tube goes in and the paramedic starts to ‘bag’ her. Now her life is wholly dependent on the skill of one person at her head all the way to hospital. I join a cacophonous convoy as it speeds to where she urgently needs to be.

I came across the ‘chest pain’ man that I’d dealt with at the train station the day before. I was called to a 55 year-old with chest pain at a bus stop and there he was, with a few concerned people around who’d called an ambulance because he’d sat down, then slumped as if in pain but without any of the real signs you see with such distress.

He recognised me and saw my expression of doubt when I approached. Remember, this guy told me he suffers from angina but he didn’t know how to take the spray. He wasn’t carrying it as he should the day before and here he was once again, supposedly in pain and with no spray. I’m to believe he went to hospital the day before, got ‘treated’, went home and then repeated his actions all over again the next day? Sorry but at the risk of sounding completely unprofessional and uncaring, I believe I am watching the development of a new frequent-flyer; a man with nothing physically wrong and who will be calling ambulances (or having them called on his behalf) because he wants to go anywhere else but home.

Of course I regret that people should be pushed to such desperate actions and I completely understand it when a homeless person is trying his/her luck but this guy is going to cost someone their life when he uses up a perfectly good FRU, ambulance and crew for nothing.

A 30 year-old man who was ‘not alert’ (often code for ‘drunk’) was being attended to by the crew when I arrived and he couldn’t have been more alert if you loaded him with caffeine. ‘I’m okay!’ he shouted at us before storming off. Some people just don’t care why we are there.

Three young ladies on their way out stopped to help a 30 year-old man that had been fitting in the street. They called an ambulance because he had been going for too long and they were worried but when I arrived (my break was interrupted for the call) he was up and walking about, although he wasn’t quite 100% recovered yet. The ambulance was right behind me and I thanked the girls for helping as he was taken on board. They smiled and continued their journey to a night of fun and alcohol (no doubt).

Another 30 year-old, this time a female, was collapsed and semi-conscious on the ground outside a night club in the West End. Her friends were with her and two of them were crying and getting completely wound up about the state of their mate. The girl on the ground was drunk; she’d downed a bottle of champagne or two – well, she’d been drinking the stuff since 4pm and it was now 3am, so she’d had a few. She also had a heart condition (SVT), so she had to be given an ECG for good measure when the ‘booze bus’ arrived to pick her up.

During my obs a street-dweller passed by and I accidentally bumped into him because he was walking too close to the area in which I was working. ‘Don’t push me!’ he yelled, raising his fist in a threatening manner. I didn’t even bother to apologise because I had other things to do but he insisted on continuing his little rant until one of the patient’s friends – one of the crying girls – recovered enough to tell him to ‘f**k off’. Nice exchange, I thought.

As the patient was being lifted onto the trolley bed I saw a bystander attempt to take a photograph of her on his mobile phone. I stepped in front of the lens and told him what I thought of him. The doorman took the camera from him and deleted the pics he’d just taken. This young girl, regardless of her state, was half-naked and helpless. She was still entitled to her dignity and, even though I deplore stupid drunkenness, I find it completely unacceptable for anyone to take photographs of an individual who can’t say no to it. Sometimes a drunken person’s mates will take pictures but for anyone else to do it, regardless of who they are...well it’s thoughtless.

Our elderly fallers are still ranked quite low on the emergency response scale and I went to a 74 year-old lady who’d fallen at her care home, bumped her head badly then lay on the floor for almost an hour waiting for me to get there. She had to crawl to the emergency cord to alert the staff and by the patient’s account they took their time getting to her. Then I came along 20 minutes after they’d called an ambulance because, on a weekend night, her needs were categorised below those of an 18 year-old drunken idiot.

The poor woman’s head was very swollen and soft at the back but she was in good spirits and chatted to me until the ambulance arrived and took her to hospital.

I only had to assist on the last call of the shift when a 19 year-old girl fitted in a shop. Her friend was on scene and so was the crew, so I had little to do. Off she went to hospital and off I went...home.

Be safe.


BBB said...

I have discussions with crew mates with regards to the classification of elderly falls. They once attended a call with the same description, which was immediately coded amber. They arrived after about 40 minutes to find her suffering from a CVA.. with only 14 minutes of the golden hour left. Madness

Uncle J said...

Re - 'Elderly fallers' being given lower priorities.

There is, I suppose, some sort of 'logic' - if they have survived un-attended for x hours on the floor - the little boxes probably don't add up to "Life-threatening condition"?

Anonymous said...

Why did the young woman need to be put in such a clinically dead sleep outside of hospital so that her life was “wholly dependent on the skill of one person at her head all the way to hospital”? Why was she not simply sedated (and told she was going to be), if she really needed that? Isn’t being put in a virtually dead state (without being informed that that is what they were going to do) taking it all a bit too far?

Anonymous said...

Blimey! Have I finally been able to leave a comment?? I have been reading for a couple of weeks, and have been very entertained,tx :-)

I have been minded of an occasion where my father and I witnessed a RTC first hand! A little boy ran out from behind his school bus, and straight into the side of of a car that was in the opposing flow of traffic. We all lost our heads there, a wee bit, but pulled ourselves together...the casualty had suffered a couple of shear fractures, along with the pretty obvious bump to the head. He was swaying a bit when we tried to sit him up, so I think he was post-ictal. By this time, all hell had let loose, and we had a 'copter on it's way from the Raigmore. They managed to put down safely in the middle of the road, and then my father gave what can only be described as one of the best ever handovers (orthopaedic surgeon) ever. I don't remember exactly what was said, but I do remember the slightly befuddled look on the paramedic's face...right before he came back with "Could you repeat that please, sir?"

Anonymous said...

Until a few months ago I worked not far from Gordon Street where it meets busy Byng Place/Torrington Street. This is a junction where cyclists going both directions meet drivers going both directions in each other’s path. When I saw this I could see a ridiculous and dangerous combination here, too.

Anonymous said...

This is a blunt message for patients whom the ambulance service says “need” to go to hospital: Come quietly into the ambulance otherwise we will have to put you into a deep sleep where you will be “managed properly”.

Oh, dear. Looks like only one other alternative when confronted by this – make a run for it!