Damage control

One lucky driver...

Night shift: Eight calls; one gone before arrival; one assisted-only; one by car and the rest by ambulance.

Stats: 1 RTC with invisible patient; 1 Cut wrist; 1 Faint; 1 ? # ankle; 1 eTOH; 1 DIB; 1 DOAB; 1 RTC.

None of us appreciate being dragged four miles on blue lights to a RTC where the patient has decided he would rather just go home and not bother to inform us of his change of heart. Luckily, I was the only one assigned and I was able to cancel the ambulance (not that one had even been sent yet) and thus avoid even more waste of resources. The driver who’d hit the cyclist told me the 27 year-old man had a head injury and was knocked out for a few seconds after colliding with his car as he cycled the wrong way round a roundabout. The police arrived and I thought it best if the driver continued his story while they were writing it down.

The patient, meanwhile, had left the scene and that meant paperwork for no reason and a long trip back to my own area.

Another call on which nothing but a solo (me) could be tasked because there was nobody else available, took me to a hotel in which a 28 year-old Lithuanian member of staff with perfect English had cut her wrist on a broken wine glass that she’d been stacking in the kitchen. The quick-thinking chef followed her as she made her own way to the back room, where the first aid kit was stored and he put pressure on the wound as soon as he saw it. The incision was very deep and close to her Ulnar artery – she was very lucky not have severed it and the actions of the chef, who had applied the pressure and elevated the arm immediately whilst waiting for the first aider to get to them from the 9th floor, had saved her a lot of blood.

By the time I arrived, the bleeding was almost under control and I was able to fix another dressing and place a sling on her for the trip to A&E, where she’d need stitches. The poor woman was terrified of her own blood and looked away as I examined and then covered the wound. I took her and a colleague in the car because there were no ambulances around and, to be fair, she didn’t need anything more than first aid and definitive care in hospital.

A 71 year-old woman fainted after having a meal at a swanky club in one of the better parts of town. She was on the floor when I arrived and her husband and a few friends were in attendance. She was conscious but still very pale and unwell. She had a history of high blood pressure and was taking Atenalol for that; this drug slows the heart rate down and sometimes the blood pressure falls a little too low and a faint results.

I sat her up to gauge her condition and sure enough she began to feel unwell and faint once more. She vomited a few times on the plush carpet as the diners around her looked on. The staff moved everyone out of the room, leaving a few lovely and delicious looking deserts behind. Tempting as they were, I still managed to look after my patient until the ambulance arrived. The crew were momentarily distracted by the food too though.

An unusual twist to the next call, which is for a 26 year-old female (who happens to be nearer 40) who has fitted. When I arrive, there is a police officer or two around because she has collapsed outside the local cop-shop and her husband, who is also there, is an off-duty policeman. She has recently had a miscarriage and for some reason her husband thinks she may have fitted for a few seconds before falling to the ground but she is only complaining of ankle pain, so I have a look and her leg is swollen at the ankle; it feels like jelly down there too, so I assume she has broken it on the way to the floor as her husband struggled to keep her upright.

She must have fainted – although a fit isn’t out of the question, she has no history of seizures and is more likely to have fallen down in faint if she is still under the strain of her latest miscarriage (she’s had three to date).

I give her entonox and it helps but she’s losing the feeling in her toes and this means her circulation is suffering. The ankle is at a strange angle, so it will have to be straightened out. I wait until the ambulance crew arrives and they can help me support the limb for splinting. This straightens it out and, with a little more pain she can once again feel her toes.

After a useless long run to the City for a drunk person with a bleeding face, for whom another FRU was already on scene and dealing, I returned for my break and found myself at the station for much longer than normal on a Friday night. This pleasant hiatus ended though and I got a call that took me into the West End for what amounts to the most typical call type for the weekend; a drunken, vomiting female.

She was in a doorway with her friends and two PCSO’s were guarding them. The patient was an 18 year-old who was throwing up and flopping like a heavy-headed baby in the stinking, rain-soaked entrance of a commercial building. Three of her mates were there; two of them fairly sober and sensible and the other just as drunk, although able to wail and whine about how bad it all was for her. She’d probably spent £40 tonight just so she could feel hard done by.

Initially the reception I got was frosty and disrespectful but I think I charmed then onto my side when I explained how ridiculous it was for them to be in this condition when they were vulnerable and depriving a really ill person of an ambulance. The two sober girls seemed to get it and, to my surprise, the head of my patient even nodded in silent, shameful agreement.

I asked for the Booze Bus and it arrived very swiftly. One of the PCSO’s had very kindly donated his hi-vis jacket to cover up the vomiting girl’s dignity. He must have been new to the job because you just don’t do things like that with stuff you need to wear. I managed to save his uniform from disgrace when the girl attempted to vomit all over it. She got a blanket instead.

As usual, the Booze Bus crew were magnificent and efficient, sweeping away the human debris from that doorway in quick time. I took the girl’s friends to hospital in the car, so that they could join their mate while she recovered.

On the way back up Charing Cross Road I saw what looked like a small woman being chased by a larger man. In fact, she was a plain clothed police officer and she was running after the man in an attempt to arrest him. The handcuffs she was brandishing helped me to come to that conclusion and as she raced across the road after him I thought she might need a hand, especially when she caught up with him but he overpowered her, throwing her to the pavement. My business or not, I am not the type to sit and watch something like that when the street is full of people who could have given the officer a hand, so I got out of the car, ran after him and grabbed his arm, while the cop held onto the other one and tried to cuff him.

Three or four other men appeared around us and began to have a go at the police woman – telling her that she had no right to arrest him because she was on her own and that it wasn’t legal. I think this is nonsense but maybe one of my police readers can confirm this. As far as I’m concerned, a police officer can arrest someone, whether they are alone or not.

The cop’s very large colleague showed up and took over from me. She had no radio and no chance of getting help if things had turned nasty (my radio, as usual, wasn't working) and, as I said, whether you judge me to have done the right thing or simply interfered, it’s in my nature to help and I’d do it again, despite the obvious risk. That female cop had a lot of guts doing what she did in any case.

Soon after that excitement, a call to a 4 year-old boy with DIB took me into the Oxford Street area in support of a crew that had just arrived as I pulled up. The boy had bronchitis and now an infection was making it worse. His guardians spoke very little English so what information we could glean was very limited but the sound of him coughing was enough and so he went to hospital.

A DOAB next and for once it was a female. The Russian woman was fast asleep, smelled heavily of alcohol and had her bag, phone and long leather boots around her as she slumbered. She’d actually settled in for the night. No wonder she scratched me when I continually harassed her to wake up and get off the bus. It took a few more minutes than usual and I think I was treated to a lot of Russian expletives but eventually, like all the others, she had to comply and get off.
As I prepared to leave the scene, she walked straight back onto the bus and the driver happily drove off with her and a few other passengers. Another complete waste of time and tax.

As I crept towards the light on a promise that I would make it home on time, the heavens opened up and I was sent a job that was almost certainly going to make me late. It was a RTC involving one car that had careered at speed into traffic lights, flattening the post and sending the red, amber and green mounts flying across the road. When I arrived the car was empty but a woman called to me and said that the driver had got out and been taken into a little shop, where he now sat with his head in his hands.

The rain had been persistent all night but now it was torrential; the worst kind of weather to be the only blue light on a crash of this type. Traffic was beginning to build on the road and my car was blocking the scene for safety, so buses and large vehicles were having trouble negotiating around me and it was only going to get worse.

I was soaked through by the time I got the man to my car and sat him inside. He’d already been up and around so he was very lucky to be walking. His windscreen was bulls-eyed twice; once by his head I suspect and again by a smaller thing that had impacted when the car stopped suddenly. This lesser crack was probably caused by his mobile phone, which I found on the floor of the driver’s side. It’s very likely, but not definite, that he was on his phone when he crashed. There seemed to be no other explanation for his abrupt loss of control on what was (at the time of the crash) a quiet stretch of road. He was probably texting.

Within twenty minutes the fire service and police were on scene in some numbers. Exposed electrical cables from the traffic light that had been wiped out and the crushed engine of the car necessitated the LFB’s presence but, typically given the time of the day, there was still no ambulance.

A crew arrived almost half an hour later and the patient, who’d spent the duration drying off in the back of my car, was finally collared and boarded for removal to hospital. It all seems a bit open-stable-door but the same precautions applied, even though his neck was more than likely in good shape, which is more than can be said for his car.

Be safe.

Street Medic - second print

The reprinted version of 'The Street Medic's Survival Guide' is now available through SP Services and my usual stockists. There were a few minor quality faults that I felt the need to redress, so I have worked on them and replaced every single stock copy of the book with a new, improved version!

Faults

The text was printed too close to the margins of the pages, making it difficult to read without breaking the spine, so I have increased the margin slightly. Unfortunately, increasing the margin increases the page number and I am reluctant to send more trees to their deaths for the sake of a minor flaw, so I have only increased it enough to make the book perfectly readable on opening. There are now 84 pages instead of 80.

There were also a couple of very minor typo's. On page 21 the CRB note has been inadvertently cut, so it is incomplete. It should read 'CRB - soon to change; from October 2009 the Independent Safeguarding Authority (ISA) will hold information on individuals which will be available free to employers and organisations wishing to check if their prospective employee can work with children and vulnerable people. Other ‘regulated activities’ will be covered and if you aren’t registered - or are barred from certain activities, then your Service may not be able to employ you.'

I have simplified the page heading and page number footers so they look cleaner and the widows and orphans (lonely single lines at the beginning and end of the pages) have been repaired.

On page 79 'Zulu zulu' should read 'Zebra zebra'!

About three spelling/grammatical errors were also identified and repaired.

And that's it. First print editions do tend to carry the teething problems associated with deadlines, so I hope I have now sorted things out. If you have a copy of the book, it is a rarity now because only a few thousand were printed with the errors. You can now go off and Ebay it!

If you are starting Paramedic Science or are thinking of going into frontline Paramedicine, click on the link (the post title), go to SP and buy the book!!

Xf

Fits and faints

Day shift: Four calls; one taken by car; one assisted-only and two by ambulance.

Stats: 1 EP fit; 1 Abdo pain; 1 Faint; 1 eTOH fit.


The whole of the morning disappeared in a flash as I ran around getting my comms sorted out and waiting for a patient. Then as lunch time crept in, I was sent to a 40 year-old man who was fitting in a cafe. He was post ictal and recovering slowly when I arrived; he made no sense yet but I managed to confirm with him that he was epileptic.

The lady running the cafe said he’d fitted for 15 minutes but I found that unlikely – two of the customers said that he’d only been down for 5 minutes. So, I spent another twenty minutes with him as he attempted, time and time again, to push me out of his way so that he could wander around. He was a good few inches taller than me so he became a handful at times and I was glad to see the ambulance pull up.

By the time he’d been checked out again by the crew, he was almost fully back to normal and he was given a lift round the corner to his workplace – he refused to go to hospital.


Immediately after this call, I made my way to an abdo pain in a restaurant, where my CRU colleague was attending a 33 year-old woman with a history of endometriosis, normally controlled by monthly injections of GnRH analogue. Her pain was so severe that entonox did nothing for it, so she was given a few mls of morphine and that did the trick. She was needle-phobic, so after persuading her to have the analgesic, I inserted the slowest cannula I’ve ever done into her arm – I had to talk her through every millimetre of what I was doing. She felt nothing and I may have convinced her that injections aren’t so bad after all, who knows?


A 45 year-old fainted at work and lay in the reception area with colleagues around her as she recovered. The woman is taking antibiotics and this may be a factor; not the drugs themselves but any stressors that affect her if she is currently suffering from depression. It’s a common enough problem. A crew arrived and took her away after my initial obs revealed no physical problems.


The last job of the shift took me to the Leicester Square area for a 33 year-old Polish alcoholic who had ‘fitted’ in a doorway. Several MOPs had called it in because they were concerned but I reassured them and spent twenty minutes with the man trying to translate his Polish into English, or as near as dammit, as his friend looked on. He didn’t want to go to hospital and his hands were very cold, so I wrote down the name and location of the nearest hostel and gave it to him. He won’t go there; he’ll hunt for alcohol instead because that’s what he does. I felt sorry for him but then dismissed it because there are many, many unfortunate people around me who don’t drink themselves into a stupor every day. I should feel sorry for them instead.

Be safe.

Glass children

Day shift: Six calls: one treated on scene; one false alarm; one by car; two assisted-only and one by ambulance.

Stats: 1 Fracture; 1 Cold turkey druggie; 1 Not choking child; 1 Faint; 1 eTOH; 1 Minor cut.


A few things have caught my eye recently and I thought I’d share them with you to brighten your day (if it’s dull). I was watching a news item on the war in Afghanistan when the Chief of the Defence Staff appeared for an interview. He was named as Sir Jock Stirrup and this had me smiling. There’s no way on Earth he got through the Academy without a few million jibes at his name (and for my American friends, if translation is needed, the man can be called ‘Jock strap’)

I drive through Camden on my way to work every morning and there is a building with a sign on the outside that states ‘Jews for Jesus’. I find this confusing and paradoxical – can anyone tell me what that is all about?

And finally, a little courier van runs around Central London with the statement ‘my little sister is a bike’ liveried upon its side. Funny and close I think... reminds me of a broken optician's sign I once saw in which the only two letters that were missing were the ‘i’s. These little things make me smile.


I had to scrape the first of this winter’s frost off my car windows this morning before I left for work and by 7.30am it still hadn’t warmed up enough to remove the slip risk from the roads, so my first call, for a fall with fracture wasn’t a great surprise.

The 69 year-old woman had slipped on spilled milk that had been left in the road outside a tube station. The liquid had frozen and she had skidded onto her wrist, landing hard enough to give her a Colles’ fracture. Her wrist was badly deformed and the pain quite severe, although entonox helped somewhat. I put her injured arm in a sling and took her to hospital in the car. Her taxi-driver husband followed in his cab and they both went into Resus.

The patient told me she recognised me from a job I did much earlier in the year at a bank where she works; luckily she had a positive memory of me – it’s a small world.


A few hours later and after several cancelled calls, including one in which a woman was described as ‘incontinent’ and nothing else, I was asked to check out a man who was lying in the street vomiting. A police officer was on scene and all he wanted to do was move the man along but he was a little concerned about the fact that he was throwing up. He described the man as ‘anti-police’ and felt that I would be able to communicate with him and persuade him to move.

The drug addict was cold turkey and vomiting comes with that territory, so he didn’t want to go to hospital. It was an impractical notion anyway because his large black dog was with him, lying under the ragged, filthy sleeping bag with his owner. He barked a warning to me several times but I wasn’t worried because these animals tend to be well cared for and less territorial than house-bound pets. They have a natural inclination to protect their masters, of course but most of them recognise the uniform and understand that we mean no harm.

I persuaded the young man to move on and tried to interest him in the local hostel, which may have been able to support him through a very tough time but he wasn’t interested. Meanwhile the dog came out from underneath its cover and began to lick up the stream of watery, bile-coloured vomit that the man had left trailing out into the gutter. That wasn’t pleasant to watch and my attempts to discourage the animal from lapping it up came to nothing as he blatantly ignored me. He was wagging his tail, so he must have been enjoying it.


On to a non-event with a ‘choking’ call for a 2-year-old who stuck a passport photo in her mouth and retched a few times. The call was made by her mother and by the time I arrived there was nothing more to see. The little girl was understandably quiet and shy about having me around and at first declined, by means of a reluctant attitude, my request to inspect her throat. I was happy to leave her with mum but I needed to know she was out of danger. The first clue I got that all was okay was when she indicated that she wanted a drink of juice from her little plastic cup and then mum offered her breast milk, which she took there and then. I figured if she could suckle, she had no trouble breathing and I wasn’t going to consider her age for too long because every mother and child will continue that feeding bond until they both feel it’s no longer required. I reckon after the age of sixteen it should be outlawed though.


I managed to get lunch in before my next call of the shift. This one took me south of the river for what, I imagine, my Control desk thought to be a straight-forward pick up and convey job after a 22 year-old female fainted in a university lecture theatre. Unusually, it wasn’t that simple. The young girl had a recent history of bilateral pulmonary embolism and was on Warfarin as a result. She was due to have a catheter inserted in her heart and today she appeared to faint and fit just before taking an exam. Now, this kind of stress can and does produce the household type faints that we are all used to running on but don’t worry too much about and so it was prudent just to send me along but this lady had a complicated history and that changed the colour of things, so I requested an ambulance. She had chest pain and was emotionally wired, so travelling to hospital in the car was not an option.


A false alarm in Soho later on as I chatted to a colleague in Frith Street. Someone dialled 999 then left the ‘phone off the hook and ‘shouting’ could be heard in the background. I went around the corner to where the call had originated, followed by my CRU colleague and saw nothing initially, although I could certainly hear the shouting. It was one of those distinctive random cries that tend to emanate from the drunk or insane (or both) and it wasn’t long before we identified the source of it. A drunken (and probably drugged up) man was wandering down the street yelling, dancing and trying to sing. He looked harmless and even approached us to shake our hands. No emergency there then.


And once again, just as the time approached to end my shift, I was sent miles north and out of area to attend a 2 year-old boy who had bumped his head on a wooden bed post and cut himself above the eye. It was a very superficial wound and needed no more than a few strips of tape to close it. The young mother, who already had another two older children, seemed to have no idea whatsoever about the difference between a simple first aid issue and a true emergency. She dialled 999 because her little boy cut his head – he wasn’t unconscious and displayed no complications whatsoever. This lack of a basic understanding of childhood injuries leaves me stunned. You don’t need lessons for this because you experience it yourself in life (well, most of us do). Obviously an ambulance had never been despatched to this; they’d sent me simply because they knew it was a nonsense call but somebody had to deal with it. It’s frustrating to have to advise grown up people, especially parents, over and over again, to do a first aid course and get some confidence. Please, we are running out of ambulances.

Be safe.

The common sense leak

Day shift: Four calls; one treated on scene - the rest by ambulance.

Stats: 1 CVA; 1 Antibiotic reaction; Scalded hand; 1 Hyerglycaemic.


Now they need to carry out studies to tell us something we already knew!
http://news.aol.co.uk/tough-love-good-for-children-study/article/2009110722504083435297


On the first of my two ambulance duty dates I was tasked to a vehicle running out in the East, outside of my sector, because we are providing much needed cover in that area. So, I found myself crewed up with a friend and running around all day in the Woolwich area.

Our first call came in after a fairly lazy morning and it was for an 88 year-old man who had suffered a stroke and was under hospital care (or so it seemed) until he decided to discharge himself and walk out. He plodded three miles home in his pyjamas and straw hat, plonked his frail body into his little warden-controlled flat and began to make a right nuisance of himself – so much so that when we received the call it stated that police may be required as he was violent.

He was indeed aggressive but not really violent; he shouted, swore and insulted the woman who had called us to have him returned to hospital. She was trying her best to help him but all she got in return was abuse. The man had a brain injury, so it was predictable behaviour, unless he was always a cantankerous old bean.

He wandered around his flat collecting bits and pieces for his trip back to hospital – he knew he was going back and he thought we were there to force him to go. ‘Are you the police?’ he asked matter-of-factly. ‘No, we are here to help you and take you to hospital again’ I replied.

He was in shorts and his legs were smeared with faecal matter, some of it was dried into blobs on his calves. I thought this was a mercy because if it had been fresh and wet, I’d be smelling it all the way to hospital and would have to clean it up – the fact that it was dried meant all I had to do was clear off the larger particles and leave the smears. Sorry, I know it’s a bit in-depth and detailed but now you know what we get up to all day. All that training and it comes down to working out how much poo you are going to scrape off an old man’s legs. There’s no chapter in the text books to cover it. Maybe I'll write one.

After a few tirades and insults, we managed to get the man back to his ward, where the medical staff had been waiting for him. During the journey, he told me he was an ex-WWII pilot and we chatted about the kind of planes he flew (bombers) and regardless of his acidic character and his filthy demeanour, this was a man, among many, that had put his life on the line so that we could all live the way we do today. So, when we got him to his ward and a doctor and two of the nurses began giggling and pointing at him (he was dressed in his shorts, t-shirt, a straw hat and flip-flops) I thought it prudent to discuss the possibility of them watching him more closely next time rather than making fun of him. He’d had a stroke and clearly wasn’t well; what he needed was a safe place to get better, not the ridicule of a few young medical professionals.


Later on we attended a 62 year-old woman who’d just started antibiotics for an infection. She was complaining of feeling dizzy and sick and it was fairly obvious that the tablets didn’t agree with her. She needed to see her GP but s/he had refused to come out to her, so we were called. Sometimes the worst abusers of the ambulance service are the very people who should know better. So, a car and an ambulance were despatched and all we had to do was drive her to hospital. She had no emergency symptoms and her trip resulted in a long stay in the hospital waiting area with her relatives.


Even more stupid was the call made by a University security man who was also one of the first aiders. A staff member had been carrying a cup of coffee and got bumped by a student walking past (with no apology of course), resulting in a small spillage of hot liquid onto the back of her hand. She stuck it under cold water for 20 minutes and was still rinsing it when we arrived (on blue lights).

She had a superficial scald; nothing could be done – no blisters in sight and no prospect of permanent damage. It was a common-or-garden variety liquid burn and all she needed was cold water (done) and pain relief until the hand got better (in approximately 24 to 48 hours). The pain would go within a few hours.

All she got from me was advice. She didn’t want or need to go to hospital – the first aider had panicked and called us or quite possibly (and this is a real problem) the University had a ‘policy’ of calling ambulances for every little thing. Sometimes ‘policy’ really means ‘scared of litigation safety net’.

This was a 49 year-old woman who had burned herself a few times like this in her life and knew exactly what to expect. She knew her hand wouldn’t fall off and she was well aware of the throbbing pain she would have to endure until it settled. We all know this but for some reason we have lost our sense of knowledge-through-experience and have replaced it with policy-minded fear that there are hidden consequences. And there will always be someone, somewhere who will gladly cite a strange and unusual story; a rare thing that happened to somebody else, somebody they have never met in their lives, who got burned just like this and had to have an amputation ‘cos it got all infected and the hand went green. So we live by the principle that if we don’t cover our backsides this could happen again – for God’s sake let's grow up!


To end the shift we were treated to a 65 year-old man who sat in a sticky-floored front room, in a filthy little drug-den flat, drinking a can of lager as his druggie friends insisted he needed to go to hospital because ‘he wasn’t right in the head’. The man had a history of walking out of hospital before being seen and he adamantly refused to go this time when I asked him. I can’t force him to go but I have to reason it out before I just say ‘ok’ and leave, so I asked about a medical history and they told me he was a diabetic but that he hadn’t been taking his tablets. I checked his BM and it was high (33.3), so I used that as an excuse to coax him into going to be checked out.

When we arrived at hospital, the staff recognised him and before I could even finish my hand-over the triage nurse said ‘waiting room’. I explained that his BM was very high and this changed her mind. He was given a cubicle and I booked him in. I watched from the receptionist’s booth as my patient wandered past on his way outside – he was escaping again. I managed to stop him and turn him back to his cubicle but I found, to my astonishment (because it had only been ten minutes) that another patient was being put into it!

‘This patient is in here’ I said as the nurse settled another old man into the chair.

‘Not any more’ she replied.

I had to argue with the medical staff that if my patient wasn’t treated he’d likely become seriously ill and that he needed to be watched because he would walk out. I had a suspicion that this is why he was being slung around. He’d come in with a crew, be sat in reception, walk out and then be returned again later on or on another day. Meanwhile, his blood glucose level was rising and rising through neglect.

None of us are perfect and we all (in the medical profession) have to bear the strain of the sheer number of patients, real or imagined who require care every day. We also have a limit to our internal professional patience because we are human but if writing this blog and receiving criticism from some of my readers has taught me anything, it’s that making assumptions about individuals just because I am fed up at times, will cause clinical misjudgement. So, much as I rant about timewasters and the stupidity of some people, I will always look at the bigger picture in case I miss something. Today I saw various levels of lethargy in my fellow professionals and in all levels of care, from first aid to medical practise; I was confronted with an impassive attitude to those who really needed help and I am reminded of what someone said to me very recently about a visit to their GP in which the doctor had to look up an illness in her book while the patient sat waiting for an answer. ‘I could have done that myself on Google’, she told me with disbelief.

Be safe.

Ominous

Carved this one myself.

Night shift: Seven calls; one treated on scene - the rest by ambulance.

Stats: 2 Head injuries; 1 Cut finger; 1 eTOH; 1 NPC; 1 Chest pain; 1 Asthma; 1 Labour; 1 Suicidal.


This was my second night shift since taking leave over a month ago and as soon as I hit the streets I got a bad feeling about it. Sometimes that happens; I get a sense of something not quite right and I keep an eye on myself, so to speak.

The first call took me to Leicester Square and the remnants of a fight that had broken out amid the crowds. One Asian man had allegedly set upon two Chinese men, laying into them with a broken bottle and smashing their heads. There was no evidence of a bottle at all, except for glass fragments in the hair of one of the assaulted men but all three had injuries – the assailant had a nasty cut to his finger and the other two had cuts to their heads and the cops were trying to figure out just what had taken place. It seemed that the bottle had cut the assailant when it broke but, as I said, there was absolutely no sign of the bottle fragment or glass in the area. I guess the actual assault took place elsewhere.

I asked for two ambulances because the assailant would have to go to a separate hospital, as is standard practice and while I waited, after treating all three for their wounds, the cops discovered a large knife on one of the men. ‘That’s not mine’, said the man sheepishly and quite unbelievably. I asked that the other two be searched because I had been in close contact with the guy with the demon blade and I didn’t fancy exposing myself or my colleagues to that risk again.

After the men had been removed and things were being cleared up, I chatted to one of the cops about what had happened and we discussed whether the injuries were life-threatening or not. As we talked, an angry white van man demanded that the police move their vehicle so that he could enter the square to make a delivery. Normally I get the brunt of such impatience but I couldn’t believe that he was confronting a police officer who was busy at a taped-off scene of a crime. Absolutely nothing is respected these days.


As I completed the paperwork for that call another came through as a General Broadcast. It was behind me, a little way down the road, so I took it and headed the hundred metres or so to the location. In a theatre doorway a man had settled down on the ground, causing the door staff to call us because they thought he was ill. He had told them he was ill. A police officer was with him and I was soon told that he had said he was passing out all the time for no known reason. Right at the outset I knew there was something not quite straight with him. He refused to get up until the police officer insisted and helped him to his feet and when he went to my car to wait for the ambulance, he became abusive towards us (the cop and me). A quick radio check on him (by the cop of course) revealed a long history of aggression and violent behavior and when the crew arrived, having been pre-warned of the nature of this man, the EMT was given a bruised arm when he grabbed at her as he left the car.


No patient contact for the French man who cut his leg on broken glass in a club. The crew was already on scene.


On two occasions tonight, as I blued my way to calls in the West End, I had to avoid colliding with police Armed Response Units on their way, in the opposite direction, to calls. Even driving to calls was going to sharpen my attention on this shift. And when I arrived back at my station for a cuppa, I was greeted with a fight which was going on at the bottom of the road. I walked down to see if I could slow it down or stop it and watched as another man got in the middle of three teenage boys and a teenage girl as they argued and hit out at each other with belt buckles (the new weapon of the streets). To be honest, the girl was doing a lot of screeching and mixing it up but when the man who tried to stop it became the victim of their combined violence, she got in there with feet and fists, just like the boys.

I had shouted for the man to get away from them because even I wasn’t going to get in the middle of it – these young kids weren’t even aware of me or anyone else, such was their red mist for each other. The consequences for the man who tried to help were fairly predictable – he got rounded on and beaten up right in front of me. I had already called the police and they arrived just as the fight broke and all parties wandered off but they were able to get a hold of two of the assailants and the girl, as well as the man who’d tried to stop them.

I was the only witness to this violence (other bystanders had cleared off) and as I stood with the cops, waiting to give them any information they might need, the girl walked over to the assaulted man and threatened him. ‘I know where you live’, she said. She did this twice, in front of the police. Then she flicked her cigarette across my face after I’d offered to get an ambulance for one of the young lads who’d suffered a fractured cheek. He’d refused and she was showing her contempt for anyone but her own. Somebody, somewhere actually loves this vicious, disrespectful little girl.


A call to Soho for a 43 year-old man who’d collapsed with chest pain in the street next and a passer-by told me that he’d called an ambulance because the man was in a lot of pain. The ex-crack-cocaine addict had been smoking cannabis earlier and now he had central chest pain and felt weak. When the crew arrived a woman appeared in front of us and listened intently to what we were discussing as I handed the patient over. I assumed she was an observer with the crew and they assumed she was with me but she wasn’t.

‘Can I help you?’ I asked.

‘I’m a doctor’, she said with an accent that could have been German or Dutch.

Once again, the phenomenon of helpful-foreign-doctor types rears its head for the night.


A crew joined me minutes after I’d arrived at the home of a large woman with asthma who was suffering DIB because she couldn’t get to her medicines. She was sitting on her bed, struggling to reach her inhalers, all of which were a mere two feet from her on a table. Her little dog was deeply concerned for her (you can always tell when a dog is worried) but her husband, who is her paid registered carer, was in bed asleep in the next room. ‘Why didn’t he come and help you?’ I asked. ‘He doesn’t give a damn’, she replied sadly.

We nebulised her until she felt better and then left her with advice on keeping her meds nearby; she could reach the phone to call us but she couldn’t get to the medicine she needed and that was a dangerous paradox we had to bring to her attention.


I thought I might be delivering a child in the early hours of the morning. The call stated that the woman was 41 weeks and her contractions were two minutes apart. In fact her contractions were five minutes apart and she was nowhere near dropping a sprog just yet. However, this lady had given birth to three children before this one and that always changes the timing, so I asked for an ambulance and prepared my Matpack just in case. I’m still in paternal mode clearly! She should have taken a taxi.


My last patient of the shift was described as ‘violent’ for some reason and I asked for the police to join me, believing that Control obviously knew something I didn’t. When I got on scene the suicidal 32 year-old was waiting for me and signalled to me with a meek wave. He stood outside a phone box and introduced himself, explaining that he had tried to cut his wrists with broken glass and had taken 12 paracetamol in a bid to end his life because he had lost everything and was at the end of his tether.

His wrists bore superficial evidence of his attempt, which was nowhere near a vein or artery and a dozen paracetamol isn’t likely to cause him great harm, so I reasoned that this guy was looking for help.

As he sat in the back of my car (I had cancelled the police because he was as gentle as a lamb) I listened to his story. He’d lost his business and gone downhill via alcohol. He had no living family except distant relatives in the north and he felt he had no prospects because nobody was willing to give him a start. There was probably a lot more to it – there usually is but I could see how easy it must be to lose it all and then find it impossible to climb back out of the hole. No bank is going to finance you, no employer will look at you and benefits can be a trap that you simply can’t get away from. I couldn’t believe that a man with such intelligence and character couldn’t find some way of getting help though – there are lots of wonderful organizations out there and the support is around if you want it. It still left me feeling sad.

I watched him walk away with the crew and wondered if he’d get his life sorted out now or if I’d meet him again in a less healthy state.



Be safe.

DOAB night

Day shift: Nine calls; two by car; three assisted-only; four by ambulance.

Stats: 1 RTC; 1 Asthma; 2 eTOH; 1 Head Injury; 2 DOAB; 1 EP fit; 1 Drug o/d.


While chatting to a CRU colleague, he received a call to a RTC in which a man had fallen from his moped. I offered to tag along and help out in case the injuries were minor enough to warrant a trip in the car, so we both left the same spot for the trip less than a mile away and I arrived to find that I had been beaten to it by the two-wheeled speedster. This says a lot for the efficiency of cycle lanes in London – at least, that’s how I will look at it.

The moped rider was sitting on a step, chatting to my colleague and looking like a minor casualty. His face, hands and feet were cut and grazed but otherwise he was well. The fall had taken place at 30mph he said but then everyone involved in an accident in a 30 mph zone will say that, even when they have injuries that are more consistent with a higher (or lower in his case) velocity.

I took him by car to A&E while his friend took it upon himself to ride the moped and check that it was still safe. It was.

We could do with a minor injuries unit in this part of town.


After a long run up to the north just so that I could be cancelled as I entered the street where the call had originated, I was off to a 62 year-old asthmatic man with DIB. He had already nebulised himself at home when I arrived but his breathing was still labored and short, so I gave him Atrovent to see if that would improve things – unfortunately it had no effect and his peak flow remained very low. The crew arrived to take him to hospital and I was glad of the timing because, short of more drugs and reassurance, he was heading for trouble and a quick trip to hospital was what he really needed now.


My order to ‘return for break’ was rescinded when I received a call to attend a 40 year-old Polish man who was in a callbox claiming chest pain. I am deeply cynical about such calls I’m afraid because invariably they produce drunken street dwellers with no reason to call ambulances except in order to secure a warm bed and a free meal at the expense of the tax payer. This is my experience and when I arrived I was rewarded with just that – a disheveled drunken Polish man who kept repeating the same two words ‘chest’ and ‘hospital’. In truth, he named the very hospital he knew would give him no-questions asked accommodation – they all do.

Now, I’m not saying he didn’t have chest pain but it is difficult to assess when the patient is so drunk he can barely stand up. Furthermore, when people have genuine chest pain, for the most part, they refer to it often because it hurts. This man only referred to it once when I spoke to him initially and once again when I was obviously badgering him with my questions in a language he knew little of. My Polish isn’t yet at a stage where I can carry out a full investigation, so we were kind of at an impasse once I’d completed all my obs and found nothing untoward. I had to wait for the crew to arrive as he sat in the back of my car attempting to go to sleep.

This is a major problem for us all. We simply can’t take the risk with claims of chest pain in anyone, so we have to cater for everyone, which is the right thing to do. However, society is supposed to behave responsibly when making such claims and so, with the easiest method of abusing the system wide open, we can quickly become overwhelmed by nonsense patients... and then, of course, when they do become seriously ill there is a question mark over them until proven legitimate.


And so to prove the point, my next call, almost immediately after the chest pain, was an ‘unconscious, shallow breathing’ man on a bus. Yes, again, experience over the years has shown me that these calls are rarely genuine emergencies. In fact, only once in the past five years have I had to open my bag and do anything for someone who was out of it on a bus and she turned out to be a drug addict. So-called unconscious males on buses tend to be drunken sleepers or those with nowhere else to go for a kip. They also tend to be located at the back of the bus where they think they are invisible.

This man was no different and I asked Control not to task an ambulance on the basis that I would more than likely be waking him up and sending him off. The bus driver assured me that he had tried ‘everything’ to wake him but the old trick of shouting and moving them into an upright position hadn’t been considered. It always works for me and within a few seconds I had him staggering off the vehicle wondering where his slumber had brought him. Obviously I asked if he required an ambulance and I got the usual stock answer – ‘no’.


Inebriated stumbles are also far too common and tonight every student on Earth is out getting drunk in celebration of Halloween – some of them have even gone to the trouble of getting all dressed up before they fall down. But my next patient was dressed like a normal person and wasn’t a student, so he didn’t fit tonight’s profile. Where he did match the circumstance for an ambulance call was in his staggering drunkenness and the fall onto an escalator step which took a small chunk out of the back of his head.

When I arrived train station first aiders were dressing the wound, which had stopped bleeding. His mate was with him, so, after the usual questions and a quick check of his obs, I decided he could travel in the car for the two minute trip to A&E. The wound would need to be cleaned and closed.

I asked that the ambulance assigned be cancelled and was told it had, so I spent five minutes with the patient and his friend, gathering info for my paperwork as they sat in the back of the car. I looked in my rearview mirror and saw that an ambulance had pulled up and the crew had decamped. They hadn’t seen me in my car, so they went into the train station. They’d find nothing of interest there.

I waited for the return of the crew and apologised to them for the hiccup in comms but they, like all of us, are used to these errors and they were glad to get back to their own area… if they managed to do that at all.

As I drove the men to hospital, the patient kept whispering something and his mate repeatedly shushed him. I don’t know what they were up to but I kept an eye on my mirror for the whole trip. Maybe they were ambulance pirates.


In the small hours I was asked to check on a man in custody at the local police station. He was complaining of left arm numbness and the cops wanted to be sure that he wasn’t having a heart attack. As soon as I woke him up in his cell he began spitting about how the police had ‘jumped’ on him and that was why he had a sore arm. His tirade was ceaseless and meandered through stories of assault against him to more personal issues that I had no desire to learn about. Soon enough I had done all my checks and decided that his pain, if it existed, was muscular. He had no history and there was no chest pain involved. He was drunk and aggressive, so he stayed where I found him. He didn’t want to go to hospital anyway because he had a long list of accusations against the medical staff too.


None of us like the thought of running on a Red call for a fitting teenager because hard lessons in the past changed the way we respond to them and the death of a child as the result of delays and miscommunication is not something any of us want to have to live with, so I motored north as fast as I could in the early morning fog to help a 12 year-old epileptic girl who was having a seizure. Thankfully when I arrived she was recovering and had fitted as normally as she does every time she has an event. Her older sister held her in the front room as mum looked on. Both she and her sister were crying as I scrambled through the cluttered hallway and lounge to get to her. If she’d been in trouble, I would have had a very difficult time working in that environment – there was no room to move.

The girl was shaking and upset but otherwise fine. She’d bumped her head on the way to the floor and for that reason the crew, when they arrived a few minutes after me, took her to the ambulance for further checks. She’ll be taken to hospital, even though she doesn’t really need to go but we all want to do the right thing and we all want a happy ending.


And so to a meeting with a large drunk and drugged up man who decided to flop down on the pavement for his coma, right in front of foreign revelers who became too concerned to leave him alone, so they dialed the nines and got me after a General Broadcast produced no takers. He pawed at me and stuck his fist my way a few times, so I gave up on the professional Samaritan approach and asked for the police.

The cops arrived fairly quickly and I was able to give the patient a Narcan injection – there was little doubt he had taken something – soon after his attempted bout with me he became a slow, shallow breathing floppy doll. It only took a few seconds for the Narc to sort that out. Soon enough he was wide awake and answering questions pertaining to his name, age and address for the benefit of the police officers.

Then the ambulance came to take him away. He was still too unfit to walk the streets, so a sleep-over in hospital (and possibly more Narcan) was necessary for his own good. He wasn’t a drug addict; he didn’t seem the type. He was just a silly man.


Another DOAB next. The 40 year-old man was slumbering on the top deck of the bus and, as usual, had been diagnosed as ‘unconscious’ by the bus driver. Once again, I asked that an ambulance be avoided because I knew I could wake this guy up and send him on his way. So, there he was, fast asleep, ticket still clenched in his fist and a Harrod’s bag at his feet containing a large Sombrero and other fancy dress items. He was easy to wake and easy to walk off the bus. He shook my hand, thanked me (for saving his life) and sauntered off in the general direction of the next bus that would take him home. DOAB’s are too easy.

Be safe.