Day shift: Nine calls; one no-trace; one left on scene; seven by ambulance.
Stats: 1 Malaena; 1 Hypoglycaemic fit; 1 Back pain; 1 Hyperventilation; 1 Mental Health Issues; 1 Haematemesis; 1 Overdose; 1 Cardiac Arrest.
Malaena, for those of you who are new to this blog, is something I find very unpleasant to work with, as do my colleagues. A 40 year-old man waited on a bench at a railway station as police stood over him because he had been ‘pooing blood for days’ as he eloquently put it. He’d been caught trying to steal wine from Marks and Spencer (good quality stuff) and the police were disinclined to take him to the police station, smelling as he was. I don’t blame them.
A MRU colleague was on scene for my next call to a 40 year-old man who collapsed and began fitting in the road. A passing moped rider stopped to help and I found him holding the patient’s head as he came out of it – my colleague was busily trying to establish his baseline obs.
The road was hazardous and just before I pulled up a large lorry turned into the street where the three men were situated, narrowly missing them. So I parked up to block a repeat performance by any other vehicle whose journey was more important than the safety of the patient, crew and helper.
The man became combative when the crew arrived and tried to persuade him to get onto the trolley bed. He was strong and fought us vigorously for almost ten minutes until he’d calmed down enough and recovered sufficiently to realise what was happening. His BM had read low when tested initially, so he needed a sugar boost. I had a small Snickers bar in the car, so I offered this to him and he greedily ate it up. His behaviour was very like a diabetic, except he wasn’t one. Neither was he epileptic, so his seizure was a mystery.
He had sustained a head injury on falling and when a work colleague was contacted, he confirmed that the patient had been in a traffic accident in the near past – he may have suffered a previous head injury and this was now manifesting in fits. He’d have to be thoroughly checked out.
His work colleague was kind enough to attend the scene and talk him into going onto the ambulance, which he’d been unwilling to do for the duration of his recovery. He was eventually walked, at his own request and preference, to the waiting vehicle. His friend travelled with him.
After a quick coffee and chat with my colleagues in the area, I was sent to a Red3, 78 year-old male, DIB, blue around the lips and known cancer patient. It was a good jog away in heavy traffic and I knew the housing estate very well. I arrived to find a man with back pain. No DIB, pink lips and his cancer was under control with treatment. This was a Green call for sure – his back pain was Sacral and non-acute; he’d been getting on with it for weeks and only in the past 24 hours had it become worse. He had no deficit and could easily walk.
The call had been graded Red because the on-call warden had given the description of a dying man to the call-taker in Control. If we’d been busier the cost of a FRU and ambulance would have been deducted from someone in real trouble at that time but there seems to be no way round this problem of panic-stricken descriptions that are sometimes given of perfectly well patients with fairly low-priority problems. It’s easier to judge when you get there I guess but common sense must surely play a part in answering leading questions.
On the Strand a 31 year-old man who’d called us because of blisters on his feet walked into a chemist and told them he had DIB, so another call was made and, of course, the upgrade meant he got an immediate response.
He was hyperventilating slightly and a bit aggressive to me at first. ‘What’s the problem?’ I asked, as I always do.
‘Well I’ve already spent a lot of time telling the ambulance service what’s wrong with me, so that’s a bit of a stupid question, isn’t it?’ was his retort. He clearly wasn’t in a good mood, so I asked him to calm down and explained that I don’t get all the details all the time.
He apologised and we got on okay from that point. Actually, I felt quite sorry for him as he explained that he was new on the streets in London and had travelled from Brighton (it’s a common street person's migratory route) after his family had rejected him (or vice versa) and his wife had left him. He was cold, hungry and thirsty. He wasn’t an alcoholic but in an ironic twist, his thirst was quenched earlier on by another rough sleeper who asked him if he was alright and then gave him two cans of lager because ‘he’d feel better’.
He seemed very distressed about his situation and his need seemed genuine, so as soon as he was taken aboard the ambulance, I arranged for him to be visited by the wonderful London Street Rescue people, who can arrange accommodation and food for him in the short term.
Then I spent a while watching a Big Issue vendor who stands on one leg with his arm outstretched, winks and flashes smiles at passing women, stands to attention for businessmen in suits and generally embraces his lifestyle with as much humility and good humour as possible. I’ve watched his antics before in sun, rain and snow and the guy just never seems to look unhappy with his lot. Unsurprisingly, he makes passers-by smile and he does well enough, from what I witnessed of his sales.
I’d like to take a photo of him and get his name so that I can give him some fame on this blog but I haven’t had the opportunity and I guess I’d better wait until I’m not in uniform. If you are interested in seeing him in action, I’ll do my best to capture him ‘at work’ for you. In the meantime, if you are on The Strand, at the Trafalgar Square end, outside Boots the chemist, then please buy one of his magazines. I saw a laughing couple take several photo’s of him, which he gladly posed for, then walk off, fags in hand, without tipping him a penny…that’s just not cricket, is it? Madonna would charge you at least a quid for the privilege!
Next up, a strange call to a University library for a 70 year-old man who was ‘foaming at the mouth’. Apparently, he’d behaved like this before and had to be chased down the street so that he could be helped, according to the library staff. He is a member and had just gone in to borrow a book when his behaviour changed. I now found him sitting on a chair, surrounded by worried people. He was shaking, clenching and had his eyes closed.
It took a few goes but I managed to get him to stop moving and calm down – sometimes you can see behind the drama, even if you can’t figure out why it’s happening.
When the crew arrived he was a bit less frantic and thus more manageable. He was taken to the ambulance, which had been blocked at the entrance by a plumber’s van (I had to drive around it and onto the kerb to get in).
There was no trace of the supposed headachy, dizzy, chest-pain suffering 32 year-old female who’d called form a phone box and even after checking in at the police station up the road to see if she’d walked in, I had no luck. The police even did a sweep of the area on foot for me. It’s unusual to get hoax calls from females.
I thought the next call had been made from inside a Medical Centre and so I was appalled when the patient, a 20 year-old withdrawing alcoholic, was standing outside waiting for me. He was vomiting blood (Haematemesis) according to the call description and so I thought it was unprofessional of the doctor to send him out to the street to wait. I was wrong, however. The patient had made the call himself from just outside the door.
He wasn’t vomiting blood. The stuff coming from his stomach was white and acrid.
I walked into a bookshop on Piccadilly and instantly recognised it. I hadn’t been in there for over twenty years and now all the memories of having been there came flooding back. I used to manage it when I first came to London. I could have led myself to where my patient sat, huddled in the toilets.
She’d walked in and collapsed and when I arrived the manager came out to meet me. ‘I didn’t know what to do and we have no trained staff here’, she said to me.
I followed her downstairs and found the 22 year-old woman shivering and cowering on the loo. She had told the staff nothing of her problem but had simply said ‘I feel horrible’. They had called an ambulance on the basis of her ‘DIB’, which didn’t exist.
I asked her three times what was wrong until she confessed that she’d taken an overdose of paracetamol. She hadn’t actually taken enough to cause Liver damage but she had attempted suicide and that was worrying enough. She was very distressed and I kept her calm and walked her out of the shop to the arriving ambulance.
The crew took over once I’d established her obs were ok and she was taken to hospital. Hopefully, her problems will be discussed and she’ll get the help she needs to prevent another attempt.
My last call of the shift came as I was winding down to go home. I was sent to an 89 year-old cancer patient who was ‘semi-conscious with shallow breathing’. This was ominous and I knew it could change at any time.
As I reached the street, the call became a Red1 and changed to cardiac arrest. I rushed in as the ambulance arrived at the end of the road. I was met at the door of the flat by the patient’s son; he was weeping and frantic. ‘He’s dead, isn’t he?’ he sobbed.
The man lay on his bed and I approached and checked his vitals – there were no signs of life. The son had been carrying out CPR under instruction and the man had stopped breathing only a few minutes ago, so I was left with a very difficult decision to make and one that I later agonised over for days afterwards. Do I continue the resuscitation attempt and thus try to save his father, even if it’s for a short time, or do I simply tell him there’s nothing more I can do? The son’s emotional state was confusing because it wasn’t clear which he’d prefer – did he want his father left in peace or did he want something done?
I decided that, as the crew were on scene and the attempt had been started, it would be better to try. So, we moved him to the floor and spent the next sixteen minutes working on him with no change in his condition whatsoever. I communicated with the son, who insisted on staying in the room throughout and made it clear to him that we would stop after a certain time unless he absolutely did not want us to continue.
I have no idea why I felt so bad about this job when it was finished. I think I felt guilt at the emotion I had put the son through by having him witness such a horribly traumatic event (CPR is a messy, noisy and emotionally painful business). I could have decided not to start because the man had a terminal illness, thus he could have been left in peace on the bed but I felt strongly that the son would have seen that as inaction on my part and I know that I would be bitter about such reticence if it was my loved one. I felt it was better to try and fail than not try at all.
I called it after sixteen minutes because I know the son had seen enough and there was no hope. We wrapped the man up and laid him back in the bed. Even though the son thanked me for trying, I felt I’d let him down horribly for continuing the attempt that he’d started and of all the cardiac arrests that I’ve called over the years, I felt more depressed about this one than any other – I knew it was illogical but I couldn’t help going home with a black cloud over my heart.
Be safe.
Tuesday, 11 November 2008
Sunday, 9 November 2008
Blame culture
This lady is ‘considering suing her son’s school’ for ‘failing to exercise their duty of care’ when he fell in the playground, bumped his head and subsequently – hours later – developed neurological problems, as the result of an intracranial bleed.
I train at many schools around the country - I teach the staff basic first aid and that's all they need to know. I also tell them some home truths about their position and what their actual duty of care is when it concerns children and accidents.
I feel very angry when people try to use their limited or flawed knowledge of the law to persecute for the sake of blaming someone for things that could NOT have been foreseen. Instead, these same individuals complain when their life is interrupted in the interest of the self-preservation of others. For example, school staff. They are an easy target, aren't they? Let's all blame the people with whom we trust the care and education of our children. Let's give them such a hard time that they are drained of power and no longer care whether their job is valued by us or not. Many of them leave the profession, rather than spend another minute listening to the constant whining, bitching and bossing of parents, some of whom are ignorant and unreasonable. Start taking responsibility for your own kids for Pete's sake!
Would it be reasonable for a school to call you every time your child fell? No. You'd have a go at them for that too.
I am a parent, so I have the right to speak about these things. I am a professional clinician, so I have the right to defend the principles upon which these words are based. I know the law and therefore I can categorically state in fact what would be right or wrong in some, but not all, cases where first aid care is concerned. I am also a member of society and was brought up to respect my teachers and all the adults working in schools. I had a healthy fear of the consequences of my actions and my parents were guided by the better judgment, in most cases, of the professionals they had put their trust in.
Now, here's the problem at schools. This case, sad as it is for the unfortunate little boy and his mother, will cause repercussions throughout the country and every nervous school will call an ambulance EVERY time a child falls and bumps his head! This is intolerable. We have all bumped our heads. Every now and again, just like in adult life, a complication occurs...sometimes people die. We can't scan every head that meets a pavement or a classroom floor.
Now who is to blame for this boy's injury? Did a teacher throw the child to the floor? Was he pushed, shoved or tripped by someone or something? Probably not. He fell by all accounts. The school staff monitored him and did exactly what they were supposed to do. What they did NOT do was dial 999 and say 'We need an ambulance for a....err...well, a child who has fallen'.
'What injuries does he have?' they would have been asked.
'Well, none that we can see'.
'Is he conscious?'
'Yes'
'Is he breathing?'
'Yes'
'Is he vomiting?'
'No'
'So, you want an emergency ambulance for an uninjured, conscious child, who is breathing and behaving normally?'
'Yes because if we don't the parents might sue us.'
'Okay but have you considered who may die of a heart attack because our ambulance is travelling to your school for nothing at all?'
In the end you have to ask yourself a perfectly logical question. Do you have any reason to send this child to hospital, other than an irrational fear that something untoward may have taken place inside his skull that you cannot see?
What if this had happened at home? Is this lady honestly saying she would have rushed him to hospital or called an ambulance because he fell and hit his head? Has he never hit his head before?
What kind of person tries to blame a school for such an unfortunate accident? A scared person? An ignorant person? A embittered person who needs to express her anger at God?
I will apologise for all these words if it transpires the child was abused in some way or there was a hazard in the school environment that caused the fall but I protest at society and it's need to hound people who care for our kids whenever it suits them. Pursue them for a reason, don't bully them just because it's easy and you feel guilty that you weren't there.
Why not sue the school for having a hard floor in the first place? Why don't we start fitting rubber flooring everywhere? While we are at it, let's ban rain because it makes the outside ground slippery and a child could fall.
When I teach, I rarely get a negative reaction to my views and generally the vast majority of people in front of me will nod their heads in agreement and debates will begin on the spot. Nothing changes though and I blame the parents for that. It's time parents got together with their schools and talked these issues through. Let's look at some of the other examples of an automatised blame culture society that seeks to justify it clingy cotton-wooled sentiments over health and safety.
Plasters; you are not allowed to put one on a child because he may react to it. RUBBISH! Even the HSE has produced a poster informing everyone that this is untrue. In fact, not putting a plaster on could be seen as neglect because it is a first aid 'tool' and an alternative may not be sterile and could cause infection. I've seen filthy toilet paper put on a wound instead of a plaster because of this stupidity.
Splinters; taking one out of a child's finger is illegal and is assault. ROT! It is NOT illegal to do the duty of a parent when you are in charge of their child. By proxy you 'become their parent' - In loco parentis - a legal term which literally means 'in the place of a parent'. So, legally, a teacher/school must show the same duty of care towards a pupil as would a reasonable parent. In other words, if you think a mother would remove a splinter, then you should remove it. Why on earth, unless there are complications, would you send your child to hospital with a microscopic bit of wood in his finger? Are you mad?
Inhalers; you can keep a spare inhaler and use it when a child has forgotten to bring theirs to school. NO, you can't...not unless it belongs to the child himself. It is illegal to use someone else's prescription medicine in any circumstance, unless it is on the exempt list (epipens are on this list). I know of at least one local authority that actually sanctions and authorises (as if they have the right) the use of anyone's inhaler in cases of emergency. In a real emergency it probably won't be effective and giving a drug that you know nothing about and does not belong to the recipient is negligent. By all means store a spare belonging to the child, and then only in term time.
I could go on and on...the list seems endless and the capacity for parents to make life miserable for school staff seems inexhaustible. I feel very sorry for them.
Have a look at the other myths being circulated as truths on the HSE's own website.
And for the record, here are some extracts of relevance from the Government's guildelines on medicines in schools. The government also makes it clear that there is no legal responsibility for school staff to administer first aid to pupils but there is a duty of care.
13. Parents have the prime responsibility for their child’s health and should provide schools and settings with information about their child’s medical condition.
16. There is no legal duty that requires school or setting staff to administer medicines.
25. Medicines should only be taken to school or settings when essential; that is where it would be detrimental to a child’s health if the medicine were not administered during the school or setting ‘day’. Schools and settings should only accept medicines that have been prescribed by a doctor, dentist, nurse prescriber or pharmacist prescriber.
34. Misuse of a controlled drug, such as passing it to another child for use, is an offence.
89. Teachers’ conditions of employment do not include giving or supervising a pupil taking medicines.
107. Large volumes of medicines should not be stored. Staff should only store, supervise and administer medicine that has been prescribed for an individual child.
108. Children should know where their own medicines are stored and who holds the key.
The head is responsible for making sure that medicines are stored safely. All emergency medicines, such as asthma inhalers and adrenaline pens, should be readily available to children and should not be locked away.
If you are a teacher or work at a school, you may find some of this information interesting, especially if it comes as a shock to you. In my experience, not many schools have seen or even know about the Government's guidelines on first aid and medicines policy in schools.
I'd like to know your views on this but please don't bombard me with stories that simply highlight rare and unusual circumstances because that's just missing the point.
Xf
I train at many schools around the country - I teach the staff basic first aid and that's all they need to know. I also tell them some home truths about their position and what their actual duty of care is when it concerns children and accidents.
I feel very angry when people try to use their limited or flawed knowledge of the law to persecute for the sake of blaming someone for things that could NOT have been foreseen. Instead, these same individuals complain when their life is interrupted in the interest of the self-preservation of others. For example, school staff. They are an easy target, aren't they? Let's all blame the people with whom we trust the care and education of our children. Let's give them such a hard time that they are drained of power and no longer care whether their job is valued by us or not. Many of them leave the profession, rather than spend another minute listening to the constant whining, bitching and bossing of parents, some of whom are ignorant and unreasonable. Start taking responsibility for your own kids for Pete's sake!
Would it be reasonable for a school to call you every time your child fell? No. You'd have a go at them for that too.
I am a parent, so I have the right to speak about these things. I am a professional clinician, so I have the right to defend the principles upon which these words are based. I know the law and therefore I can categorically state in fact what would be right or wrong in some, but not all, cases where first aid care is concerned. I am also a member of society and was brought up to respect my teachers and all the adults working in schools. I had a healthy fear of the consequences of my actions and my parents were guided by the better judgment, in most cases, of the professionals they had put their trust in.
Now, here's the problem at schools. This case, sad as it is for the unfortunate little boy and his mother, will cause repercussions throughout the country and every nervous school will call an ambulance EVERY time a child falls and bumps his head! This is intolerable. We have all bumped our heads. Every now and again, just like in adult life, a complication occurs...sometimes people die. We can't scan every head that meets a pavement or a classroom floor.
Now who is to blame for this boy's injury? Did a teacher throw the child to the floor? Was he pushed, shoved or tripped by someone or something? Probably not. He fell by all accounts. The school staff monitored him and did exactly what they were supposed to do. What they did NOT do was dial 999 and say 'We need an ambulance for a....err...well, a child who has fallen'.
'What injuries does he have?' they would have been asked.
'Well, none that we can see'.
'Is he conscious?'
'Yes'
'Is he breathing?'
'Yes'
'Is he vomiting?'
'No'
'So, you want an emergency ambulance for an uninjured, conscious child, who is breathing and behaving normally?'
'Yes because if we don't the parents might sue us.'
'Okay but have you considered who may die of a heart attack because our ambulance is travelling to your school for nothing at all?'
In the end you have to ask yourself a perfectly logical question. Do you have any reason to send this child to hospital, other than an irrational fear that something untoward may have taken place inside his skull that you cannot see?
What if this had happened at home? Is this lady honestly saying she would have rushed him to hospital or called an ambulance because he fell and hit his head? Has he never hit his head before?
What kind of person tries to blame a school for such an unfortunate accident? A scared person? An ignorant person? A embittered person who needs to express her anger at God?
I will apologise for all these words if it transpires the child was abused in some way or there was a hazard in the school environment that caused the fall but I protest at society and it's need to hound people who care for our kids whenever it suits them. Pursue them for a reason, don't bully them just because it's easy and you feel guilty that you weren't there.
Why not sue the school for having a hard floor in the first place? Why don't we start fitting rubber flooring everywhere? While we are at it, let's ban rain because it makes the outside ground slippery and a child could fall.
When I teach, I rarely get a negative reaction to my views and generally the vast majority of people in front of me will nod their heads in agreement and debates will begin on the spot. Nothing changes though and I blame the parents for that. It's time parents got together with their schools and talked these issues through. Let's look at some of the other examples of an automatised blame culture society that seeks to justify it clingy cotton-wooled sentiments over health and safety.
Plasters; you are not allowed to put one on a child because he may react to it. RUBBISH! Even the HSE has produced a poster informing everyone that this is untrue. In fact, not putting a plaster on could be seen as neglect because it is a first aid 'tool' and an alternative may not be sterile and could cause infection. I've seen filthy toilet paper put on a wound instead of a plaster because of this stupidity.
Splinters; taking one out of a child's finger is illegal and is assault. ROT! It is NOT illegal to do the duty of a parent when you are in charge of their child. By proxy you 'become their parent' - In loco parentis - a legal term which literally means 'in the place of a parent'. So, legally, a teacher/school must show the same duty of care towards a pupil as would a reasonable parent. In other words, if you think a mother would remove a splinter, then you should remove it. Why on earth, unless there are complications, would you send your child to hospital with a microscopic bit of wood in his finger? Are you mad?
Inhalers; you can keep a spare inhaler and use it when a child has forgotten to bring theirs to school. NO, you can't...not unless it belongs to the child himself. It is illegal to use someone else's prescription medicine in any circumstance, unless it is on the exempt list (epipens are on this list). I know of at least one local authority that actually sanctions and authorises (as if they have the right) the use of anyone's inhaler in cases of emergency. In a real emergency it probably won't be effective and giving a drug that you know nothing about and does not belong to the recipient is negligent. By all means store a spare belonging to the child, and then only in term time.
Or how about this? Let the child take care of his/her own medicines. If they are deemed to have capacity, they can keep their own.
I could go on and on...the list seems endless and the capacity for parents to make life miserable for school staff seems inexhaustible. I feel very sorry for them.
Have a look at the other myths being circulated as truths on the HSE's own website.
And for the record, here are some extracts of relevance from the Government's guildelines on medicines in schools. The government also makes it clear that there is no legal responsibility for school staff to administer first aid to pupils but there is a duty of care.
13. Parents have the prime responsibility for their child’s health and should provide schools and settings with information about their child’s medical condition.
16. There is no legal duty that requires school or setting staff to administer medicines.
25. Medicines should only be taken to school or settings when essential; that is where it would be detrimental to a child’s health if the medicine were not administered during the school or setting ‘day’. Schools and settings should only accept medicines that have been prescribed by a doctor, dentist, nurse prescriber or pharmacist prescriber.
34. Misuse of a controlled drug, such as passing it to another child for use, is an offence.
89. Teachers’ conditions of employment do not include giving or supervising a pupil taking medicines.
107. Large volumes of medicines should not be stored. Staff should only store, supervise and administer medicine that has been prescribed for an individual child.
108. Children should know where their own medicines are stored and who holds the key.
The head is responsible for making sure that medicines are stored safely. All emergency medicines, such as asthma inhalers and adrenaline pens, should be readily available to children and should not be locked away.
If you are a teacher or work at a school, you may find some of this information interesting, especially if it comes as a shock to you. In my experience, not many schools have seen or even know about the Government's guidelines on first aid and medicines policy in schools.
I'd like to know your views on this but please don't bombard me with stories that simply highlight rare and unusual circumstances because that's just missing the point.
Xf
Friday, 7 November 2008
A mixed bag
Day shift: Seven calls; one conveyed in the car; six by ambulance.
Stats: 1 Hyperglycaemic; 1 eTOH fit; 1 Abod pain; 1 Asthma; 2 Allergic reactions; 1 Head injury.
I arrived shortly before the crew to deal with a 77 year-old man with ‘diabetic problems’ who was lying on the floor ‘unable to move’. As usual the location was at the top of the stairs, four floors up and there was no lift. If I didn’t keep myself fit, I’d have been more flushed than he was when I got to the top. Luckily, I gave away only a few rasped breaths as I dropped all my bags on the kitchen floor.
The man was lying face down on the floor and his wife told me he’d been there all night. ‘No I haven’t’, he denied as I approached.
He couldn’t remember how he got to the floor and I waited for the crew before moving him, so that gave me time to check his BM. He is insulin dependent and had been out the night before drinking, although he swore he had downed only two pints. His BM was high but not critical.
The crew and I turned him over, sat him up then moved him onto a kitchen chair for a more human approach to his treatment. He was an affable character in complete denial about his circumstances. His wife said that she’d left him sitting in the kitchen after he’d been brought home by friends feeling ill the night before. She had gone to bed, probably unimpressed with him and he’d been found on his face in the morning. She spoke and looked like a woman resigned to her fate.
We completed our obs and advised him to go to hospital because he had no memory of what had happened during the night. He’d been incontinent and was confused at times. He agreed and was taken to the ambulance after a long, slow walk down the steep stairs of his block of flats.
He is an ex-professional footballer and he certainly didn’t look his age, which must be thanks to his fitness in youth and, I suppose, a good set of genes. I suspected, as did my colleagues, that he drank a few more pints than he admitted to in front of his wife.
A 50 year-old Polish man who refused to speak to us had an eTOH fit at a bus stop in Oxford Street. Passers-by stopped to help him and when I arrived he was sitting up on the pavement. I don’t know if he spoke no English or if he was still a little confused after his seizure but he complied and went with the crew to hospital when they arrived to take care of him.
Then a call to an underground station for a 33 year-old woman who’d collapsed on the platform after leaving her train because she didn’t feel well. At first she didn’t speak to me either and rolled about on the floor clutching her abdomen as soon as I introduced myself, something the police and staff on scene said she hadn’t been doing until that moment. During my initial obs a train pulled in and spilled out its contents. Most of the hurrying commuters went around us but one lady insisted on stepping over me and my equipment so that she could cut a route through and save two seconds on her journey. It was a very selfish and thoughtless thing to do and I reacted by telling her that I didn’t appreciate her actions. She ignored me, of course but the police weren’t too impressed with her either and I think they may have had a word if we hadn’t been pre-occupied with the patient.
This was a strange one because the lady on the ground had no medical history and only began to speak when the crew arrived and she was aboard the ambulance. She was sleepy and every now and again weepy too. She wouldn’t give us a reason for her behaviour and we found, as I had earlier, that her pulse was consistently slow at around 49 – 50 bpm.
This Scottish lady only cheered up once when I was there but broke down again during the trip to hospital. I suspect that she’d taken something in the morning prior to leaving home (she was due to go to a job interview) and the drug, whatever it was, was affecting her pulse rate…but not her blood pressure, which remained within normal limits.
A 45 year-old man lay on the floor of his office with colleagues crowded around him after suffering an allergic reaction to his medicine. He had a rash and his blood pressure was low, so he fainted when put on the chair by the crew.
Another allergic reaction, this time at a YMCA and a 43 year-old man broke out in a global erythemic rash after eating sardines for lunch. The rash was inside his mouth too, so, even though there was no swelling and no DIB, it was a good idea to have him checked out in hospital.
There was no ambulance available for the 4 year-old boy who'd fallen on his head at school and was now vomiting. He was with his mum and a few worried looking members of school staff when I arrived. He was behaving just like a 4 year-old does when he's had an accident; he was quiet, moody and hugging mum every now and again for reassurance. Other than that, he seemed absolutely fine and THAT is an important point.
I studied the faces of the school staff present and realised they were a bit on edge. The boy had fallen and smacked his head off the ground. Then he'd got up and been taken care of - monitored for a while. There was no visible injury and he did not display any sign or complain of any symptom associated with his recent fall. He was fully conscious, fully mobile and fully able to integrate back into his normal school day. Until he vomited, that is.
A teacher told me he became tired and vomited in class. His mother was called and he was monitored. He vomited again an hour later and mum arrived as the ambulance was being called. Then I showed up and spent twenty minutes in his company. The boy was fine but he'd go to hospital now just to rule out any nasty surprises. I decided to take him and his mother in the car rather than wait any longer for an ambulance which, given his emotional fragility, may have been too upsetting for him anyway. That the only reason I made that decision.
I reassured the school staff that everything they had done was correct. They were seriously worried because of THIS nonsense, which I will elaborate on in a separate post soon.
As I discussed this story with the boy's mother, she agreed that all some people want to do is blame someone. Blaming school staff is just too easy and it's time to STOP it.
The boy will be checked out in hospital and monitored but there will probably be no x-ray or scan carried out. He will go back home, go to sleep to get over his trauma and then go back to school with a story for his friends. That's it. Very rarely does it turn out any other way.
Finally, a call for an asthmatic 19 year-old Portuguese woman who had only arrived in the UK a few weeks ago and had yet to register with a GP or get meds. There were no ambulances available because we were being run ragged, so I made the long trip south to see her. She had waited 20 minutes and when I arrived she was outside her home, wheezing and suffering SOB. She was so desperate for help that she climbed into the back of my car as soon as I pulled up.
I gave her Salbutamol and was fully prepared to take her to hospital myself if there was going to be a longer delay but the crew turned up minutes later and by that time her condition had improved significantly.
Be safe.
Stats: 1 Hyperglycaemic; 1 eTOH fit; 1 Abod pain; 1 Asthma; 2 Allergic reactions; 1 Head injury.
I arrived shortly before the crew to deal with a 77 year-old man with ‘diabetic problems’ who was lying on the floor ‘unable to move’. As usual the location was at the top of the stairs, four floors up and there was no lift. If I didn’t keep myself fit, I’d have been more flushed than he was when I got to the top. Luckily, I gave away only a few rasped breaths as I dropped all my bags on the kitchen floor.
The man was lying face down on the floor and his wife told me he’d been there all night. ‘No I haven’t’, he denied as I approached.
He couldn’t remember how he got to the floor and I waited for the crew before moving him, so that gave me time to check his BM. He is insulin dependent and had been out the night before drinking, although he swore he had downed only two pints. His BM was high but not critical.
The crew and I turned him over, sat him up then moved him onto a kitchen chair for a more human approach to his treatment. He was an affable character in complete denial about his circumstances. His wife said that she’d left him sitting in the kitchen after he’d been brought home by friends feeling ill the night before. She had gone to bed, probably unimpressed with him and he’d been found on his face in the morning. She spoke and looked like a woman resigned to her fate.
We completed our obs and advised him to go to hospital because he had no memory of what had happened during the night. He’d been incontinent and was confused at times. He agreed and was taken to the ambulance after a long, slow walk down the steep stairs of his block of flats.
He is an ex-professional footballer and he certainly didn’t look his age, which must be thanks to his fitness in youth and, I suppose, a good set of genes. I suspected, as did my colleagues, that he drank a few more pints than he admitted to in front of his wife.
A 50 year-old Polish man who refused to speak to us had an eTOH fit at a bus stop in Oxford Street. Passers-by stopped to help him and when I arrived he was sitting up on the pavement. I don’t know if he spoke no English or if he was still a little confused after his seizure but he complied and went with the crew to hospital when they arrived to take care of him.
Then a call to an underground station for a 33 year-old woman who’d collapsed on the platform after leaving her train because she didn’t feel well. At first she didn’t speak to me either and rolled about on the floor clutching her abdomen as soon as I introduced myself, something the police and staff on scene said she hadn’t been doing until that moment. During my initial obs a train pulled in and spilled out its contents. Most of the hurrying commuters went around us but one lady insisted on stepping over me and my equipment so that she could cut a route through and save two seconds on her journey. It was a very selfish and thoughtless thing to do and I reacted by telling her that I didn’t appreciate her actions. She ignored me, of course but the police weren’t too impressed with her either and I think they may have had a word if we hadn’t been pre-occupied with the patient.
This was a strange one because the lady on the ground had no medical history and only began to speak when the crew arrived and she was aboard the ambulance. She was sleepy and every now and again weepy too. She wouldn’t give us a reason for her behaviour and we found, as I had earlier, that her pulse was consistently slow at around 49 – 50 bpm.
This Scottish lady only cheered up once when I was there but broke down again during the trip to hospital. I suspect that she’d taken something in the morning prior to leaving home (she was due to go to a job interview) and the drug, whatever it was, was affecting her pulse rate…but not her blood pressure, which remained within normal limits.
A 45 year-old man lay on the floor of his office with colleagues crowded around him after suffering an allergic reaction to his medicine. He had a rash and his blood pressure was low, so he fainted when put on the chair by the crew.
Another allergic reaction, this time at a YMCA and a 43 year-old man broke out in a global erythemic rash after eating sardines for lunch. The rash was inside his mouth too, so, even though there was no swelling and no DIB, it was a good idea to have him checked out in hospital.
There was no ambulance available for the 4 year-old boy who'd fallen on his head at school and was now vomiting. He was with his mum and a few worried looking members of school staff when I arrived. He was behaving just like a 4 year-old does when he's had an accident; he was quiet, moody and hugging mum every now and again for reassurance. Other than that, he seemed absolutely fine and THAT is an important point.
I studied the faces of the school staff present and realised they were a bit on edge. The boy had fallen and smacked his head off the ground. Then he'd got up and been taken care of - monitored for a while. There was no visible injury and he did not display any sign or complain of any symptom associated with his recent fall. He was fully conscious, fully mobile and fully able to integrate back into his normal school day. Until he vomited, that is.
A teacher told me he became tired and vomited in class. His mother was called and he was monitored. He vomited again an hour later and mum arrived as the ambulance was being called. Then I showed up and spent twenty minutes in his company. The boy was fine but he'd go to hospital now just to rule out any nasty surprises. I decided to take him and his mother in the car rather than wait any longer for an ambulance which, given his emotional fragility, may have been too upsetting for him anyway. That the only reason I made that decision.
I reassured the school staff that everything they had done was correct. They were seriously worried because of THIS nonsense, which I will elaborate on in a separate post soon.
As I discussed this story with the boy's mother, she agreed that all some people want to do is blame someone. Blaming school staff is just too easy and it's time to STOP it.
The boy will be checked out in hospital and monitored but there will probably be no x-ray or scan carried out. He will go back home, go to sleep to get over his trauma and then go back to school with a story for his friends. That's it. Very rarely does it turn out any other way.
Finally, a call for an asthmatic 19 year-old Portuguese woman who had only arrived in the UK a few weeks ago and had yet to register with a GP or get meds. There were no ambulances available because we were being run ragged, so I made the long trip south to see her. She had waited 20 minutes and when I arrived she was outside her home, wheezing and suffering SOB. She was so desperate for help that she climbed into the back of my car as soon as I pulled up.
I gave her Salbutamol and was fully prepared to take her to hospital myself if there was going to be a longer delay but the crew turned up minutes later and by that time her condition had improved significantly.
Be safe.
Thursday, 6 November 2008
Chest pain walking
Day shift: Ten calls; all by ambulance.
Stats: 1 ?fit; 4 Chest pains (one eTOH, so possibly not); 1 RTC with knee injury; 1 Hypothermia; 1 DIB; 1 Seizure with chest pain; 1 faint.
Off to the Strand before I had a chance to grab a coffee and a homeless man is lying on the pavement, near his usual haunt, after having what his friend described as ‘shaking legs’. His foot is heavily bandaged and the stump shape indicates that is doesn’t exist anymore…or at least his toes don’t. So he’s unstable when he walks anyway. The call was for a male ‘fitting’ but he’s not post ictal and I don’t think he had a seizure. I think he lost his balance and fell down. His leg-shaking was probably the result of the shock of tumbling.
The crew was right behind me and he was taken to hospital where he’ll get a warm bed for a few hours.
I’ve been to the patient I was treating next a few times before. She is a 97 year-old lady who has ongoing problems with chest pain. She is always frustrated when I get to her because she’s fed up of the trouble she’s going through, which I totally empathise with. ‘Can’t someone help me to cope with this?’ she appeals as she is wheeled from her second floor flat in a secure estate. She needs to be somewhere less lonely than this; somewhere with company because I think she misses it, living alone as she does at her age.
I wasn’t required for the 30 year-old man with a cardiac history who was now complaining of chest pain at work. He seemed fine when I saw him with the crew and I’m not sure the call description was accurate.
The first RTC of the morning involved a motorcyclist and a pedal cyclist. One was wearing a helmet because it’s the law and the other, who should have known better, wasn’t…because it isn’t.
The cyclist allegedly shot out of a side street as the motorcyclist pulled away from the traffic lights. Both collided and the cycle was crushed under the heavier machine. Both fell over but only the soft-target cyclist was injured – he had a grazed knee and hands. He was lucky not to lose his life.
If I take ‘pot-shots’ at GP’s I get a lot of stick and much as I have a great respect for the writings of the esteemed Dr. Crippen, I think I might attract his wrath for this next bit BUT when a GP sends a patient with a known cardiac condition out to the waiting room on foot, after he has presented with shortness of breath and a history of being ‘unwell’ for the past few hours, we tend to get a bit annoyed.
The 47 year-old has had an ablation procedure recently for his dodgy pacemaker and now he isn’t doing too well – he is consistently tachycardic at around 140 bpm, has chest pain and is short of breath when moving around. He was offered no oxygen (although that now depends on the saturation levels recorded) and consideration was not given to the fact that it may be safer to leave him where he was (in the doc’s treatment room) until we arrived to take him away…on a chair.
The waiting room was absolutely full of people and this poor guy had to sit on his own, worrying about his condition. He was given a referral letter and told to go back and take a seat until the emergency ambulance arrived. Now, I respectfully suggest that if it was such an emergency, he should have been given greater care than that.
His ECG was unhealthy - he had an irregular heartbeat - and he was taken straight into Resus when the crew took him to hospital. At least someone was taking his condition seriously.
The crew was with me again when we took care of a 70 year-old man with sandals on his blackened feet at a hostel. He was feeling generally unwell and our checks revealed that he had a low BP and hypothermia. A bolus of warmed fluids would start the process of recovering him and he was taken to hospital for more of the same.
A 71 year-old lady began to feel unwell in an art gallery café after lunch. Her friend became so concerned that she called an ambulance. She was very pale and short of breath, even though she had no medical history of significance. The crew was on scene at around the same time, so I spent less than five minutes with her before she was taken away.
It’s rare to meet someone who has survived a cardiac arrest and my next patient had suffered a seizure in front of her friend. She told me she had gone into arrest a few years earlier and the resultant lack of oxygen to her brain left her with some neurological deficit, similar to those of a stroke victim. This interested me and I became more concerned when, after all the usual questions had been asked about her history and the current problem, she told me she had been suffering ‘similar’ chest discomfort to the one she had before, when she had her cardiac arrest. This had been going on for a few days.
The jigsaw of her problem now complete, it was clear she had to go to hospital as soon as possible. The crew was with me now and her ECG confirmed the need to ‘blue’ her in.
Ten pints of lager and a long way from home, so the 65 year-old Irish alcoholic claimed he had chest pain which merited an ambulance. He was in a public building and the staff were worried that he might ‘keel over’ any second. The only keeling he’d be doing, as far as I was concerned, was as a result of too much booze. He’d been out since 6am and it was now 6pm. He’d wandered around until he’d got utterly lost and his first (and only) demand when I arrived was that I take him home – I think this was his reason for feeling chest pain, especially as he didn’t refer to it unless I asked him about it.
His obs revealed that he was hypothermic and so off to hospital he went, telling the crew all about his HGV licence.
I ended the shift with a 30 year-old pregnant female who’d fainted at an underground station – a common occurrence. She was fully recovered when I got to her and the crew was left to complete the assessment I’d begun – she may or may not have opted to travel with them; I’ve supposed in the stats that she did but I was on my way home within twenty minutes, so I don’t know for sure.
Be safe.
Stats: 1 ?fit; 4 Chest pains (one eTOH, so possibly not); 1 RTC with knee injury; 1 Hypothermia; 1 DIB; 1 Seizure with chest pain; 1 faint.
Off to the Strand before I had a chance to grab a coffee and a homeless man is lying on the pavement, near his usual haunt, after having what his friend described as ‘shaking legs’. His foot is heavily bandaged and the stump shape indicates that is doesn’t exist anymore…or at least his toes don’t. So he’s unstable when he walks anyway. The call was for a male ‘fitting’ but he’s not post ictal and I don’t think he had a seizure. I think he lost his balance and fell down. His leg-shaking was probably the result of the shock of tumbling.
The crew was right behind me and he was taken to hospital where he’ll get a warm bed for a few hours.
I’ve been to the patient I was treating next a few times before. She is a 97 year-old lady who has ongoing problems with chest pain. She is always frustrated when I get to her because she’s fed up of the trouble she’s going through, which I totally empathise with. ‘Can’t someone help me to cope with this?’ she appeals as she is wheeled from her second floor flat in a secure estate. She needs to be somewhere less lonely than this; somewhere with company because I think she misses it, living alone as she does at her age.
I wasn’t required for the 30 year-old man with a cardiac history who was now complaining of chest pain at work. He seemed fine when I saw him with the crew and I’m not sure the call description was accurate.
The first RTC of the morning involved a motorcyclist and a pedal cyclist. One was wearing a helmet because it’s the law and the other, who should have known better, wasn’t…because it isn’t.
The cyclist allegedly shot out of a side street as the motorcyclist pulled away from the traffic lights. Both collided and the cycle was crushed under the heavier machine. Both fell over but only the soft-target cyclist was injured – he had a grazed knee and hands. He was lucky not to lose his life.
If I take ‘pot-shots’ at GP’s I get a lot of stick and much as I have a great respect for the writings of the esteemed Dr. Crippen, I think I might attract his wrath for this next bit BUT when a GP sends a patient with a known cardiac condition out to the waiting room on foot, after he has presented with shortness of breath and a history of being ‘unwell’ for the past few hours, we tend to get a bit annoyed.
The 47 year-old has had an ablation procedure recently for his dodgy pacemaker and now he isn’t doing too well – he is consistently tachycardic at around 140 bpm, has chest pain and is short of breath when moving around. He was offered no oxygen (although that now depends on the saturation levels recorded) and consideration was not given to the fact that it may be safer to leave him where he was (in the doc’s treatment room) until we arrived to take him away…on a chair.
The waiting room was absolutely full of people and this poor guy had to sit on his own, worrying about his condition. He was given a referral letter and told to go back and take a seat until the emergency ambulance arrived. Now, I respectfully suggest that if it was such an emergency, he should have been given greater care than that.
His ECG was unhealthy - he had an irregular heartbeat - and he was taken straight into Resus when the crew took him to hospital. At least someone was taking his condition seriously.
The crew was with me again when we took care of a 70 year-old man with sandals on his blackened feet at a hostel. He was feeling generally unwell and our checks revealed that he had a low BP and hypothermia. A bolus of warmed fluids would start the process of recovering him and he was taken to hospital for more of the same.
A 71 year-old lady began to feel unwell in an art gallery café after lunch. Her friend became so concerned that she called an ambulance. She was very pale and short of breath, even though she had no medical history of significance. The crew was on scene at around the same time, so I spent less than five minutes with her before she was taken away.
It’s rare to meet someone who has survived a cardiac arrest and my next patient had suffered a seizure in front of her friend. She told me she had gone into arrest a few years earlier and the resultant lack of oxygen to her brain left her with some neurological deficit, similar to those of a stroke victim. This interested me and I became more concerned when, after all the usual questions had been asked about her history and the current problem, she told me she had been suffering ‘similar’ chest discomfort to the one she had before, when she had her cardiac arrest. This had been going on for a few days.
The jigsaw of her problem now complete, it was clear she had to go to hospital as soon as possible. The crew was with me now and her ECG confirmed the need to ‘blue’ her in.
Ten pints of lager and a long way from home, so the 65 year-old Irish alcoholic claimed he had chest pain which merited an ambulance. He was in a public building and the staff were worried that he might ‘keel over’ any second. The only keeling he’d be doing, as far as I was concerned, was as a result of too much booze. He’d been out since 6am and it was now 6pm. He’d wandered around until he’d got utterly lost and his first (and only) demand when I arrived was that I take him home – I think this was his reason for feeling chest pain, especially as he didn’t refer to it unless I asked him about it.
His obs revealed that he was hypothermic and so off to hospital he went, telling the crew all about his HGV licence.
I ended the shift with a 30 year-old pregnant female who’d fainted at an underground station – a common occurrence. She was fully recovered when I got to her and the crew was left to complete the assessment I’d begun – she may or may not have opted to travel with them; I’ve supposed in the stats that she did but I was on my way home within twenty minutes, so I don’t know for sure.
Be safe.
Monday, 3 November 2008
Drunks on buses - two for one
Day shift: Eight calls; two assisted-only; one false alarm; the others by ambulance.
Stats: 3 eTOH (one with a head injury); one asleep; one with MH issues; two faints; one unwell adult.
Two bus-sleeping drunk calls and my first was to a 30 year-old man, given a Red1 because the bus driver couldn’t or didn’t want to approach in order to confirm the presence of breathing. I have never had a call to a cardiac arrest on a bus after a boozy Saturday night, so I went there knowing what I’d find.
The slumbering man woke up after my second attempt to get his attention and he lazily sloped off the bus and into the morning air, thanking me for ‘helping’ him as he lit a cigarette. The crew had arrived just in time to see him leave.
On my way to this call I was nearly totalled when a van in front of me slammed on his brakes, rather than pull over to let me pass. I found myself running at 40mph with nowhere to go and hoping that my brakes would stop me in time. They did but I wasn’t happy to know that I could have been injured or killed because of someone who got drunk and snoozed or because a bus driver refused to try and get some facts for us.
After that an 83 year-old lady apologised and told me she didn’t need an ambulance when I entered her flat. She was lying in bed and had tripped her emergency call button by mistake. Her ‘DIB’ didn’t exist but I noticed that her inhalers were empty, so I made sure her GP was alerted so that she could have a replacement. I left her in the care of her carer.
Drunk on a bus number two was slobbering saliva down his chin as he lay slumped in the aisle between seats. He too was breathing, obviously but he too had been made an emergency by the driver who refused to touch him and preferred to have an ambulance person do it instead. Again, I woke him up and walked him off and again the crew arrived to witness their redundancy. Lots of tax money going down a drain with these calls I fear.
A man with mental health issues who hadn’t been taking his prescription Librium was lying head first over a small wall. His feet were dangling over the edge and he could have been dead…but he wasn’t. A passer-by had called us and she looked on anxiously as I pulled up to ‘rescue’ him from the dirt and the spiders that were crawling over his face as he slept.
‘I don’t feel very well’, he said as I hauled him up onto his rear end. I couldn’t haul him any further because he wouldn’t help me, the space I had clambered into was tight and he was bigger and heavier than me – still, a valiant effort on my part.
When I finally managed to convince him to help me lift him onto the edge of the wall, he seemed unbalanced and I don’t mean in a mass versus gravity way. He didn’t like me touching him, even to hold him steady (he’d been drinking) and he had that ‘not-going-to-help-you-help-me’ look on his face. I thought he might try to swing a punch or kick at me, so I prepared to move quickly if he did. He probably had no mind to but I was on my own now and not willing to take the risk. It’s too cold to get beaten up.
When the crew appeared, they helped me get him off the wall and into the ambulance. He had collapsed across the road from the hospital, so at least my colleagues would have a short-lived risk if he was a danger to anyone.
Period pain can be quite agonising, by all accounts and from my second-hand experience with it, so my next call to a 28 year-old who’d fainted because of the pain wasn’t a surprise to me. She had a strange combination of problems associated with her monthly cycle; diarrhoea, vomiting, faint and severe pain. Luckily she didn’t suffer like this every month but she’d had this combo before and she looked quite ill as a result.
Her boyfriend had called an ambulance when she passed out and I found her in the small ladies’ toilet in a cafe in a posh part of town – so posh that I doubt they’d have approved of her being there with such a pale face and sickly look.
I rescued her out of the range of glaring, staring people as they trooped by and met the ambulance as it landed outside. She was taken aboard and privacy was restored – privacy and dignity.
As I left the crew to it and stepped out of the ambulance, I was confronted by an irate motorist who’d got out of his car and was marching over to give us all a piece of his mind for parking in the middle of the road. I had parked near the pavement but the ambulance had nowhere else to go – it was a very narrow street and with cars parked all along on both sides, it was impossible to situate the vehicle other than where my colleague had put it. Yet despite this and the fact that he must have seen the patient being taken onto the ambulance looking like death warmed up, he insisted on getting in our faces about it. His journey to wherever was simply far too important for an obstruction from the likes of us to interfere with it.
I’ve heard from at least one cop who says they get this problem too but I still doubt that this whipped up driver would have come out and stamped around like a child if the police had been there instead of us. I had to use my firm but professional voice (that means I said sir at least once) to get him away from us and into his car again. People like that can create an unnecessarily threatening atmosphere for a patient.
Two for one again! I was called to yet another ‘unconscious male on bus’ and arrived to find that the police were getting aboard and there were two of them, slumped in their seats. Like babies, only not so cute and not worth fostering.
I woke one of them up after trying my best with the other, who had a bleeding head wound caused by falling on his face at some point (judging by the little pool of blood on the floor of the bus). His mate awoke and looked at me with disdain – not even a ‘hello’. It took a few more tries to get his sleeping buddy to rouse.
Both men were Eastern Europeans and neither gave a damn about me or the cops or why we were there...or the cost of it all. I was happy to leave them in the street to be honest because the arrogance and low-level threatening behaviour of the non-head busted drunk was starting to annoy me and it had been a long day so far.
Eventually it was agreed that the man with the head wound, which I’d now dressed, should go to hospital (across the road – yep, same hospital that wall-man went to). His friend demanded to go with him but I said that he could walk himself over there. He wouldn’t get through the doors in that state and he would be a threat to the crew, so it was best to separate them.
The crew hated me for a few seconds. They had been cancelled on a run to a genuine injury for this and they weren’t impressed. Some poor patient had to wait because their limb injury was a lower priority than that of two sneering, alcohol-loving, Brit-hating Lithuanians with no jobs, no prospects and no hope of contributing to a generous, caring and ultimately easily walked-over society.
I greened up just in time for FRED to send me miles out of my area for a ‘?CVA’ that was nothing of the sort. ‘Close the door or the cats will get out!’ the 61 year-old woman said as I entered her flat with my MRU colleague (why two solo’s? I’ve no idea).
She was sitting on the bottom stair, cradling her head and complaining of feeling unwell. The call had described her as ‘collapsed behind doors. On floor’. Not quite what I saw, however and she seemed more pre-occupied with the possibility of an escaping moggy than her current state of health. I left as soon as the crew was on scene. I’d done nothing but pass bits and pieces along to my colleague anyway.
I needed to get away by end of shift time – I had an important prior appointment but, as always and I should really know better, you cannot make plans in this job. Typically, I was given a late job...it was a few miles south and there were no ambulances available. So, I spent 30 minutes of my own time (sarcastically called overtime) baby-sitting a 38 year-old woman with a headache who’d fainted earlier. She was surrounded by kids – her son and a few of his mates – all of whom harangued me about how long it was taking to get her to hospital. If I’d been less tired, I’d have driven her there myself.
I shouldn’t moan so loud because some of my colleagues have been caught out and spent more than a few hours on enforced overtime when they had better things to do.
Be safe.
Stats: 3 eTOH (one with a head injury); one asleep; one with MH issues; two faints; one unwell adult.
Two bus-sleeping drunk calls and my first was to a 30 year-old man, given a Red1 because the bus driver couldn’t or didn’t want to approach in order to confirm the presence of breathing. I have never had a call to a cardiac arrest on a bus after a boozy Saturday night, so I went there knowing what I’d find.
The slumbering man woke up after my second attempt to get his attention and he lazily sloped off the bus and into the morning air, thanking me for ‘helping’ him as he lit a cigarette. The crew had arrived just in time to see him leave.
On my way to this call I was nearly totalled when a van in front of me slammed on his brakes, rather than pull over to let me pass. I found myself running at 40mph with nowhere to go and hoping that my brakes would stop me in time. They did but I wasn’t happy to know that I could have been injured or killed because of someone who got drunk and snoozed or because a bus driver refused to try and get some facts for us.
After that an 83 year-old lady apologised and told me she didn’t need an ambulance when I entered her flat. She was lying in bed and had tripped her emergency call button by mistake. Her ‘DIB’ didn’t exist but I noticed that her inhalers were empty, so I made sure her GP was alerted so that she could have a replacement. I left her in the care of her carer.
Drunk on a bus number two was slobbering saliva down his chin as he lay slumped in the aisle between seats. He too was breathing, obviously but he too had been made an emergency by the driver who refused to touch him and preferred to have an ambulance person do it instead. Again, I woke him up and walked him off and again the crew arrived to witness their redundancy. Lots of tax money going down a drain with these calls I fear.
A man with mental health issues who hadn’t been taking his prescription Librium was lying head first over a small wall. His feet were dangling over the edge and he could have been dead…but he wasn’t. A passer-by had called us and she looked on anxiously as I pulled up to ‘rescue’ him from the dirt and the spiders that were crawling over his face as he slept.
‘I don’t feel very well’, he said as I hauled him up onto his rear end. I couldn’t haul him any further because he wouldn’t help me, the space I had clambered into was tight and he was bigger and heavier than me – still, a valiant effort on my part.
When I finally managed to convince him to help me lift him onto the edge of the wall, he seemed unbalanced and I don’t mean in a mass versus gravity way. He didn’t like me touching him, even to hold him steady (he’d been drinking) and he had that ‘not-going-to-help-you-help-me’ look on his face. I thought he might try to swing a punch or kick at me, so I prepared to move quickly if he did. He probably had no mind to but I was on my own now and not willing to take the risk. It’s too cold to get beaten up.
When the crew appeared, they helped me get him off the wall and into the ambulance. He had collapsed across the road from the hospital, so at least my colleagues would have a short-lived risk if he was a danger to anyone.
Period pain can be quite agonising, by all accounts and from my second-hand experience with it, so my next call to a 28 year-old who’d fainted because of the pain wasn’t a surprise to me. She had a strange combination of problems associated with her monthly cycle; diarrhoea, vomiting, faint and severe pain. Luckily she didn’t suffer like this every month but she’d had this combo before and she looked quite ill as a result.
Her boyfriend had called an ambulance when she passed out and I found her in the small ladies’ toilet in a cafe in a posh part of town – so posh that I doubt they’d have approved of her being there with such a pale face and sickly look.
I rescued her out of the range of glaring, staring people as they trooped by and met the ambulance as it landed outside. She was taken aboard and privacy was restored – privacy and dignity.
As I left the crew to it and stepped out of the ambulance, I was confronted by an irate motorist who’d got out of his car and was marching over to give us all a piece of his mind for parking in the middle of the road. I had parked near the pavement but the ambulance had nowhere else to go – it was a very narrow street and with cars parked all along on both sides, it was impossible to situate the vehicle other than where my colleague had put it. Yet despite this and the fact that he must have seen the patient being taken onto the ambulance looking like death warmed up, he insisted on getting in our faces about it. His journey to wherever was simply far too important for an obstruction from the likes of us to interfere with it.
I’ve heard from at least one cop who says they get this problem too but I still doubt that this whipped up driver would have come out and stamped around like a child if the police had been there instead of us. I had to use my firm but professional voice (that means I said sir at least once) to get him away from us and into his car again. People like that can create an unnecessarily threatening atmosphere for a patient.
Two for one again! I was called to yet another ‘unconscious male on bus’ and arrived to find that the police were getting aboard and there were two of them, slumped in their seats. Like babies, only not so cute and not worth fostering.
I woke one of them up after trying my best with the other, who had a bleeding head wound caused by falling on his face at some point (judging by the little pool of blood on the floor of the bus). His mate awoke and looked at me with disdain – not even a ‘hello’. It took a few more tries to get his sleeping buddy to rouse.
Both men were Eastern Europeans and neither gave a damn about me or the cops or why we were there...or the cost of it all. I was happy to leave them in the street to be honest because the arrogance and low-level threatening behaviour of the non-head busted drunk was starting to annoy me and it had been a long day so far.
Eventually it was agreed that the man with the head wound, which I’d now dressed, should go to hospital (across the road – yep, same hospital that wall-man went to). His friend demanded to go with him but I said that he could walk himself over there. He wouldn’t get through the doors in that state and he would be a threat to the crew, so it was best to separate them.
The crew hated me for a few seconds. They had been cancelled on a run to a genuine injury for this and they weren’t impressed. Some poor patient had to wait because their limb injury was a lower priority than that of two sneering, alcohol-loving, Brit-hating Lithuanians with no jobs, no prospects and no hope of contributing to a generous, caring and ultimately easily walked-over society.
I greened up just in time for FRED to send me miles out of my area for a ‘?CVA’ that was nothing of the sort. ‘Close the door or the cats will get out!’ the 61 year-old woman said as I entered her flat with my MRU colleague (why two solo’s? I’ve no idea).
She was sitting on the bottom stair, cradling her head and complaining of feeling unwell. The call had described her as ‘collapsed behind doors. On floor’. Not quite what I saw, however and she seemed more pre-occupied with the possibility of an escaping moggy than her current state of health. I left as soon as the crew was on scene. I’d done nothing but pass bits and pieces along to my colleague anyway.
I needed to get away by end of shift time – I had an important prior appointment but, as always and I should really know better, you cannot make plans in this job. Typically, I was given a late job...it was a few miles south and there were no ambulances available. So, I spent 30 minutes of my own time (sarcastically called overtime) baby-sitting a 38 year-old woman with a headache who’d fainted earlier. She was surrounded by kids – her son and a few of his mates – all of whom harangued me about how long it was taking to get her to hospital. If I’d been less tired, I’d have driven her there myself.
I shouldn’t moan so loud because some of my colleagues have been caught out and spent more than a few hours on enforced overtime when they had better things to do.
Be safe.
Sunday, 2 November 2008
Cold and wet
Day shift: Six calls; one declined after treatment; the others by ambulance.
Stats: 1 eTOH; 2 EP Fit; 1 RTC with leg injury; 1 Near drowning; 1 DIB.
A bag was found in our station bin this morning. It was discovered by the rubbish men (refuse technicians or whatever the PC term is). Inside was some clothing and an ID for a Clinical Pharmacologist from UCL. How it got there is a mystery but only two theories for its presence hold water as far as I’m concerned. The young man was either robbed and it was dumped there, or he got so drunk the night before that it was abandoned. Cynical of me I know but my world doesn’t offer much else in the way of explanation. Needless to say we will be trying to reunite the bag with its owner.
And so a Saturday morning, freezing with the start of true winter, opens with a call to a 70 year-old man who has collapsed outside his hostel. I know this place well and none of us particularly enjoy coming here. The old man was drunk and had just returned from a morning shopping trip in which he purchased breakfast – a bottle of cider. He is, of course, an alcoholic and somehow he’d lost his balance and fallen, giving himself a minor head injury. His trousers were half way down his legs, revealing his naked behind as I approached – it was his introduction to me.
The man has no medical problems but it’s impossible to completely rule out a non-alcohol related reason for a fall like this, especially as he obviously made it to the shop and most of the way back without toppling. Could it be that the very anticipation of a drink made him walk too fast for his aged legs? He had to go to hospital regardless of my theories and suppositions because his habitual drunken state would mask any problem related to his head injury or a medical cause for it.
His undignified transfer (trousers around his ankles) to the ambulance from the street was witnessed by the hostel staff and everyone else who just happened to have business in the area at that time in the morning. He was helpless despite the help offered by the crew. Beyond help is probably more accurate.
My first of two EP fits was a 45 year-old man who collapsed in a shop. His groceries were all over the floor and he was recovering when I arrived, although he was still a bit confused. He confirmed his condition and was taken to the ambulance and off to hospital. I managed to gather his shopping together and the kind staff allowed me to take it to the patient even though he hadn’t yet paid for it, so I felt like a shoplifter as I left.
My second fit was a 38 year-old man who fell down a few stairs at work in front of his colleagues. He was unconscious when I got to him and there was a little blood coming from his mouth (this is common). He regained consciousness over the next few minutes with oxygen and, although he remained vague and restless for a while longer, he began to recover to the point where he understood what was going on. He told me he was prone to have more than one fit at a time and so I put a line in just in case. There’s no point in getting caught out. The crew arrived soon after and he was taken away. His colleagues looked very relieved. I think they thought the worst. Until I could establish that he was epileptic, which none of them knew for sure, I too, was concerned.
A minor RTC in Central London next. The relentless cold rain was bound to throw up more than a few of these today. A young woman fell off her moped when the vehicle lost traction on a slippery drain as she rode along the busy road. She had leg pain and the police and a passing ambulance crew were on scene when I got there, so she was already being taken care of. I helped her up and into the ambulance for further checks. The low speed and low height of her fall meant she probably had no more than a bruised knee. She was lucky not to have fallen in front of a bus.
This is the season for suicide and my next call, to a male who’d jumped from Blackfriars Bridge, had been fished out of the river by the RNLI. My MRU buddy, the one I seem to always get tough jobs with, told me that he’d been taken further up river to the lifeboat station because he was dead. Normally, we are asked for an opinion first, so that seemed very strange. Nevertheless, off we went in search of our supposedly dead patient.
When I arrived at the station, my colleague was already inside and I made my way down the slippery jetty and into the small floating cabin that serves as a first aid room for the RNLI and river police. I could see a man lying on his back on the bed and I noticed that his chest was rising. So, not dead then.
A lifeboat man had dragged the suicidal man from the river after he was spotted floating face down under the bridge. He wasn’t breathing and his rescuer, a man called Paul Ward, began resuscitating him. By the time he’d reached the station, his charge was breathing again and conscious. So all our efforts were now concentrated on keeping him that way. He was re-heated (his temperature had plummeted and couldn’t be read on our thermometers) with blankets and warmed IV fluids. I’d already cut away all of his wet clothing to accommodate the process and now we waited for his body temperature to rise and for his vital signs to normalise.
Meanwhile, two officers and an ambulance arrived and a plan was prepared for his removal. The deck and walkway of the lifeboat station is very hazardous when wet and I’ve tackled it more than once with patients (dead and alive). The risk of slipping is high, so we needed all hands to remove our patient to the safety of the ambulance.
It took almost half an hour for the man’s body heat to recover to normal; two bags of warm fluid and loads of blankets did the trick. His vital signs were good and he was making sense, although his ambition to die had been thwarted, it seemed he regretted trying. Apparently he had mental health issues and woman problems.
I’ve named Paul with his permission because these men and women don’t get enough recognition for the job they do. The majority of recoveries from the river will be dead and there’s never any thanks for that I guess but when they do save a life, it seems to be seen as part of their function and that’s it. I shook the man’s hand, thanked him myself and introduced him properly to the patient, informing him that he now knew the person who’d saved his life. I don’t know if he’ll ever visit Paul and his colleagues to say thanks personally but at least the job was done in part and by proxy.
I ended the shift with a call to an underground station for a 58 year-old man with DIB. I arrived to find him wheezing dramatically but still able to talk to me in full sentences. His wife and friends were with him and he told me he had a history of MI. He had no chest pain and this event had been triggered by a skateboarding teen who’d whipped past him on the platform, giving him a fright. He may have been bumped by the wheeled maniac and it looked to me like he was just winded. He requested (and got) oxygen and within two minutes was fully recovered and declining further aid.
I cancelled the ambulance and walked down the platform after bidding them farewell and an enjoyable evening. A female member of the underground staff squared up to the male staff member who’d led me to the patient and demanded to know why there was such confusion over the location given to me when I arrived. I hadn’t noticed any problems but I left them arguing at full volume as I made my way back to fresh air.
‘I told you where to send him!’
‘No you didn’t’
‘Oh, yes I did!’
‘No you didn’t’
Christmas has come early...
Be safe.
Stats: 1 eTOH; 2 EP Fit; 1 RTC with leg injury; 1 Near drowning; 1 DIB.
A bag was found in our station bin this morning. It was discovered by the rubbish men (refuse technicians or whatever the PC term is). Inside was some clothing and an ID for a Clinical Pharmacologist from UCL. How it got there is a mystery but only two theories for its presence hold water as far as I’m concerned. The young man was either robbed and it was dumped there, or he got so drunk the night before that it was abandoned. Cynical of me I know but my world doesn’t offer much else in the way of explanation. Needless to say we will be trying to reunite the bag with its owner.
And so a Saturday morning, freezing with the start of true winter, opens with a call to a 70 year-old man who has collapsed outside his hostel. I know this place well and none of us particularly enjoy coming here. The old man was drunk and had just returned from a morning shopping trip in which he purchased breakfast – a bottle of cider. He is, of course, an alcoholic and somehow he’d lost his balance and fallen, giving himself a minor head injury. His trousers were half way down his legs, revealing his naked behind as I approached – it was his introduction to me.
The man has no medical problems but it’s impossible to completely rule out a non-alcohol related reason for a fall like this, especially as he obviously made it to the shop and most of the way back without toppling. Could it be that the very anticipation of a drink made him walk too fast for his aged legs? He had to go to hospital regardless of my theories and suppositions because his habitual drunken state would mask any problem related to his head injury or a medical cause for it.
His undignified transfer (trousers around his ankles) to the ambulance from the street was witnessed by the hostel staff and everyone else who just happened to have business in the area at that time in the morning. He was helpless despite the help offered by the crew. Beyond help is probably more accurate.
My first of two EP fits was a 45 year-old man who collapsed in a shop. His groceries were all over the floor and he was recovering when I arrived, although he was still a bit confused. He confirmed his condition and was taken to the ambulance and off to hospital. I managed to gather his shopping together and the kind staff allowed me to take it to the patient even though he hadn’t yet paid for it, so I felt like a shoplifter as I left.
My second fit was a 38 year-old man who fell down a few stairs at work in front of his colleagues. He was unconscious when I got to him and there was a little blood coming from his mouth (this is common). He regained consciousness over the next few minutes with oxygen and, although he remained vague and restless for a while longer, he began to recover to the point where he understood what was going on. He told me he was prone to have more than one fit at a time and so I put a line in just in case. There’s no point in getting caught out. The crew arrived soon after and he was taken away. His colleagues looked very relieved. I think they thought the worst. Until I could establish that he was epileptic, which none of them knew for sure, I too, was concerned.
A minor RTC in Central London next. The relentless cold rain was bound to throw up more than a few of these today. A young woman fell off her moped when the vehicle lost traction on a slippery drain as she rode along the busy road. She had leg pain and the police and a passing ambulance crew were on scene when I got there, so she was already being taken care of. I helped her up and into the ambulance for further checks. The low speed and low height of her fall meant she probably had no more than a bruised knee. She was lucky not to have fallen in front of a bus.
This is the season for suicide and my next call, to a male who’d jumped from Blackfriars Bridge, had been fished out of the river by the RNLI. My MRU buddy, the one I seem to always get tough jobs with, told me that he’d been taken further up river to the lifeboat station because he was dead. Normally, we are asked for an opinion first, so that seemed very strange. Nevertheless, off we went in search of our supposedly dead patient.
When I arrived at the station, my colleague was already inside and I made my way down the slippery jetty and into the small floating cabin that serves as a first aid room for the RNLI and river police. I could see a man lying on his back on the bed and I noticed that his chest was rising. So, not dead then.
A lifeboat man had dragged the suicidal man from the river after he was spotted floating face down under the bridge. He wasn’t breathing and his rescuer, a man called Paul Ward, began resuscitating him. By the time he’d reached the station, his charge was breathing again and conscious. So all our efforts were now concentrated on keeping him that way. He was re-heated (his temperature had plummeted and couldn’t be read on our thermometers) with blankets and warmed IV fluids. I’d already cut away all of his wet clothing to accommodate the process and now we waited for his body temperature to rise and for his vital signs to normalise.
Meanwhile, two officers and an ambulance arrived and a plan was prepared for his removal. The deck and walkway of the lifeboat station is very hazardous when wet and I’ve tackled it more than once with patients (dead and alive). The risk of slipping is high, so we needed all hands to remove our patient to the safety of the ambulance.
It took almost half an hour for the man’s body heat to recover to normal; two bags of warm fluid and loads of blankets did the trick. His vital signs were good and he was making sense, although his ambition to die had been thwarted, it seemed he regretted trying. Apparently he had mental health issues and woman problems.
I’ve named Paul with his permission because these men and women don’t get enough recognition for the job they do. The majority of recoveries from the river will be dead and there’s never any thanks for that I guess but when they do save a life, it seems to be seen as part of their function and that’s it. I shook the man’s hand, thanked him myself and introduced him properly to the patient, informing him that he now knew the person who’d saved his life. I don’t know if he’ll ever visit Paul and his colleagues to say thanks personally but at least the job was done in part and by proxy.
I ended the shift with a call to an underground station for a 58 year-old man with DIB. I arrived to find him wheezing dramatically but still able to talk to me in full sentences. His wife and friends were with him and he told me he had a history of MI. He had no chest pain and this event had been triggered by a skateboarding teen who’d whipped past him on the platform, giving him a fright. He may have been bumped by the wheeled maniac and it looked to me like he was just winded. He requested (and got) oxygen and within two minutes was fully recovered and declining further aid.
I cancelled the ambulance and walked down the platform after bidding them farewell and an enjoyable evening. A female member of the underground staff squared up to the male staff member who’d led me to the patient and demanded to know why there was such confusion over the location given to me when I arrived. I hadn’t noticed any problems but I left them arguing at full volume as I made my way back to fresh air.
‘I told you where to send him!’
‘No you didn’t’
‘Oh, yes I did!’
‘No you didn’t’
Christmas has come early...
Be safe.
Radio Five Live
I'm back and I will be chatting to Donal McIntyre tonight on his radio five live show at 7.30pm. He wants to discuss the rising violence against paramedics (and by that I think he means ambulance staff in general).
Tune in if you can. I'm on duty today, so hopefully I'll get back home in time to take his call!
Xf
Tune in if you can. I'm on duty today, so hopefully I'll get back home in time to take his call!
Xf
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