Saturday, 12 November 2011

Naomi the Welsh

This was one of the most entertaining tours of duty I've had in a long time. My Welsh paramedic joined me so that she could compare her job to ours, out here in the frontline battlefield that is London. Her name is Naomi and she's been a paramedic for only a short time. Her shifts consist of a few calls and a lot of time driving from one place of 'cover' to the next. Her patient-bound journeys can take up to an hour and the hospital runs are just as long. The LAS? Well, our patient journeys are about 1 to 10 minutes on average and our hospital runs tend to be in the same ballpark. However, we pay for this with many, many more calls, a hell of a lot more abuse and a great deal of risk and violence.

So, a fainting rough sleeper in a train station, whose medical history included five heart bypasses, started us off but we were joined by the ambulance crew at the same time, so neither of us laid a hand on the patient.

This was quickly followed by a police call to a young woman who was fitting in a shop. Armed cops had come across her and had rendered some basic aid whilst waiting for our arrival. Again, the crew was on scene very quickly too, so it was a minimal challenge for us. I spoke to the patient's mother on the 'phone, because her daughter was post ictal and very confused, so couldn't tell us anything about herself. The cops had taken her mobile phone and called mum to explain what had happened, and to glean more information. I was passed the phone, so that I could get the medical info I needed.

'She has these all the time. She'll be okay soon. She doesn't need to go to hospital', mum told me.

'But she took her anti-epileptic medicine and she still had a fit', I explained.

'Yes, but she'll be fine. She always recovers', mum replied.

'Well, she fell onto a cafe floor this time. If we let her go now, she may have another fit and fall in front of a car.'

I think I persuaded her mum not to pursue the 'she'll be okay' route. The crew took the patient to hospital.

In Oxford Street, a 19 year-old Red Bull drinking girl was hyperventilation and having palpitations. I told the crew we'd deal with it without the need to take her to hospital. She'd declined that anyway and just wanted not to be at work I think. Her colleagues were around and they were very sympathetic, so, after calming her down and reminding her what Red Bull and the likes can do, we left her in the gentle care of her boss.

And a fainting 21 year-old hotel cleaner, who'd been unconscious for a brief time, was taken away for checks by the crew after we'd spent a few minutes finding out that she was doing three jobs a day and not eating well enough to remain standing up. Low-paid foreign workers are suffering in the Capital as they try to make ends meet. They earn enough in reality, thanks to the minimum wage (which you might argue is never enough... but at least it's a start), however, living in or around London is very expensive, and so anything they work hard to earn simply disappears in rent and other costs. No wonder the poor woman was running from one job to another and neglecting herself.

During the weekend of shifts, we had two anaphylactic calls. The first was serious; the man was collapsed at the bottom of the stairs inside a shop. His wife was with him and she explained that he'd come in to buy antihistamine because he'd felt he was reacting to something he'd touched earlier. He'd fallen down and couldn't get back up.

He was covered in a rash and, although his breathing hadn't become compromised, it was clear he was going into Anaphylactic shock. His systems were shutting down. He looked like a man deteriorating there and then. He'd lost bowel control and his vital signs - pulse and blood pressure especially - were out of control.

Naomi is a registered paramedic, so there was no need for her to stand and do nothing. She helped me get started on saving this man's life. A crew had arrived, with another paramedic, so we had more than enough hands and resources to deal with this. If only the shoppers would stop climbing the stairs by walking over us!

We got oxygen on, an anti-histamine and some adrenlanine into him, and very quickly moved him to the ambulance, where we'd stabilise him even more before setting off to hospital. He'd need urgent intervention to bring his BP up. He was still very conscious and quite able to talk to us, but he was clearly frightened.

Naomi has had little experience in giving IM injections, by her own admission, I should add. So I asked her to administer an injection to the patient. She did so and I've never seen anyone jump so much in my life. The patient lurched as if being lanced by a ten-foot pole. Poor Naomi's face... bless.

It was, nevertheless, a job well done by all; a good team effort. A combined Anglo-Welsh effort you could say. The patient arrived at hospital in much better shape than we'd found him and (just so you know) has no objection to this being written.

Our second anaphylactic call was less dramatic. A 17 year-old French visitor began to suffer shortness of breath after eating something she disagreed with. She injected herself with her Anapen auto-injector and her family called an ambulance.

I was a little concerned that they'd chucked the Anapen, with exposed needle, into a litter bin. I asked the family members to go and retrieve it. If someone had pricked their skin with it whilst rummaging around (there are people who do rubbish-rummaging), they'd have been given a nasty little puncture, which may have carried a little Adrenaline into the tissue. Epinephrine causes local tissue necrosis; it's not friendly.

She was fine though. Her Anapen had worked and her breathing was normal, but she still had to go to hospital because Adrenaline doesn't last very long... Histamine does.

There's a sinister looking Santa-type wandering around Trafalgar Square. He has the red suit and the white beard... but he wears orange wellies and he has the complexion of a 1990's Michael Jackson. He is utterly weird to behold and I wouldn't want my little boy seeing him and believing him to be the bringer of presents. I have no doubt his reindeer are parked somewhere but I don't want to see them. Look out for him and send me a pic if you can.

Naomi's comical adventures didn't end with the jumping patient, so I'll share them with you, because they are a lot more entertaining than a list of no-patient-contacts.

A visit to a 52 year-old hostel-dwelling man with abdominal pain, caused by liver damage and Hepatitis, meant she had to ask a simple question or two....

"Do you take pain killers?" She asked.

"Yes, I do", he answered.

"What for?" She continues.

"Pain!" He says, with the exasperated look of a man who is speaking to the Village Idiot.

I had to grin, as did she. We both knew what she meant, but it was funny to hear how it was received.

Then we went to see an 88 year-old man who'd collapsed in a department store. He was very unwell looking; diaphoretic and with suspicious periods of apnoea. We'd already started treatment, wrapped him up and taken him out to the ambulance. The vehicle was parked at a risky angle because the road had been narrowed due to works going on, so we'd asked the workmen to keep an eye on traffic flow and our bags as we continued treatment inside the vehicle.

Just as I was about to get on the ambulance, I saw Naomi trip over the bags and fall, like a lumbering sack of wood, to the ground. It was as though she'd seen them but still wanted to fly over them. This was also witnessed by about five grinning workmen. The poor woman didn't know where to look. Obviously balance and grace aren't taught out in Wales... in London we are all practically Ballerinas!

Maybe I should retract that last comment :-)

Anyway, she recovered, but without the benefit of video evidence (and I wish I'd filmed it), there is no way you can know just how comical it was. She's tough as nails, so she won't mind how I've described it.

The rest of the weekend consisted of more no-show patients and no-contact calls, including the one to Park Lane underpass for an 'unconscious' man. When we got there and went underground to find him, we saw a slumbering street-dweller... inside a sleeping bag. Now, if someone inside a sleeping bag in an underpass in the middle of the day isn't the biggest clue you'll ever get to NOT being dead, then I despair.

He even had a little pool of change lying next to him. Evidently, other, less frantic members of the public who'd passed by had seen it for what it was and thrown a little money at him. Now he has effectively cost you and I hundreds of pounds, just so we can see that he is, in fact..asleep. Oh, and not too happy to be woken up by me.

We ended the tour of duty with a very unwell man with chest pain and a soaring blood pressure. He needed to go to hospital quickly and we made sure that he did.

I've been invited by Naomi's boss to do a few shifts out that way, so that I can experience another way of working. I'm looking forward to it and will report back of course, with all the details. Well, the ones I'm allowed to write about.

All in all, Naomi gave me and my colleagues a laugh at her own expense but she was very well liked and respected. Cheeky banter and humiliating situations often combine in this job to make us what we are. This is a human profession and, regardless of the perspectives of a narrow minority, we really care about what we do. I now know that the Welsh produce paramedics that are just as caring and professionally minded... even if a little brutal with their needles and a little confusing with their questions... and a bit clumsy and blind.

We love you Naomi, you're the best.

Be safe.


Sarah said...

What do you think will have happened to the girl who had the seizure, after you managed to persuade her mother she needed to go to hospital despite their usual pattern of dealing with what sounds like a regular occurance for them?

There isn't any treatment to be given to someone who is post-ictal and the hospital probably just told her to go home. Depending on the relative locations of her home, the cafe and the hospital, you may well have actually made her more likely to be in danger on her way home.

As someone who regularly has seizures, this is a bit of a touchy subject for me as I hate the experience of coming to full consciousness only to find that I have been transported to a hospital and face an inconvenient journey home.

Xf said...


I am an advocate of leaving those who suffer regular seizures alone to recover. But this lady was NOT having regular seizures; they were out of control and unpredictable. She had taken her meds and they clearly did not work for her.

I'm not sure what you mean by making her 'more in danger on her way home' because we had a duty of care and she wasn't in a fit state to say no. So, I'm afraid we have no choice but to play the 'best interests of the patient' card.

I'd rather inconvenience you than let you go and you have another seizure and fall into the road, or die at home because they become status in nature.

This woman needed an urgent medical review of her situation... and her meds.

Anonymous said...

I agree with Sarah...there was nothing here to suggest that her fit was out of control. Anticonvulsant medications are prescribed to reduce seizures, I don't know of a single epileptic patient who NEVER has a fit on their meds. Saying that she may fall into the path of a car is pure scaremongering and is irresponsible.

Can you also clarify what you mean when you say that LAS crew are subject to more abuse than crews who work in less metropolitan services???

Xf said...


We get a lot more calls, so a lot more abuse. My information comes from colleagues who work in other services who can't believe the scale of the stuff we deal with - it doesn't mean other services don't suffer it too. The comment was inside a compensatory paragraph and nothing more.

As for the fitting patient. I don't disagree with you but I object to your description of my comment as scaremongering. I can give you a few good examples of how things can go badly wrong when a seizure affects someone unexpectedly. Nobody said there was going to be perfect control for her but I'd still argue the case for the crew here. While she was incapable of making a decision for herself; we did. Simple.

Anonymous said...

A registered paramedic who hasn't had experience of IM injections?


Anonymous said...

You cannot expect a paramedic to have experience in actually says she has had little experience by her own admission,not that she has no experience.everyone views levels of experience differently.