Wednesday 4 April 2007

Acting under warrant

Four emergencies, 4 Green calls, 4 conveyed, 1 assisted, 1 treated at work, 1 not required and absolutely NO ambulances required.

My first shout of the day was to a female having an epileptic fit. I got on scene to find the flat being searched under a warrant by the police. I thought there may be less of a medical emergency and more of a distraction going on here. On numerous occasions I have attended calls for fits, faints, asthma attacks and chest pains only to find the abode being ransacked by the authorities and the suspect claiming one, some or all of these conditions in order to get out of the situation - not unlike the shoplifters I have mentioned before. It's human nature, I guess. when you are desperate and need to buy time, a little chest pain goes a long way. The theory is that we are too dumb, or scared to say they are faking it...there's the whole liability thing if it goes wrong. Unfortunately, we see the situation for what it is and often these people get nowhere. We are not dumb and some of us will tell them they are faking.

This young girl had two witnessed events, described as blackouts. They could have been seizures but she was more alert than me when I walked into the flat. You generally need a little more than five minutes to recover from an epileptic fit. She could have been genuine, so I gave her the works, in terms of obs. and she checked out just fine. I explained to her that it sounded like she may just have passed out. She agreed. It was her boyfriend who was being arrested, after all, not her.

I offered her the opportunity of going to hospital and she declined, twice. That wasn't the game plan anyway, I was there as a distraction. In fact, when I first got on scene and entered the flat, the police had to guide me past another little distraction left in the hallway on a piece of newspaper - human excrement.

Then I was sent 3.5 miles over the River (you know how I feel about that) to attend a 'female with headache'. It was given a Green2 category, which is fine but its a long way to drive (no blue lights for this one) for someone who could have taken a cab. Sorry to be so harsh but I get headaches, on the odd occasion they have been blinding and made me physically sick but I certainly DO NOT call the ambulance service. I do what you do, I cope.

I arrived on scene but could not identify the house. Then a woman waved out of the window. No, she didn't wave, she summoned me to stop and wait. I felt like a mini-cab driver. So I stopped and began to get my bags out of the car. Before I got to the door, the woman hustled the patient, who was holding her hand against her forehead, out of the house. Usually I get a chance to introduce myself and do some obs. on scene. Not this time.

I carried out my obs. in the car and took some details and discovered that she had...a headache. A bad headache. She was young and she had no significant medical problems. Her obs. were perfectly normal and she had no rash, photophobia or stiff neck. She had not been in contact with anyone who was ill and she had not been intimate with birds or foul. She had not been abroad recently and she was taking no medicines or drugs. She simply had a headache. I took her to hospital. They won't find a tumour and they won't even bother trying. She will get better.

I tried to get back across the river and made it as far as SE1 when I got call to a 'bus driver, assaulted, punched in head'. I got on scene in 3 minutes and couldn't find the bus. Well, its not an obvious object in a road full of buses. I knew the police were coming, so as soon as I saw them I tagged along and they led me to the correct vehicle. I had to pull a u-turn to achieve this.

The bus driver was unhurt and didn't want to go to hospital. He was angry about being hit like that and I don't blame him. The man can't even do his job without risk to himself. He had been hit with an iron bar across the head in the past - just for saying "fares please". It's not right.

Ironically, the bus was parked up directly in front of the local police station, yet neither the driver nor his boss had thought of nipping in and speaking to an officer on the front desk. They had called the police instead. Then they had waited for about 6 minutes until they (and I) arrived! Just as well he wasn't badly hurt.

I went to a train station to help a man with learning difficulties get home. He was a little lost and confused after wandering away from his home and he had got his head trapped in the doors of a train, so the ambulance was called (British Transport Police worry about these things). He wasn't really hurt and I established that fairly quickly, but he needed the encouragement, so I told him he was fine and I had the BTP escort him to a bus bound for home. Last time I saw him he was standing at the bus stop with the two officers next to him, waiting for appropriate transportation.

Then a 2-for-1. I attended an elderly lady who had fallen and broken her wrist. I sat her in the car and drove to hospital, as is my routine, but on the way I came across a collapsed female with police in attendance. I felt I couldn't justify driving past, so I asked my patient if she was okay with me stopping and checking this other lady and she nodded her confirmation. I got out and approached the little gathering. The lady on the ground was conscious but had a few minor cuts. The police told me they had been waiting for an ambulance but it had been diverted to a more serious call. I checked the patient out, took a short history and still wasn't sure what was going on. She seemed very confused but not post ictal. She denied being epileptic anyway. She had just collapsed for no reason, according to witnesses. The police thought she might be a bit dodgy and they wanted to check her out but time was pressing and I had a patient in the car with a painful wrist. I thought about it and decided to bundle the new patient into the car too. I took them both to hospital (with a police escort) and got them both assessed at the same time. They were quite happy with that arrangement and the second patient didn't become a werewolf.

When I eventually got on stand-by in Trafalgar Square I heard a mother chastise her young son for chasing the pigeons around.

"Benjamin, get over here! You do NOT go running after birds", she shouted.

"Not 'til you are older anyway", I thought to myself wickedly.

A call to a diabetic going hypo had me summoning up all the skills and knowledge I needed for this particular emergency - chocolate and coke. He was not alert and he was sweating profusely. His own BM meter read 5.6 but I knew that could not be right. Mine said 2.3 - that was more likely. I got a member of staff in his office to gather the necessary materials for appropriate treatment and I fed and watered him for five minutes. I had one chocolate myself too, for moral support.

He recovered very quickly and finished his treatment off with a salad roll. By the time I left him his BM read 6.2 - much better. His meter would have been skewed because his fingers had not been cleaned prior to the first measurement so any sugar residue would have given a falsely high reading. No ambulance and no hospital needed. He's fine and I got a free chocolate.

My last job dragged me South again, this time for a ? fractured ankle that looked more like a sprain to me. The young man had been playing football and had fallen awkwardly, twisting his ankle inward. That'll do it. He heard it crunch and saw the joint go 'wobbly'. It was swollen and bruised. Sprained, possibly fractured.

I splinted it, hopped him to the car, drove him to hospital (very busy now) and chatted along the way, as I do - just tell me to shut up if I bore you. I arrived, unsplinted him, wheel-chaired him to A&E and left him to ponder his footballing future. Nice guy actually.

Be safe.

9 comments:

Anonymous said...

Who in their right mind would phone 999 for a headache?? I wouldn't even phone for an ambulance if I had a serious migraine, mainly because the only place that's good for you if you've got a migraine is bed. In a dark room, not a busy A&E cubicle!

Xf said...

Agreed. There will always be a few people who go on about the possibility of someone being left at home with a headache only to die of a stroke later. It can happen but not often. More often than not, its a headache.

Anonymous said...

Hello Again :)

I'm one of the people who would call an ambulance if I have that type of blinding light, vomit inducing headache because thats what my GP and endocrinology consultant have told me to do. I'm waiting for surgery just now as I was diagnosed with a tumour in January this year, after numerous tests and eventually an MRI.

I was hospitalised in August last year with exactly what you describe as being 'just a headache' although I also had photophobia. It was dismissed as being nothing more than a migraine and I was sent home after 4days.

Would I be classed as a waste of time by the ambulance service if I called for help? I err on the side of not bothering anyone and coping with the pain medication I've been given. But I've been told that if I get that type of headache again to dial 999 without hesitation (but i would hesistate because thats just me and especially reading this cos I wouldnt want to waste people's time)

I'm asking out of curiosity and not hostility.

Rosie x

Xf said...

Rosie

You make a pertinent point and I know I can sometimes come across as arrogant or non-caring when I approach these subjects but I did point out that there will always be one or two cases of genuine need, as is yours.

You should call an ambulance because your situation is different but can we really live in a world where we spend billions on the basis of what might go wrong with the majority of callers? We already live in a society way too cautious for its own good and the result is a virtual nanny state and millions of people who just cant take care of themselves.

I took this lady to hospital precisely because, as a healthcare professional, I had to err on the side of caution. Statistically though, I would have been safe to leave her at home - we both know that. The presence of photophobia is a definite convey in my book, so I am very careful about my clinical judgements,

I am sorry to hear of your diagnosis and I wish you well. Thank you for raising this point as it is important that we get the balances right.

Please don't hesitate to call 999 if you get a bad headache - we moan all the time about stuff but we always care for our patients.

Anonymous said...

Hiya,

I'm 100% in agreement with you, a headache is a headache and lets face it a cut finger or grazed knee is just that aswell. It drives me absolutely mad to know that people will waste your valuable time and put others at risk with stupid, trivial call outs.

The headache point I raised was a purely personal enquiry which I probably had no right to post on your blog (with hindsight). I think my last trip into hospital was a real eyeopener, although at the time my eyes were tight shut unless in a very dark room.

I was admitted via A+E by my GP who thought that some major bleed had happened, this was before the tumour diagnosis was official but suspected. Within 30min I was in the CT scanner and getting prepped for an LP, not fun but very interesting to look back on. My husband was with me throughout and when I was well enough to be coherent he told me about some of the other patients he had seen while being send outside my little bay while they took ob's and stuff.

It truly shocked me. The waste of time that paramedics appeared to be going through was unspeakable. It was that which made me pretty sure I'd never call you guys for myself, although now that you've poken to me I might consider it... that said, if it was anything like last time I wouldnt have any choice in the matter cos I couldnt see the dr in front of me never mind a telephone keypad. Photophobia is the weirdest thing I've ever experienced, I found myself crying in pain when even dim lights were shone, never mind those pen-torch things they use.

Anyway, sorry for rambling on and on and thank you for taking the time to respond to me. I'm sure everything will be fine, its not the tumour I'm worried about to be honest, its the general anaesthetic needed to take it out but maybe thats my way of avoiding the issue. I'm getting help from "Maggie's" Centre who are wonderful, shame there arent more centres around cos the service is invaluable.

Yours,
Rosie x

Anonymous said...

I was once called, on Blues & Twos, to a patient with headache...on arrival scene we were met by the woman who just wanted us to open her bottle of paracetemol (childproof top)...!!!

Xf said...

Rosie

You have every right to make comments that are constructive or inquisitive. In your case you just wanted a point clarified.

Xf said...

Kingmagic

Was that the call that was highlighted in the press and news? I remember one where a guy just wanted his TV channel changed but he couldn't get to the remote (he was disabled), so he dialled 999 for us!

Crazy.

Anonymous said...

May I compliment you on your ability to convey so many pts by car. I work in Essex were you 'back up the car' maybe 60-70% of the time, if only every RRV pilot was so versatile....