Wednesday, 8 September 2010

Cold heartbeat

This is one of the BTP's explosive search dogs. They each have a card giving their names and details. Apparently these cards are collectable, so I'm going to try and get them all! I have three, the other two dogs are named Pete (#42) and Cookie (who was sacked because he was no use at sniffing for explosives!). Don't you just love the look old Bouncer is giving the photographer?

Have I told you that the worst kind of drunkard is a well-to-do drunkard? Yes? Probably ad nauseum but these people never fail to depress me about the state of society when, compared to a good-old honest alcoholic, they get themselves so wasted that they turn into animals and their attitude and behaviour becomes arrogant and abusive. Historically, as you know, I’ve been sworn at, spat at, punched, kicked and generally insulted by doctors, lawyers, bankers and stockbrokers – people with money, affluence and no good reason to overdo it with the sauce.

This man, a 50 year-old City type, was found at the bottom of escalators at an underground station. He’d fallen. I was asked to attend but by the time I arrived he’d gone – last seen hugging a lamp-post I was told by the staff member who met me.

We managed to locate him harassing a complete stranger in the street. His stance was unbalanced and he looked like he would fall any second if I didn’t get a hold of him. So, I impressed upon him the importance of going to hospital to sober up a little before continuing his long journey home to an entirely different county. He was unimpressed but walked with me to the car.

Our conversation consisted of me trying to advise him that he had no capacity to make a decision about going or not going to hospital and that he was a danger to himself. I explained that he might fall into the busy road and get killed. None of this stuck in his brain and he launched into a verbal nursery rhyme of rubbish information about ‘70’s rock bands. He wasn’t listening at all.

He became a little abusive in his language and claimed he’d had a bag with him. At that point I couldn’t leave the scene with him; I had to ask for police to come and record his claim, otherwise I might get lumbered with the blame for its loss. Witnesses confirmed that he had no bag with him but I needed this written down and so the BTP were called in.

If you are going to get drunk and you are a clever person with degrees and a good career, don’t blow it by becoming an idiot when you drink and more importantly, don’t start giving the police abuse when they try to reason with you about going to hospital for your own safety.

This well-off, well-turned out, intelligent drunkard got himself arrested. He was hand-cuffed in full public view (he tried to fight the cops off) and was taken unceremoniously to the waiting van. He’ll spend a few hours in a cell and dry out. He will certainly regret what he’s done and he will have a record for being drunk and disorderly. I don’t expect his wife will be impressed.

A sudden collapse during a dinner at an hotel (same one as last night!) had a wife, who was a nurse by profession, panicking as she watched her husband falling in and out of consciousness for reasons unknown. The scene was very noisy, with hundreds of people wining and dining themselves and having a good old look at the excitement on the floor. But it was all too dramatic and, although the 30 year-old was diaphoretic and weak, he recovered well on oxygen.

The man had a known fish allergy but he hadn’t eaten fish, so I think he probably reacted to something else. A sudden release of Histamine would do that; increased capillary permeability, drop in blood pressure, possibly leading to collapse and unconsciousness. There was nothing on his ECG to suggest a sinister reason for his drop and his vitals returned to normal within ten minutes of the crew’s arrival. He went to hospital for further checks but I’m sure his wife has nothing to worry about.

Time-wasting individuals with selfish ulterior motives are fairly common in pre-hospital care unfortunately and the next patient, a 35 year-old claiming DIB and ‘can’t move’ was sitting outside a tube station directly across from the hospital when I arrived. He thumped his leg a few times to demonstrate that it was ‘completely dead’ and that he’d need assistance, so I enquired about him at A&E and was told that he had been thrown out twice for drinking their alcohol gel and that he had no clinical need.

I told him what I’d found out and warned him that if he called for an ambulance again it was very likely the police would come and deal with him. He seemed to get my point and I left him sitting where I found him – he will have to hatch another plan if he was going to get what he wanted from the NHS.

Smelly jobs come along every now and again and I’ve had my fair share of them. Tonight the Gods decided I’d get a rancid, putrefying leg in a police station cell. The drug addict had been arrested and was seen by the doctor for an ulcerated leg. He’d been ignoring it and taken none of the antibiotics prescribed for him, so the thing had reddened, become inflamed and a vigorous infection had taken root and was working its way through his flesh to the bone. As soon as I got to the cell door I could smell it; a very strong odour of fish. If he didn’t go to hospital and get it seen to, he would lose his leg.

Of course, he was awkward about it and adamantly refused to go. However, being in custody meant he really didn’t have a choice, so, with the help of a crew, two police officers to guard him and a mask and gloves for everyone concerned, off he went. I can still smell his leg as I write this. I have gone off fish too.

Ending the shift with a bit of drama is guaranteed to wake you up; this is not good if you are kept very late as a result and have another night shift to do later on. Fifteen minutes from going home and a Red1, cardiac arrest is given to me. There is no-one nearer (no paramedic in the area) and the journey will take me north, miles from the station. I know that unless I am cancelled down I am going to be at least an hour late off, possibly more but the call is not for a drunk or an abdo pain, it’s for someone whose life could be saved – it’s a 30 year-old female ‘not breathing at all’, so I raced up to the address and got there just ahead of an ambulance and another FRU; I’m the only paramedic on scene so the onus is on me to run the show, as it were.

The door to the flat was opened by a young child who pointed to the front room and said ‘in there’ as if, at 6.20am, there was no crisis in the place. I would usually be sceptical by this time, thinking that this was a nonsense call but at no point in this run did that cross my mind – it felt genuine from the start.

We bundled into the front room and a woman was straddled over another, carrying out chest compressions using the loud timing ‘beep’ that could be heard over the ‘phone. On the other end of the line was a 999 call-taker who’d calmly and professionally guided the resuscitating woman to this point, and thus began the life-saving process. I went over to the woman and asked her if she was alright, which always seems strange and inappropriate. She nodded and continued but I asked one of my colleagues to take her place and so the well-rehearsed ALS routine began in earnest.

The woman on the floor had last been seen alive the night before and her friend said she’d been making snorting or snoring noises when she breathed. This struck me as strange – if it was true, why didn’t she call an ambulance? A number of other statements seemed out of place but I can’t record them here for pertinent reasons.

There were at least two children wandering in and out of the room as we worked on this young woman and I had to ask a number of times for them to be removed; this is not the kind of thing you want your kids to witness. Resuscitation is a messy, noisy and emotionally traumatic event for anyone to see, let alone a small child.

We had been there for twenty minutes and I was deciding on the exit strategy (we were four floors up and there was no suitable lift). The woman had been asystolic throughout, despite drugs and good CPR, so I really thought we were going to end this with a run to hospital and that it would be called there. But then one of my colleagues said that we had output – a pulse was palpable at the neck. I’d tried Narcan on her, just in case, after asking about drug use. It’s possible this helped to ‘bring her back’. We had no idea how long she’d been in arrest –it could have been all night and her body core temperature (32c) suggested this but the change threw all of us; we really weren’t expecting to get a result.

We continued ventilations and fluids as we struggled with her body all the way down the concrete stairs of the flats and into the ambulance. We connected her to piped oxygen, IV fluids and more drugs as they were needed, then rushed her to hospital, which was less than five minutes away.

At hospital there was genuine disbelief that she had a heartbeat; she was cold and her blood gases were all over the place – she was very acidotic. She was put on a ventilator and I left to do my paperwork and get back to my station. I was two hours late and it took me another hour or so to get home but I didn't really mind because I felt I had done something worthwhile for a change.

When I went back to work later on I was told that the young woman had died. The doctor told me they had struggled to keep her stable and that a drama had unfolded at the hospital when I left and the woman’s family arrived. There is a lot more to this story but I can’t divulge any of the details. It certainly wasn’t a straight-forward job and I expect I will be called upon to relive it.

Be safe.


Passing Met Sgt said...

Well done to you and the techs for getting her to hospital with an output. Despite the eventual outcome, you more than demonstrate the benefits of pre-hospital emergency care by skilled and committed people.

Anonymous said...

I wouldn't do your job for all the tea in China, however, without you Guys I wouldn't have woken up a few times. Thank you for sacrificing so much to try and help save lives.

Fiz said...

Good luck, Stuart - I can see all sorts of alternative scenarios. I love the dog, but he certainly doesn't like that photographer. I've had 4 labs in my childhood and life and now have a 12 week black lab puppy and I have never been looked at like that by one! Promise you'll print all the pictures, if you get all the cards!I really want to see the one who left, too!

Anonymous said...

Must be awful when you put your all into a job like that and they don't make it.

I think you should share the pics of the dogs, especially the one that left. Will he end up as a pet now?


ps miss your blog please please start posting again.

Rocky said...

I have two of those cards in my wallet! I have the old edition ones which were given out on Virgin trains and one of the newer ones. My Dad is in the BTP and he gave me a card of his new dog when I was in hospital getting my appendix removed. :D

Danny said...

Hi my names Danny im just in the process of applying for university ( Paramedic Science ). Im currrently 17 i would like to ask you a few questions about your life as a paramedic and what the course is like etc. I live in Essex and hope one day to join the London Ambulance service .Reading your book many times i have been inspired by your story . Please Please would you get in contact with me my email address is i understand your very busy and wouldnt expect an instant response

Eileen said...

BTP explosive dog - is that a "fall down go bang" dog then?