Monday, 29 January 2007

A night under the weather

My last night shift for a while. I have a few days off now, which is just as well as I've been feeling a bit under the weather.

My first call came in as I prepared to get something to eat, so that had to wait (the food, not the job). It was to a woman who had fallen and hit her head. The call came from a seedy estate block that I go to regularly and I wasn't expecting to save a life here. When I arrived I was greeted by a young boy, the woman's son, who opened the gate for me and showed me to the flat. I went in and entered the kitchen, where the woman was being supported by her husband/boyfriend/partner. She was obviously drunk and the second she saw me she told me I wasn't required. Well, she didn't quite phrase it in such an eloquent way - she used the gutter version especially for me.

I looked at her and she gave me that stare - the weapon of the drunken female; the 'I hate you and all you stand for' look. I gave her one of my 'you don't scare me' looks in return and she returned to her back-up tactic of being abusive instead. I bid her and her family goodnight and left the premises. Not required.

Another drunken fall later on in the night was a little more serious. The man had returned home from the pub and had fallen down the stairs leading to his basement flat. He had landed hard on his nose and when I found him he was in a forward-facing kneeling position and out cold. The ambulance arrived soon after me and we all gathered around the heap. His wife came to the door, looked at him, looked at me and said nothing.

"What happened?", I enquired.

"He fell. He's breathing." She said. Then she walked back into the flat and left me to it.

I think she meant, take him away, I'm not interested.

When he came to a couple of minutes into the survey, we got him to sit up. He had no neck injury but his nose was split right down the middle and through to the bone, which was probably broken. He was a bloody mess and it was congealing around his face like jelly. He smelled foul; alcohol, blood and sweat. We managed, with a great deal of effort (because he wasn't going to help at all) to get him up the narrow stairs and into the ambulance. He was secured and off he went. He'll certainly live to do that another day. His wife, meanwhile, will continue to suffer in silence no doubt.

Drunk Russians. More and more are showing up in the streets. What is it about them? They are invariably BIG and usually aggressive. I had one of them to deal with as the night progressed but I decided to pass the problem along to the crew who arrived on scene. I felt too ill to concentrate on avoiding trouble.

My final call was to a sickle cell crisis. The guy had been suffering agonising pain in his legs and arms for two hours before calling us. I gave him 5mg morphine but it had no effect. I followed that up with another 5mg, put fluids up and followed the ambulance to hospital. The crew decided to blue him in half way there as he was still writhing about in agony! I am pretty sure that 10mg of morphine will reduce pain from 10/10 to 5/10 at least. The attendant had also put him on extonox but nothing was having any effect. This was a strange one.

When we finally got him to his designated hospital (which, incidentally, was a good few miles away) he was still crying out in pain. I chatted to his doctor and was told that he had 'done a runner' after receiving 30mg diamorphine on his last visit. Sickle Cell or quick fix?

Be safe.

Sunday, 28 January 2007


Rapid Sequence Induction (RSI) is carried out in emergencies where there is a need to quickly intubate a patient in order to preserve their airway and lungs. It's also useful when a patient is combative after head trauma.

I didn't think I was going to get to this call. It was in an area that I normally get cancelled down on before I arrive. The call was for a 'car v pedestrian' and when I got on scene there was a crew already in attendance; a paramedic and an EMT. They were working around a large male who looked either unconscious or dead in the road. I got closer and was told by the paramedic that he had been unconscious since being hit by a car at an unknown speed a few minutes earlier. A Delta Alpha (our term for a rapid response doctor) had been called.

The man had sustained a head injury and we could find no other significant obvious injury to the rest of his body. His neck was stabilised and an Oropharyngeal Airway (OP) had been inserted to keep his tongue from obstructing his airway. He was breathing and he had a strong pulse but when I lifted his eyelids to check his pupils his eyeballs were rolling from side to side, a sign of possible brain injury. He also had blood coming from his left ear, so a basal skull fracture was likely. The guy was in serious trouble.

We got him into the ambulance and began to gather all the information we needed for our baseline obs. His breathing was unpredictable (shallow then deep) and he needed assistance with a bag-valve-mask while I got on with getting a couple of cannulas into his arms. I knew that the doctor was going to RSI this patient and so we prepared him for the routine.

When the doctor arrived all four of us had a specific role to play in preserving this patient's life and that began with induction. Just prior to the doctor administering the drug to put the patient to sleep, the injured man had started thrashing about (no doubt the oxygen was waking his brain up a little). When the drug was given he went to sleep. A muscle relaxant, which effectively stops him breathing for himself, was then given. He had to be intubated immediately after this in order to preserve his airway. He also had to be 'bagged', or ventilated to keep him breathing. After all the drugs had been given and he had been put up on fluids, his condition stabilised and he was ready to go to hospital.

I got in my car and led the ambulance as rapidly as possible to hospital. At that time of night I used the vehicle to clear a path for the ambulance, thus helping to ensure a smooth ride for the patient and those in the back with him.

We got him into resus and he was quickly taken for a CT scan. His chances of survival should be good and I will try to follow up on his progress for you if possible.

This was a team effort and I enjoyed it. Most calls are routine but every now and then a job like this reminds you of why you got involved in pre-hospital care in the first place.

Earlier in the evening I was called to a young man who had been robbed and stabbed in the back of his thigh for good measure. The assailants had also tried to stab him in the chest but he had moved to avoid the blow. I can't believe how dangerous these people are. Stabbing him in the leg was bad enough - that stopped him from resisting I'm sure but to try and finish him off for the price of a mobile phone and a few quid? Time to bring back REAL punishment for these crimes.

Another assault later in the night. This time an elderly man was punched around the face and head as he entered his own premises. The assailant had been following him and tried to rob him as he went into his home. I guess the drug addicts in town had heard that a clearance sale was on.

And my funny moment of the night came when I watched a gang of girls on a hen night barge into a cinema, forcing their way past the staff and into one of the theatres to do God-knows-what to the men watching the movie! They were ejected by the female members of staff. The blokes just stood there with stupid grins on their faces, until they were told off by the woman in charge. Hen night gangs are dangerous. Cross the road if you see one coming.

Be safe.

Saturday, 27 January 2007

Salted amputations

For some reason I was handed a little bottle of salt by a drunken passer-by as I sat in the car on stand-by during the first of my run of night shifts. I think I sat holding it for a few seconds before I even reacted to the fact that he had given me it. An unexpected gift and proof that drunks will steal and subsequently give away anything.

I went to a call soon after that for a young girl who had trapped her finger in a door (she was drunk too) and had torn the tip of it off as a result. The bone could be seen gleaming underneath the ragged flesh but she remained cheery nonetheless! She was a wriggling, non-compliant talkative sort and I found myself cruelly thinking of the effect my little bottle of salt would have on a wound this raw. A terrible thing to think, I know, but I was in a dark mood and that only lifted towards the end off the night. I dressed the finger and stuck her arm in a sling instead.

One of the bar staff had the presence of mind to preserve the missing chunk of finger in a glass of ice, which I thought was good of him. I asked him to take it out, wrap it in sterile gauze and then replace it. For reference, if you amputate a bit of you, place the missing part in a sterile wrap or plastic bag, then put it in the ice. You should never expose living tissue directly to ice. One day you'll thank me :-)

As the night wore on the drunks began to accumulate on the streets. The noise level increased and became strangely animalistic; grunts, groans and howls - especially at ambulance sirens. It wasn't a family atmosphere and I thought that things had got back to normal in London Town on a weekend. No more happy, smiling tourists and small people milling about in a low or non-alcohol environment. No more gangs of middle-aged and elderly men and women out on their trips of patronage to their favourite theatre/cinema/restaurant. The West End had been given back to the heathen masses, laying waste to the streets and each other. Roll on Spring.

FRED, the new call allocation system is still giving me a headache. I now look at the area it wants me to go to, start rolling slowly and then, predictably, stop when I receive my cancellation. What a waste of time. I get, on average, six of these far flung calls a shift now but I have worked out how to stop it happening when I am on stand-by; I press 'green away from vehicle'. That way I only get called when Control actually want me to do a job.

Among my other calls of the night was a 'bus v ped' during a busy time of the early hours. I got on scene and found no-one. I saw lots of buses but they were all moving around. After ten minutes of searching Control informed me that he had got on the bus that hit him and gone home. How thoughtful of him.

I met a well-mannered ex-marine who was assaulted on a bus and walked over to the car with a bleeding head wound. Whatever he had been hit with was small and sharp. It had pierced his scalp and gone throught his Temporal artery, causing a bit of a blood storm for a few seconds before coming under control. "Don't worry", he said, "I've been putting pressure on it while I waited". How thoughtful of him too.

My last job of the night dragged me into overtime, whether I liked it or not. An elderly gentleman with severe asthma. A straightfoward job. I nebulised him with Salbutamol and Atrovent and his wheeze, which was very bad when I got on scene, became less obvious and his breathing less difficult. He was one of those stubborn types who don't call ambulances unless they are at death's door, or a relative does it for them. In this case, a relative made the call. He had been suffering like that for two days.

Well, time to get into a better mood for the shift ahead.

Be safe.

Tuesday, 23 January 2007

Jobs I hate

I get a feeling of foreboding when I am asked to enter a property where the resident is thought to be 'trapped behind a locked door'. You may remember an entry from last year when I discussed a job in which we searched a house with the police and the resident returned home. His dog had been left at home and so it was assumed that something was badly wrong as he never left home without him, allegedly. Most of our calls to persons trapped in their homes turn out to be nothing or next to nothing. The jobs I hate most are the ones that turn out to be something.

The call, as usual, was to a 'female possibly trapped behind a locked door'. I raced round to the address and the police arrived seconds later. We went up to the flat with a relative who had called because he was concerned about the lack of response when he knocked and, eventually, hammered at the front door. It turned out the resident was a male and that he would only leave home to go to certain places. His relative had checked all the usual haunts and had not found him in any of them. He had gone back to the flat and called us out. The man in question had not been seen for three days now.

The first thing I did was to look through the letterbox and have a sniff of the air inside at the same time. There was no unusual smell but a light was on in the front room. No sound though. The door was very well secured and the police officer had no luck trying to kick in in. There was, however, a piece of plywood up above the door, covering a small window where the glass had been broken by accident in the past. The relative unscrewed the board whilst one of the two police officers went to get the 'key' - a device used to force entry.

Once unscrewed, the female police officer climbed up and squeezed herself in through the gap. She dropped to the floor and immediately unlocked and opened the front door. I made my way in behind her and the relative followed. We checked each room and I was expecting to see a corpse in any one of them. Nothing. The relative sighed with relief and said "Thank God". He spoke too soon.

He noticed that the man's inhalers were still on the table among other personal effects that would normally be with him if he went out. He went ahead to the bedroom, which had yet to be checked and again I felt a gnawing persistence that all was not well. Again, the room was empty.

We were all heading out of the flat via the small hallway when I noticed the bathroom door ajar. I had assumed this room had been checked. I saw the man's body inside on the loo through the gap and I signalled to the police officer that I had found him. I also signalled that the relative should be kept back for a moment. I went in and there he was, slumped dead on the loo. I checked him and found that he was pulseless, cold and stiff. Definitely dead.

The relative pushed past me and fell apart. He cried all the way out of the flat and was still crying when I left him outside the premises. I felt sorry for him but I couldn't help him and I had nothing to offer him.

I did my paperwork confirming life extinct and left the scene.

I am used to all sorts of horror but I still get apprehensive when I walk into a place where I might find a dead body. Not that the body itself concerns me, it's the way the person may have died. I have a vivid recollection of a job I did 18 months ago where neighbours had called us for an elderly woman trapped behind her door. When I got there and we broke in she was lying semi-conscious in a pool of vomited blood. She also had a serious head wound, either from falling onto the door or something sinister had taken place (the police looked into it later). It was a terrible situation to go into and she was extremely difficult to remove. Her airway was a mess and she was covered in blood and faeces. She was hypothermic and her respiratory effort had all but ceased by the time we got her into the ambulance. I thought we had saved her life but she died of her injuries later in the day.

I hate jobs like that. They are expensive on the soul and they remind you of how useless you are at times.

Be safe.

Slippery slope

I went to a 'care centre' / hostel for alcoholics yesterday. I was on a call for a 'male vomiting blood'. This individual had a history of gastric ulcer and so vomiting blood would be a fairly regular occurence for him (if he didn't take care of himself).

I walked in to a tirade of abuse from a small, very loud alcoholic man who was remostrating with one of the carers about having called an ambulance for his mate who was "suffering". My patient was sitting in the corner smoking a cigarette. Obviously suffering.

I quietened the little man down and then turned my attention to my patient. The staff had not called an ambulance for him because they had seen nothing untoward. His little loud mate had made the call. His loud mate, incidentally, took pride in telling me that he went to America when he was a child and fought in the American Air Force and was a paramedic in the States. It's so difficult to tell whether they are fanticising or telling the truth. I looked suitably impressed I think so he sat down again.

I spoke to my patient (after requesting he put his cigarette out) and he asked me if I could cure him. He told me he had an ulcer and had been vomiting blood.

"How long have you been vomiting blood?", I asked.

"Five years", he replied.

"You must feel weak then", I said.

"I do indeed", he said. Then he took a swig of his extra strength lager for comfort.

I did my usual obs. and discovered he was a healthy(ish) alcoholic. There was no evidence of recent vomiting of anything, let alone blood, and I discovered (shock, horror) that he did not take his medicines regularly. In fact, the carer said that she had been trying to persuade him to downgrade onto a weaker brand of lager so that he didn't feel so ill! Even I could see how lost this cause was.

All the while my patient was hic-upping in my face. Not pleasant but a whole lot better than having him belch or cough at me. Close proximity in these jobs is limited to about arms length unless a life is at stake or you are stupid.

I can't judge these people but my opinion is that they have chosen the life they lead. They rarely seek, or want help and the existence of institutions like this simply remove the problem from public view and tuck it away in a corner of society. We get to see all corners of society. We know where all the secrets are kept.

At the end of my examination I decided he didn't need to go to hospital and I could imagine the looks I would get from the nursing staff if I did take him in. He didn't really want to go anyway, he just wanted me to produce a miracle for him.

"So can you cure me or not?"

"No, I can't and if you carry on, which you will, you'll kill yourself and I'll see you again."


He took another swig of his breakfast and shook my hand. Perhaps he hadn't been told the truth before. Maybe he already knew the truth.

As I left I watched a parade of 'residents' walking in with plastic carrier bags, each containing four cans of Special Brew extra strength (guaranteed to kill) lager. I bid them all 'good morning' and headed off to my next call. They didn't hear me, didn't know me, didn't care. It was ten in the morning.

Be safe.

Thursday, 18 January 2007

Purple plus

First job of the night. Suspended. I hadn't even got my paperwork together; I wasn't due to start for another ten minutes! No other vehicles available so could I run on it? Yes, of course.

It was a long way off and it took me 7 minutes to get there at a good speed. Another ambulance crew were on scene and were dealing. The man was dead in his bed; had been for a while. Stone cold and rigor mortis just creeping in to the fingers and around the face. Nothing any of us could do.

I find myself dealing with death with a detachment that probably makes me look cold. I was about to remind myself of this when the wife of the man said "His eyes are still open".

"Do you want me to close them?", I asked

"But his eyes are open", she repeated.

I went over to the bed and together we closed his eyes for the last time.

"What am I going to do now?", she cried.

I put an arm around her shoulder until a relative took over. What the hell did I know about this woman's pain after all? I didn't know her husband - he wasn't the first and he won't be the last for me but I empathise strongly with her emotions. I imagine what I will feel like when a person that close to me dies. What then will I do?

I left the house and let the crew do their job. My skills were useless here and I was nothing but an extra hi-vis jacket. I got on the radio and called it in as a 'Purple plus', the term we use for the dead. We call the morgue the Purple Annexe. It should be obvious why.

Immediately after the Purple plus, I got called to another 'suspended' in a location I had just driven past. When I got on scene he turned out to be a drunk who was fast asleep on the pavement - can of extra strong lager and half eaten fish and chips by his side (in case he needed a sugar boost halfway through his inebriated nap). I shook him hard and got him up. I discussed the error of his ways with him, as you do, and he seemed to be taking it all on-board ('course I'm kidding). Not at all; he was angry, aggressive and smelled bad. In fact, he was the perfect start to my shift. After an age I persuaded him to stagger off home, wherever that was.

Drunks have a wide and curved walking route. They move towards the dangerously busy road but they rarely step into oncoming traffic (funny that) and then they veer wildly in the other direction, cutting an amazingly accurate arc towards an obstacle, any obstacle, which enivitably stops them. They have a quick think and then proceed with the next stage of their route, yet another stupendous arrangement of short steps which somehow chaotically balances them precisely for the onward leg of their trip towards oncoming traffic again.

In short, they stagger. The less experienced ones fall. Then we come; heroes of the night.

** I am driving around with extra caution now because I believe my nemesis of the road is out there and is looking for an excuse to take me out :-)

A new system is running our calls. The computer selects the first 'nearest' vehicle to the call origin and sends it to the MDT. Never mind that the location of the call is miles away and that halfway there it will be cancelled to a nearer vehicle (inevitably). I have been running on calls that get cancelled all over the shop and so I am now calling in to verify whether or not I am required. This results in a cancellation being sent without my having to move. It seems very inefficient in my opinion.

Nevertheless, this new system gives me a glance at calls in other sectors. For example, "Blisters on vagina", but given as a RED3 because she claimed to have difficulty in breathing. I couldn't see the connection physiologically, but maybe that's a bloke thing. If I had the same problem down there I'm sure I'd gasp but I doubt I'd be short of breath.

Another came in from a doctor who was 'shaking badly' in his hotel room. What would you ask him? Would you ask him for a self-diagnosis? A few doctor, doctor jokes might spring to your mind.

I thought some of my calls were strange and funny but there are other worlds out there.

In the end I went back to the station. That stopped the seemingly endless out of area calls. It means I can't sit on stand by and watch the world go by as much these days. Hey ho.

Be safe.

Tea break

I was just about to have a cup of coffee when I got a call for a 'suspended'. The press would have loved this because the ambulance crew on duty with me at my little station were on their EU enforced break and therefore couldn't be called for this job! The paramedic from the crew was eager to do get involved and help out but he was powerless and I had to go alone to this one.

As fate would have it, I was updated on the way to the car. It wasn't a suspended after all, it was a fit and could I please still run on it as there was no ambulance crew available. Yes there was! They were trapped inside the station being forced by the European regulators to have their tea and biscuits. Talk about fiddling while Rome burns. None of us are happy about this and it won't be long before the public loses faith in us, whatever of that they have left.

I started running on this call, blue lights and sirens, as you do, when suddenly, from out of nowhere I glanced a car as it sped past and right across me. Once again I had almost been hit by some lunatic on the road. I'm concerned about the third time lucky law that operates in these incidents as I am on duty again tonight. This time I was driving across a traffic light junction, with the lights just turning in my favour. I was doing no more than 20 mph (after last night I didn't want to take any chances) and I looked to my left. As I scanned across to my right I saw a blur of movement. I tracked it and saw that a car had just cut across me at high speed. He must have been racing the red light on his side. Or he was a drunk moron. Or both. Probably both.

It was very wet and windy last night and visibility was poor enough without the extra concentration required to avoid nutters on the road. I know that this time I would have been seriously injured or killed if I had been one second earlier across that junction. I better update my will.

I got to the scene of the alleged fit and saw that a few police officers were gathered around a young man on the ground. He was thrashing and relaxing alternately but was talking to the officers too. I got to him and asked if he was epileptic. He said 'no'. The officers told me that he had been mugged a few weeks ago and had sustained a head injury which he did nothing about (he didn't go to get it checked at hospital). Indeed, his over-riding worry seemed to be that he was going to be forced to go to hospital, which I can't do obviously.

I carried out my checks and found nothing wrong with his vital signs. His demeanour told me he was acting this out. He certainly wasn't having a fit and he wasn't having a neurological event as far as I could gather from his actions. He threw a lot of clues and kept repeating that he had been mugged and that his head was burning. I could see no fire but I could smell something amiss.

I spoke to the police officers and to his friend who was with him but I got no additional information about him that would help me discover his problem. I was sure it was a lot to do with alcohol (he had consumed a lot) and my instincts told me he had emotional problems. The two simply don't mix. He refused and refused and so I was left with little option but to cancel the ambulance (no point in wasting the crew's time on this) and get him to sign my magic 'If you die it's not my fault' form.

When he realised things were serious and that the police were concerned about him (I wasn't too worried to be honest), he suddenly recovered, stood up and had a lengthy conversation with them about not going to hospital. The police had no option either. They even hailed a cab for him and had it wait whilst they remonstrated with him. He walked off with his mate and the cabbie lost a fare and ten minutes of his livelihood.

All the time this was going on it was pouring with rain and the wind was battering us silly. A drunk kept approaching us and moaning about having no money to get home. He kept pestering us until one of the officers had to threaten him with arrest. It made no impression but he eventually ran out of steam. Another drunk asked me if I could call him a taxi. I was going to get annoyed with him but I decided that would be arrogant and petty of me so I asked his name and where he needed to go. I discovered he wasn't from London and was staying at a nearby hotel. He had taken a private cab but had been dumped and ripped off because the taxi driver didn't know where the hotel was. I felt sorry for him so I hailed a cab and shoved him in the back with reassurances to the (black cab) driver that his passenger had the cash to pay and was in no way violent. I hoped I was right.

If I don't post anything tomorrow I have nothing to tell you. Either that or I am in A&E. Or dead.

Be safe.

Wednesday, 17 January 2007

Close encounters

I had a slow night. The rain is keeping people away from their beloved alcohol.

I witnessed a punch up in which a young Spanish-speaking man attempted to protect the honour of his young female friend when a loud, arrogant and very drunk French-speaking man (does anyone speak English anymore?) allegedly touched her inappropriately. He pushed the attacker away and was rewarded with a beating in which Frenchy and his two mates set about punching and kicking him to the ground. All in full view of anyone who was passing by.

The noise of it all had upset my friend who sleeps in the cinema doorway and it was the unusual sight of seeing him standing up and looking about that made me aware that something was going on. I drove nearer to the scene, parked up and watched. The local doormen were also watching and one of them was attempting to intervene (not wise). Eventually the three youths walked off, hurling insults and threats at the Spanish protector of women. The police arrived on their bikes (literally) and detained the little gang as they attempted to leave the scene of their crime. Another police patrol arrived and approached the victim.

Of course it only took seconds before the victim was brought to my attention and I saw that he had a bad cut to his finger and a small nick in his ear. His finger had been stitched up at hospital the previous week and the stitches had burst as a result of the punching he had received. The police advised him that, although he was making a complaint of assault against the men, he too would be arrested for assault because the assailants had made a counter-allegation. That's how it works these days. You might as well forget about trying to get justice for yourself in this country. For a more interesting perspective (and a more professional one), read Copper's Blog.

This poor guy kept saying "I can't believe what he did. why would he do that to her?"

I kept telling him the same thing in response. "He's drunk and stupid and its a very common occurence."

We have to do something soon about alcohol abuse in this country, don't we?

I also watched a beggar go from person to person with a paper cup in his hand. He had a sense of urgency in his mission and I knew his face. He wasn't sitting in one spot plying his trade, he was harrassing everyone walking by. He was approaching groups of people and interrupting their conversations to get some money out of them. Was he desperate to get enough for his midnight meal before Burger King closed shop? Was he trying to raise enough cash in a hurry to help some poor kid on the street? Nope. He was trying to get enough for his next fix because he was going cold turkey. He was so close to mugging his next potential donor.

As for my own close encounter. I was driving to an emergency call behind an ambulance, which was going to the same call (I discovered later), when we crossed a red light. It was around 3am so there wasn't much traffic around but I am always careful not to go too fast through a junction. The ambulance went through, lights flashing, sirens blaring and I followed. I had probably slowed down to about 20 mph and was beginning to pick up speed again when I suddenly saw a taxi coming straight at me from the right. I turned to look at him and I had one of those incredible slow-motion moments. He kept coming and didn't seem to brake at all for a second. I continued to look at him as I travelled across the junction and he continued to drive straight towards me like I was invisible. I too had my lights on and my siren blaring but he was obviously a deaf-blind taxi driver. They are rare.

Then my slow-mo interlude ended and he veered off, with a skid (road surfaces were slick with rain) and did a sweeping arch behind and around me as I past. He had customers in his cab and he was travelling much too fast through the lights, even though they were in his favour (the lights not the customers). I saw him recovering control of his vehicle in my rear-view mirror. Then I got cancelled on the call! The vehicle I was following was 'nearer to the incident'. Yeah, right.

In the past when I had a near-miss like that I would have had my heart in my mouth for a while but I felt nothing at all. I felt no fear or apprehension, I just looked at the driver and carried on. I would have taken evasive action but I didn't feel I needed to. I was right in this instance but I hope I'm not becoming a driving robot because I will get it wrong one day (or night) and I'll be damned if I am going to end up in hospital. I've seen what goes on in there!

Be safe.

Saturday, 13 January 2007

Its a small world

I had a good shift last night. I attended again. I'm beginning to realise that working with someone else can be fun and doesn't have to be stressful. That always depends on the person you are working with and my new crew mate is only on my line until February, when he begins his paramedic training, so I'll have another EMT assigned to it after that. Maybe he or she will be just as agreeable and I'll be happy to go back to an ambulance for a while after this next car secondment.

We did good. We got a call to a 'collapse with head injury' outside a pub. We made our usual assumptions about the possibility of the patient being a little worse for wear and set off. When we got on scene there was a rather large man lying on the pavement, covered in a quilt (!) and a pillow was placed under his head. There were a few people around him helping him lay still.

I went over as my crew mate parked up and asked my usual questions.

"What happened?"

"He came out of the pub and just collapsed on the ground", a Liverpudlian man said.

"Yeah, he had a couple of drinks, not a lot, took some pills and fell outside", interjected a woman who turned out to be the pub Manager.

"Did he bump his head at all?", I asked.

"No", they replied.

Good. No injury. I looked down at this guy and I was struck by something that seemed familiar, like recognition. He was thrashing about a bit and making no sense, just repeating garbled garbage but it was the look of him that switched a light on in my head. This guy was schitzophrenic.

"Do you have mental health problems?", I asked, somewhat cheekily.

"Yes, I'm schitzophrenic", he shouted.

"I took my pills. I took all of my pills. I'll kill someone", he went on, rather convincingly.

He then began to get a LOT more aggressive and started aiming punches and kicks at us. By this time my crew mate was helping me to hold him down, as were the other two people on scene. This was happening in a very public place and so a lot of interest was developing among the locals. I asked my crew mate to call for police assistance because I knew we were never going to get this guy into the ambulance without a fight and something didn't seem right.

I continued to hold him down and tried to glean information from him, like his name. He told me it was Adrian, so I addressed him as Adrian from then on. By the time my crew mate returned he had calmed down and we all relaxed a little. Big mistake. He thrashed out and launched a kick which connected with the back of my head, very hard. I think I said something unprofessional and decided to speed the police response up a little because this guy was going to become dangerous. I called Control for an urgent police response and they obliged.

The police arrived a few minutes later, as did one of the FRU's and we soon had enough hands on 'Adrian' to control him but he was very strong and very determined. The police had to handcuff him (no choice) and we bundled him onto the ambulance, holding him down on the stretcher (I should stress that at no point did we put pressure on his chest). He continued to thrash and threaten all the way to hospital. He made claims of recent murder and that he would do it again.

We got him into hospital and he was secured, with four police officers, in a cublicle. I booked him in and when I returned one of the police officers told me that they had identified him. He wasn't Adrian at all. He was an escaped prisoner who had walked out of a supposedly secure mental hospital. I think he had actually murdered someone. Apparently he and another runner were featured on the evening news earlier!

I asked if there was a reward. I was offered a smile. Never mind.

After a short break my head stopped hurting. Occupational hazard.

Our last call of the night was to a drug user who had injected cocaine into his leg but missed the vein. He now had a serious infection in his leg and possibly a deep vein thrombosis (DVT). While I was talking with him (and I have to say he was an intelligent guy who seemed to realise how stupid he was being with his life) we discussed the end point for addicts. He mentioned a friend of his who had been found dead and who had died alone (as they usually do) in a filthy warehouse building. Guess what? It was the dead man with the shiny shoes!

His friend had died of an overdose up on the third floor of that filthy, rat-infested warehouse that I was in weeks before. I found that a sad and depressing coincidence. I told him that I had dealt with that incident and I said that I really didn't want to meet him again when he was dead, which was extremely likely if he didn't change his life somehow. I know that this is much easier said than done, however, so far be it from me to judge or patronise. I hope maybe something I say will make a difference to someone like that.

Back on the car for a while next week.

Be safe.

Friday, 12 January 2007

Back in the back

Back on the bus tonight (attending, so back in the back) and I actually enjoyed being on it. I have a new partner (temporarily) and he has been working my line whilst I have been on the car, so this is the first time he has worked with me since he transfered a few months ago!

Admittedly I get to spend lots more time with patients when on the ambulance as opposed to the car but the pace is a little slower. I used a few skills tonight, including giving narcan to a drugged up man who was taken to a police station because he was wandering aimlessly around the road. When we got there he was barely with it but able to talk sense but when we got him into the ambulance he started to go downhill; his breathing became depressed and he was much more difficult to rouse. I couldn't ascertain from anyone what he may have taken and so, on the basis of his condition and his pin-point pupils (oh and the fact that he looked a likely character) I 'narced' him - nice and slow, IV.

We were about to leave on a blue call to hospital when he suddenly (and miraculously :-)) recovered. He wandered up from his slum of narcotic sleep to a world in which he realised he had been robbed of his £20 hit (or whatever today's going rate is). Now he wanted out of the ambulance. He wasn't violent and we reached an understanding, kind of. I monitored him for a few more minutes and all his vitals were back to normal so, at his insistence and him being of 'sound' mind, I got him to sign my form and I let him go. I disconnected him from everything and removed his IV obviously!

He will probably relapse in a corner somewhere and someone else will have him as a problem for the rest of the night. He declined. What can I say?

We also dealt with a middle aged lady who collapsed and passed out in a theatre. When I did her obs. her BP was a very low 84/53 and her pulse rate was in the low 50's consistently. She had no relevant medical history for this and her ECG was unremarkable. She had no chest pain and no current illnesses. Her BP didn't improve a lot when she was laid flat but she felt a little better. I put IV fluids up for her and this improved her BP to 102/87 with a relative increase in her pulse rate. She looked a hell of a lot less pale when she arrived at hospital. She began to complain of abdominal and back pain (around the kidney area) just before she got to resus., so I wonder if the problem lies within her.

It was nice to talk to someone whilst on duty tonight. I didn't realise how lonely the job on the car was until now. Maybe a combination of car and ambulance work during the year is best. This is the suggestion being made when they roll out all the new cars and I think it may be healthier to do both.

I've changed the background colour (not much I can do about the dots as they are part of the template). Is this better?

Be safe.

Thursday, 11 January 2007

Wind and rain

Wet and windy...and that's just the weather! My first call of the day was to a young man who had been found near a London landmark with a head injury (the man, not the landmark). It was 7.30am and he had allegedly been mugged. Strangely, his wallet and belongings were still with him on scene.

I asked him a few questions and it was clear that he didn't know where he was but he was pretty sure that someone had attacked him.

"Where were you going", I asked

"Home from work", he replied

"You work nights then?"

"No, I work during the day."

"What time do you think it is now?"

"About five o'clock?"

He was clearly concussed and his head injury was significant, although it didn't look life threatening. You never know with these things though. Sometimes a person can sustain the most innocuous of head injuries and it kills them because the bleeding creates internal pressure that the brain can't cope with.

It's still fairly dark at this time of the morning so I found it difficult to assess his injury thoroughly and torchlight didn't help much, especially mine; it keeps switching itself off when it feels like it. Dodgy contact I guess. I really should do something about that or I will get caught out one day.

I carried out as good a secondary survey as I was going to get under the circumstances and the ambulance arrived to take the man away. He appeared to have no other injuries and was able to walk to the vehicle with assistance.

I got my usual bundle of life and death, hero-making calls too of course. A man who was 'coughing up blood' and who, when I arrived, sat pathetically on the floor of his front room whilst his female relatives got on with their day with little or no interest.

"So, what's happened to him today?", I enquired of the closest disinterested woman to me.

"Oh, he's been coughing up a lot of blood" she said as she pointed to him and turned her back on me in order to get on with something more worthwhile.

Fine, I thought. I shall direct my questioning to the cry baby on the floor. He really didn't look ill and he struck me as someone who was trying to get attention from someone, probably Miss notatallinterested.

He had coughed something up but it was a little blob of characterless ooze from somewhere inside his throat and nothing more. His vital signs were good and he was playing listless and weak for his audience, including me. Sorry but he was. I even had to ask him to speak up because part of the package in this particular act is to deliberately slur, slow and quieten your speech. It's annoying and I have better things to do. I have a rest break to get to.

Then there was my 9013, our code for no trace. I spent ten minutes searching Tottenham Court Road for a 'female with abdo pain' and found no-one interested. Not even a tourist who needed directions. Another life saved, I thought. I think this is the mind-set of someone who calls an ambulance under these circumstances:

"Oooh..bit of a twinge in my tummy there. Better dial 999"

Five minutes later.

"I feel better now. Must have been gas. Never mind. Silly me. I wish those sirens weren't so loud, I can hardly hear myself think."

And off he/she/it wanders.

I love this job. No two ways about that. I find people funny, annoying, interesting and altogether human. Keeps me sane.

The administrative problem I told you about (the one that has displaced me from the car) means that I am back on my line at my usual station. I will be working the next few shifts on an ambulance, which I am looking forward to. Next week I'll be back on the car as normal.

Oh, it has been pointed out that the colour scheme may be giving you headaches; white text on a dark background. I personally like it but if enough of you say you would like it changed then I will find something easier on your eyes. Let me know.

Be safe.

Wednesday, 10 January 2007

Give us a break

I have had a few days of routine work recently. No skills (thrills) or spills, thankfully and so I have been able to absorb what is going on in the press. It seems LAS are once again being criticised and yet another scandal is rearing its head.

Rest breaks.

According to European legislation our bosses must give us a rest break each shift, the time of which is usually determined by EOC and generally (or hopefully) coincides with quieter periods. This hasn't exactly been the case. The ambulance service is an unpredictable beast, as are the people who call us. For this reason a number of people have allegedly died (according to the Press) as a result of crews sitting at their stations on a break. You see, whilst on our break we cannot be activated and that's that.

Unfortunately, the way the Press has portrayed this problem may have the general public thinking that we want to sit there and ignore calls. This simply isn't the case. When a crew is put on a break they are not allowed to be activated and if a call comes in the next nearest in-commission vehicle (even from a different location) will be sent instead...thus the delay.

I can't get into this in detail because it may cause problems for me, I just wanted to air my thoughts and since I have an audience of potential 999 callers, it is worth letting you know in advance that this situation may result in a delay but it won't be because the crew ignored your cry for help.

I am currently in limbo. Not only do I have this new format to get to know but I have temporarily lost my usual line on the car due to an administrative error(!). I am working an unfamiliar callsign and don't yet know what my future line will be. I will keep you all posted.

As for the new comment entry routine, I do apologise. I know it's a little more time consuming for you but it secures me against those who, for reasons I still have to understand, wish to destroy this blog. I think their confusion was that they believed this to be an open forum just because it was in the public domain, so to speak.

It's not. It's mine.

Be safe.

Friday, 5 January 2007

A Fresh Start

Welcome to my new home. AOL didn't suit me too well and I can now control who does and does not read and comment on my blog. Its also clearer I think and leaves a bit of design room for me to work with.

I hope to set up my own domain blog in the near future and that will give me even greater control over what I do.

For those of you who may be dropping in for the first time, you can read all of my 2006 entries at

Comments on the new format welcomed!

Be safe.