Tuesday 8 May 2007

A new definition of emergency

Eleven emergency calls; 1 non-convey, 1 running call and 1 on scene cancellation.

I started the day as N377, the call sign for the amber car. Then it all got a bit confusing when it was changed after my first job to CS47, the sector car call sign. Apparently that's the way it will stay from now on - I am told that the amber car is officially dead. We'll see.

My first job (as the amber car) was to a call 4.5 miles away; a RTC involving a cyclist and a van. I got on scene, eventually and the cyclist, a rather tall chap, was sitting on a wall with a police officer in attendance. The cyclist had been clipped by the wing mirror of a white Transit van and was consequently lobbed off his saddle and onto the road, where he accrued a few minor injuries (mainly abrasions and bruises) to his legs and hands. Fortunately for White-Van-Man the speed of the collision caused no serious injuries. Unfortunately for said WVM, the cyclist was a criminal barrister.

Pregnancy and back pain are common enemies. A call to an underground station for a pregnant woman with back pain had me thinking about poster advertising and how it could help to deliver this message to young pregnant persons: 'Your back will ache, see your G.P.' Followed possibly by a campaign aimed at the pre-imminent deliverers, simply captioned 'Contractions started? Get a taxi to maternity. You've had 9 months to save up'.

Every now and again, I will get a call for which nothing more than a plaster is required, these still tend to come in as emergencies but they don't need to go to hospital. Like the 70 year-old man who tripped on loose paving and fell on his head, resulting in a cut above his eye. He refused to go to hospital and, after carefully checking his obs., I agreed that he didn't need to anyway. He wasn't knocked out and he was fully alert and aware. I put a strip across the wound, got him to sign my 'get out of jail free' form and left him to it.

Then on to the tiniest alley in the world, to a posh(ish) hotel in the West End for a 36 year-old male with chest pain. It was very difficuly to squeeze down the lane leading to this establishment and when vans parked on the kerb, it became almost impossible. The ambulance must have had a great time trying to get out of the place by the time they had loaded the patient up. Luckily, he wasn't suffering any cardiac problems. It looked and sounded as if he had simply had a panic attack. The cycle responder was on scene before me and, after a quick chat and liaising with the ambulance crew, I left.

Another trip and fall, this time an elderly lady who had fallen and hit her head on the floor of an indoor market. She was knocked out, according to witnesses, but was conscious and alert when I got to her. The ambulance crew arrived within a minute and we took her in the chair for a proper check up. The lady had a nasty bump developing over her eye but she seemed fine otherwise. I assumed the gentleman with her was her husband and so I referred to him as such but he corrected me - "I'm her partner", he said. Oops.

Here's a classic failure of human communication and common sense. I got a Red3 call for a 'leaking catheter; patient to be transferred'. First of all, I'm on the car and can't do transfers, secondly, the patient lived literally on the corner of the hospital and finally, there was no way on Earth that this could be categorised as a RED call! It simply wasn't an emergency. How could it be? I called my Control desk to raise these points and was told that there was a new system in place and that these calls were going to slip through the net and we still had to respond to them as emergencies. This is despite the fact that anyone, absolutely anyone, looking at it would know that it was NOT a life-threatening emergency.

I arrived on scene and when I finally got to the flat the patient expected me to change his catheter and I can't do that. Shockingly, the call had been made by the District Nurse who was sitting on the sofa in the same room, shouting down her mobile phone. When I tried to talk to her she raised her hand and said "just a minute". Now that didn't please me at all and I know she saw what registered on my face at that moment.

The patient became annoyed with me because he had expected to be sorted out (quite rightly) as a result of my being called. He did not want to go to hospital (around the corner) but I explained to him that there was no option and then wondered why the nurse wasn't able to fix this leaky catheter for her patient. I couldn't see the point in her being here if she had no skills to use. Maybe one of my nursing readers can help with this one.

Believe me, I wasn't angry with the patient or the nurse, although she was incredibly rude (and loud). I was angry at being put in such an awkward situation by the new system, of which I was told nothing when I started my shift. Apparently, the Government are behind the new change of goalposts. Keep your eye on Tom Reynolds' blog for more detail; I don't do politics here, as you know.

Eventually, the man was taken to hospital (around the corner) by the ambulance crew, who were just as mystified as me.

Later, I was cancelled on scene by police after a RTC call in which a motorcyclist had been knocked off his vehicle. He didn't want to go to hospital and had stormed off in a huff.

A large part of Covent Garden was closed off because of a suspect package and I got myself stuck in a dead-end or two whilst trying to respond to a call for a male who was having an epileptic seizure in a park. I got there late as a result and the motorcycle responder was just ahead of me. Neither of us knew where exactly this patient was in the park and so we started looking around. I saw a woman running down the path and thought she may be connected but then I didn't want to move unless she actually was something to do with the call. As she got closer she waved at us and I got back in the car and headed towards her. I gave her a lift back to where the young man had been fitting. She was puffing and panting after her mini-marathon, so it would have been rude to drive off and leave her to hoof it back, right?

He was standing up, supported by a few people around him and one of his friends. He had been seen fitting on the grass, although his friend said he wasn't epileptic. He was still post ictal and had to be persuaded to sit in the car until I could complete my obs. Meanwhile, the police and the ambulance had arrived - communing on the grass in the sunshine. Lovely. If we weren't all on duty we could have had a 999 picnic.

Not a bad idea that.

Anyway, he was taken to hospital with his friend in tow and as soon as I had completed my paperwork, another call came in for yet another 'male fitting'. This time in a Knightsbridge store (no, not Harrods. Nice try).

I was taken a few floors up by security and found the man lying next to one of those long shoe-fitting benches. His wife was with him and she explained that he had been receiving treatment for a brain tumour recently and today he had suddenly collapsed and had a fit of some kind.

You may remember that I dealt with exactly the same type of call a month or so ago. After treatment for brain tumours, swelling can occur and this can lead to momentary deficits, headaches or seizures, as in this case. The man still wasn't fully recovered when I started talking to him; he was confused and a little agitated. His wife requested that he be taken to a private hospital where he was receiving his treatment. She became quite upset when I explained we couldn't do that. When the crew arrived, the attendant also explained that, as she had called 999, he would be taken to the nearest NHS hospital with an A&E department. He could then be transferred to his private hospital if it was deemed safe and appropriate to do so.

After that call, I got a few minutes to myself on stand-by. I was approached by a homeless man who asked me to check his eye, which had swollen after he had fallen down drunk the previous night. I know this because he was quite candid about it. I didn't recognise him and asked him if he was new to the area. He laughed and told me he had been sleeping rough for 40 years! I asked his name and told him mine (I usually do this). I shook his hand and off he went, happy with the advice I had given him.

Then a call to a male in his 60's who had fallen down some steep steps and bashed his head hard enough to knock himself out. He was drunk and he wasn't shy about it. Despite the fact that he was now fully aware and had nothing more than a minor head injury, he was taken to hospital for a proper examination...and a chance to sober up.

A ? anaphylactic reaction at a department store next. A 19 year-old female was lying on the floor of one of the stairwell landings, feeling unwell after eating shellfish. She had no allergies that she knew of and her airway was fine; no trouble talking at all, but she was vomiting regularly and this concerned me. After I had covered all the other bases; pregnancy, medication, etc., I assumed she must be reacting to something she ate, quite possibly the shellfish she mentioned. The ambulance crew took her to hospital with a bag under her chin, just in case.

My final call, a running call, was for a young Slovakian girl who felt she had something in her eye. She was with a male friend, who spoke English and was her translator for the trip to hospital. I had examined her eye and could find nothing in it. I flushed it with saline and still she felt something there. I knew it was possible that she had a corneal abrasion and the scratch could feel like an annoying foreign body in the eye. I was hoping the eye casualty would be open but it wasn't. I had to leave the girl and her friend in the crowded waiting area with a possible three hour wait time - especially if all you have wrong with you is a scratched eyeball.

On my way back to base I noticed a police patrol car with a couple of stickers on the side. Advertising stickers, one of which was for HSBC bank. Is that for real? Please tell me that isn't the future.

Be safe.

8 comments:

Anonymous said...

Maybe the guy with the leaky catheter didn't have any spare ones in the house, and that's why the DN couldn't do it. Although I've no idea why they would call 999 instead of a taxi.

I know when I had a catheter in for 10 weeks post op it was a nightmare getting problems sorted, especially when we had no bladder washout kits in the house. It meant 4 trips to A&E in 6 days over Xmas - and the out of hours GPs were not interested "go to A&E" was all they could offer!

Anonymous said...

Speaking as a nurse, calling an ambulance for a leaky catheter seems excessive. We have to be certificated to catheterise, yes certificated not certified though that might help, but even if the lady was not current I think I would have called a colleague who was, rather than an ambulance, unless of course there was a known problem with the said gentleman though I cant think what off hand unless there was a stricture. Oh well! As always - take care. Gill

Xf said...

Thanks for your input with the catheter problem guys. I don't want to judge the DN if it wasn't her fault but there is something wrong with the protocols here.

Anonymous said...

I can understand your frustration at being called for something that a GP could deal with but on the flip side, some friends of mine recently visited their GP surgery to be met with a poster saying that if they had a sore throat, chest tightness and runny eyes and nose, then it was just a virus doing the rounds and they didn't need to see a doctor.
They took this on board and at 4am the following morning they had to call the emergency ambulance and she ended up in ITU having been diagnosed with meningitis. Sometimes poster campaigns can put people off getting help when it's needed and will rarely stop the timewasters unfortunately

Anonymous said...

yes there is a new system but theres no way you should have been sent on that, sounds like some EMD needs to get some common sense (and yes i can say that cos i am one)

David said...

Re: sponsorship on police cars, I've seen this too, though only on 'Community' policing vehicles, PCSO cars (both with no blue lights) and Special Constable cars. All these are, I believe 'extras' which local businesses may sponsor.
I'd be as surprised as you if regular patrol cars started carrying adverts. Having said that, there's an awfully large flat area on the side of an LAS van... might be a way to fight the funding cuts...

Xf said...

David

Thanks for the info...it may well have been a PCSO vehicle. There was a discussion a few years ago about LAS vehicles carrying ads but I think it would be bad taste. However, with the budget being so tight....

Xf said...

anonymous

Unfortunately common sense and the EOC are drifting apart. Too many machines making decisions on our behalf..I'm getting so sick of FRED!!