Vote!

It's that time of year again and I'm up for a Health Blogger nomination. Last year I did well and have obviously been able to get free meals and hotel stays in all the top places as a result of my new-found fame (yeah, right).

I may have left it a bit late this year... possibly too late, but it would be nice to update the little winners medals on the blog, so please click on the button and VOTE FOR ME. See you at the next movie premiere :-)

And while am at it... can you please drop a review on Amazon for either A Paramedic's Diary or The Street Medic's Survival Guide if you bought one. I'm beginning to look like a poorly-read author.

Ta very much.

Madness and mayhem

Here's a photo (taken with permission) of a fightfighter at one of my jobs. I thought my female readers might appreciate it. And he seemed chuffed about it anyway.

Day shift: Six calls; three by car; three by ambulance.


Stats: 1 Fall; 1 Sickle cell crisis; 1 Abdo pain; 1 Hypoglycaemic; 1 Allergic reaction; 1 Festering ulcer.


More car trouble, so the regular vehicle is once again off the road and I am working with the secondary unit, which is no better to be honest. My MDT crashed on the way to my first call, which was to assist a crew who had a 67 year-old lady on the floor after a fall. They needed an extra pair of hands to get her up and onto the trolley bed, so I was happy to help. I had to imagine my way to the location though and did pretty well, considering I’m not a pigeon.

Then south of the river for a 20 year-old with Sickle Cell Crisis; a painful and debilitating condition brought about by the 'sickling' of red bloods cells in the body. When I arrived she was lying on the sofa with her family at hand. She had moderate pain from what I could assess, so I gave her a little bit of Oramorph and that seemed to work. It was my intention to take her to hospital in the car because her legs were unaffected by the crisis but a crew showed up and invalidated my very existence on the ‘Amber Car’.


Then a miracle occurred. A human being with good medical instincts started to task the calls and I solved the mystery of the lady with abdominal pain – the 22 week pregnant 27 year-old at a train station – (that one), by telling her that these things would happen now that she was pregnant and ended up taking her to hospital anyway. She was sent to the waiting area and a large black woman with (possibly) mental health issues sang loudly and incredibly out of tune for me and a few others as she stood outside her cubicle in A&E.

‘Well done, three yeses – you are through to the next round’, I said as I passed by on my way out. I like to stir things up then leave while others have to contend with any chaos that ensues as a result of my meddling.


Then I was asked to check out the condition of a 75 year-old man who’d walked into a chemist and began to ‘behave confused’, according to the pharmacist, who related the story when I arrived. The tall man was standing at a strange angle against a counter with the pharmacist and his assistant propping him up as if he was going to fall. I tried to communicate to the man but all he said was ‘I think I’m ok’ but he didn’t look right at all; very diaphoretic, weak, hardly responding and unsteady on his feet, which is why the next thing I did was virtually force him onto a chair so that I could assess him properly.

I asked the pharmacist if he knew him. ‘Yes, he comes here for his prescriptions’, he told me.

‘What does he take medicines for?’, I enquired.

‘Oh, lots of things’, the pharmacist said. I’m not sure if he thought I was asking him to reveal something covered by the Official Secrets Act, so I asked him to be specific.

‘He has meds for cardiac conditions, high blood pressure and he takes insulin’.

‘Oh’, I said, waiting for the pharmacist to get it, which he didn’t.

I checked the man’s BM and it was 1.1 – now I knew what I was dealing with and I requested an ambulance for backup because if he didn’t recover, I couldn’t take him anywhere in the car.

I injected Glucagon and set up an IV Glucose drip, the way I always do with hypo’s. The crew was with me within five minutes and I got extra hands to help out as the man slowly began to recover. His BM improved to 3.2 by the time I’d set up the Glucose and he was smiling and fully communicative by the time he got into the back of the ambulance. All good, except for one major problem in my view – I teach every pharmacist in London first aid as part of their pre-registration training and they all know that they have a legal duty of care if someone becomes ill in their place of employment but, even though the pharmacist here knew what meds this man was on, he couldn’t work out the problem nor see the solution. This is no criticism against him because he doesn’t have to be trained in first aid but if he has the right drugs (Glucagon), he could give them in order to save a life.

The man’s BM was critically low and this was a potentially serious omission on the part of a professional person, so I think, despite the basic training they receive, more needs to be done to educate pharmacists on the use of this type of drug because it’s so easy to save a life with them. This pharmacists was quite mature, so I doubt I trained him but even those that have had first aid training would probably benefit from a short session on the use of Glucagon, Epipens and possibly Narcan for emergency use. He freely admitted to me that he had no confidence because he'd never actually had to use Glucagon and didn't know how to. I shall think about this...

During this call and just as the crew was taking over from me, I was asked to rush off to another job near the West End. A 25 year-old woman was reacting to something and her throat was ‘itchy’ – she had a very persistent cough too and when I looked inside her mouth I could see her throat swelling slightly. She was in no immediate danger but she’d need an antihistamine and I only offer IV, so I took her in the car. That cough became more and more annoying as we travelled I can tell you. I was tempted to turf her out and let her get the bus.


Back to that train station later on for a drug addict who’d been arrested for (allegedly) shoplifting. His pupils were pin-point and he was trying to fall asleep, so I made a judgment call and decided he’d recently used. His favourite drug is heroin and he looked smacked out on it, although he strenuously denied this when Narcan was mentioned. During his arrest and subsequent hand-cuffing he’d offered the only illness he could think of to avoid the cops and get to the nearest hospital – he had septicaemia. Apparently his groin had a suppurating ulcer on it, no doubt a resident resulting from the constant puncturing of the skin and veins in that area. He offered to let me see it but I declined on the basis that (1) I believed him and (2) I had my dinner to look forward to later on.

When I checked his bag (later in the hospital and at the behest of the police) I found no fewer than 30 unused needles, 5 used needles, paraphernalia and a single condom... for when you get lucky after a good session with heroin I guess.

The bottom of the bag was a lake of filthy liquid from God knew where and floating around as scum was the remnant of some kind of solid food, like a big cake. On first inspection it looked like he had vomited into his bag. Whatever he’d done, the needles were all now filthy – even the wrapped ones – and had to be thrown.

I left him in the care of the police officers guarding his cubicle and walked out to the various off-tune and shouted airs from that mad black woman who was still occupying cubicle 1.

Be safe.

The kindness of strangers

A lucky escape.

Day shift: Five calls; three by car; two by ambulance.

Stats: 1 ? #Leg; 1 Arm injury; 1 ? Spleen; 1 eTOH; 1 French person


On my own again for a few shifts.

I drove at 1mph trying to reach a RTC that had taken place a mile up the road I was travelling on. That’s the trouble with some of these road accidents; they can cause such a tailback of traffic, especially in rush hour, that even the emergency services have trouble getting to them.

An ambulance was fighting its way through the same mess that I was but we both arrived at the same time at the scene of a lorry vs lorry vs car RTC. The first lorry had ploughed into the back of the second at 30mph. The second lorry was stationary when hit and was shunted off his brakes into a small car carrying a mother and her two young kids. Luckily nobody was badly hurt and all we had to concern ourselves with was the passenger of truck number two because he’d bashed his head on the dashboard and, more significantly, the driver of truck number one, who was trapped by his left leg because the entire front section of his vehicle had come into the driver’s cab, pinning him.

It took a long time for the LFB to pull away the dash and steering wheel so that the driver could be freed – they had to work very carefully, as always, so that they didn’t inadvertently injure the patient. Meanwhile another two ambulances were requested to take away the head injury and the kids (just to be sure). I considered HEMS because the lorry driver’s injured leg had been squashed against his seat for some time now – going on an hour – and I was concerned about crush syndrome. But the leg didn't look too badly pinned and once he was freed, another, more thorough, physical examination ruled out any immediate threat.

I gave him morphine for his pain and we immobilised him for good measure. He’d been very lucky and if he’d had a passenger, he’d have been trapped next to a corpse.


Next, a 68 year-old lady from New York was hit by a speeding motorcyclist as she stepped from the pavement. Police were on scene and she was sitting in a shoe shop insisting that she was okay. She was a feisty 'New Yoiker' type and didn’t look her age at all – it was given as 50 by the system and I believed it.

She wanted to get on with her day and visit the theatre and my advice to go to hospital for a proper examination of her arm, which was swollen and bruised after the hit, was met with mild resistance. Due to fly home the next day, she clearly didn’t want her day to be spoiled by a mere broken arm (if she had one), so I agreed to take her to the local minor injuries centre for assessment. She was happy to do this and invited me to join her at the theatre later on (she’d also offered to take the female police officer who’d been dealing with her back to New York – for her son). I declined her generous offer on the basis that I was too bury with my shift, otherwise I might have been tempted.

This was a pleasant lady with friends in high places (judging by the names she quoted when phoning around) and she was sensible enough to know that her injury may or may not be significant enough for hospital but that she’d take responsibility for herself.

She was deemed fit to carry on (the nurse and I came to an agreement) and so I drove her to the street she’d had her accident in, where she could get to the theatre on time and without fuss. She got the best treatment the NHS could offer and I got a peck on the cheek as a thank you.


Ironically and coincidentally I had been asked by my last patient if accidents like hers occurred regularly on that particular street. I confirmed that they did and, as if the point needed to be made, another call came in for yet another collision at the same spot. This time a pedestrian had been hit by a cyclist who’d run the red light. His handlebar had hit the 30 year-old woman at 20mph, punching into her left lower abdomen, exactly where her Spleen lies and this is what concerned me.

She was sitting on the pavement as police officers interviewed the cyclist and I was given a short handover by an A&E nurse who happened to be passing at the time of the incident. The patient had no significant pain, other than in her abdomen and there was some tenderness on palpation of the area, so I decided I would not be conveying this one in the car and asked for an ambulance. The Spleen is an organ that can be damaged without much in the way of visible changes in vital signs and so I wanted to play it safe with her.


I witnesses a demonstration of the frustration that real patients feel when they take themselves to hospital but don’t get seen because it’s too busy and priority appears to be given to those less worthy.

I had been called to a collapsed 40 year-old man and I found the police around a human lump with a blanket over him and a bottle of wine at his feet. He was drunk and had already been assessed as being so by a crew earlier on in the day. I knew that he was playing the winter game because it was cold today and he was dishevelled and shivering, so I asked him if he needed to go to hospital and got the expected response – an enthusiastic nod of the head. I agreed to take him in the car if an officer accompanied him because he had a record of hitting the police, so I would be fair game with my back to him as I drove, should he decide to kick off.

We arrived to a packed A&E and I apologised for what I’d brought in because it was clear they had bigger fish to fry but as a vulnerable drunken man who’d go on playing his game until a dozen ambulances had been called for him, I was left with little choice.

I sat him down on the seats in A&E and two women who had been waiting there (one of them had been crying), stood up and walked off. To be fair, he did stink of urine and I wouldn’t want to be unwell and in his proximity either. Then one of the women collapsed in pain and I had to steady her until other medical staff helped out. She had a serious headache and had been sitting waiting for attention for hours after having come by taxi and booked herself in. Now I understood the look of disgust she had given me as she stood up to walk away from my offensive friend. As far as she was concerned, a drunk would get higher priority than her. After all, he had arrived by ambulance. For all we knew that poor woman was suffering a serious condition (subarachnoids can present as severe headaches initially).

Meanwhile, out in reception, an impatient patient stormed out of the waiting area to complain about how long she’d been made to wait, only for her name to be called while she was away. She had to sit down again and wait for even longer. This annoyed her, so she got up and stormed off once again to complain. I walked into reception to hear her name being called again and the staff’s amazed reaction that she had missed her second chance at being seen. She might go on all day like that.


Calls can often be a little strange and my next (and last) call of the shift sent me east for a 26 man who had abdominal pain and a headache. He had collapsed in the street but two young ladies found him and taken him to their 5th floor flat in a nearby tower block. This strange action was carried out in the name of humanity and kindness I can assure you because when I got there, three young men and two young women were standing over a doubled-up Frenchman in their kitchen. He was like a sick stray cat, except, as I pointed out for their benefit, he wasn’t and they didn’t know what he might have been up to. He spoke very little English and my French is just about good enough to get by in an emergency, so they didn’t even know what his background was.

I found, through fumbled broken Francais, that he had broken up with his family in France and had run away to London, where he’d spent two days on the streets, penniless. His abdo pain and headache may have been real enough but I think his underlying problem was being lonely in a strange city.

I took him to hospital in the car because he was another vulnerable case as far as I was concerned but I had to keep checking him in the mirror – he was behaving oddly and I had that ‘I’m not sure why but I’m not comfortable’ feeling with him. I imagined him reaching over with a huge knife or attempting to strangle me with my own seatbelt but this mild paranoia probably had more to do with my instinct and natural wariness of people who behave oddly than any actual threat, otherwise I would never have conveyed him, right?

A&E was packed and I had to wait a long time before I got to book him in. All the while, he sat in a seat, looking pain-free and watching everything and everyone around him as if he was expecting something. Maybe I’d behave the same way in a strange, foreign environment if I was alone and desperate.

Be safe.

Locked out

Day shift: One call (but technically two); All by car.

Stats: 1 Head injury; 1 Abdo pain.

I drove in this morning to lashing rain and lightning, which always looks more sinister in the very early hours I think. The weather changed late afternoon yesterday and it had been raining ever since. Less than half the people I would normally expect to see crowding the streets in Central London for the way-too-early pre-Christmas spendathon were out as a result. This meant I had a quiet start to the day.

The first call came in the afternoon and we were off to an ice rink to attend to a 3 year-old girl who’d fallen – not on the ice but on the walkway leading to the rink. She had a nasty bump and cut to her forehead but she was otherwise alive and well. Mum wasn’t too fazed but the first aiders on scene felt she needed an ambulance and called us. Then they completely ignored the fact that we’d need access to the area and we found ourselves outside locked gates with nobody to meet us and no idea where we were to go. This is fairly typical of large scale events when the staff is not properly co-ordinated.

We wasted ten minutes communicating back and forth with Control until somebody finally came to help and then I had to drive around for another quarter of a mile to get in. An inner security barrier was down when we got as far as throwing distance of the fair’s main entrance, so we waited for that to be raised but then I was told to park up and walk.

The SP went on ahead of me and I parked the car. Then I walked along a pedestrian avenue with funfair stands and attractions either side, including a giant singing moose-head that was chucking out-of-tune Christmas songs into the air at high volume while a woman stood directly underneath it attempting to use her mobile phone. The moose was the cleverer of the two I think.

Inside the rink, the SP was happily dealing with a very stable, quiet little girl with a bumped head. The girl’s mother was there and I decided they could go in the car rather than an ambulance. But a member of staff asked me to look at an employee who had abdo pain; the 23 year-old had left-sided pain which had started earlier in the morning although, typically, she hadn’t bothered to take anything for it, so now she was doubled up. I asked for another car to be sent for this patient because I had no room for the SP, the child, her mother, this abdo pain lady and her husband, so a colleague arrived a short time later to convey patient number two.

I managed to get the car all the way into the park and just outside the rink but only after I made it clear that I wasn’t happy with their access arrangements for the emergency services. These were minor first aid problems but if they had a real emergency they’d need to sort out their comms and gates.

Be safe.

Tricky situations

Day shift: Six calls; three by car; three by ambulance.

Stats: 1 Broken nose; 1 eTOH fit; 1 Gas inhalation; 1 Back pain; 1 Flu; 1 Fractured wrist and ? Neck.


On this mild November morning, a 25 year-old woman tripped over an uneven kerb and fell flat on her face, breaking her nose and bleeding all over the pavement. She sat alone, crying and leaking from her nostrils until an off-duty police officer saw her and stopped to help. I think she was on her own for ten or twenty minutes.

I have my Student Paramedic (SP) on duty with me all weekend, so she attended as I watched. There was nothing we could do for the young woman except take her to hospital in the car as she sobbed into her phone, explaining to her friend what had happened. Her bleeding was under control but her nerves weren’t settled yet.


Alcoholics are prone to seizures and sometimes it’s obvious what’s happened to someone when you see their pallid, profusely sweating faces. Add a history of falling over suddenly and evidence of possible alcoholism in the form of a half bottle of vodka in their pocket and it’s a no-brainer.
This 30 year-old alcoholic had fallen over in seizure, smashing the back of his head on the glass part of the front door of a coffee shop. There was a large crack where his head had made contact. His fit had lasted a few seconds and he’d bitten his lip but he was over the worst and recovering in the company of two police officers when we arrived.

I wasn’t sure of the man’s honesty when he assured us that he’d behave in the car if we took him to hospital that way, instead of by ambulance because he was reluctant to go to either of the two hospitals that I serve. He must be getting thrown out of them and there’d be a good reason for that, so I asked the cops to do a background check on him and, sure enough he had a history of violence and other problematic things (like suicidal tendencies). He was calm and reasonable though, so the cops agreed to follow me down to the hospital if I took him in the car. I’m still not happy to make an ambulance crew convey a patient who could quite easily be taken in the back of the FRU, so that was that and the trip was uneventful.


After coffee and one of those messy but delicious chocolate swirl thingies, we were off to an 82 year-old man with a history of black outs who’d collapsed at home and triggered his Careline alarm. Another FRU was on scene and we all travelled the lift to the floor on which the elderly gentleman lived. The SP and the other FRU paramedic went into the flat and I followed a few seconds behind them. They were assisting the patient as he lay on the floor of his room but I immediately smelled gas and asked if the others did too. He had left his cooker ring on and for at least 20 minutes, gas had been escaping into the little flat. He also had heaters on and this meant the hazard was higher for all of us.

We evacuated him and I took the keys from the door and allowed it to close. A window had been left open to air the flat out but we asked for the LFB anyway, just in case because I suspected that an electrical heater was running in one of the rooms.

The FRU paramedic’s equipment was inside the flat when I closed the door and I was distracted by the fact that the patient collapsed and became unconscious on the landing just as the crew arrived to help. He recovered quickly on oxygen but I found that when the door had closed it locked on the Yale. The keys I had taken were the wrong ones and didn’t fit, so now all the equipment was locked inside. I’d taken quite a lungful of the gas and, although it shouldn’t do me any harm, it still made me feel dizzy for a while. So we were on the landing with a collapsing patient (his ECG showed a heart block), a paramedic’s gear locked behind a door and the prospect of something igniting the gas inside the flat.

The police showed up just before the Fire Brigade arrived and I went downstairs with the patient and crew to the ambulance. He was stable now but his breathing wasn’t great and there was an obvious retraction of his intercostals and diaphragm, so he was blued in.

The LFB made the flat safe before we left for hospital and the fuss died down around the building (residents were beginning to worry). My head cleared and we got on with it.


An unnecessary ambulance trip next for a 40 year-old man with a childish estimation of his age: ‘How old are you?’ ‘I’m 40 and a half’. He was lying face down on the floor of a police station where he’d presented himself after travelling from deepest south London. His only business with the police was to inform them that he had a sore back.

He had been drinking (a half bottle of vodka by his own admission) and his hands bore the tell-tale swollen knuckles that indicated a puncher (of things or of people), so I was wary of him. He moved into a sitting position after much persuasion and the crew took him, reluctantly on his feet and slowly, to the ambulance, where he became cured by distraction, as often happens with people who are drunk and have nothing else wrong with them. He would now tie up a hospital bed or waiting room chair until he is sober.


Oxford Street was pedestrian-busy as we weaved around the buses to get to our next port of call. Inside the large store, a 30 year-old member of staff lay on the floor of the Manager’s office, refusing to open her teary eyes and playing limp as if dying. I’ve seen this many, many times before and you know I just hate it when adults behave like that; with some certainty I can tell immediately that there is little wrong with them – not enough to warrant an emergency ambulance, that’s for sure.

The SP managed to get the patient to speak but of course, in time-honoured fashion for this behaviour, all verbal responses were whispered. Little voice patients believe that making inaudible sounds with their vocal chords is tantamount to establishing serious illness for the benefit of colleagues and anyone else near enough to actually hear them.

She had aches and pains (pain all over), a cough, dizziness and vomiting – she probably had ‘Flu and since all influenza these days is H1N1 Piggy-type, she was given a mask and we donned our own. The drama was too much for the staff and we found ourselves with some clearance as we made our way out of the place, with the patient in a wheelchair, via the back entrance.

We took her in the car and she ended up waiting, like everyone else with minor problems, suitably masked up, for a doctor to tell her what we already knew – she could go home and get over it naturally.


Finally, as darkness invaded the day and the rain spoiled everyone’s fun, we were sent to the 5th floor of a large store where a 30 year-old staff member had slipped on water and landed awkwardly on the hard toilet floor near the urinals he’d just visited. He was complaining of pain in his right wrist, which was probably broken at the Ulna, lower back pain and, more significantly, high spinal pain, at around C2, so he was going to be collared and boarded. Trouble was, there was no ambulance around and I had to call for one.

During the wait for the ambulance I gave the man morphine for his wrist pain (he couldn’t tolerate entonox) but his respirations suddenly dropped and he tried to go to sleep. I’d only given him a smallish amount but I was forced to reverse it all by giving him Narcan in small doses until he came back to normal (or as normal as possible).

Now that he was stable and feeling the same pain as he had originally, thanks to the lack of analgesia (next time I will give Oromorph), the crew arrived and together we got him onto a stretcher and took him down in the freight elevator (the only one big enough for the stretcher and all of us) to the ambulance.

This was blued in once I was sure his breathing was better and his trip to hospital lasted five minutes. The entire job, from start to finish, took almost 2 hours. And I got home late. Never mind.

Be safe.

Head cases

Night shift: Three calls; one treated on scene; two by ambulance.

Stats: 1 CVA; 2 Head injuries.


The last night shift and I’m glad of it. This is a quiet one, which makes up for the three nights before.

A call to an elderly man with a previous history of CVA first; he’s losing power in one arm but otherwise he’s stable, so I left the crew with it and made my way back across the river to a West End that had settled down somewhat compared to the previous nights. The revellers had clearly had enough.

It wasn’t until the early hours of the morning that I received my next call for a 28 year-old female who’d been assaulted during a fight at a club. She was being helped by the security people but it was clear from a distance that she wasn’t a happy person.

She had minor cuts to her mouth and scalp, some of which needed to be cleaned and dressed and I made a valiant effort to do just that when she went a bit mad, screaming at everyone and generally being abusive. ‘Where the f**k is that bitch!’ she yelled. I assumed she meant the person who’d done this damage to her. And try as the security did to calm her down, she wasn’t interested and stood up, pushing her way through him and me, almost knocking me off balance. She didn’t care and made that clear as she tore the perfectly bound dressing from her head, throwing it to the floor.

I accepted her refusal because that's what it amounted to and I wasn’t in the mood to baby-sit a drunken outraged woman, so I told her I was leaving and made my way back out into the street, passing the two police officers who’d been brought in to interview her. She followed with a male friend and stormed past us all. Neither the cops or anyone else who’d been sent to help her were given any courtesy, so it all ended there. Sad and stupid.


A little more stupid was the passenger who allegedly threw a man from a bus because he didn’t have the patience to wait for him to produce his travel pass. The call was for a 25 year-old man who’d dialled 999 as he lay on the ground at the bus stop with blood pouring from his head after making hard contact with concrete as a result of this assault. The well-spoken patient was being attended to by police when I pulled up and he lay where he’d landed until I’d deemed it safe enough to move him into an upright position so that I could apply my second head dressing of the night. This time it wasn’t torn off but the man was very reluctant to go to hospital and the reason for this became clear as I progressed through my clinical interview with him.

More and more young Muslims are drinking alcohol these days and, with the strict upbringing they receive, when they get into trouble and the police and ambulance services are involved, the last thing they want advertised is the fact that they were drunk; if their parents find out, they risk more than a ticking off I understand. So, he didn’t want to be treated at hospital unless we promised him that it would all be confidential. And for the benefit of my readers I should let you know that treatment is entirely confidential unless you are unconscious or seriously injured and a next of kin has to be notified.

With this assurance, he went with the crew to A&E, where his wound could be cleaned and properly assessed.

As for the bus driver, I think he will find himself in trouble for driving off after one of his passengers carried out such an unprovoked and violent attack. The poor man was only having trouble getting to his pass but the delay was obviously too much for one person on board. The driver should have stopped the bus and contacted the police, unless there is a rule I know nothing about which states that they can leave the scene of a crime. The cops have the bus number and they know where it was headed; it will be stopped and if the assailant isn’t on board, the CCTV footage will be examined. The driver will have questions to answer I should think.

Be safe.

Ghost hospital

Night shift: Eight calls; two false alarms; one by car; the rest by ambulance.

Stats: 2 Head injuries; 1 ?PE; 1 ?Allergic reaction; 1 Sleeping non-fitter; 1 Homeless sleeper; 1 eTOH with fracture; 1 Abdo pain.

Radio communication is still leaving me in awkward and dangerous situations and being solo without a voice at the end of a call is beginning to look like a rotten option. My first call highlighted, once again, that our new all-bells-and-whistles radio system may not be as good as we are told because I found myself crouched down next to a semi-conscious man who’d sustained a head injury after hitting the ground hard, surrounded by drinkers from the pub outside which he’d come to grief, all denying that he’d been punched in the face when the evidence was clear that he had, and absolutely no reply to my repeated requests for assistance over the air. One of my MRU colleagues heard my open-channel request for the police and an ambulance and liaised on my behalf to get things organised as I attempted to keep control of an increasingly restless patient and a crowd of witnesses who ‘didn’t see anything’ in very close proximity to me as I worked to get obs.

The police arrived within few minutes as I put oxygen on and completed the minimal obs I could gain under the circumstances, then the MRU paramedic pulled up to add another pair of hands to the task.

I’d palpated the man’s neck and it felt like he had a step deformation (where the bone feels like it has sunken in) of his upper spine at the neck; this is not good and suggests a seriously hard landing on the ground when he fell, probably hitting the kerb with his neck. His mouth was bloodied and burst around the side (the first indication that I’d got of an assault and not a fall, as had been vehemently suggested) and he was slipping in and out of consciousness, although the alcohol he’d imbibed possibly had a lot to do with that.

HEMS was requested because the man needed to be calmed for the trip to hospital and his head injury would soon make him very difficult to manage safely, so the police threw a taped cordon around the scene and once the doctor arrived, the patient was RSI’d and rushed to Resus, with me ‘bagging’ him all the way there.

I'd find out later on that this man's condition was very serious indeed. He had multiple skull fractures with internal haemorrhaging to his brain and a broken neck.


A 23 year-old French girl fell down at work, complaining of leg pain, chest pain and feeling faint. She told me she had a history of ‘bad circulation’ in her legs and I thought that working as a waitress at a restaurant was possibly not a good move if this was the case. She may have been describing blood cots in her leg because the actual problem she suffered with was not clear. Certainly, and even in the absence of dyspnoea, there was reasonable cause to believe that she may have a PE and so I asked for an ambulance, rather than risk taking her in the car.


If we come to help your young child after you’ve called 999 and requested an emergency ambulance, please do not do the following; (1) expect us to assess him/her while he/she is still asleep in bed; (2) tell the paramedic who has just had to wake your potentially dying child up in order to do said assessment to ‘speak quietly’ so that he doesn’t wake your other child up (the one in the cot nearby) and (3) inform your child that the paramedic will be sticking a needle in you when he is about to do a BM test.

The parents had called us because mum thought her child was having an anaphylactic reaction in his sleep. The crew was arriving as I pulled up and we were led into a dark room in which two children slept peacefully. The boy in question had been breathing a little noisily so mum was concerned. He had a history of potential allergic reaction, so she was being careful and wanted us to check that he was okay but she didn’t want to wake him up and took issue with the volume at which I spoke to him when he was awake. She’d dialled 999 but was more concerned that I’d wake up the other sleeping child; it was a confusing paradox, so I suggested we take the boy into another room, where I could speak like a normal person and not a librarian.

‘What’s he allergic to’ I asked. ‘Horses’, mum replied. Bearing in mind we were in Central London and the nearest horse was probably rotating on a spit in the local kebab shop, I found it unlikely that her little cherub was reacting to one.

He was fine, except for a cough; there was no wheeze or swelling or rash or any other problem that I could determine – not that he was very good at co-operating; he wriggled and cried and was obviously too tired to be prodded about like this, so I decided a BM would be the last of my obs while I had the opportunity. Unfortunately mum decided it would be prudent to inform her little 4 year-old that I was about to stick a pin in him and, predictably he went a bit mad; writhing, screaming and generally making more fuss than it was worth. On this basis, I confirmed that he was well enough to stay home and abandoned the idea of taking a drop of blood from him. Mum seemed pleased. ‘It’s okay, she’d said to him, it’s just a little prick’. Yeah I thought... it is.


And then the local drunks had a laugh at our expense when a bus driver called in a ‘collapsed person’ that he’d seen fall down at a bus stop before driving off. What he had seen (and had generated a Red1 call) was a very drunk fool falling over. The guy was on his feet and swaying when I arrived. His grin and sheepish look made him the ideal culprit for someone who frightens citizens into doing the right thing. He stood with a black bin bag in his hand – it either contained his worldly goods or cans of extra strength lager (which amounts to the same thing). So, without actual proof and his denials ringing in my ear, this was a no-trace nonsense call.


A ‘fitting’ call in Oxford Street was nothing of the sort. The poor guy was trying to get his head down for the night in the doorway of a shop and had been rubbing his hands together to keep warm when two MOPs, one of which identified himself as a nurse ‘with a year’s training’ decided he was epileptic and having a seizure! So, when I arrived, the homeless man was understandably peeved and the ‘nurse’ continued to be concerned despite the fact that the man was very clearly not having a fit. ‘If I was having a fit, I would have told them’, he shouted illogically. The MOPs should have taken the hint but they didn’t and were keen to see me haul the man off for tests and such no doubt. ‘I’m being harassed now’, said the trying-to-sleep man.

After I’d politely sent the MOPs away, the homeless man told me that the ‘nurse’ had been feeling his leg and saying ‘come home with me’. Apparently one go wasn’t enough and the nurse-MOP had returned again and again after several objections from the man, allegedly to cop a feel and ask him back to his place. London just gets weirder and weirder.


On the second attempt at trying to put me on a rest break, I was called to attend a 75 year-old man who fell down a few steps at his apartment building and cracked his head on the floor. He’d been carrying a plastic bag containing two half bottles of whisky and these were now rattling about inside it, so his money and ambitions to get even more drunk than he already was, had evaporated.

Two of the tenants, returning from holiday, had come across him and his bleeding head as he lay around waiting for rescue. Luckily they had been returning from holiday at a rubbish hour of the morning and just happened to be entering the building at the right time to call for help. Otherwise he may well have been there til much later on in the day before being discovered.
His injury was minor – a cut or two to the top of his head and a slight bruise on his face but his age and the circumstances of his inebriated fall were worthy of a hospital trip.


As I sat on Trafalgar Square watching as workmen placed a bunch of strange trees onto platforms I got a call to a bus on the other side of the Square. There was an unconscious man on it apparently, shock horror. He was a tall, filthy, homeless chap with dreadlocked hair and huge laceless shoes. He was asleep and easily woken. Within 3 minutes he was off the bus. Then he crossed the road at a pace (he’d been limping as he left the bus) and boarded another bus going north. I watched him go upstairs, sit at the back (where he’d be invisible), pull his hood over his head and settle down for a sleep (part II). Somewhere in London later on an ambulance will be called just so that he can be ejected from the vehicle; he will bus-hop at the expense of the tax payer and genuinely ill people all night and probably every night.

Now, I wonder how he and his fellow bus-hopping homeless sleepers get aboard. Do they have bus passes? Doesn’t the driver recognise a potential problem when he or she sees it climb on? I’d really like to hear from bus drivers on this subject.

Of course, I complain about them but it’s the drunks on buses that annoy me, not so much the sleepers with nowhere else to go. I think I’d rather be called to wake them up than have them go to hospital to steal a warm bed and a free meal from a more deserving person (like someone who is unwell). In some respects they are playing the system where London Buses is concerned. If they are allowed on and can hide at the back without being bothered then they might get an hour to sleep at a time. Unfortunately, the bus people can’t manage this problem so we are called to deal with it and that is an abuse of the service. Street dwellers looking for a dry, warm place to sleep is nothing new and they will go anywhere that gives them an undisturbed kip – the buses are included, so why don’t the bus people fix their own problem? Maybe it’s best just to leave this status quo for the sake of the ‘they have to go somewhere’ argument or purely on humanitarian grounds but what if this costs someone their life?


This debate continues with a trip to a bus terminus to attend to an alcoholic whose been removed from a bus by the police. They think he needs to go to hospital and they are right because not only is he very cold (temp read ‘LO’) but he has a cast on his arm and from the appearance of his upper arm, just above the cast and sling, it looks to me as if he has broken his Humerus and dislocated his shoulder. This drunken man has fallen onto his already injured limb. So, I take him to hospital in the car and I walk into a ghost town – beds are empty and there is nothing going on. For the first time in a long time (as far as I can remember in fact) there are no ill or injured people around. Except of course for the one I’m bringing in. Judging by the reception I got you’d think I ruined someone’s birthday party. Even in the waiting area there was nobody waiting. This must mean that Londoners have drunk themselves to sleep or that alcohol has simply run out.

A local call to end the shift and a crew arrived behind me for the lady with abdominal pain who needed more advice than treatment. I left as the crew settled in to listening to her entire medical history. They had another 30 minutes to go, so I’m sure they didn’t mind.

Be safe.