Day shift: Four calls; two by ambulance; two by car.
Stats: 1 Chest pain; 1 Abdo pain; 1 Back pain; 1? # Humerus.
A late start and a 35 year-old man with chest pain in a Government building. He had no medical history and there was no family cardiac history but his pain was the ‘tightening band’ kind and it started when he was at rest - always a suspicious event. He’d walked from the underground station to work and had let the pain ‘settle’ before calling an ambulance an hour later because it hadn’t quite gone away. This was a risky strategy but one I fully understand as this is probably how I’d behave if I got pain like that. No healthy person wants to admit that they may be having a heart attack.
His ECG had several anomalies on it – an inversion in one of the leads that should have been positive and, despite two printouts to rule out vibration, his P waves were multiple and possibly suggestive of an AV block but, until he’d gone to hospital and had a more thorough check, there was no way of telling one way or the other whether he was in trouble.
Ovarian cysts are painful and I fully appreciate the struggle women have with this condition if not dealt with definitively, so my next patient, a 24 year-old, who was rolling about on the floor of her office while her two extremely concerned and often slightly obstructive colleagues looked on, made for a challenging scenario. She was three floors up with no lift available and I had to manage her, her two companions and the possibility of walking her down those steps to the car, without losing control of the situation.
Apart from the pain, there was no need for this call to be more than a simple in-car transfer but the young woman made life very hard for me. She wouldn’t communicate, insisting only that she would be ‘fine’ and she attempted to pass out several times, in between bouts of thrashing and rolling. Getting obs was all but impossible and I gave her Entonox but she wouldn’t use it properly. Her friends were too close and too involved and had to be told several times to let me do my job. Granted they had probably never seen someone in such pain before but physically getting in the way and verbally interrupting wasn’t helping at all.
A crew turned up because this was given a Red category (breathing difficulties), so I got help when I had her at the top of the second flight of stairs. If she’d dramatically collapsed she may have taken me with her when she tumbled but, with encouragement and a few reminders to stay upright, we got her into the ambulance. She proved just as difficult for the crew when she threw herself to the floor of the vehicle and delayed the journey to hospital even more. Meanwhile, outside, her two friends huddled the back doors and became a real problem – the traffic (including buses and lorries) was slowly edging past the ambulance in a very narrow street and they were at risk. They had to be told to move out of the way of danger several times before they got the hint.
I left the crew to it as they tried to get the woman to sit on a chair for the trip and I told the pair what they obviously didn’t want to hear. The woman in pain did not want them to travel with her. No doubt my strict attitude to controlling the situation and this announcement from their stricken colleague will earn me a complaint but this is something the public need to understand – we are there to do a job and we need to feel safe while doing it; removing any risk or possibility of risk to ourselves, the patient and others is of primary importance, even if that means a sterner attitude. Not rude - stern.
Another pain that can be unbearable is that which is generated by damage to the spine, the cord or the muscles around the vertebrae. A 31 year-old man slumped awkwardly in his chair at work as I administered (or he administered) Entonox to reduce the agony he was suffering after a diagnosis of ‘back problems – unknown aetiology’ was given by his doctor - and then he was left to cope with tablet analgesia and the promise of physiotherapy. He’s on a waiting list.
His problems started with a bout of Epididymitis and, after a check for other problems, he was told that this was probably to blame for his backache. It wasn’t, so now he has to get by when it strikes. Today, however, he couldn’t even stand up and it took a lot of gas and air to get him moving to the car. Neurologically he was fine but he needed something done to help him and that’s why he went to A&E. Unfortunately he was then sent to the waiting area and I had to take my Entonox away from him. Poor guy.
Breaking your ‘funny bone’ isn’t funny at all – I’ve yet to see someone laughing their heads off after doing it, unless they have been given Entonox and Morphine. A call to a GP surgery for a 74 year-old man with heart problems (currently being dealt with by said GP), left me a little annoyed because the gentleman had fallen on the steps outside the surgery after having just seen his doctor and all they did was take him in, sit him down and call an ambulance for a ‘possible broken shoulder’. I arrived to find him on his own and with nobody around initially to tell me what was going on. There were no notes with him until I asked for them and the Receptionist wasn’t interested.
This man had been left sitting in pain, unable to move his arm and with no examination having been done to ensure that an open fracture hadn’t occurred or that neurological or circulatory damage hadn’t taken place as a result of his injury. He’s had three heart attacks, so I am surprised that no basic obs were carried out prior to my arrival. I think there was a duty of care in this instance and it was left to me to do everything possible to ease his pain and protect his broken limb. All it took was an arm sling – a basic first aid skill.
Be safe.
Tuesday, 30 March 2010
Monday, 29 March 2010
Tail pain
Day shift: Five calls; three by ambulance; two by car
Stats: 1 ? CVA; 1 Back pain; 2 Abdo pains; 1 eTOH (because it’s Monday)
A mystery start to the shift when a call for a 45 year-old man came in and I was tasked to support the motorcycle paramedic who’d just been sent before me. The call had come in describing the patient as ‘can’t wake up, breathing slowly and clammy’.
When I arrived the MC paramedic had been on scene for a few minutes. The man was on his side and breathing slowly. His respirations were shallow and he’d been snoring (airway occlusion by the tongue) when found. He was also very, very sweaty – the whole of his body was bathed in cold perspiration.
With no medical history known, we worked on the basis of a possible hypoglycaemic event but his BM was normal. He’d just gone to sleep, according to the witnesses on scene, so there was no evidence of prior chest pain or a seizure, both of which would also have fitted the bill for his condition. But he was a large man and so his BP may be a clue, however it turned out to be normal too, as did his ECG.
It was reported via his wife on the phone that he’d recently been complaining of chest and left arm pain but when he started to come round, after oxygen was given, he complained only of a headache. I think he may have suffered a neurological insult of some kind but there was no way to rule out other problems and the crew found his BP to be high when they checked it in the ambulance, so maybe something had gone awry in his brain after all.
In one of London’s nicer offices a 47 year-old staff member with a prolapsed and fused vertebral disc was in extreme pain. He had an electrical device fitted which sent impulses down through L5 and the Cauda Equina to resolve this but it had failed a few days ago and now he had uncontrollable pain, despite his diet of Tramadol. This was an awkward one because moving him at all meant giving him pain and he was standing up – propped by his colleagues – when I arrived.
He got Entonox and this helped and when the crew arrived I had managed to get him to sit down on an executive chair, which we rolled out to the lift and downstairs so that he could be put on the trolley bed as flat as he liked. It took us a few delicate minutes but we got there and so did he.
A 24 year-old female with abdo pain presented at an underground station and a motorcycle paramedic kindly offered me up as the driver to take her all of half a mile to A&E, which was packed. The young French woman was likely to sit there in discomfort for a few hours but these days Casualty Departments are a lottery...
...As was emphasised for my next abdominal pain – an 18 year-old who waited in the street for me to do something about her lower abdo pain, probably caused by Cystitis, but for which I had no remedy except to take her to yet another crowded and noisy Emergency Department so that she could sit for hours and wait for someone to ease her pain. Meanwhile, at least two drunken, violent men were sitting in cubicles reserved for ill people.
And finally – the drunk that didn’t get away. He was found sitting in the street ‘unresponsive’ by a passing off-duty police officer (he was appalled at the people he’d seen just step over the man). It took me a wee while to wake him up and establish hat drink was his only demon and then we waited in the rain until an ambulance arrived. He was too big and too drunk for the car... he was also certainly too out of it to go home.
Be safe.
Stats: 1 ? CVA; 1 Back pain; 2 Abdo pains; 1 eTOH (because it’s Monday)
A mystery start to the shift when a call for a 45 year-old man came in and I was tasked to support the motorcycle paramedic who’d just been sent before me. The call had come in describing the patient as ‘can’t wake up, breathing slowly and clammy’.
When I arrived the MC paramedic had been on scene for a few minutes. The man was on his side and breathing slowly. His respirations were shallow and he’d been snoring (airway occlusion by the tongue) when found. He was also very, very sweaty – the whole of his body was bathed in cold perspiration.
With no medical history known, we worked on the basis of a possible hypoglycaemic event but his BM was normal. He’d just gone to sleep, according to the witnesses on scene, so there was no evidence of prior chest pain or a seizure, both of which would also have fitted the bill for his condition. But he was a large man and so his BP may be a clue, however it turned out to be normal too, as did his ECG.
It was reported via his wife on the phone that he’d recently been complaining of chest and left arm pain but when he started to come round, after oxygen was given, he complained only of a headache. I think he may have suffered a neurological insult of some kind but there was no way to rule out other problems and the crew found his BP to be high when they checked it in the ambulance, so maybe something had gone awry in his brain after all.
In one of London’s nicer offices a 47 year-old staff member with a prolapsed and fused vertebral disc was in extreme pain. He had an electrical device fitted which sent impulses down through L5 and the Cauda Equina to resolve this but it had failed a few days ago and now he had uncontrollable pain, despite his diet of Tramadol. This was an awkward one because moving him at all meant giving him pain and he was standing up – propped by his colleagues – when I arrived.
He got Entonox and this helped and when the crew arrived I had managed to get him to sit down on an executive chair, which we rolled out to the lift and downstairs so that he could be put on the trolley bed as flat as he liked. It took us a few delicate minutes but we got there and so did he.
A 24 year-old female with abdo pain presented at an underground station and a motorcycle paramedic kindly offered me up as the driver to take her all of half a mile to A&E, which was packed. The young French woman was likely to sit there in discomfort for a few hours but these days Casualty Departments are a lottery...
...As was emphasised for my next abdominal pain – an 18 year-old who waited in the street for me to do something about her lower abdo pain, probably caused by Cystitis, but for which I had no remedy except to take her to yet another crowded and noisy Emergency Department so that she could sit for hours and wait for someone to ease her pain. Meanwhile, at least two drunken, violent men were sitting in cubicles reserved for ill people.
And finally – the drunk that didn’t get away. He was found sitting in the street ‘unresponsive’ by a passing off-duty police officer (he was appalled at the people he’d seen just step over the man). It took me a wee while to wake him up and establish hat drink was his only demon and then we waited in the rain until an ambulance arrived. He was too big and too drunk for the car... he was also certainly too out of it to go home.
Be safe.
Friday, 26 March 2010
Everyone's falling down
Day shift: Seven calls; one assisted-only; one declined; one no-trace; one went home; three by ambulance.
Stats: 1 Hypo fit; 1 Faint; 1 ? eTOH fit; 1 NPC; 1 Seizure; 1 Tired person.
After a quiet start I was sent to a train station to deal with a seizure. The 45 year-old man was on the ground and a member of staff and a passing MOP first aider were on scene with him. The first thing I noticed was that he was clutching a handful of little sugar bags, so a BM was carried out straight away. The ambulance crew was on scene with me and we got him into the vehicle within a few minutes. He was recovering but still very vague and confused, so he was going to hospital despite the fact that his BM was normal, as were his other obs. Nevertheless the seizure had been witnessed and it’s entirely possible that he managed to get some sugar into his system just prior to falling down – a bolted horse as it were. This would have meant a rapid increase in his blood glucose level during and post fit, giving that normal reading in the face of his obviously recent hypoglycaemic state.
A frightened Romanian woman with an inconsistent story next – the 25 year-old collapsed on an underground train and an off-duty PCSO attended to her as she recovered from her faint. She was lugging a huge case with her and this was next to her when I arrived and found her inside the station office, where she’d been taken after her event.
During our chat she seemed very nervous and would not make eye contact, even with the female PCSO who was with her. Maybe it was the fact that she was being bombarded with questions and medical tests after falling down (maybe in Romania they just leave people on the floor to get on with it) or maybe something significant had happened to her. She was young and vulnerable travelling around with a whole load of luggage and very little English – that can attract the more unsavoury characters from the rotten woodwork, so I just wanted to ensure there was nothing amiss before I left her.
She didn’t want to go to hospital and her vitals were normal. She had no medical history and, apart from a dehydrated lip, she looked healthy enough. But she’d told us she was travelling in to the UK for the first time. Then she changed her story and said she was living with her boyfriend and had worked in London for the past two years. Her English markedly improved and now she was speaking in paragraphs instead of little one-liners.
The British Transport Police arrived to help out and to arrange translation via Language Line and by the time we’d asked the same questions over and over, it was well established that, 1. She could speak English perfectly well, 2. She didn’t want to go to hospital and 3. She was probably hiding something but nobody was going to find out what.
Now, it may well be that whatever she was keeping close to her chest was her own business and that’s fine. She could also have been scared looking because we were standing over her and that’s intimidating if you don’t know how things work here and her language block may have simply been the result of that fear. I’m sure my rubbish French would be non-existent in similar circumstances and some personal issues that I may have will be of no concern to the police or anyone else but me. I just wanted to know, as did the others, that she was ok and we weren’t missing something important.
Seizures are usually easy to recognise but every now and then we will be sent to individuals who are ‘fitting’ but have full control of their muscles and appear to know what they are doing. They don’t lose bladder control and they are completely lucid in between these events. Medically, it’s possible to have such seizures but on many occasions the individual is play-acting. Alcoholics tend to do this and many of our visiting alcoholics use it as a means to get into hospital. So I was skeptical about the seven seizures my next patient, a 33 year-old alcoholic man with HIV, HepB and HepC, who collapsed just outside the clinic he visits. I found him on the pavement with medical staff around him. He’d already had three fits and he had another two while I was dealing with him. I can’t afford to be negative about their authenticity but my gut instinct and experience with hundreds of epileptics and fitting alcoholics had me looking at this side-on.
It was only when a passing police officer showed up to help and stuck around that the man appeared to desist. He didn’t have any problems at all while the cop was there and then, when in the ambulance and away from the officer, he had a further couple of fits – he literally attempted to throw himself off the trolley bed, almost causing injury to my colleagues who were holding him down.
When he was lucid, he asked for one thing only... and he asked politely. ‘Can I have a beer please?’
Then a phantom stabbing took me north and the police were already on scene with a crew. The stabbing had supposedly happened at a College but after an area search and lots of denials about who had called, we all went back to our start positions.
Following rapidly on that job’s heels was an abdo pain but I couldn’t get the people inside the address to help because nobody knew where the patient was. Another FRU paramedic turned up and I handed over to her before we were told that the patient, a 25 year-old female, was in another building somewhere else on the road. I went to help out in case the call, which was Red, turned out to be a cardiac arrest but it wasn’t. The woman was chatting to the other paramedic when I popped my head around the door.
Off to another fitting call and this time the man was on the floor of a busy store restaurant. He had a history of brain tumour and had fitted once before but today he had two in a row. His daughter was graduating later on but they would all miss the ceremony (including the daughter) for the sake of their loved one. He was post ictal and when he fully recovered he declined to go to hospital. I gave my usual advice but it was clear he was not for turning, so I got my signature and he got a copy.
His wife had told me they were advised not to bother if he had seizures and just to monitor him but I felt his medication may not be working effectively if he was having multiple seizures and now I was concerned about him going home, which is where they were headed, and having another fit on the way. I took them all in the car to the nearest taxi rank and let them get on with their day.
A last-minute call for a ‘not alert’ 25 year-old female turned out to be an alert but not-willing-to-talk female. She was tired and hadn’t slept for a while. She tried again and again to go to sleep as I sat with her attempting to get sense. Then the crew arrived and I handed her over to them. I went home late and she was taken to hospital for some sleep.
Be safe.
Stats: 1 Hypo fit; 1 Faint; 1 ? eTOH fit; 1 NPC; 1 Seizure; 1 Tired person.
After a quiet start I was sent to a train station to deal with a seizure. The 45 year-old man was on the ground and a member of staff and a passing MOP first aider were on scene with him. The first thing I noticed was that he was clutching a handful of little sugar bags, so a BM was carried out straight away. The ambulance crew was on scene with me and we got him into the vehicle within a few minutes. He was recovering but still very vague and confused, so he was going to hospital despite the fact that his BM was normal, as were his other obs. Nevertheless the seizure had been witnessed and it’s entirely possible that he managed to get some sugar into his system just prior to falling down – a bolted horse as it were. This would have meant a rapid increase in his blood glucose level during and post fit, giving that normal reading in the face of his obviously recent hypoglycaemic state.
A frightened Romanian woman with an inconsistent story next – the 25 year-old collapsed on an underground train and an off-duty PCSO attended to her as she recovered from her faint. She was lugging a huge case with her and this was next to her when I arrived and found her inside the station office, where she’d been taken after her event.
During our chat she seemed very nervous and would not make eye contact, even with the female PCSO who was with her. Maybe it was the fact that she was being bombarded with questions and medical tests after falling down (maybe in Romania they just leave people on the floor to get on with it) or maybe something significant had happened to her. She was young and vulnerable travelling around with a whole load of luggage and very little English – that can attract the more unsavoury characters from the rotten woodwork, so I just wanted to ensure there was nothing amiss before I left her.
She didn’t want to go to hospital and her vitals were normal. She had no medical history and, apart from a dehydrated lip, she looked healthy enough. But she’d told us she was travelling in to the UK for the first time. Then she changed her story and said she was living with her boyfriend and had worked in London for the past two years. Her English markedly improved and now she was speaking in paragraphs instead of little one-liners.
The British Transport Police arrived to help out and to arrange translation via Language Line and by the time we’d asked the same questions over and over, it was well established that, 1. She could speak English perfectly well, 2. She didn’t want to go to hospital and 3. She was probably hiding something but nobody was going to find out what.
Now, it may well be that whatever she was keeping close to her chest was her own business and that’s fine. She could also have been scared looking because we were standing over her and that’s intimidating if you don’t know how things work here and her language block may have simply been the result of that fear. I’m sure my rubbish French would be non-existent in similar circumstances and some personal issues that I may have will be of no concern to the police or anyone else but me. I just wanted to know, as did the others, that she was ok and we weren’t missing something important.
Seizures are usually easy to recognise but every now and then we will be sent to individuals who are ‘fitting’ but have full control of their muscles and appear to know what they are doing. They don’t lose bladder control and they are completely lucid in between these events. Medically, it’s possible to have such seizures but on many occasions the individual is play-acting. Alcoholics tend to do this and many of our visiting alcoholics use it as a means to get into hospital. So I was skeptical about the seven seizures my next patient, a 33 year-old alcoholic man with HIV, HepB and HepC, who collapsed just outside the clinic he visits. I found him on the pavement with medical staff around him. He’d already had three fits and he had another two while I was dealing with him. I can’t afford to be negative about their authenticity but my gut instinct and experience with hundreds of epileptics and fitting alcoholics had me looking at this side-on.
It was only when a passing police officer showed up to help and stuck around that the man appeared to desist. He didn’t have any problems at all while the cop was there and then, when in the ambulance and away from the officer, he had a further couple of fits – he literally attempted to throw himself off the trolley bed, almost causing injury to my colleagues who were holding him down.
When he was lucid, he asked for one thing only... and he asked politely. ‘Can I have a beer please?’
Then a phantom stabbing took me north and the police were already on scene with a crew. The stabbing had supposedly happened at a College but after an area search and lots of denials about who had called, we all went back to our start positions.
Following rapidly on that job’s heels was an abdo pain but I couldn’t get the people inside the address to help because nobody knew where the patient was. Another FRU paramedic turned up and I handed over to her before we were told that the patient, a 25 year-old female, was in another building somewhere else on the road. I went to help out in case the call, which was Red, turned out to be a cardiac arrest but it wasn’t. The woman was chatting to the other paramedic when I popped my head around the door.
Off to another fitting call and this time the man was on the floor of a busy store restaurant. He had a history of brain tumour and had fitted once before but today he had two in a row. His daughter was graduating later on but they would all miss the ceremony (including the daughter) for the sake of their loved one. He was post ictal and when he fully recovered he declined to go to hospital. I gave my usual advice but it was clear he was not for turning, so I got my signature and he got a copy.
His wife had told me they were advised not to bother if he had seizures and just to monitor him but I felt his medication may not be working effectively if he was having multiple seizures and now I was concerned about him going home, which is where they were headed, and having another fit on the way. I took them all in the car to the nearest taxi rank and let them get on with their day.
A last-minute call for a ‘not alert’ 25 year-old female turned out to be an alert but not-willing-to-talk female. She was tired and hadn’t slept for a while. She tried again and again to go to sleep as I sat with her attempting to get sense. Then the crew arrived and I handed her over to them. I went home late and she was taken to hospital for some sleep.
Be safe.
Thursday, 25 March 2010
Moped Sandwich
Day shift: Five calls; two by car; three declined.
Stats: 1 Cut finger; 2 Faints; 1 Leg injury; 1 Service run; 1 RTC.
A chef was tidying up in his kitchen when the door buzzer sounded, startling him. A delivery person had shown up earlier than normal and this unexpected visit caused the chef to grip a wine glass a little too tightly as he put it away. It shattered in his hand and cut through the tip of his forefinger, severing a vein but not the artery. He covered it with a tea towel (there was no first aid kit in sight) and the delivery person called an ambulance. He didn’t need the emergency response and he could easily have taken himself to a Minor Injuries Unit or the local A&E but, since I was there, I dressed it, elevated it and carried it, with him attached, to hospital in the car.
I may be slow in finding this out but, for the benefit of those of you that don’t know; tetanus injections are no longer given routinely. In fact, unless you have never been given it or you cut yourself down on the farm, you will not get a jab when you cut yourself and go to hospital to have it treated.
More often than not, faints in young people are benign but it’s always smart to err on the side of caution when dealing with first timers and my next call took me to Covent Garden, where a 23 year-old female had passed out at work, landing on the concrete floor of her shop when she fell by all accounts. Her four colleagues were with her when I arrived and she had begun to recover, although she still had a headache and was a bit vague and ‘wooly’.
While she got better I checked her obs and chatted with the women standing around us. The shop hadn’t yet opened and there was time for light-hearted banter as I monitored the fallen woman. I decided to take her in the car, after giving her the choice because she was fully recovered and stable now. She’d need a proper medical examination to rule out any problems with her heart before she could go back to work, so off she went to A&E. Her Canadian friend accompanied her and we had a conversation about the history of Scottish Royalty – a topic I don’t normally get to jaw about. We also talked about the hidden secrets of London. My patient suggested I do a tour and I thought about it; the London Ambulance tour of London... could be a winner.
Then a man who had a minor RTC and whose Hamstring was pulled as a result had me rushing down to watch him limp dramatically on the pavement. He had a very minor injury and his initial aggressive tone convinced me that I was the pawn in a game that was being played between him and the female taxi driver whose cab he’d hit. I examined him, did his obs and he took my paperwork before I left him to wait for the police to come and sort out this in-street domestic.
The ambulance service is often used as arbiter in such disputes – someone with ‘pain’ being checked out by a crew is less likely to be frowned upon by those wishing to blame him for something I think.
Not long after the ink on my PRF for that job was dry, I was tasked to go to the aid of a crew who had a diabetic patient on their ambulance. They needed a BM monitor because theirs had either packed up or was missing. These things happen. They shouldn’t but they do. It was a long four-mile run, most of which was spent sitting behind a truck driver who couldn’t or simply wouldn’t move out of my way. He was, however, very keen to acknowledge my existence with a finger shown in his wing mirror. This rude and totally uncalled-for gesture could easily have put my unprofessional side into gear but both my hands remained on the wheel. I raised an eyebrow instead. Yeah, that should do it.
An 18 year-old Chinese girl got herself caught up in the ‘fainting on the underground’ that commonly occurs in London. The heat, prolonged standing (where applicable) or a combination of these and other physiological interactions can make just about anybody fall down but it’s more likely to happen to a female (sorry but I have the stats!). She didn’t want to go to hospital and I gave her and her two friends a lift to Covent Garden, which was the next place they were visiting on their short tour of London.
A very lucky motorcyclist was caught on the outside of a bus, between the vehicle and a barrier. He and his ride were dragged for about five metres before the bus stopped but he only sustained a minor hand injury as the result of his right hand being pulled across the metal posts of the barrier as he travelled (whether he liked it or not) at the unsympathetic behest of the bus. If he’d lost his balance or misjudged a single move during his experience, he may well have been crushed bodily against the barrier or been dragged under the wheel of the bus. Despite the advertising currently going on for us to look out for motorcyclists (and indeed that would include any two-wheeled vehicle), incidents are still occurring like this.
The man was toughing it out and declined to go to hospital. His wound was very superficial anyway and there was no reason to drag him off to A&E. He probably wanted to go and think about his life after such a shock.
'You were very lucky', I told him.
'No, not lucky', he said, as if he knew someone was watching over him.
Be safe.
Stats: 1 Cut finger; 2 Faints; 1 Leg injury; 1 Service run; 1 RTC.
A chef was tidying up in his kitchen when the door buzzer sounded, startling him. A delivery person had shown up earlier than normal and this unexpected visit caused the chef to grip a wine glass a little too tightly as he put it away. It shattered in his hand and cut through the tip of his forefinger, severing a vein but not the artery. He covered it with a tea towel (there was no first aid kit in sight) and the delivery person called an ambulance. He didn’t need the emergency response and he could easily have taken himself to a Minor Injuries Unit or the local A&E but, since I was there, I dressed it, elevated it and carried it, with him attached, to hospital in the car.
I may be slow in finding this out but, for the benefit of those of you that don’t know; tetanus injections are no longer given routinely. In fact, unless you have never been given it or you cut yourself down on the farm, you will not get a jab when you cut yourself and go to hospital to have it treated.
More often than not, faints in young people are benign but it’s always smart to err on the side of caution when dealing with first timers and my next call took me to Covent Garden, where a 23 year-old female had passed out at work, landing on the concrete floor of her shop when she fell by all accounts. Her four colleagues were with her when I arrived and she had begun to recover, although she still had a headache and was a bit vague and ‘wooly’.
While she got better I checked her obs and chatted with the women standing around us. The shop hadn’t yet opened and there was time for light-hearted banter as I monitored the fallen woman. I decided to take her in the car, after giving her the choice because she was fully recovered and stable now. She’d need a proper medical examination to rule out any problems with her heart before she could go back to work, so off she went to A&E. Her Canadian friend accompanied her and we had a conversation about the history of Scottish Royalty – a topic I don’t normally get to jaw about. We also talked about the hidden secrets of London. My patient suggested I do a tour and I thought about it; the London Ambulance tour of London... could be a winner.
Then a man who had a minor RTC and whose Hamstring was pulled as a result had me rushing down to watch him limp dramatically on the pavement. He had a very minor injury and his initial aggressive tone convinced me that I was the pawn in a game that was being played between him and the female taxi driver whose cab he’d hit. I examined him, did his obs and he took my paperwork before I left him to wait for the police to come and sort out this in-street domestic.
The ambulance service is often used as arbiter in such disputes – someone with ‘pain’ being checked out by a crew is less likely to be frowned upon by those wishing to blame him for something I think.
Not long after the ink on my PRF for that job was dry, I was tasked to go to the aid of a crew who had a diabetic patient on their ambulance. They needed a BM monitor because theirs had either packed up or was missing. These things happen. They shouldn’t but they do. It was a long four-mile run, most of which was spent sitting behind a truck driver who couldn’t or simply wouldn’t move out of my way. He was, however, very keen to acknowledge my existence with a finger shown in his wing mirror. This rude and totally uncalled-for gesture could easily have put my unprofessional side into gear but both my hands remained on the wheel. I raised an eyebrow instead. Yeah, that should do it.
An 18 year-old Chinese girl got herself caught up in the ‘fainting on the underground’ that commonly occurs in London. The heat, prolonged standing (where applicable) or a combination of these and other physiological interactions can make just about anybody fall down but it’s more likely to happen to a female (sorry but I have the stats!). She didn’t want to go to hospital and I gave her and her two friends a lift to Covent Garden, which was the next place they were visiting on their short tour of London.
A very lucky motorcyclist was caught on the outside of a bus, between the vehicle and a barrier. He and his ride were dragged for about five metres before the bus stopped but he only sustained a minor hand injury as the result of his right hand being pulled across the metal posts of the barrier as he travelled (whether he liked it or not) at the unsympathetic behest of the bus. If he’d lost his balance or misjudged a single move during his experience, he may well have been crushed bodily against the barrier or been dragged under the wheel of the bus. Despite the advertising currently going on for us to look out for motorcyclists (and indeed that would include any two-wheeled vehicle), incidents are still occurring like this.
The man was toughing it out and declined to go to hospital. His wound was very superficial anyway and there was no reason to drag him off to A&E. He probably wanted to go and think about his life after such a shock.
'You were very lucky', I told him.
'No, not lucky', he said, as if he knew someone was watching over him.
Be safe.
Thursday, 18 March 2010
Private Dancer
Night shift: Six calls; one hoax call; one treated on scene; one declined; one false alarm; two by car; by ambulance.
Stats: 1 Drug O/D; 1 Pretend asthmatic; 1 Headache; 1 Abdo pain; 1 Vomiting person; 1 Faint.
I had to borrow a car again – this time the headlight had gone on my own. I also had an observer from Control out with me and the first call we got helped break the ice for the night ahead. A 50 year-old drug addict lay slumped on the toilet seat in a public loo – he was barely breathing after taking an overdose. The person who’d given him the narcotic had run off as soon as he’d realised his client was potentially dead. We arrived with another FRU behind us to find the crew giving Narcan to him. This had an immediate effect and within seconds the patient was awake and aware.
His blood pressure was low, so I plumbed him into fluids for a while to resolve it. The police arrived to investigate the scene but the drug addict refused to co-operate and he didn’t want to go to hospital. ‘You could have died if it wasn’t for this crew’, I told him. ‘I wouldn’t mind if I’d died’, he responded.
The next call came later as the drizzle of the night settled down. We were off to a train station where a Polish alcoholic sat on the ground with police officers around him. Initially he claimed to be asthmatic, which he clearly wasn’t because he was speaking (in Polish) without drawing breath and he was covering his mouth in between for some strange reason, something an asthmatic is not likely to do. After a frank discussion with him (after he’d come clean and admitted he could understand English), he confirmed that he didn’t want an ambulance and that he wasn’t asthmatic at all. He’d been drinking and wanted to be taken to Kings Cross. He didn’t get his taxi ride.
It seems our East European friends were out in force tonight. We went to a 37 year-old male who was standing in the street waving at us as we arrived. He had a headache but I think he also needed to sleep because when we got him to hospital in the car he went to dreamland on the cubicle bed within minutes of being shown to it.
We waited for a while on Leicester Square until a security man from one of the burger chains approached and asked if I could help him with his recent stomach cramps. I did all the obs and found him to be normal, except for his painful tum of course. He didn’t have diarrhoea and there was no vomiting going on (except for the man who past the car earlier and threw up as he walked, carrying on as if this was no more than a spit onto the pavement). He didn’t want to go to hospital, so I guess he was looking for a quick fix. He didn’t get one but he got advice and a copy of my PRF to take to his GP.
A 66 year-old lady stepped from her front door to meet us as we arrived at her 999 call for ‘Swine Flu’. She was in her night clothes and fully made up, nails and all, for the trip. We don’t take people to hospital with Swine Flu and they usually don’t come to meet us, so I knew already that this lady didn’t have the virus and that she had probably never called an ambulance before in her life, so didn’t quite know that an emergency call usually meant us coming to the patient and not the other way around.
She was very pleasant and explained that she’d vomited – this single incident prompted her to grab the phone and dial 999 on the assumption that she had H1N1. ‘We don’t take people with Swine Flu to hospital’, I told her. ‘But where do I get my inoculation?’ she asked.
I also found out that she was Bipolar and that probably explained a lot. Her husband was away for the night and she was alone, so I decided she should go to hospital anyway.
The police cancelled us after we’d run a few miles up to a non-existent assault with a non-existent victim. The hoax call had been made from a callbox and before the cops had arrived to catch him, the caller had fled. He was probably watching us though.
As we waited for the final curtain to fall on this shift, we were sent one last little surprise – a call to a private gentleman’s club for a 21 year-old ‘exotic dancer’ who was unconscious. She wasn’t because her eyelids fluttered when I tested her eyelashes and it was clear that she wanted to play dead. She was flat on her back and wearing the tiniest of top and tails (exotic dancer bikini). She was surrounded by large, heavy (and I don’t mean fat) men who were straight-faced and without humour.
The crew arrived and we lifted her onto a chair but her bra fell off – it had been loosely placed across her breasts. Her jeans had been hastily put on and they were only half way up her legs – I assumed therefore that the staff had tried to dress her before we arrived. Still, we all carried on professionally and covered her up as soon as possible.
When she got into the ambulance she miraculously recovered and began asking who we were, whilst smiling broadly. She had a female chaperone with her and I continued to talk to them both as the crew prepared to complete the obs I’d started. This young dancer then began to flirt outrageously with me and I think I might have gone a bit red in the face. I’m not sure though but I looked at my watch and, realising the time and that my shift was over, I decided to beat a hasty retreat. I bid them goodbye and closed the ambulance doors with the words ‘I’ll see you again in my dreams’ ringing in my ears. I just know I’m never going to hear the end of this.
Be safe.
Stats: 1 Drug O/D; 1 Pretend asthmatic; 1 Headache; 1 Abdo pain; 1 Vomiting person; 1 Faint.
I had to borrow a car again – this time the headlight had gone on my own. I also had an observer from Control out with me and the first call we got helped break the ice for the night ahead. A 50 year-old drug addict lay slumped on the toilet seat in a public loo – he was barely breathing after taking an overdose. The person who’d given him the narcotic had run off as soon as he’d realised his client was potentially dead. We arrived with another FRU behind us to find the crew giving Narcan to him. This had an immediate effect and within seconds the patient was awake and aware.
His blood pressure was low, so I plumbed him into fluids for a while to resolve it. The police arrived to investigate the scene but the drug addict refused to co-operate and he didn’t want to go to hospital. ‘You could have died if it wasn’t for this crew’, I told him. ‘I wouldn’t mind if I’d died’, he responded.
The next call came later as the drizzle of the night settled down. We were off to a train station where a Polish alcoholic sat on the ground with police officers around him. Initially he claimed to be asthmatic, which he clearly wasn’t because he was speaking (in Polish) without drawing breath and he was covering his mouth in between for some strange reason, something an asthmatic is not likely to do. After a frank discussion with him (after he’d come clean and admitted he could understand English), he confirmed that he didn’t want an ambulance and that he wasn’t asthmatic at all. He’d been drinking and wanted to be taken to Kings Cross. He didn’t get his taxi ride.
It seems our East European friends were out in force tonight. We went to a 37 year-old male who was standing in the street waving at us as we arrived. He had a headache but I think he also needed to sleep because when we got him to hospital in the car he went to dreamland on the cubicle bed within minutes of being shown to it.
We waited for a while on Leicester Square until a security man from one of the burger chains approached and asked if I could help him with his recent stomach cramps. I did all the obs and found him to be normal, except for his painful tum of course. He didn’t have diarrhoea and there was no vomiting going on (except for the man who past the car earlier and threw up as he walked, carrying on as if this was no more than a spit onto the pavement). He didn’t want to go to hospital, so I guess he was looking for a quick fix. He didn’t get one but he got advice and a copy of my PRF to take to his GP.
A 66 year-old lady stepped from her front door to meet us as we arrived at her 999 call for ‘Swine Flu’. She was in her night clothes and fully made up, nails and all, for the trip. We don’t take people to hospital with Swine Flu and they usually don’t come to meet us, so I knew already that this lady didn’t have the virus and that she had probably never called an ambulance before in her life, so didn’t quite know that an emergency call usually meant us coming to the patient and not the other way around.
She was very pleasant and explained that she’d vomited – this single incident prompted her to grab the phone and dial 999 on the assumption that she had H1N1. ‘We don’t take people with Swine Flu to hospital’, I told her. ‘But where do I get my inoculation?’ she asked.
I also found out that she was Bipolar and that probably explained a lot. Her husband was away for the night and she was alone, so I decided she should go to hospital anyway.
The police cancelled us after we’d run a few miles up to a non-existent assault with a non-existent victim. The hoax call had been made from a callbox and before the cops had arrived to catch him, the caller had fled. He was probably watching us though.
As we waited for the final curtain to fall on this shift, we were sent one last little surprise – a call to a private gentleman’s club for a 21 year-old ‘exotic dancer’ who was unconscious. She wasn’t because her eyelids fluttered when I tested her eyelashes and it was clear that she wanted to play dead. She was flat on her back and wearing the tiniest of top and tails (exotic dancer bikini). She was surrounded by large, heavy (and I don’t mean fat) men who were straight-faced and without humour.
The crew arrived and we lifted her onto a chair but her bra fell off – it had been loosely placed across her breasts. Her jeans had been hastily put on and they were only half way up her legs – I assumed therefore that the staff had tried to dress her before we arrived. Still, we all carried on professionally and covered her up as soon as possible.
When she got into the ambulance she miraculously recovered and began asking who we were, whilst smiling broadly. She had a female chaperone with her and I continued to talk to them both as the crew prepared to complete the obs I’d started. This young dancer then began to flirt outrageously with me and I think I might have gone a bit red in the face. I’m not sure though but I looked at my watch and, realising the time and that my shift was over, I decided to beat a hasty retreat. I bid them goodbye and closed the ambulance doors with the words ‘I’ll see you again in my dreams’ ringing in my ears. I just know I’m never going to hear the end of this.
Be safe.
Wednesday, 17 March 2010
Land of Leprechauns
Night shift: Nine calls; five by car; two assisted-only; two by ambulance.Stats: 1 Abdo pain; 1 RTC (2 people, no injuries); 1 Asthma; 4 eTOH; 1 Vulnerable adult; 1 No trace.
Sometimes a patient will experience pain of an undetermined origin and my first call took me to an 18 year-old girl who had this problem – in fact, she’d had it for 5 years on and off. She was complaining of severe sharp pain in her lower right abdomen. She also felt dizzy and sick with it. I found her sitting outside with her friend. She was hugging the painful area as if it would go away if it was held long enough. She’d had all the usual tests done but nothing had ever been found wrong – they’d taken away her appendix and she’d undergone a laparoscopy investigation to see if her ovary was to blame but that drew a blank. Now she was living with it and I took her to hospital in the hope that on a busy St. Patrick’s night, with all and sundry (Irish and mostly non-Irish) using the excuse to become unconscious with alcohol, she’d be given an answer. I wasn’t holding out much hope for her.
Tonight seemed popular with car drivers because there was evidently a need to collide with each other, if the calls coming in were to be judged. I was sent to a two-car collision where a patient was complaining of neck and back pain. This would need an ambulance but when I arrived I was drawn into a medical conversation with one of the drivers, who I had assumed was the neck pain man but he told me about old illnesses that had nothing to do with hitting a car. The van in front of him (the one he hit) was empty of a driver and I found him wandering about and chatting on his mobile phone. This was my neck pain man but again he told me of an old history of back pain and the possibility that it had been exacerbated by the rear-end shunt he’d received from the first man I’d spoken to. It was a little confusing and I knew that an ambulance was on its way but that we could barely spare it on account of the antics of thousands of drunken and soon-to-be drunken ‘Paddy’s day’ revellers. Incidentally, I find it strange that people can go around wearing leprechaun beards and funny tall hats without fear of being branded ‘racist’ but in almost every other aspect of celebratory life there is occasion to worry about who might be offended – just goes to show you that the Irish still have a sense of fun without fearing that their whole nation is under attack. I’m sure we wouldn’t give a hoot if everyone sported tartan shirts and kilts on St. Andrew’s day (but few people know or care when that is down here primarily because it is not associated with getting blind drunk).
Anyway, I cancelled the ambulance and waited for the police to get their stories written down before leaving the two colliding gentlemen to it. I didn’t get far though because the first man hailed me back to him and told me his car wouldn’t start. The battery was flat and he had no affiliation with any rescue service. The police were still on scene and we planned to push his vehicle onto the kerb and let him work out how to get home but he’d been acting strangely – he was very unstable at times on his feet, although alcohol had been ruled out earlier. This was one of those calls where I felt something wasn’t right but I couldn’t put my finger on it. The cops asked him some searching questions and he became a little erratic with his answers, so they looked in his car. There they found two heavy wooden rolling pins on the floor. Obviously, these are domestic items that can be carried anywhere but two? And on the floor of your car? What would they be used for?
The man was arrested on the spot and, although normally this wouldn’t have gone quite that far, the circumstances surrounding this incident and the man’s general behaviour warranted further investigation by the cops and, flimsy as it may have seemed, they felt he had possible offensive weapons in his possession.
Asthma attacks are pretty well defined but the 15 year-old girl I saw after running on this Red2 emergency could speak to me without drawing breath and she had been unwell recently with a virus, so she wasn’t going to die imminently. She sat up in bed as her family looked on and performed a peak flow test for me; she’s been asthmatic all her life but didn’t seem to know how to do this properly, even though she told me it had been done many times before. Neither did she know her best peak flow. This, I assume, is down to inadequate education about her condition, if she had it at all, and her current state presented no more than an annoying viral cough. The ambulance crew arrived and took her into their vehicle for further checks and she may have been left at home but I was on to my next call before I discovered her fate.
A drunken 56 year-old diabetic man was found lying in the gutter on a tight bend – a bend that practically encourages cars to cut the corner – by two passing MOPs. They called an ambulance and helped me get him into the car as I waited for backup. The man’s BM was high and his temperature was low, neither of which is surprising when someone is that badly drunk. ‘I only drink like this every now and again’, he told me, as if being in this state was some kind of reward.
As I parked up to do my paperwork, a drunken Norwegian man knocked on my window and begged to be taken to his hotel; he’d staggered around lost and was beside himself with worry. The street, which he thankfully remembered, was just around the corner, so I called it in and became his free NHS taxi. At least he was safe and well.
The drunken fun continues with a call to a 22 year-old female who is vomiting in a pub toilet. The landlord is not a happy bunny when he finds out an ambulance has been called to his establishment and he has no knowledge of it so he lays down the law with the American woman and her husband, who is standing at the sinks with her as she throws up into an already well blocked drain. There are four leprechauns sitting like an audience watching this in the ladies loos and they are quickly shoo’d out of the way. The patient’s temperature is low and she is unfit to travel home, even with her husband, so I take them both in the car for the short journey to hospital. The husband apologises profusely, explaining that she’s ‘never been like that before’ and I have to say I accepted his confusion over what to do. In the part of the States where they live it is ‘normal’ for an ambulance to be called when someone is suffering ‘alcohol poisoning’. My definition is much more straightforward – she was drunk on too many pints of Guinness.
Someone else who should blame the drink and not the circumstances was the 25 year-old man found lying in the street. He denied being drunk until his attempt to get up ended in failure and he had to admit, through the fumes of strong alcohol, that he was indeed intoxicated. There were no ambulances available and his temperature, like the others, was dropping below hypothermia, so I got him into the car. He had to be warned when he tried to open the door to get out – obviously the child lock was enabled and he couldn’t. Then, as we approached the hospital he threw up on the floor of the car. I could smell it before I saw it. He made a mad dash for the A&E exit while the nurses ‘ backs were turned but he walked into the wall instead, missing the door by a ninety degree angle and a good few feet.
A common problem for us is frequent flyers – callers who make 999 pleas on a regular basis for no medical reason and end up choking the system. I didn’t know that’s what I had next when I arrived to find a 49 year-old man crouched inside a telephone box. He’d called and said ‘please’ a few times but not much else. I couldn’t get much out of him either, except for his name. Then he told me he’d been abused in the street and started sobbing. I had initially asked for an ambulance because he’d also told me he had ‘heart problems’ but I took him in the car when I discovered that he was known for calling us with this problem. In fact, he was famous for telling everyone he had a ‘broken heart’. He had no cardiac history - he was just sad.
Continuing with the theme of wasted calls, I was asked to investigate a callbox from which an unknown male had dialled 999 with an unknown problem almost two hours earlier. This was a clear-up exercise I guess because when I got there nobody was around – not surprising really.
A 37 year-old man (a large man) knelt at a bus shelter waiting for me. He was still on the phone to the call-taker and waved for me to stop. This wasn’t his first time calling 999 I figured. He was very drunk, could barely walk, barely speak and had no sense of what I and my colleagues were actually around to do. All he wanted was a hospital bed and for no other reason than he wasn’t feeling well. He’d been sick at the bus stop and told me he had diarrhoea. There were no ambulances available and I had to make my usual (now much more detailed) judgment call about whether or not he really needed an ambulance or if I could take him in the car. I offered him the chance to go if he behaved and he waited until I was well underway before announcing that he only hurt people who ‘annoyed him’. Great.
Be safe.
Tuesday, 16 March 2010
Navigation
Night shift: Seven calls; one treated on scene; two assisted-only; one by car; three by ambulance.
Stats: 1 NPC; 1 Fall; 1 Near faint; 1 Chest pain; 3 eTOH.
My Mobile Data Terminal (MDT) was playing up and the first call I got had to be taken and processed ‘manually’, so I went to an underground station to help an elderly man who’d fallen and had a head injury. The call was upgraded and I thought there might be a significant reason for that but it turned out he was ‘not alert’ according to the report given by the MOP who’d called it in. This can mean nothing and everything to a lay-person. We really should find a better way of saying these things – like pain scoring (out of 10, how bad is the pain?) – many people just don’t know what it means. Anyway, it was all moot because I’d been given the wrong location (the caller had given the wrong location) and I ended up walking what felt like a mile to the other side of the station. By that time, and having given the correct location to be passed on to the crew, the ambulance had arrived and he was no longer my patient.
After a changeover of vehicle (yep, another broken one), I was off to the aid of a 66 year-old gentleman who stumbled on the kerb, fell over and smashed his face on the road. He had various minor cuts and grazes on it but he’d also broken his dental crown and burst his lip. Nevertheless, he didn’t want to go to A&E (and why would he?) and agreed to see his dentist first thing for a repair. He was a lovely man who understood the difference between a minor injury and an emergency. Oh, and it was the concerned staff at his club that had called 999 for this but I guess they were being cautious.
I saw a low-loader taking two of those pedi-cabs away on the back of it. They must have parked illegally; it was unlikely they were being taken in for repair. That made me smile because I just don’t like them.
A 19 year-old female collapsed after being in a sauna at a health club and I was sent to see if there was a need for an ambulance. There wasn’t because she was fine but her legs wouldn’t work and, with the help of a staff member, we got her to fresher, cooler air by wheeling her carefully around the edge of a swimming pool and then supporting her up to the reception area. She had other issues going on and her collapse and useless legs were part of an ongoing situation, so we had a frank chat about it all and she seemed to feel better and her legs became more useful. I took her home by request (yes, we do that) and her flatmate helped me to get her back to safety.
Later on a 42 year-old man complained of chest pain at work. He had right-sided pain and a troubling ache down his right leg and the two could well be connected as PE’s can manifest like this. However, before we all go jumping to clinical conclusions, he had also been attempting to get fit again after quitting cigarettes recently and a heavy workout at the gym could cause this kind of problem when muscles have been over-worked. His ECG was fine and the rest of his vital signs were normal, so there was no definitive diagnosis here. He stated that he’d been feeling ‘out of breath’ when he exerted himself but, again, this could be the result of his new-found health drive – his body may simply be rebelling. He went to hospital by ambulance for further tests.
A crying Italian 20 year-old next. He was found slumped against a shop window – clearly drunk but people thought he might need an ambulance so 999 was called for ‘abdo pain’, which covers a multitude of sins. A police officer was standing with him when I arrived after my ten-second dash up the road from where I was sitting in the car (I think they see where I am and make these calls up sometimes). The man was telling the cop that he wanted to go home. His broken English was bad enough for us to have to ask him to repeat himself over and over, while he had the same problem with us and frequently said ‘eh?’ or ‘what?’ in response to our questions. It was like a little comedy had opened up in the street at one in the morning.
He wasn’t going to hospital because there was nothing wrong with him and the police officer offered to unclog the NHS by taking him to the local police station, where he could sit and cry and sober up. I offered, in turn, to drive them both there and it was sewn up like that. The man just wanted to go home and thought we could help him. He was crying because, as he stated repeatedly in his own words, ‘I am uncomfortable with alcohol’. I respectfully suggest you don’t drink it then.
Another drunken young man who thought he could just go home with too much alcohol on board and a distinct, and very real, inability to stand up, walk, talk or function generally, was lying on the pavement next to a pool of his own vomit and being chaperoned by two police officers when I arrived. ‘I’m alright. I’ve only had a few’ he said. I couldn’t take him in the car so I waited a while for an ambulance and ran out of things to do just before they arrived. The conversation I was having with the patient was pretty much one-way, so I was glad to see the crew.
A repeat of the last job not much later on and I was on my way to Oxford Street to check on a 20 year-old man who’d fallen and possibly had injuries. This usually means nobody has checked.
As I crossed a junction (and this is almost 3am) a car sped towards me as if I was invisible. Luckily I was crawling through the junction at the time, blue lights or not but if I hadn’t stopped in time this idiot driver would have taken the middle of my car out (and me probably). But I got across safely and stopped when I saw two armed police officers standing over my prize. He’d been drinking of course and the call had been made by a strange lady waiting for a bus who seemed to shout and rant for no reason. When another armed unit stopped to see if we were okay, she went into the middle of the road and began to shout at them too. They weren’t happy about that and she was promptly ordered back onto the pavement, an order she thankfully obeyed. Relative peace descended after that and I’m not sure if it was because she’d taken the hint or she’d taken the next bus.
I conveyed the guy in my car – we had no ambulances to spare and this time he sat in the right place, where I could watch him and the cops followed on behind, just in case. He was asleep by the time we got to hospital.
Be safe.
Stats: 1 NPC; 1 Fall; 1 Near faint; 1 Chest pain; 3 eTOH.
My Mobile Data Terminal (MDT) was playing up and the first call I got had to be taken and processed ‘manually’, so I went to an underground station to help an elderly man who’d fallen and had a head injury. The call was upgraded and I thought there might be a significant reason for that but it turned out he was ‘not alert’ according to the report given by the MOP who’d called it in. This can mean nothing and everything to a lay-person. We really should find a better way of saying these things – like pain scoring (out of 10, how bad is the pain?) – many people just don’t know what it means. Anyway, it was all moot because I’d been given the wrong location (the caller had given the wrong location) and I ended up walking what felt like a mile to the other side of the station. By that time, and having given the correct location to be passed on to the crew, the ambulance had arrived and he was no longer my patient.
After a changeover of vehicle (yep, another broken one), I was off to the aid of a 66 year-old gentleman who stumbled on the kerb, fell over and smashed his face on the road. He had various minor cuts and grazes on it but he’d also broken his dental crown and burst his lip. Nevertheless, he didn’t want to go to A&E (and why would he?) and agreed to see his dentist first thing for a repair. He was a lovely man who understood the difference between a minor injury and an emergency. Oh, and it was the concerned staff at his club that had called 999 for this but I guess they were being cautious.
I saw a low-loader taking two of those pedi-cabs away on the back of it. They must have parked illegally; it was unlikely they were being taken in for repair. That made me smile because I just don’t like them.
A 19 year-old female collapsed after being in a sauna at a health club and I was sent to see if there was a need for an ambulance. There wasn’t because she was fine but her legs wouldn’t work and, with the help of a staff member, we got her to fresher, cooler air by wheeling her carefully around the edge of a swimming pool and then supporting her up to the reception area. She had other issues going on and her collapse and useless legs were part of an ongoing situation, so we had a frank chat about it all and she seemed to feel better and her legs became more useful. I took her home by request (yes, we do that) and her flatmate helped me to get her back to safety.
Later on a 42 year-old man complained of chest pain at work. He had right-sided pain and a troubling ache down his right leg and the two could well be connected as PE’s can manifest like this. However, before we all go jumping to clinical conclusions, he had also been attempting to get fit again after quitting cigarettes recently and a heavy workout at the gym could cause this kind of problem when muscles have been over-worked. His ECG was fine and the rest of his vital signs were normal, so there was no definitive diagnosis here. He stated that he’d been feeling ‘out of breath’ when he exerted himself but, again, this could be the result of his new-found health drive – his body may simply be rebelling. He went to hospital by ambulance for further tests.
A crying Italian 20 year-old next. He was found slumped against a shop window – clearly drunk but people thought he might need an ambulance so 999 was called for ‘abdo pain’, which covers a multitude of sins. A police officer was standing with him when I arrived after my ten-second dash up the road from where I was sitting in the car (I think they see where I am and make these calls up sometimes). The man was telling the cop that he wanted to go home. His broken English was bad enough for us to have to ask him to repeat himself over and over, while he had the same problem with us and frequently said ‘eh?’ or ‘what?’ in response to our questions. It was like a little comedy had opened up in the street at one in the morning.
He wasn’t going to hospital because there was nothing wrong with him and the police officer offered to unclog the NHS by taking him to the local police station, where he could sit and cry and sober up. I offered, in turn, to drive them both there and it was sewn up like that. The man just wanted to go home and thought we could help him. He was crying because, as he stated repeatedly in his own words, ‘I am uncomfortable with alcohol’. I respectfully suggest you don’t drink it then.
Another drunken young man who thought he could just go home with too much alcohol on board and a distinct, and very real, inability to stand up, walk, talk or function generally, was lying on the pavement next to a pool of his own vomit and being chaperoned by two police officers when I arrived. ‘I’m alright. I’ve only had a few’ he said. I couldn’t take him in the car so I waited a while for an ambulance and ran out of things to do just before they arrived. The conversation I was having with the patient was pretty much one-way, so I was glad to see the crew.
A repeat of the last job not much later on and I was on my way to Oxford Street to check on a 20 year-old man who’d fallen and possibly had injuries. This usually means nobody has checked.
As I crossed a junction (and this is almost 3am) a car sped towards me as if I was invisible. Luckily I was crawling through the junction at the time, blue lights or not but if I hadn’t stopped in time this idiot driver would have taken the middle of my car out (and me probably). But I got across safely and stopped when I saw two armed police officers standing over my prize. He’d been drinking of course and the call had been made by a strange lady waiting for a bus who seemed to shout and rant for no reason. When another armed unit stopped to see if we were okay, she went into the middle of the road and began to shout at them too. They weren’t happy about that and she was promptly ordered back onto the pavement, an order she thankfully obeyed. Relative peace descended after that and I’m not sure if it was because she’d taken the hint or she’d taken the next bus.
I conveyed the guy in my car – we had no ambulances to spare and this time he sat in the right place, where I could watch him and the cops followed on behind, just in case. He was asleep by the time we got to hospital.
Be safe.
Friday, 12 March 2010
Free lunch (there is such a thing)
Day shift: Four calls; one by car; one assisted-only; one declined; one gone before arrival.
Stats: 1 eTOH; 1 Panic attack; 1Headache.
They put me on a ‘truck’ for the morning to help a trainee who was being assessed. I was his bitch for a few hours as he impressed the Training Officer with his skills and knowledge. We used to call this rideout a ‘Millar’ (or the clinical part of it) and it qualified you as a fully-fledged Ambulance Technician. I left them to it when I had to go to my regular(ish) FRU meeting – I’m sure he will do well.
When I returned from my free lunch and discussions, I was tasked to a one-after-the-other treat of low-grade calls, starting with a 40 year-old female who was ‘almost falling over’ and ‘drunk’ outside a cafe. She had hip problems in fact, and her balance was all over the place because of it but she had a stick to compensate. Yes, she’d had a drink or three as well but she always did, she told me. She wasn’t happy that people had called an ambulance for her but I offered to drive her to her flat because I was sure she wouldn’t get too far down the street before she toppled over. Her home was a few streets away and it wasn’t a problem.
She chatted to me (or at me) all of the way in the car and to the top of her stairs, where her flat, shrouded in dust and debris from ongoing building works, greeted us with open door. The workmen were inside – she’d given them the key.
As soon as I stepped out of the flat (the woman offered me a pair of shoes from the hallway because she thought they’d suit me) I was sent literally across the street to a pub where a 21 year-old Italian tourist had collapsed. Her friends thought she was having an asthma attack but she was panicking. Her bag had been snatched while she sat with the group she was with and now she was upset. Not really a 999 call.
I reassured her and she declined medical help or a trip to hospital – the only sensible choice.
Straight away, I was off to a surveillance store, where a 50 year-old man had called us and the police. He’d stated that he had a headache (thus an ambulance was required)and that the store staff were ‘keeping him in there’. The police were on scene when I arrived but the man, who insisted I took his blood pressure and then promptly asked me to write it down for him, as well as my own details (he got my call sign), was erratic and nervy – he refused to go to hospital, then said he wanted to, then refused again. I asked him over and over if he wanted me to take him but in the end he told us he’d make his own way ‘immediately’ and that was that.
The patient with back pain who’d suffered for a week and now wanted an ambulance got one – me. Unfortunately, even after a week, he had no patience to wait and went up the road to the Walk-in Centre in a taxi. Apparently, according to his colleague who met me when I arrived on scene, he had to be carried.
Be safe.
Stats: 1 eTOH; 1 Panic attack; 1Headache.
They put me on a ‘truck’ for the morning to help a trainee who was being assessed. I was his bitch for a few hours as he impressed the Training Officer with his skills and knowledge. We used to call this rideout a ‘Millar’ (or the clinical part of it) and it qualified you as a fully-fledged Ambulance Technician. I left them to it when I had to go to my regular(ish) FRU meeting – I’m sure he will do well.
When I returned from my free lunch and discussions, I was tasked to a one-after-the-other treat of low-grade calls, starting with a 40 year-old female who was ‘almost falling over’ and ‘drunk’ outside a cafe. She had hip problems in fact, and her balance was all over the place because of it but she had a stick to compensate. Yes, she’d had a drink or three as well but she always did, she told me. She wasn’t happy that people had called an ambulance for her but I offered to drive her to her flat because I was sure she wouldn’t get too far down the street before she toppled over. Her home was a few streets away and it wasn’t a problem.
She chatted to me (or at me) all of the way in the car and to the top of her stairs, where her flat, shrouded in dust and debris from ongoing building works, greeted us with open door. The workmen were inside – she’d given them the key.
As soon as I stepped out of the flat (the woman offered me a pair of shoes from the hallway because she thought they’d suit me) I was sent literally across the street to a pub where a 21 year-old Italian tourist had collapsed. Her friends thought she was having an asthma attack but she was panicking. Her bag had been snatched while she sat with the group she was with and now she was upset. Not really a 999 call.
I reassured her and she declined medical help or a trip to hospital – the only sensible choice.
Straight away, I was off to a surveillance store, where a 50 year-old man had called us and the police. He’d stated that he had a headache (thus an ambulance was required)and that the store staff were ‘keeping him in there’. The police were on scene when I arrived but the man, who insisted I took his blood pressure and then promptly asked me to write it down for him, as well as my own details (he got my call sign), was erratic and nervy – he refused to go to hospital, then said he wanted to, then refused again. I asked him over and over if he wanted me to take him but in the end he told us he’d make his own way ‘immediately’ and that was that.
The patient with back pain who’d suffered for a week and now wanted an ambulance got one – me. Unfortunately, even after a week, he had no patience to wait and went up the road to the Walk-in Centre in a taxi. Apparently, according to his colleague who met me when I arrived on scene, he had to be carried.
Be safe.
Thursday, 11 March 2010
The man in the Watergel mask
Day shift: Eight calls; two by car; one treated on scene; five by ambulance.
Stats: 1 Hypothermic; 1 Viral infection; 1 Cyst in foot; 2 Head injuries; 1 Burns; 1 RTA with leg & neck pain; 1 Cut hand.
As I drove across Waterloo Bridge this morning I saw a large drift of black smoke, somewhere in the east of London, where a fire was, or had been burning. I wondered if any of our crews had been sent to it.
Almost immediately into the shift we were tasked with recovering a drunken male who’d been found asleep outside a tube station. He had been waiting for it to open so that he could go home but I think he’d been there all night because when his temperature was checked it read 33c. He was with the police and was refusing any help but underground staff wouldn’t let him travel in his current condition, so the only thing for it was to take him to hospital and after a bit of a debate, he agreed. He was quiet and good natured, so it was a routine trip and another life saved with no effort
Same again later on when we were sent to a 19 year-old supposedly ‘fitting’ at a hostel for foreign visitors. He wasn’t fitting and never had been – he had a viral infection and a sore throat. His raised temperature could go with him to the local GP or walk-in centre because, if we could possibly avoid it, he wasn’t going to a busy hospital with ill people in it. An ambulance arrived obviously (before I could cancel it), so I left the ultimate decision with the crew.
A special assignment next for a high-ranking foreign diplomat who had a cyst on his foot. All he needed was a dressing on it – it had already been partially drained by a doctor. We were ushered into a posh hotel and up to the Presidential Suite floor by a Diplomatic Protection Officer. The treatment process took no more than a few minutes to complete but the security surrounding him was such that it took almost 30 minutes to get to him and be shown back out via back lifts and cellar areas. We were, for the time we were on scene, the secret agents of the ambulance service.
The next job was interesting too – an employee of the Inland Revenue fell down concrete steps and cracked her head open. She’d been laying on the cold floor, bleeding into a dressing applied by the first aider for 20 minutes before we arrived (ambulance shortage at the time). She hadn’t been knocked unconscious but as soon as I lifted the dressing to peer at the wound a line of arterial blood squirted across my glove. She had severed her Temporal Artery. I immediately applied pressure and placed another dressing on to the site as quickly as possible – this was tricky considering she was a potential neck injury and her fine, long hair (matted in blood) made the task awkward. When it was done, we moved her (with the help of lots of hands) carefully into a better position for a collar and awaited the ambulance crew – then she was immobilised and lifted out to the ambulance.
Before I could get anything to eat (but luckily managed to go to the loo) we got a call for a 17 year-old chef at a high-brow restaurant who’d burned his face with hot oil. The stuff reaches 200c I was told and as soon as I saw him I realised how lucky he’d been. His entire face was scalded – he had partial thickness burns from his scalp to his chin. He’d also burned his hands and shoulder and one of his ears but these were less severe and only superficial - like a bad sunburn without blisters. In total he had around 20 – 25% burns to his body. He’d been smart enough to douse his face in cold water for almost ten minutes before we arrived and I applied a Watergel mask (which had to be made on the spot). His hands could be dealt with simply enough and I acquired a couple of plastic bags to be tied over the Watergel dressings we’d put on them.
He sucked on Entonox and this helped ease the pain considerably. The crew arrived shortly after we’d settled him down and done all we could to stop the burning process but he will still need specialist treatment at hospital to prevent any permanent scarring to his face.
A RTC that presented us with nothing more than a young man sitting on a wall, waving at us as if we were his taxi, started out as a simple covey in the car to a collar and immobilisation job. His car had been shunted from behind and his leg had been injured (a minor muscle pain) when his seat slid forward. The police weren’t too happy with him because he let the driver who’d hit him go after supplying details. You only do that if you are in a minor vehicle accident with no injuries – otherwise all parties must stay on scene.
He complained of C4 neck pain after fifteen minutes and as I was just about to set off for hospital with him in the car and this, of course, changed the rules. Now we had to have an ambulance and another twenty minutes passed by as we collared him and got him onto a scoop and stretcher for the journey.
A fairly drunken 72 year-old fell off his bar stool and smashed his head on a metal carpet strip, cutting it open above his eye. His friends told us he’d just ‘blacked out’ when he fell, so after his wound had been dressed, his pulse and blood pressure measurements were taken – one was slow and one was low – a combination often seen in heart blocks.
An ambulance arrived and his ECG was taken (I couldn’t do it in the pub now that it was filling with regulars). There was evidence of an AV block – a long P-R interval. This accounted for his bradycardia (averaging at 48bpm) and thus, the low blood pressure... and ultimately his syncope and head injury. Off he went then, for treatment to his head injury and some advice from a doctor about his heart.
We still get 999 calls from people who have fairly minor injuries that could and should walk into A&E for treatment... or a Minor Injuries Unit. I might open up a little treatment centre in the future. It would deal with all those little cuts, bumps and grazes that some individuals believe, hand-on-heart are emergencies. So, the 22 year restaurant worker who sliced open the palm of her hand when a wine glass she was handling shattered, was given an expensive run in the car to hospital, after basic first aid; dressing and elevation sling, was applied. Prior to that, she’d been given a blue plaster and a gauze sheet to wrap her poorly hand up in.
Be safe.
Stats: 1 Hypothermic; 1 Viral infection; 1 Cyst in foot; 2 Head injuries; 1 Burns; 1 RTA with leg & neck pain; 1 Cut hand.
As I drove across Waterloo Bridge this morning I saw a large drift of black smoke, somewhere in the east of London, where a fire was, or had been burning. I wondered if any of our crews had been sent to it.
Almost immediately into the shift we were tasked with recovering a drunken male who’d been found asleep outside a tube station. He had been waiting for it to open so that he could go home but I think he’d been there all night because when his temperature was checked it read 33c. He was with the police and was refusing any help but underground staff wouldn’t let him travel in his current condition, so the only thing for it was to take him to hospital and after a bit of a debate, he agreed. He was quiet and good natured, so it was a routine trip and another life saved with no effort
Same again later on when we were sent to a 19 year-old supposedly ‘fitting’ at a hostel for foreign visitors. He wasn’t fitting and never had been – he had a viral infection and a sore throat. His raised temperature could go with him to the local GP or walk-in centre because, if we could possibly avoid it, he wasn’t going to a busy hospital with ill people in it. An ambulance arrived obviously (before I could cancel it), so I left the ultimate decision with the crew.
A special assignment next for a high-ranking foreign diplomat who had a cyst on his foot. All he needed was a dressing on it – it had already been partially drained by a doctor. We were ushered into a posh hotel and up to the Presidential Suite floor by a Diplomatic Protection Officer. The treatment process took no more than a few minutes to complete but the security surrounding him was such that it took almost 30 minutes to get to him and be shown back out via back lifts and cellar areas. We were, for the time we were on scene, the secret agents of the ambulance service.
The next job was interesting too – an employee of the Inland Revenue fell down concrete steps and cracked her head open. She’d been laying on the cold floor, bleeding into a dressing applied by the first aider for 20 minutes before we arrived (ambulance shortage at the time). She hadn’t been knocked unconscious but as soon as I lifted the dressing to peer at the wound a line of arterial blood squirted across my glove. She had severed her Temporal Artery. I immediately applied pressure and placed another dressing on to the site as quickly as possible – this was tricky considering she was a potential neck injury and her fine, long hair (matted in blood) made the task awkward. When it was done, we moved her (with the help of lots of hands) carefully into a better position for a collar and awaited the ambulance crew – then she was immobilised and lifted out to the ambulance.
Before I could get anything to eat (but luckily managed to go to the loo) we got a call for a 17 year-old chef at a high-brow restaurant who’d burned his face with hot oil. The stuff reaches 200c I was told and as soon as I saw him I realised how lucky he’d been. His entire face was scalded – he had partial thickness burns from his scalp to his chin. He’d also burned his hands and shoulder and one of his ears but these were less severe and only superficial - like a bad sunburn without blisters. In total he had around 20 – 25% burns to his body. He’d been smart enough to douse his face in cold water for almost ten minutes before we arrived and I applied a Watergel mask (which had to be made on the spot). His hands could be dealt with simply enough and I acquired a couple of plastic bags to be tied over the Watergel dressings we’d put on them.
He sucked on Entonox and this helped ease the pain considerably. The crew arrived shortly after we’d settled him down and done all we could to stop the burning process but he will still need specialist treatment at hospital to prevent any permanent scarring to his face.
A RTC that presented us with nothing more than a young man sitting on a wall, waving at us as if we were his taxi, started out as a simple covey in the car to a collar and immobilisation job. His car had been shunted from behind and his leg had been injured (a minor muscle pain) when his seat slid forward. The police weren’t too happy with him because he let the driver who’d hit him go after supplying details. You only do that if you are in a minor vehicle accident with no injuries – otherwise all parties must stay on scene.
He complained of C4 neck pain after fifteen minutes and as I was just about to set off for hospital with him in the car and this, of course, changed the rules. Now we had to have an ambulance and another twenty minutes passed by as we collared him and got him onto a scoop and stretcher for the journey.
A fairly drunken 72 year-old fell off his bar stool and smashed his head on a metal carpet strip, cutting it open above his eye. His friends told us he’d just ‘blacked out’ when he fell, so after his wound had been dressed, his pulse and blood pressure measurements were taken – one was slow and one was low – a combination often seen in heart blocks.
An ambulance arrived and his ECG was taken (I couldn’t do it in the pub now that it was filling with regulars). There was evidence of an AV block – a long P-R interval. This accounted for his bradycardia (averaging at 48bpm) and thus, the low blood pressure... and ultimately his syncope and head injury. Off he went then, for treatment to his head injury and some advice from a doctor about his heart.
We still get 999 calls from people who have fairly minor injuries that could and should walk into A&E for treatment... or a Minor Injuries Unit. I might open up a little treatment centre in the future. It would deal with all those little cuts, bumps and grazes that some individuals believe, hand-on-heart are emergencies. So, the 22 year restaurant worker who sliced open the palm of her hand when a wine glass she was handling shattered, was given an expensive run in the car to hospital, after basic first aid; dressing and elevation sling, was applied. Prior to that, she’d been given a blue plaster and a gauze sheet to wrap her poorly hand up in.
Be safe.
Wednesday, 10 March 2010
Poor little heart
Day shift: Four calls; two by car; two by ambulance.
Stats: 1 Abdo pain; 1 Chest pain; 1 RTC with fracture; 1 Earache.
My Uni Student is out with me for the next few shifts and so I’m observing more than doing for a change. The shift started with a straight-forward car transfer from an underground station, where a 28 year-old woman was suffering abdo pain (period pain).
Then a call came in for an 11 year-old girl at school who had chest pain. Normally a young-person-chest-pain call is actually nothing of the kind but when it’s a child there are implications. We took the call seriously and the update informed us that she had a heart condition and was waiting for a pacemaker to be fitted. I’d already sussed the possibility of her having this kind of problem because I’ve been called to a few in the past and, in my time teaching in schools, I’ve heard of other cases.
The girl was floppy, quiet and looked very frightened. She had that particular look on her face - you normally see it on adults when they are genuinely in trouble and they know it. I couldn’t detect a radial pulse and her pulse rate was very slow – around 45bpm via my sats probe. Typically for a child, her oxygen saturation was high despite her condition.
The ambulance arrived quickly and we moved her by chair into the back of it for an ECG. I’d expected to see a profoundly bradycardic rhythm and, sure enough, she had a slow rate (41bpm) with few P waves and escape complexes randomly spaced in couplets and triplets. Her natural pacemaker wasn’t functioning and her heart was firing slow compensatory impulses from the upper ventricles to stay alive. I think if she’d been older, she’d have had a very short time before her heart gave up. Even at her age, this could be a potentially life-threatening condition.
We got her to hospital rapidly and she was taken into Resus with her worried teachers in tow. She may have to be given an artificial pacemaker to resolve this issue. The poor little girl never uttered a complaint throughout.
A RTC in which a motorcyclist hit a U-turning car (all too common) next and we found him in the middle of the road with police officers trying to control the traffic, although buses and other vehicles were still passing quite close to his feet. I asked for the traffic to be stopped completely to safeguard the patient and ourselves while we assessed him. He was conscious and alert and the only pain he had was in his shoulder. He had a badly fractured collar bone and I discovered later that he’d landed on this when he came off his bike at around 20mph.
He was very reluctant to allow us to examine him properly – this meant cutting away clothing and his biggest fear was that we would cut into his leather jacket. Now, I completely understand how motorcyclists feel about this item of protective clothing because it is very expensive but we can hardly sit a potential spinal patient up and remove it manually. He was more worried about his jacket than his broken bone.
In the end, and with a crew on scene to help, we managed to get the jacket off without butchering it. He could have claimed compensation for it anyway.
The last job of the day was to a 6 year-old girl with earache, neck pain and a sore throat. When we got to her flat she was lying in bed feeling very sorry for herself and I could see why immediately. She had an advanced infection and we were told this was recurrent; ongoing for the past year or so. This recent bout had been treated with antibiotics but they weren’t working and, although the family had asked for more, they had been told the girl was ‘okay’ and didn’t need anything else. This, in my opinion, was nonsense because she had a hugely swollen Submandibular gland, an almost closed pharyngeal space, a high temperature and severe earache. She had all the signs of Chronic Recurrent Otitis Media, a disease that could ultimately destroy her middle ear bones and lead to deafness.
She was awaiting an operation but the family couldn’t specify what she was going to have done – it could be an adenoidectomy, a typanoplasty, myringoplasty or to have a grommet fitted. If she didn’t get help with this, it could develop into a more severe infection – spreading into the bones and causing Mastoiditis or Meningitis, which can be fatal.
We took her and her family in the car to hospital where, hopefully, they will see how urgently she needs treatment to resolve her acute condition.
Be safe.
Stats: 1 Abdo pain; 1 Chest pain; 1 RTC with fracture; 1 Earache.
My Uni Student is out with me for the next few shifts and so I’m observing more than doing for a change. The shift started with a straight-forward car transfer from an underground station, where a 28 year-old woman was suffering abdo pain (period pain).
Then a call came in for an 11 year-old girl at school who had chest pain. Normally a young-person-chest-pain call is actually nothing of the kind but when it’s a child there are implications. We took the call seriously and the update informed us that she had a heart condition and was waiting for a pacemaker to be fitted. I’d already sussed the possibility of her having this kind of problem because I’ve been called to a few in the past and, in my time teaching in schools, I’ve heard of other cases.
The girl was floppy, quiet and looked very frightened. She had that particular look on her face - you normally see it on adults when they are genuinely in trouble and they know it. I couldn’t detect a radial pulse and her pulse rate was very slow – around 45bpm via my sats probe. Typically for a child, her oxygen saturation was high despite her condition.
The ambulance arrived quickly and we moved her by chair into the back of it for an ECG. I’d expected to see a profoundly bradycardic rhythm and, sure enough, she had a slow rate (41bpm) with few P waves and escape complexes randomly spaced in couplets and triplets. Her natural pacemaker wasn’t functioning and her heart was firing slow compensatory impulses from the upper ventricles to stay alive. I think if she’d been older, she’d have had a very short time before her heart gave up. Even at her age, this could be a potentially life-threatening condition.
We got her to hospital rapidly and she was taken into Resus with her worried teachers in tow. She may have to be given an artificial pacemaker to resolve this issue. The poor little girl never uttered a complaint throughout.
A RTC in which a motorcyclist hit a U-turning car (all too common) next and we found him in the middle of the road with police officers trying to control the traffic, although buses and other vehicles were still passing quite close to his feet. I asked for the traffic to be stopped completely to safeguard the patient and ourselves while we assessed him. He was conscious and alert and the only pain he had was in his shoulder. He had a badly fractured collar bone and I discovered later that he’d landed on this when he came off his bike at around 20mph.
He was very reluctant to allow us to examine him properly – this meant cutting away clothing and his biggest fear was that we would cut into his leather jacket. Now, I completely understand how motorcyclists feel about this item of protective clothing because it is very expensive but we can hardly sit a potential spinal patient up and remove it manually. He was more worried about his jacket than his broken bone.
In the end, and with a crew on scene to help, we managed to get the jacket off without butchering it. He could have claimed compensation for it anyway.
The last job of the day was to a 6 year-old girl with earache, neck pain and a sore throat. When we got to her flat she was lying in bed feeling very sorry for herself and I could see why immediately. She had an advanced infection and we were told this was recurrent; ongoing for the past year or so. This recent bout had been treated with antibiotics but they weren’t working and, although the family had asked for more, they had been told the girl was ‘okay’ and didn’t need anything else. This, in my opinion, was nonsense because she had a hugely swollen Submandibular gland, an almost closed pharyngeal space, a high temperature and severe earache. She had all the signs of Chronic Recurrent Otitis Media, a disease that could ultimately destroy her middle ear bones and lead to deafness.
She was awaiting an operation but the family couldn’t specify what she was going to have done – it could be an adenoidectomy, a typanoplasty, myringoplasty or to have a grommet fitted. If she didn’t get help with this, it could develop into a more severe infection – spreading into the bones and causing Mastoiditis or Meningitis, which can be fatal.
We took her and her family in the car to hospital where, hopefully, they will see how urgently she needs treatment to resolve her acute condition.
Be safe.
Earache
Day shift: Four calls; two by car; two by ambulance.
Stats: 1 Abdo pain; 1 Chest pain; 1 RTC with fracture; 1 Earache.
My Uni Student is out with me for the next few shifts and so I’m observing more than doing for a change. The shift started with a straight-forward car transfer from an underground station, where a 28 year-old woman was suffering abdo pain (period pain).
Then a call came in for an 11 year-old girl at school who had chest pain. Normally a young-person chest pain call is actually nothing of the kind but when it’s a child there are implications. We took the call seriously and the update informed us that she had a heart condition and was waiting for a pacemaker to be fitted. I’d already sussed the possibility of her having this kind of problem because I’ve been called to a few in the past and, in my time teaching in schools, I’ve heard of many other cases.
The girl was floppy, quiet and looked very frightened. She had that particular look on her face that you normally see on adults when they are genuinely in trouble and they know it. I couldn’t detect a radial pulse and her pulse rate was very slow – around 45bpm via my sats probe. Typically for a child, her oxygen saturation was high despite her condition.
The ambulance arrived quickly and we moved her by chair into the back of it for an ECG. I’d expected to see a profoundly bradycardic rhythm and, sure enough, she had a slow rate (41bpm) with few P waves and escape complexes randomly spaced in couplets and triplets. Her natural pacemaker wasn’t functioning and her heart was firing slow compensatory impulses from the upper ventricles to stay alive. I think if she’d been older, she’d have had a very short time before her heart gave up. Even at her age, this could be a potentially life-threatening condition.
We got her to hospital rapidly and she was taken into Resus with her worried teachers in tow. She may have to be given an artificial pacemaker to resolve this issue. The poor little girl never uttered a complaint throughout.
A RTC in which a motorcyclist hit a U-turning car (all too common) next and we found him in the middle of the road with police officers trying to control the traffic, although buses and other vehicles were still passing quite close to his feet. I asked for the traffic to be stopped completely to safeguard the patient and ourselves while we assessed him. He was conscious and alert and the only pain he had was in his shoulder. He had a badly fractured collar bone and I discovered later that he’d landed on this when he came off his bike at around 20mph.
He was very reluctant to allow us to examine him properly – this meant cutting away clothing and his biggest fear was that we would cut into his leather jacket. Now, I completely understand how motorcyclists feel about this item of protective clothing because it is very expensive but we can hardly sit a potential spinal patient up and remove it manually. He was more worried about his jacket than his broken bone.
In the end, and with a crew on scene to help, we managed to get the jacket off without butchering it. He could have claimed compensation for it anyway.
The last job of the day was to a 6 year-old girl with earache, neck pain and a sore throat. When we got to her flat she was lying in bed feeling very sorry for herself and I could see why immediately. She had an advanced infection and we were told this was recurrent; ongoing for the past year or so. This recent bout had been treated with antibiotics but they weren’t working and, although the family had asked for more, they had been told the girl was ‘okay’ and didn’t need anything else. This, in my opinion, was rubbish because she had a hugely swollen parotid gland, an almost closed pharyngeal space, a high temperature and severe earache. She had all the signs of Chronic Recurrent Otitis Media, a disease that could ultimately destroy her middle ear bones and lead to deafness.
She was awaiting an operation but the family couldn’t specify what she was going to have done – it could be an adenoidectomy, a typanoplasty, myringoplasty or to have a grommet fitted. If she didn’t get help with this, it could develop into a more severe infection – spreading into the bones and causing Mastoiditis or Meningitis, which can be fatal.
We took her and her family in the car to hospital where, hopefully, they will see how urgently she needs treatment to resolve her acute condition.
Be safe.
Stats: 1 Abdo pain; 1 Chest pain; 1 RTC with fracture; 1 Earache.
My Uni Student is out with me for the next few shifts and so I’m observing more than doing for a change. The shift started with a straight-forward car transfer from an underground station, where a 28 year-old woman was suffering abdo pain (period pain).
Then a call came in for an 11 year-old girl at school who had chest pain. Normally a young-person chest pain call is actually nothing of the kind but when it’s a child there are implications. We took the call seriously and the update informed us that she had a heart condition and was waiting for a pacemaker to be fitted. I’d already sussed the possibility of her having this kind of problem because I’ve been called to a few in the past and, in my time teaching in schools, I’ve heard of many other cases.
The girl was floppy, quiet and looked very frightened. She had that particular look on her face that you normally see on adults when they are genuinely in trouble and they know it. I couldn’t detect a radial pulse and her pulse rate was very slow – around 45bpm via my sats probe. Typically for a child, her oxygen saturation was high despite her condition.
The ambulance arrived quickly and we moved her by chair into the back of it for an ECG. I’d expected to see a profoundly bradycardic rhythm and, sure enough, she had a slow rate (41bpm) with few P waves and escape complexes randomly spaced in couplets and triplets. Her natural pacemaker wasn’t functioning and her heart was firing slow compensatory impulses from the upper ventricles to stay alive. I think if she’d been older, she’d have had a very short time before her heart gave up. Even at her age, this could be a potentially life-threatening condition.
We got her to hospital rapidly and she was taken into Resus with her worried teachers in tow. She may have to be given an artificial pacemaker to resolve this issue. The poor little girl never uttered a complaint throughout.
A RTC in which a motorcyclist hit a U-turning car (all too common) next and we found him in the middle of the road with police officers trying to control the traffic, although buses and other vehicles were still passing quite close to his feet. I asked for the traffic to be stopped completely to safeguard the patient and ourselves while we assessed him. He was conscious and alert and the only pain he had was in his shoulder. He had a badly fractured collar bone and I discovered later that he’d landed on this when he came off his bike at around 20mph.
He was very reluctant to allow us to examine him properly – this meant cutting away clothing and his biggest fear was that we would cut into his leather jacket. Now, I completely understand how motorcyclists feel about this item of protective clothing because it is very expensive but we can hardly sit a potential spinal patient up and remove it manually. He was more worried about his jacket than his broken bone.
In the end, and with a crew on scene to help, we managed to get the jacket off without butchering it. He could have claimed compensation for it anyway.
The last job of the day was to a 6 year-old girl with earache, neck pain and a sore throat. When we got to her flat she was lying in bed feeling very sorry for herself and I could see why immediately. She had an advanced infection and we were told this was recurrent; ongoing for the past year or so. This recent bout had been treated with antibiotics but they weren’t working and, although the family had asked for more, they had been told the girl was ‘okay’ and didn’t need anything else. This, in my opinion, was rubbish because she had a hugely swollen parotid gland, an almost closed pharyngeal space, a high temperature and severe earache. She had all the signs of Chronic Recurrent Otitis Media, a disease that could ultimately destroy her middle ear bones and lead to deafness.
She was awaiting an operation but the family couldn’t specify what she was going to have done – it could be an adenoidectomy, a typanoplasty, myringoplasty or to have a grommet fitted. If she didn’t get help with this, it could develop into a more severe infection – spreading into the bones and causing Mastoiditis or Meningitis, which can be fatal.
We took her and her family in the car to hospital where, hopefully, they will see how urgently she needs treatment to resolve her acute condition.
Be safe.
Sunday, 7 March 2010
HEMS aboard
Day shift: Four calls; one dealt with by police; one treated on scene; one by car; one by ambulance.
Stats: 1 Bite; 1 Bacterial infection; 1 EP fit; 1 ? Sprained ankle.
There’s nothing quite like the stupidity of petty brawling between a boyfriend and girlfriend first thing in the morning – especially when it culminates in the boyfriend being bitten and the police being called. The girl was behaving wildly and he was holding her down, trying to control her. A passing motorcyclist had stopped to help and was on the phone to us when I saw them on the bridge. I called it in, got confirmation that it was coming in ‘on the nines’ and attended to stop it getting any uglier than it was.
A crew joined me very soon after and by that time she was making claims of assault against the young lad whilst he sported a very fetching ‘whole set of teeth embedded in forearm’ look. Luckily the skin wasn’t broken because her temperament bore a striking resemblance to someone affected by Rabies.
The cops arrived, talked to them sternly and sent them packing.
I picked up an observer later in the morning – a HEMS doctor was joining me for a few hours to see what us grunts get up to on the line. He chose a Sunday morning, so I was hoping he’d get something out of his free time. Luckily, we didn’t have too long a hiatus before things kicked off.
A 25 year-old man walked into a doctor’s surgery and asked for help with his breathing problems and an ambulance was called for him, so myself and my observer went to help and found him sitting in the waiting area, GP letter to hand and in some distress. He had a raging throat and mouth infection, tonsillitis and pharyngitis, the combination of which was giving him a lot of difficulty when it came to breathing properly, although he was in no immediate danger. The bacterial matter had spread to his tongue, such was the state of his health and I wondered why he had let himself become so run down. Then I read the letter and it detailed his personal circumstances. This young man and his partner had recently lost one of their twin children to meningitis and of course they were at rock bottom. He’d been smoking cannabis constantly and hadn’t eaten for days. His health was suffering and it wasn’t long before he was crying in deep emotional pain. I felt very, very sorry for him.
A crew arrived to take him to hospital and I advised them of the circumstances and the risk to his kidneys – he had been complaining of lower back pain just above each kidney too. He was taken to hospital where, I hope, someone will talk this through with him, as well as treating his physical illness.
Another call came in just as I was offering to pay for coffee at Frith Street for my Doctor guest (a happy coincidence for a Scot you might say), so we went to Park Lane, where a 17 year-old Italian student had fitted. She was recovering when we arrived and a motorcycle colleague was already on scene. He was the one who requested the car instead of an ambulance because the girl was stable.
She was with her tutor and a large group of other visiting students and seemed tired but otherwise okay after her 2-3 minute seizure. She had a single history of fitting but was not on any meds. She had this one four years on from the last and I think it may have been triggered by the change in light (she was in a dark underpass and walked out into the strong sunlight when it happened). She lost bladder control in the car and vomited when she arrived at hospital. In between, the trip was uneventful and she was booked in.
A mum and her two teenage daughters set off for an evening of entertainment – JLS style – but had to pause when one of the daughters, a 13 year-old, took a bit of a tumble down steps (actually as the result of her mother tumbling first). I suggested compensation may be in order if her mother confessed to attempting to throw her child down the stairs but for some reason that bait wasn’t taken. It was all in good humour I have to say.
The girl’s ankle was slightly swollen and if she had a sprain it looked no more than a grade I anyway. Her night out was important and they’d travelled a distance, so mum asked me to ‘strap up’ the ankle and I got the girl to take paracetamol for the pain, which wasn’t too bad. That way they could avoid 4 hours of waiting in hospital and having to return home empty-handed and bereft of the JLS experience. I did advise accordingly but I also understood and the young lady was perfectly able to walk on her injured ankle – always a positive sign. I left them in the care of themselves and the kind and helpful London Underground staff.
It wasn’t long after this that I went home – the sight of a bald man walking around Trafalgar Square with a little black ball balanced on his head made me think it was probably time to leave.
Be safe.
Stats: 1 Bite; 1 Bacterial infection; 1 EP fit; 1 ? Sprained ankle.
There’s nothing quite like the stupidity of petty brawling between a boyfriend and girlfriend first thing in the morning – especially when it culminates in the boyfriend being bitten and the police being called. The girl was behaving wildly and he was holding her down, trying to control her. A passing motorcyclist had stopped to help and was on the phone to us when I saw them on the bridge. I called it in, got confirmation that it was coming in ‘on the nines’ and attended to stop it getting any uglier than it was.
A crew joined me very soon after and by that time she was making claims of assault against the young lad whilst he sported a very fetching ‘whole set of teeth embedded in forearm’ look. Luckily the skin wasn’t broken because her temperament bore a striking resemblance to someone affected by Rabies.
The cops arrived, talked to them sternly and sent them packing.
I picked up an observer later in the morning – a HEMS doctor was joining me for a few hours to see what us grunts get up to on the line. He chose a Sunday morning, so I was hoping he’d get something out of his free time. Luckily, we didn’t have too long a hiatus before things kicked off.
A 25 year-old man walked into a doctor’s surgery and asked for help with his breathing problems and an ambulance was called for him, so myself and my observer went to help and found him sitting in the waiting area, GP letter to hand and in some distress. He had a raging throat and mouth infection, tonsillitis and pharyngitis, the combination of which was giving him a lot of difficulty when it came to breathing properly, although he was in no immediate danger. The bacterial matter had spread to his tongue, such was the state of his health and I wondered why he had let himself become so run down. Then I read the letter and it detailed his personal circumstances. This young man and his partner had recently lost one of their twin children to meningitis and of course they were at rock bottom. He’d been smoking cannabis constantly and hadn’t eaten for days. His health was suffering and it wasn’t long before he was crying in deep emotional pain. I felt very, very sorry for him.
A crew arrived to take him to hospital and I advised them of the circumstances and the risk to his kidneys – he had been complaining of lower back pain just above each kidney too. He was taken to hospital where, I hope, someone will talk this through with him, as well as treating his physical illness.
Another call came in just as I was offering to pay for coffee at Frith Street for my Doctor guest (a happy coincidence for a Scot you might say), so we went to Park Lane, where a 17 year-old Italian student had fitted. She was recovering when we arrived and a motorcycle colleague was already on scene. He was the one who requested the car instead of an ambulance because the girl was stable.
She was with her tutor and a large group of other visiting students and seemed tired but otherwise okay after her 2-3 minute seizure. She had a single history of fitting but was not on any meds. She had this one four years on from the last and I think it may have been triggered by the change in light (she was in a dark underpass and walked out into the strong sunlight when it happened). She lost bladder control in the car and vomited when she arrived at hospital. In between, the trip was uneventful and she was booked in.
A mum and her two teenage daughters set off for an evening of entertainment – JLS style – but had to pause when one of the daughters, a 13 year-old, took a bit of a tumble down steps (actually as the result of her mother tumbling first). I suggested compensation may be in order if her mother confessed to attempting to throw her child down the stairs but for some reason that bait wasn’t taken. It was all in good humour I have to say.
The girl’s ankle was slightly swollen and if she had a sprain it looked no more than a grade I anyway. Her night out was important and they’d travelled a distance, so mum asked me to ‘strap up’ the ankle and I got the girl to take paracetamol for the pain, which wasn’t too bad. That way they could avoid 4 hours of waiting in hospital and having to return home empty-handed and bereft of the JLS experience. I did advise accordingly but I also understood and the young lady was perfectly able to walk on her injured ankle – always a positive sign. I left them in the care of themselves and the kind and helpful London Underground staff.
It wasn’t long after this that I went home – the sight of a bald man walking around Trafalgar Square with a little black ball balanced on his head made me think it was probably time to leave.
Be safe.
Saturday, 6 March 2010
The Lion man
Day shift: Six calls; one assisted-only; two by car; three by ambulance.Stats: 3 Head injuries; 1 asleep; 1 Period pain.
I’m still not feeling 100% but I’m back on a weekend tour and hoping to keep myself fit and well enough to stay the course until my next rest day. Luckily nothing happened for a few hours and I didn’t get my first call, which was a ‘no patient contact’ because the crew was on scene, for a few hours.
Later on an 89 year-old lady stumbled on a rough, sloping pedestrian ramp and hit her head on landing. She was with a motorcycle colleague and had already been checked and cleared as fit for the car. She had a large bump on her head but had sustained no other injury and wasn’t knocked out. This was her second fall on this type of pedestrian crossing ramp and I suggested that she asked for assistance next time but her face told me she wasn’t sure about asking strangers for help. It’s a shame we’ve arrived at this point in society because, despite her fears, I’m sure she’d still find plenty of people willing to hold her in balance as she negotiated the pavement.
The lions on Trafalgar Square are slippery at the best of times but sitting on them whilst wearing a sleek lycra costume is not advised unless you want to fall off. A Facebook gathering of costumed characters gathered in the Square and one of them, a 24 year-old man, slipped and fell fifteen feet onto his head, landing hard on the ground below. When I got there he had the attention of plenty of police officers and a lot of bystanders, including bemused tourists. He had a small cut to his head but I suspect that hid bone damage underneath. He had no neck pain but he was treated to the full immobilisation required for a fall like that.
Interestingly, as I treated him and waited for the arrival of the crew, none of the lions were occupied. Only after he’d been scooped up and taken into the ambulance did people, including children, start to clamber over them again.
A sleepy-headed man triggered a Red1 call because he chose to go to sleep on a bus. This, as you know, is very, very common and, as yet, nothing is being done about it except that we run around with cars, cycles and ambulances just to wake them up and send them on their way. I was with a cycle responder on this one and initially couldn’t get to it because the roads were being closed down due to yet another demonstration being held in Central London. Typically, none of us out and about knew anything about it – there was no warning. We must get together with the council one day and chat about this stuff. Oh, and the bus-slimbering man eventually got the hint and walked off.
In an underground station a 19 year-old female suffering from abdominal pain asked for an ambulance. She was starting her period today and, although she had been through this higher level of pain several times before, she hadn’t taken anything for it. She had vomited several times and so she felt this additional problem warranted an emergency response.
I took her to A&E in the car and she felt sick as soon as she sat down in the department. I scrabbled around looking for a vomit bowl, knowing that time was running out (it’s a familiar look – that imminent-vomit blanch) but didn’t find one and so she got off the chair, ran around the corner - where the porters usually sit and chat - squatted down and threw up copiously onto the floor - several times. Luckily the porters weren’t in position or there would have been tears (mine probably).
And just to prove that London’s visitors get along just dandy I was called to a 24 year-old male who’d been allegedly assaulted by his erstwhile friend. He was literally chucked onto the ground after a headlock in which he stretched out his arms in submission – nice touch I think. For his trouble he ended up with a 5cm incision in the back of his head that will probably need stitches. His blood-soaked clothing gave away the nature of this short but obviously nasty little encounter – caused primarily by alcohol-induced rage. He was flanked by other, less violent mates and a lone police officer when I arrived and an ambulance turned up just as I finished off the knot on his second head dressing.
Be safe.
Monday, 1 March 2010
Sick
Night shift: Six calls; one cancelled on scene; one left at home; two by car; two by ambulance.
Stats: 1 abdominal pain; 2 back injuries; 1 eTOH; 1 Hyperglycaemic.
I was asked to run to a chest pain but got cancelled on scene as the ambulance arrived, so that I could go in the opposite direction for three miles to attend a woman with abdominal pain. The 34 year-old was with staff when I arrived and she had been suffering an acute ‘sharp’ pain for two hours prior to asking for help. I gave her entonox and got her into the car after checking her medical history (or lack of it) and observations. When I got to A&E it was packed. Every bed was taken up and people queued outside the Majors Department to be seen. In Reception it was just a bad, with a 4-hour wait to see a doctor, if you were lucky.
Then off to see a 5 year-old boy and tell his parents that he didn’t need an ambulance. He’d slipped between a sofa and the wall and landed (not very hard) on the metal end of a set of barbells. He had an insignificant scratch on his lower back and when tested, could flex, bend and move his body properly without pain or guarding. This was a typical example of over-reactive parenting. The tests I did were simple and proved a point – anyone can do them and they are obvious. Look at what happened. Consider what kind of injury could be caused, or not. Test for dysfunction, extreme pain or immobility. In doubt? Call us out. Seemple... as the Meerkat says.
Another soldier call and this time he’d fallen down steps at an underground station. The 19 year-old tripped and toppled, landing hard on his back. He was with police and staff when I arrived and it took 10mg of morphine to deal with the pain before I could move him, with the help of a crew. He was in an awkward position but the move was done slowly and carefully without the need of a scoop or board, which would have added to the nightmare. His injury was mostly muscular and he probably jarred the Sciatic nerve when he hit the hard steps, so I’m sure he will be on his feet and soldiering again very soon.
The drunks of the town have yet to leave us alone, even on a Monday morning they are turning up in police stations. A 22 year-old man sat in the caged entrance to custody with police officers propping him up on a chair as he vomited almost continuously and lolled around muttering stupidity to nobody in particular. He was a large man and I’m told he had to be carried from the police van to this spot. He wasn’t being arrested but he needed to go to hospital because his drinking binge had poisoned him. He got a yellow bag around his neck to vomit in (a Booze Bus invention) and an ambulance to transport him – there was no way he was getting in the car.
I got a break and the system was shut down as calls went ‘manual’ for a few hours. During that time it seemed reasonably quiet but I began to feel quite unwell as the hours passed by and when my next call came in I was feeling very ill. This is not the job to have when you are sick yourself, so my 39 year-old diabetic who’d asked a gang of builders on an early-morning renovation to call an ambulance for him because he was ‘feeling cold’ and had ‘diabetic problems’ got the best of the professional attention I could summon, considering that I probably felt worse than he did.
I had two hours to go and was prepared to see the shift through, as long as I wasn’t exposed to anything that could set my delicate system off (like my earlier vomiting drunk). I took the patient to hospital in the car – he had a BM of 23. By the time I booked him in the nurses were asking if I’d like to book myself in too because I was looking very pale. Needless to say I got myself off home as soon as possible before I dragged the profession into the gutter.
Be safe.
Stats: 1 abdominal pain; 2 back injuries; 1 eTOH; 1 Hyperglycaemic.
I was asked to run to a chest pain but got cancelled on scene as the ambulance arrived, so that I could go in the opposite direction for three miles to attend a woman with abdominal pain. The 34 year-old was with staff when I arrived and she had been suffering an acute ‘sharp’ pain for two hours prior to asking for help. I gave her entonox and got her into the car after checking her medical history (or lack of it) and observations. When I got to A&E it was packed. Every bed was taken up and people queued outside the Majors Department to be seen. In Reception it was just a bad, with a 4-hour wait to see a doctor, if you were lucky.
Then off to see a 5 year-old boy and tell his parents that he didn’t need an ambulance. He’d slipped between a sofa and the wall and landed (not very hard) on the metal end of a set of barbells. He had an insignificant scratch on his lower back and when tested, could flex, bend and move his body properly without pain or guarding. This was a typical example of over-reactive parenting. The tests I did were simple and proved a point – anyone can do them and they are obvious. Look at what happened. Consider what kind of injury could be caused, or not. Test for dysfunction, extreme pain or immobility. In doubt? Call us out. Seemple... as the Meerkat says.
Another soldier call and this time he’d fallen down steps at an underground station. The 19 year-old tripped and toppled, landing hard on his back. He was with police and staff when I arrived and it took 10mg of morphine to deal with the pain before I could move him, with the help of a crew. He was in an awkward position but the move was done slowly and carefully without the need of a scoop or board, which would have added to the nightmare. His injury was mostly muscular and he probably jarred the Sciatic nerve when he hit the hard steps, so I’m sure he will be on his feet and soldiering again very soon.
The drunks of the town have yet to leave us alone, even on a Monday morning they are turning up in police stations. A 22 year-old man sat in the caged entrance to custody with police officers propping him up on a chair as he vomited almost continuously and lolled around muttering stupidity to nobody in particular. He was a large man and I’m told he had to be carried from the police van to this spot. He wasn’t being arrested but he needed to go to hospital because his drinking binge had poisoned him. He got a yellow bag around his neck to vomit in (a Booze Bus invention) and an ambulance to transport him – there was no way he was getting in the car.
I got a break and the system was shut down as calls went ‘manual’ for a few hours. During that time it seemed reasonably quiet but I began to feel quite unwell as the hours passed by and when my next call came in I was feeling very ill. This is not the job to have when you are sick yourself, so my 39 year-old diabetic who’d asked a gang of builders on an early-morning renovation to call an ambulance for him because he was ‘feeling cold’ and had ‘diabetic problems’ got the best of the professional attention I could summon, considering that I probably felt worse than he did.
I had two hours to go and was prepared to see the shift through, as long as I wasn’t exposed to anything that could set my delicate system off (like my earlier vomiting drunk). I took the patient to hospital in the car – he had a BM of 23. By the time I booked him in the nurses were asking if I’d like to book myself in too because I was looking very pale. Needless to say I got myself off home as soon as possible before I dragged the profession into the gutter.
Be safe.
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