Sunday, 28 December 2008

The 999 Virus

Night shift: Ten calls; One assisted-only; one taken by car and the rest went by ambulance.

Stats: 1 Allergic reaction; 2 Faint; 1 ?EP fit; 1 In labour; 1 Chest pain (non-cardiac); 1 Dislocated shoulder; 1 Viral tonsillitis.

It’s unusual for babies to be vomiting blood, so when this call came in for a 13 month-old who was allegedly doing that I was a little sceptical. The parents were anxious because they were sure they’d seen blood and told me that the little girl may have eaten a bit of one of the pine cones from the Christmas tree. She had recently suffered Croup and, although her breathing was fine and there was no evidence of bleeding from anywhere, it was wise to have her checked out in case there was a re-occurrence of the virus.

I assisted the MRU paramedic with the next call for a 60 year-old who’d fainted in a crowded bar. He was stable and the paramedic had everything in hand, so I fetched and carried for a few minutes until I was made redundant by the ambulance crew.

My next faint was for an 82 year-old lady who’d passed out in church. Again, there wasn’t much for me to do because she was fully recovered when I arrived and all that was needed was a couple of sets of obs. She declined to go to hospital and so was left in the care of the church staff.

I nearly broke my neck on the grease-covered floor of a Chinese restaurant’s basement kitchen as I attempted to reach a 66 year-old man who was currently in the toilet throwing up. He’d arrived for work looking very pale and unwell. The normally fit and well man took his time in the loo while I stood outside and waited for him. By the time he was out the crew had arrived and I had assumed nothing about him without a single measurable observation.

An amber call for an epileptic who was ‘no longer fitting and breathing normally’ meant I didn’t have to risk as much in the traffic as I made my way there but when I walked into the McDonald’s restaurant I saw that the 29 year-old female was on the floor – still in seizure. She’d been like that for twenty minutes, according to her boyfriend. I tried to keep her head protected as she flailed and bashed around the counter area but she was on a mission and I could see something was amiss. Customers continued to queue for their burgers as I attempted to reason with her but she was determined to continue what I firmly believed was a charade for some time. Her legs were dancing but the upper part of her body was toned and controlled, something you don’t see in epilepsy where uncoordinated muscular twitching is the general rule ( in doesn't always apply, I know).

When the crew arrived she was given diazepam just in case I was wrong but when she went to hospital the Resus team thought the same and the doctor wasn’t convinced by her acting either. I have seen a lot of this kind of behaviour; the usual mixture is alcohol, a history of depression and the Festive season…for some reason that combination produces bizarre pseudo behaviour, especially in the female of the species. Sorry if that’s sexist to you but I’ve only seen this in women. If it’s an attention-seeking device it certainly works…until people who know epilepsy turn up. As for the diazepam, I’m duty bound to treat what I see, regardless of my opinion.

Just before I left hospital, she threw herself dramatically onto the floor of Resus and continued the display. The doctor rolled a screen around her and she was left there until she came to her senses. I heard later that she stormed out in a huff (the patient, not the doctor).

A young mother-to-be panicked when her waters broke and she flooded the bedroom, so her husband called an ambulance. Her contractions hadn’t yet started and she was perfectly calm now that a yellow jacket was on scene. Her husband had packed everything in readiness and off they went to maternity for a delivery that might take hours or seconds. This lady needed special care because she had two mechanical valves fitted to her heart and was on ‘blood-thinning’ drugs.

I was in poshville for the next call. I don’t often get sent to well-off people’s houses; they just don’t seem to need us much. The house owners didn’t have a medical emergency themselves but their 27 year-old live-in nanny apparently did and it was her I saw leaning over the toilet vomiting. She was pale, shaky and very unwell. She had rib pain which was flaring up again tonight after she’d completed a course of antibiotics for inflammation diagnosed earlier in the month. Of course it was given as chest pain and technically that can’t be faulted but a few specifics would have sorted the wheat from the chaff.

A fight in the West End created a short moment of havoc for the police and the booze bus, the crew of which was on scene before I arrived. It wasn’t a call for me; I was just visiting but while I was there a police officer asked me to look at a young man’s shoulder. The cursing 22 year-old had attempted to punch someone during the fracas and missed. He had swung his fist so hard that the energy used and not transferred to a face or body had simply resulted in his shoulder joint coming apart. He was in a great deal of pain and swore through it like a trooper – I prefer quiet moaning myself.

The cop on duty was my big Scottish friend from Soho and once again he handled the young man’s behaviour with calm reason – it would have been so easy to get annoyed with him but then the pain of a dislocated shoulder can’t be underestimated.

I put him on entonox and enquired about an ambulance – silly me. I waited and waited then took an executive decision…I would drive him to hospital myself. The police officer came along too, informing me in a quiet whisper that the patient was probably going to be arrested at some point anyway – it just wasn’t his night.

At hospital several attempts were made to pull his joint back into place (you don’t want to know the details) but they failed. A loud click signalled misery for him as the ball at the end of his Humerus refused to align itself with the socket and simply slipped out again and again. He was too tense, the doctor decided, so he’d need a muscle relaxant. IV pain relief was problematic because the man was so drunk. So, I left him in the care of the doctor and nurses who prepared yet again to rein in his loose limb with brute force. The patient lay back and joked, swore and cried out intermittently. He was, in the end, good humoured about it all but then if you are going to miss a punch so badly, humour is all you have left.

I left the crew to search for the 26 year-old student who was apparently coughing up blood and unwilling to give an accurate room number for his address at a Halls of Residence building. I had already waited ten minutes to be shown where he was – just as well I got there within the Government target.

My last ‘DIB’ call in the early hours of the morning led me south for a woman at a hotel who had viral tonsillitis. My years of treating hundreds of children with sore throats on summer camps have given me enough experience to recognise it immediately. She was breathing just fine but her swallowing was difficult and she felt unwell. An ambulance arrived for her but she really needed to join the big worldwide club of people who tend to these things themselves. If this kind of behaviour continues REAP 4 will become our standard operating level.

Be safe.


JB102 said...

Reap level 4 is a fine thing for the las to implement, but it would be all the better if us call handlers could give people a little education when we take the call.
I had countless cancellations today, all ending with the phrase, 'if I thought it'd take this long I'd have taken the car!'.

Fiz said...

I was about to comment on this and JB102 said it for me - so why don't they take the ruddy car in the first place?! I think we are so used to having what we want when we want it that it's spilled over and affected the ambulance service! Grr, humbug! Happy New Year, everyone, and hoping against hope that the ambulance writers and readers won't be rushed off their feet today or tomaorrow!