Thursday, 31 December 2009

Trojan horses

Night shift: Eleven calls: Three no trace; one by FRU; everyone else by ambulance.

Stats: 4 eTOH; 1 Croup; 1 Fractured legs; 1 DIB; 1 EP Fit.

New Year’s Eve is our busiest night of the year and tonight was going to prove no exception as thousands of people flooded into Central London for the fireworks, booze and violence that comes with the territory these days. But it was a night of disguised problems too – I was working on an ambulance all night and a few of the calls were not as they seemed, catching me out on one occasion. I was working on an ambulance tonight.

But it started with a drunken 43 year-old woman who was found in the street by police after they’d been called to a possible mugging. She told me she’d been attacked as she spoke on the phone and she was very drunk – not that this had any bearing on the truth of her claim but it turned out she had no phone, nor any valuables and not because she was mugged but because her angry boyfriend, who was fed up with her constant drunken stumbling, took them away from her and left her in the street to fend for herself.

On the way to hospital, where she had to go just for safety, she told me she used to be a cardiologist. Someone, clearly, should have known better.

A 10-month old baby with croup next and it took us a while to find the address, so we were late getting there but a car was already on scene and the paramedic brought the patient and his mother down to us. The child had been diagnosed with a chest infection and given antibiotics, which he’d completed but the problem persisted. Now he was barking and crying in the ambulance all the way to paediatric A&E.

The first serious call of the night came in as party-people started to fill the West End and Soho. Two people had apparently fallen from a first floor window and we were asked to check on injuries. Then the call changed and we were asked to report on arrival because now it was a fifth floor window they'd fallen from. I knew the street well and I knew the injuries would be significant if this call was genuine because there is only pavement to land on. There are also people and this part of town would be very busy with them.

We arrived after struggling through crowds and closed roads (which were opened for us by the police) to find an ambulance and two FRUs already on scene. There was someone lying on the pavement and the first crew was dealing with her so I was instructed by the Duty officer to go and check on a child who had fallen from a window. I was sent upstairs into a block of flats with the police leading the way. This stumped me – hadn’t I been told that the child had fallen from a window? What was he doing upstairs in the flat?

When we got to the door it was opened by a very frightened looking man. ‘Where’s the child?’ I asked. He pointed at a bedroom and said ‘in there’, then his face crumbled.

I walked into the room and a woman was standing by a bed, so I asked her where the child was – she didn’t hear me the first time because she had started to speak the moment she saw us and the police inside the flat. ‘I just turned away for a second and he was gone’, she kept repeating. ‘Where’s the child?’ I insisted again. She pointed to the bed and there was a lump on it, completely covered by a blanket. At first I thought I was about to see a dead kid but when she pulled the blanket away from his head, the little boy cried and screamed. The shock of seeing us probably brought that on because it wasn’t the sound of pain.

It took a while to get the facts of this incident but when I did, after a long time trying to console the four year-old and attempting to find out what, if any injuries, he had, I discovered that he had been looking out of the fifth floor window, which had a sheer drop to the pavement below and had simply toppled out of it when his mother turned her back. All she and her older son (the one who answered the door) knew about it was the sound of crying from the street soon after he vanished from the ledge. I looked over that ledge and there was a glass jar or bottle on the little plinth below; I think he was trying to reach that or had dropped it. Whatever the case, the jar will have to be recovered or the first decent wind to come along will whip it off and onto someone’s head in the future.

The boy fell almost 50 feet by my reckoning and that was enough to get him to hospital, even though he showed no visible signs of injury and was very vague about pain or immobility. He would not weight-bear on his legs and that was significant.

He had landed onto an awning that stuck out from a shop below (the only awning for a long way on that street). He must have bounced off it, reducing the energy of his flight by a great deal, then he landed on a passing woman – striking her across the back and flattening her onto the pavement. After that he simply rolled off her. This woman told me how it had happened and she was very lucky to be alive, just like the little boy. If that awning hadn’t broken his fall, there would probably have been two dead people on the pavement. Ironically, the woman he struck across the back was already suffering from a back problem.

His brother had run down stairs and out to the street, finding him crying there next to the woman. He’d grabbed him and taken him back upstairs before calling an ambulance. His mother was now talking about letting us know if anything got worse – she was considering leaving him at home. I explained that the fall was enough to warrant going to hospital. That sort of mechanism for injury cannot be ignored and even though I thought he was the luckiest kid alive on New Year’s Eve, I would be surprised if nothing was found wrong with him.

We blued him in but he was so feisty and inconsolable that boarding, collaring and restraining him in any way, except on the stretcher, was impossible to do. He went in and I had to explain why he wasn’t tied up. We later found out that he had two broken legs. He was still a very lucky little chap.

The drunk calls started in earnest as we went through the night and a 21 year-old girl who fell onto her chin at an underground station was our next catch of the day. Her male friend stuck with her all the way to hospital. He was sober but she was so far gone she had to be given fluids.

We were north of the river now and at one minute to midnight we were asked to go south for another call, which wasn’t even an emergency. This was not a wise thing to ask of us because when the New Year arrived the crowds blocked every possible route and we soon found ourselves locked-in tight with an ocean of bodies around us. Not all of them were friendly – we got the odd ‘Happy New Year’ but we also got a bottle or two thrown at the ambulance and more than one fist slammed against it as we attempted to move through the crowd to our call. In the end and after warning Control that we wouldn’t make it, I called in to inform them that we were stuck and going nowhere. The fireworks were going off overhead but we saw nothing of them – it was the flattest start to the New Year I’ve had in years (since the last time I worked on this night in fact).

As the fireworks died down a roar came up from the crowd but it wasn’t appreciation; it was awe. A lot of people were looking skyward and I followed their gazes – it had started to snow.

The warm fuzzy feeling of seeing the first snow of the new decade dissipated (as did the snow) with the next call – to a 23 year-old female who was lying, blind drunk, outside a club. Her friends abandoned her as soon as we got her into the ambulance, so she was alone and out of it most of the time. But she wasn’t so bad that she couldn’t make some sense and when another drunken person came to the window of the ambulance and asked if we could attend his even more inebriated friend, she repeated my answers from the back as she lay on the stretcher. ‘Has your friend been drinking?’ I asked. ‘Yes!’ came the enthusiastic response from behind me. Both her hearing and her attitude were sharp.

The next proper call of the shift was for an 88 year-old woman with constipation and abdominal pain. At first I thought it was cut and dry but she had a noisy rasp to her breathing and her sats were very poor. So poor in fact that I didn’t believe the probe – she was cold and the figures tend to be low as a result. I put her on oxygen anyway and there was no real change in her condition. In fact, she tore the mask off her face several times because she didn’t like it.

Apart from her abdo pain and a history of a recent pacemaker fitting, she had no other immediate problems – no chest pain, no true DIB, although that soon changed. She had type II diabetes and hadn’t been able to control it very well – her BM was high but not critical and her GP had taken her off Metformin for some reason. She was very distressed but her daughter told me she was always like that and the raspy sound was being made by her vocal cords as she panicked. What was hard to pick up was any probable cause for her distress, apart from the pain of constipation. She’d had a chest infection and that had been treated with antibiotics and she’d been constipated before and it was treated, so we proceeded on that basis.

When we got to A&E, however, I noticed that five minutes after arriving and during my handover, her breathing rate had doubled and she was getting more and more restless with it. They took her into Resus and found that her sats were indeed low and that she needed to have oxygen forced into her lungs because her blood gases were so bad. I wonder if her high blood glucose had been in status for a while. If so, that could have a detrimental affect on her health.

The next drunken person was a 17 year-old who was in the street with his mates. His temperature was 34.1c and that was reason enough to take him into hospital, which was becoming busier by the minute.

After that we were being sent to calls that had been held for two or three hours at a time. Of course, every time we arrived, like to the epileptic who’d been fitting in a club, we found that they’d gone – in this case the FRU pilot had got fed up waiting and had driven the patient to hospital himself. The other calls were for drunks who’d long gone home or slithered into some other place for the night. It was an exercise in clearing up.

Well, that’s another year gone. More of the same to come I guess unless something changes for me. Happy New Year.

Be safe.


Rick said...

And a happy new year to you, sir. I'm very glad you're continuing this blog - I value it a good deal.

Ben said...

I'd second that