Tuesday, 26 June 2007

Intelligent sheep

You get all sorts riding the buses these days!

Nine emergency calls. One conveyed, one refused and seven required an ambulance.

Another chance to read my book while it was quiet this morning. Usually I don’t bother picking up a book when I’m on duty because I don’t like getting into something and having to dog-ear the page half way through a paragraph. I have been taking the risk recently for two reasons: it has been slower to kick off each morning (weather relevant) and I get bored if I’m not doing something constructive.

I dog-eared the book for a 60 year-old male with DIB, got on scene and realised I wasn’t required. There was a crew already attending to the patient, who was staggering out of a shop with them, drunk, unsteady and a little wheezy.

Once it starts, it usually continues (like rain). I went straight to a 51 year-old man having an asthma attack outside a pub in south London. He had been suffering since the night before and had used up his inhaler, with very little effect. He was able to speak but had to draw breath every few seconds. His sats were low and he was struggling a bit. I started his treatment by the roadside and the crew arrived just as I was about to deliver salbutamol into his lungs. It was raining and miserable, so we got him into the ambulance and continued his care in a warmer, drier environment. Then I said my goodbyes and left the crew to it. The patient was already improving.

I managed to get near to my station (the plan was to have a coffee and a biscuit, if there were any left) but I found myself driving north for a 90 year-old lady who was ‘unconscious on the floor’. I thought, given the age and the call description, I might be heading toward a suspended patient. When I got on scene I couldn’t get into the premises. Large gates blocked my way and they were locked. Nobody was at them to meet and greet, so I asked Control to let the caller know I was waiting outside. It took four minutes to finally get in and by that time the ambulance had arrived too.

Once inside, we discovered a fully conscious elderly lady sitting on her kitchen floor. Apparently she had just had a ‘funny turn’ and collapsed. The woman who called had mistaken the interlude of lucidity for death I think and had panicked. She admitted as much when we went inside the house. I think you have to live a long and relatively trouble-free life to have such a melodramatic way of thinking when you deal with an acute situation. Still, the patient needed to go to hospital and have the mishap investigated properly, so although the call description was a little over the top, the situation still necessitated an ambulance.

I got an ‘ouch’ job after that. A 20 year-old woman who was placing shoes on a rack in a shop. The rack was made up of lots of shiny metal posts which stuck out of the wall. She got too close to them and managed to thrust her eyeball directly onto one. Although she wasn’t impaled (that would be bad), she did tear the cornea right across, causing visual problems and a whole lot of pain. She cried a bit and then settled down when I covered the eye to stop her touching it. Although there is no need to patch an eye damaged in this way, it has a reassuring psychological short term effect.

I took her to hospital in the car and she was calm (and in less pain) when she got there. I even treated her (by request I should add) to a ‘fast’ ride in her wheelchair. I always offer a fast or slow trip down the corridor – I believe it’s a tax-payer’s right to have a choice. She was squealing like a child on a roller-coaster.

My next call was to an EP fit. A 21 year-old man’s grand-parents had called because they were concerned about his behaviour. He was vague, staring into space and didn’t seem to know the time of day. He was also quite fidgety. I asked him about his history with epilepsy but it was undefined – no doctor had actually diagnosed him yet but he was given prophylaxis in case he ‘ever went funny again’ – I found that quite surprising. The drug had been left on a shelf and only taken when he thought he might need it. A year had elapsed since he last used it.

I watched him moving restlessly on his bed and asked him pertinent questions about his other habits, including drug use. He admitted he had smoked cannabis earlier and had been drinking too. I suggested the cannabis might have more to do with his behaviour than epilepsy. He agreed in principle.

The crew arrived and he was taken to hospital anyway. He wasn’t an emergency but my colleague, quite rightly, thought the drug he had been prescribed didn’t fit the bill and that a doctor needed to re-evaluate what this young man required. A diagnosis would be a good start.

A 40 year-old man who had abdominal pains after drinking and who had a long history of duodenal ulcer called 999 to complain of ‘chest pain’. He didn’t have chest pain but he knew that saying he did it would elicit a faster response – clever chap. I’m not being sarcastic this time around because, although he was complaining of abdominal pain and coupled with his habit of drinking on an ulcer he was obviously asking for trouble, his ECG showed deep Q waves in some of the leads – this may indicate significant heart disease or an underlying MI (or a previous MI) – well, it’s possible. So, as far as I was concerned, his pain could be something or nothing – but probably something.

A hit and run call for a 40 year-old male who had sustained a suspected fractured arm as a result. I thought I was heading toward another miserable job where yet another innocent person had copped it from a sleaze ball driver who doesn’t care enough to stop when he damages someone. Fortunately, it was ‘not as given’ – the patient had a minor arm injury, if any at all and the driver had stayed where he was after clipping the victim’s bicycle.

After my break I wandered back into the West End and got a Red1 call for a suspended male in the street. As I rushed to get there (we all rush to get to these jobs) it was updated and now read ‘ineffective breathing’. I was beginning to smell a rat and because I was looking for a windmill I over-shot the location (which was vague at best) and had to turn around and head back to where I thought the caller might be. I stopped and looked around – nothing. The cycle responder arrived and he looked as lost as I did. Luckily a passer-by told me that the man was further down the street (I had just shot past him), so we turned ourselves around and headed to his rescue.

He was a drunk and he was sleeping on the pavement. He had his tell-tale bottle of booze on him and his breathing was better than mine, so he didn’t need to go to hospital and we cancelled the numerous ambulances that were about to descend on this ‘suspended’ patient.

The person who called us out for this guy was nowhere to be seen. He must have been intelligent enough to call 999 and describe the patient but he lacked the common sense to go and physically check his facts. This is very common; a lot of people call us when they believe someone is dead in a doorway. We generally get there, prod the patient a couple of times and they wake up - empty cans will often roll around next to them.

If only these people would look closely at the person they are son worried about, or stick around when we get there. There’s more than one way to hit and run I guess.

Be safe.

Monday, 25 June 2007

Saving Superman

Don't be a pigeon in Trafalgar Square.

Ten emergencies; all required an ambulance.

After a slow start this morning things got hectic and I reached the end of my shift tired and ready to go home. I spent the morning on stand-by and chatted to my friends on Trafalgar Square; the security staff and the lady who keeps this pigeon-scaring hawk under control. Rain threatened but didn’t arrive until later on, so it was a pleasantly warm start to the day and the tourists seemed to appreciate that.

When I got my first call, it was already well into the morning and I was off to deal with a male who was fitting in the street. I arrived to find a van load of armed cops standing around a shivering man who had lost bladder control (whether that was a result of a fit or his new close friends, I don’t know). An off-duty consultant neurologist was on scene and handed the patient over to me. I thought this was fortuitous indeed – how handy was that for the patient?

The fitting man was Polish and didn’t speak much English, so communicating with him about his condition was difficult. My weekend in the Ukraine hasn’t helped me achieve much in the way of Russian translation (either way) obviously, although I was able to reassure him by using the Russian term for ‘OK’ – only to be told by my 'A' level Russian language speaking colleague (the crew were on scene a few minutes after me) that I was pronouncing it incorrectly. Next week – Chinese language lessons.

I was asked to go to a patient whose on-call doctor had decided he needed an emergency ambulance. The patient had a fast heart rate and was generally panicky. Apart from that, he looked absolutely fine and had no specifically relative medical history for his current state. There was no chest pain and no other physical problem associated with his tachycardia. I could see his carotid artery bouncing up and down in his neck, even when he sat still, and there are a number of medical conditions that will cause this – anxiety is one of them. I have to admit I was thinking along cardiac lines initially and the GP had me convinced that there may be cause for concern – even though I wasn’t persuaded that this was life-threatening but he’s the doctor, so I listened and checked the man out. I could find nothing obviously wrong in any of my obs.

The crew arrived to take him to hospital and an ECG was carried out, along with a repeat set of obs., again nothing obvious jumped out. The on-call doc had left the scene by now and the patient allegedly confessed that he had been taking his own blood pressure, convincing himself that it wasn’t normal. This made him anxious about his health and probably resulted in today’s racing heart rate and a trip to hospital. Talk about self-fulfilling prophecy.

My next call was for a 16 year-old male with DIB. I got on scene at the same time as the ambulance crew and so I left them to it. I expected them to come out of the building with a young, healthy panic-stricken boy. Instead they appeared with a much older man – he was 60 years-old. Someone had misheard this over the ‘phone I think.

I went north for a Greek woman with arthritis next. She had stated chest pain on the ‘phone and that’s what I was originally running to. When I got there and started my obs I quickly realised the ‘chest pain’ was being stuck on for good measure. Her pain was all in her leg, so it was the arthritis playing up and nothing more. She had been discharged from hospital a few days earlier and given tables for her pain but she insisted she needed to go back because the drugs didn’t work.

The crew took her back to hospital, after having to lift and wheel her all the way down from her fourth floor flat – we never rule out chest pain, even if we can see little evidence of discomfort, so every patient confirming they have it is moved by chair to the ambulance. This can be hard work, dangerous (narrow stairwells and trip hazards) and is no good for the lumbar spine, regardless of the education we get on logistics and lifting techniques. I can’t walk around for more than a couple of hours these days without low back pain.

Of course our Greek lady would have needed support and a chair for her painful arthritic leg in any case, so some lifting was inevitable.

Then south again for an elderly lady who was described as becoming 'confused' by her son, who made the 999 call. When I got there he was helping her on the toilet. He thought I might want to check her out while she was sitting there. I declined the offer and politely requested that he bring her into the front room. It took an age to achieve this as she was very, very slow moving. I tried to help but the corridor was a little narrow and her son was at her side already, so I waited patiently in the front room.

Eventually she arrived and sat down. She seemed a little confused and not quite with it so I set about getting some basics – she had high blood pressure, a high temperature (+38c) and a high BM (+21). She hadn’t been drinking fluids often enough according to her son and she had a recent history of ‘mini-strokes’, known as TIA’s. It was possible she had experienced another of these but it was more likely that she had an infection, probably a UTI. She had been going to the loo frequently and there was a tell-tale smell hanging around. Actually, there were two smells – she had been doubly incontinent.

The lady went to hospital, accompanied by her anxious son.

I don’t know, you can go for days without seeing a single off-duty doctor and then they all arrive at once. My next call was to a 36 year-old who had fainted in a large department store. I found her lying on a pile of expensive-looking cushions that the staff had provided by cannibalising a nearby (expensive) sofa, currently on sale. Beside her were her husband and an off-duty G.P. who gave me a hand-over and left the scene shortly after to continue her shopping.

The patient was pregnant (halfway there) and was concerned about her unborn child, even though it was fairly obvious that she had nothing to worry about. She had fainted and was recovering well until she decided to become dazed and floppy again. Her husband became increasingly concerned about her and I continued to reassure him until assistance arrived in the shape of a colleague on the cycle response unit. Together we managed to keep the patient conscious with oxygen and conversation. All her obs were normal and a recent scan had given the baby a clean bill of health, so why she was fainting repeatedly was a bit of a mystery. She was also periodically very tearful – I think her hormones were playing games with her – physically and emotionally.

Another doctor passed by and asked if she could be of any assistance - this time I recognised her as one of the SHO's I knew from a few years ago when I was working in A&E at St. Thomas' Hospital. I chatted with her and discussed the patient's situation briefly before she too moved along to finish her shopping. This was a popular store for the medical profession.

The ambulance arrived after ten minutes and she was taken to hospital, just in case.

Here’s a believable call description. ’52 year-old male, chest pains, says he is famous and will wait near a call box in Whitehall’. Hmm, I thought, had the PM snuck out for a Mars Bar and a can of coke and got caught short by dodgy coronary arteries? Was I about to be implicated in saving the life of our Premier (Blair, not Brown – although you could have swung this either way)? I could see my Knighthood being awarded by King Charles (she can’t last forever).

I raced to the scene and saw...nobody. Every phone box in the location was empty and no-one was hanging around. There were lots of curious tourists but they didn’t look famous. I went back to the car and read the updated information I had received. Now it stated that this famous person wanted to be taken directly to Buckingham Palace. Maybe one of the Queen’s corgis (the one that can make phone calls) had escaped, run up the Mall and developed chest pains along Whitehall as he attempted to return via the park. I didn’t know and it was just a theory, so I called in and asked for the callbox number so that I could track down the patient more effectively.

More information appeared on my screen: ‘claims he is Superman’. Right.

I was back on the radio and about to call this a ‘no trace’ when a small man with a wild face appeared at the window of the car. It was Superman.

I had a long conversation with my famous friend and discovered his chest pain was a myth. He just wanted to get to Buckingham Palace. He told me he was an agent of the Queen and that he had to return immediately. It was raining now and I wasn’t pleased to be having this conversation with a wet head (I've just had my hair cut short, so I can feel every cold droplet). I asked him if he had anything on him that could harm me or himself (I didn’t know him and I wasn’t letting him in the car – I also didn’t know if he was psyched enough to use a weapon in order to have his demands met). He said “Of course not, what a stupid thing to ask”. I conceded his point but I still looked in the bag he was carrying. He was in possession of a bunch of lethal looking bananas. He proudly boasted that he had only paid £4 for the lot. I really didn’t know if that was a bargain or not to be honest – I eat them but I can’t remember the last time I went out and bought some.

The ambulance crew arrived after a short wait and he was packed into the back for his short trip (he could have walked – or flown – in less time than it took him to buy those bananas) to hospital.

I think I smiled all the way back to the car. I'd rather have an entertainingly mad time-waster any day of the week than some of my usual suspects.

A 23 year-old female with acute abdominal pains next. It was her birthday and she had been out celebrating – although not drinking. She couldn’t move for the pain so I gave her a little entonox and she took to it fast. I had to wrench the mouthpiece out of her hand when the ambulance arrived and she was giggling like a school girl as the crew walked her into the vehicle. Once inside her first request was for some more gas. Well, at least she was happy.

I wasn’t required for my next call – a 64 year-old with chest pain - so I excused myself and greened up after completing my paperwork. It was almost going home time and I made my way across the river but my evil plan to do 12 hours and no more was foiled when I was dragged back across the bridge and into the West End to deal with a 52 year-old female who had fainted an hour earlier and was now in the back of a private ambulance, still recovering.

I spent 20 minutes with the patient, during which time she continued to recover, although she remained very pale. Her BP had initially been low but only when she sat up (postural hypotension) but this improved over time. She was still taken to hospital so that a thorough examination could be carried out.

The Heavens opened up as I drove home and people were running for cover. I don’t know why because the clouds had been heavy and black for a good ten minutes – adequate warning to get out of the impending rain I suggest.

On the way I saw a man dragging his unwilling big fat brown dog through the street. Obviously the man had been soaked enough and wanted to get home. The dog, however, had other ideas and wasn’t quite finished with the outside world. I thought a lesson in life was staring this man in the face: never buy a dog that is too big to lift up and run home with.

Be safe.

Thursday, 21 June 2007

TPD glossary

In response to your requests to have some kind of glossary of terms I have started work on TPD glossary - a blog in its own right. I have only just started this but will add new explanations for terms used in the main blog as time goes on.

It's easy to use, just click on the link I have placed on TPD main page (and here) and then browse or search for a term. I have added links and photo's wherever possible to enhance the information available.

I hope you all find this useful.


Tuesday, 19 June 2007

It's not all bad

Eight emergency calls. One refused. All others taken by ambulance.

Another rushed start and off to deal with a 58 year-old homeless alcoholic with chest pain. He was lying in an alleyway with his mates, one of whom was sensibly helpful whilst the other was just annoyingly irritating. I had to ask him to stop talking a number of times while I tried to determine the patient’s condition.

The patient had a long history of heart problems, claiming three heart attacks and he was on a lot of drugs for high blood pressure and various other afflictions. His pain was convincing enough and he didn’t look too well, so the crew took him off to hospital after my obs and handover. Control sent an ambulance, another FRU and a cycle responder one this one, although I have no idea why.

A short spell on standby and a call ‘up north’ for an 87 year-old male who was ‘not alert’, which can mean anything you like. I never got to deal with this patient and spent all of five minutes in his presence because by the time I had found the correct address, the crew (who had also struggled to find this flat) had arrived. I spent ten minutes trying to locate the exact flat in one of Camden council’s finest modern complexes. What a nightmare these places are for us. If this man had been having a heart attack, or worse, had been in cardiac arrest, his chances of survival, at any age, would have been next to nil. Councils have a lot to answer for when designing these stupid places. Even one of the locals who lived in the place couldn’t work out how to get to the particular flat number I required. Worse still, the guy who lives almost directly below the flat I was searching for didn’t know where it was!

I met colostomy man again. He is a notorious regular and I have had the displeasure of dealing with him on a number of occasions. The last few times I have taken him to hospital myself in the car and have spent more time cleaning it afterwards than I care to talk about. Never again.

This time he was wedged in between the seats of a bus, feigning epilepsy (very badly) – he usually tries Hep B and wears a mask for effect but everyone knows he is not infected. He always smells very bad and his attitude changes from docile to aggressive and abusive if he isn’t taken seriously. When I recognised him I attempted to help him because there’s no point in having an aggressive waste of space lying on a bus from which he will refuse to move, causing all kinds of problems and delays. So, I was nice to him; I always am (at first).

When the crew arrived, they too recognised him and were a little less inclined to pander to him (which is fair enough), so he became abusive – no change there. I gave up the mister nice guy act and left him on the floor (I had been trying to help him up). I handed over to the crew and let them deal. I’m sure I will meet Mr Colostomy again, we seem to get on.

I rushed down to a potential assault in south London after that. The call described a ‘male, collapsed ? chest injury ? assault’. Of course the police hadn’t been activated for me, so I had to request them as I had no idea what I was driving into.

When I got on scene, I was waved down by a bus shelter cleaning operative (got to get his title right) who had come across a man lying flat on his back on the shelter bench. He was in a lot of pain and complained mainly of chest pain and shortness of breath. His obs were all over the place, so I put him on oxygen and kept him still whilst I checked him out physically. He had not been assaulted but he had renal failure and was being treated for it. He had a history of hypertension associated with this, so I assumed, reasonably I believe, that his problem was probably PE relevant.

The crew arrived after a short wait, during which I completed my obs and physical exam (and interrogation, although he was too breathless to answer questions). They loaded him into the ambulance and checked him all over again. His blood pressure was through the roof and his ECG was abnormal so no time was wasted in getting him to hospital. The man was in real trouble.

My next patient, said to be ‘unconscious’ was in fact asleep. He was a local alcoholic who had chosen the wrong place (and time) to lay down and snooze off the effects of his recently consumed White Lightning. The empty bottle was lying next to him. He was obviously asleep but it didn’t stop someone from dialling 999, claiming an unconscious person had been discovered and then clearing off to let me find him in the dark. Again, the address was vague and it took me five minutes to locate him on the street, under a bridge where he was, quite sensibly, staying out of the night drizzle.

I feel sorry for some of these people. He was trying get a sleep – he has nowhere else to go but because he doesn’t look good (let’s say outside a smart restaurant), we will be called to clear him away like someone else’s rubbish. Most of these individuals leave a clue so that you (the general public) can tell the difference between dead and drunkenly asleep. The empty lager cans, the bottles, the rank smell of booze drifting towards you with every grunt and snore. Please, please take the hint. If you want a filthy, smelly drunken alcoholic removed from the general area of your snooty establishment, at least have the decency to stick around and own up when I get there. Watching from a safe distance while me and my colleagues do the job for you is just plain bad manners and another example of how little you think of us as professionals.

Off into the city for a 23 year-old female with a nut allergy who ate a peanut earlier by mistake. She was treated in hospital with an antihistamine and had flared up again. Not really a shocker that one. Anaphylaxis can recur again and again because the body is in a state of self-defence for hours or days (or weeks) after an assault on it by an allergen. Giving someone Piriton and a pat on the head will not always be enough. This young lady was in a bit of trouble; her oesophagus was closing up and she had a pretty generalised rash with itching. She had a coughing fit and her airway could easily have become compromised – a potentially fatal complication. She had a history of such reactions and yet still had not been given an Epipen.

I found out later that the patient was just about to qualify as a doctor. I wondered why she hadn’t insisted on an Epipen when she herself must have understood the implications of her condition.

After my break I was sent east again for a 28 year-old female who had chest pain. I found her sitting in the hallway of her flat, struggling to breath and complaining of left sided chest pain, radiating to her left arm. I know it’s presumptuous but I asked her (instinctively) about cocaine use, and she confirmed that she had used recently and was a past habitual user. So this is where my diagnosis was taking me, although I was still aware of other possibilities.

The patient had a lovely young daughter who just lit up when she was woken up and brought out of the bedroom by one of the female crew who arrived with me. Most children bear a worried frown when their parent is being treated by us but this little girl loved the adventure; she even helped put the ‘dots’ on for her mum’s ECG!

I accompanied the ambulance to hospital with the patient, who went straight to resus and her daughter continued to enjoy herself, playing with the nurses who took to her immediately. Later on, when I returned to check on mum’s condition, we played pass the balloon with a glove that had been blown up and had a face drawn on it earlier by one of the crew.

My last call of the shift was to a 40 year-old male who had fallen off his motorcycle. It was early in the morning and there was very little traffic about. Rain had made the roads slick and hazardous. The man had simply slipped when he tried to get through the traffic lights as they were changing to red. He fell off, scraped his bike and banged his knee. He didn’t need to go to hospital and decided to carry on his short journey to work instead. I agreed with his plan and he signed my form. Easy.

I always feel tired by the end of a stint of nights but I appreciate busier times – at least the shift goes quicker and I don’t get bored, or fall asleep. The run in with Mr Colostomy, having to wake up yet another poor drunken sod who just wants to be left alone and the giggling, heart-warming encounter with the well-balanced little girl who lit up an A%E department for a short while made this a contrasting night for me. I was glad of it.

Be safe.

Sunday, 17 June 2007

Out cold

Ten emergency calls. One cancelled and one conveyed. Eight required an ambulance.

You should be seeing a trend. One of the reasons I started logging the number of calls I attend was to record, in some basic way, the trends in call volume, using my calls as a sample. Obviously, the ambulance crews are dealing with a few more than me simply because the FRU doesn’t get sent to anything other than emergencies whereas my hard-working colleagues also have to put up with non-emergencies, inter-hospital transfers and the categorised rubbish we run on because our service is too scared to say no in case we get sued. Long live the ‘sore tooth’ calls. Of course, I mustn’t be simplistic, there are other complicating factors but my sense is that someone, way up high, is just too scared to say no.

This is why you have seen a steady climb in the number of calls I am dealing with every shift. Summer is here and the weather is improving daily, this brings the masses out from behind their desks, the clubbers from their bedsits and flats and the tourists from their coaches into the streets of the West End – to drink themselves to death, or as close as they can possibly get. We also get the odd shooting.

I have designed a poster to hang on the walls of every pub and club in London (not that any sane, profit-minded publican will ever want to hang it). It has the picture of a drunken person (let’s say a female since we get more of them than men generally) on the ground with an ambulance crew standing over her. The caption says:


We really must start thinking about imposing fines on people with more money than sense. How much does it cost to get drunk and unconscious these days anyway?

Again, my VDI and equipment preparation went out the window because my first call, for a teenager who was stressed, came in before I had time to draw breath on-duty. I was half way there when I was cancelled. I was just getting the numbers you see, nothing more. I noticed that I had almost no fuel and so spent 30 minutes filling up and completing my VDI. I had bits of kit missing, including blankets but I never got back to the station to sort this problem out.

I was off to a 49 year-old male with chest pain. He and his family lived in one of those horrible flat complexes that councils think are trendy (and possibly were in the 70’s when all it took was a hallucinogenic to make it seem so). The first thing I did when I stepped into the lift was sniff the air; it was rank with urine. I looked down and saw that I was standing in a large puddle of fresh pee, especially made for me I assumed. It gave me a warm feeling to know that the locals felt it necessary to welcome visitors in such a fashion – I also felt I was in someone else’s territory.

This man, who is from Glasgow and didn’t realise I was too, had abdominal pain that radiated up into his chest, along the track of his oesophagus. My best guess was that he had an ulcer. This guess was reinforced when he told me it was a sharp, burning pain and that he had been drinking lager all day – ten pints to be precise. He also told me that his daily intake of alcohol was the equivalent (I worked it out for him as he could only measure this in pints and shorts) of 20 – 30 units, (Oh and I didn’t mean he was wearing shorts in that last parenthesis). This was all confessed as his adoring family stood around him. He was their hero and who was I to argue with that?

I asked him if he smoked (I noticed he had an asthma inhaler) and he looked at me as if I was from Mars (or Pluto). A lot of people actually absorb things like smoking, drinking and drug-taking into the fabric of their very being so much that a simple enquiry about whether they do or do not partake comes as a shock, I mean, surely you should know that they do?

He wasn’t having a heart attack; that much I was sure of. His ECG confirmed this when we got him into the ambulance but he steadfastly refused pain relief and insisted on walking, despite the offer of a chair. By the time he landed in hospital (I followed behind the ambulance), he was laughing and joking and still stinking of fags and beer. His proud wife stood by his side.

My next call took me to a part of the city I have never been to before on-duty. We were short of ambulances, due to the volume of calls, and so I was being sent out as far as possible. This call was very similar to the one I did last night when I dealt with banshee woman, remember? Again, the young girl had been drinking (but not very much this time) and again she was in a collapsed state in which she thrashed about, swinging her limbs wildly – almost smacking me in the face (when will I ever learn?). She was lucid momentarily and then would become quiet and semi-conscious. This was followed by an extreme flail of the arms and backward arching of the back. During her lucid windows I asked her questions and discovered that she was taking diazepam for depression, just as the woman last night was. She was also on her period. This is a question I ask all of the collapsed drunken young women I deal with because it’s extremely relevant; during a period, alcohol has a much more profound effect on the body. This would explain why some women swear that they have not had any more than usual when they get so drunk that they collapse.

I just couldn’t figure this out, so I asked a doctor friend of mine (later on) to see if any studies had been done on the effects of a combination of alcohol, (regardless of the amount), diazepam and women’s periods and although nothing specific came to light, there was at least one study showing an increase of the side effects of diazepam on the nervous system when taken with alcohol and if the effects of alcohol itself is amplified during a period then my guess is that the side effects, which include hallucinations, tremors and muscular activity, of diazepam are too.

She was taken to hospital but I don’t think the crew would have wanted to share my theory of her condition, so I reported it as seen – had a drink, collapsed, flailing like a wild woman, query cause.

A 22 year-old with a history of pneumonia twice in her life and who was now feeling unwell with ‘heavy lungs’ was my next patient. Her lungs were clear but she had a high temperature so she needed to go to hospital, given her history.

On my way back to the station (which I didn’t see until the big small hours) I was called to a shooting in south London (where else?). A 17 year-old had been shot in the leg and the assailant was still around so I was given an RVP. I have told you about RVP’s before and its not funny, I just can’t find the damned things and usually end up right in the war zone where I shouldn’t be. This RVP was changed three times as I struggled to find the little side streets they were sending me to. In time honoured fashion I rolled into the high street and on scene. There were armed police everywhere, one of whom was waving me down. At first I thought I was going to be told off for wandering into a dangerous area but I saw a crowd of onlookers and a young black man slumped on the pavement and realised he was the patient. This 17 year-old looked a lot older. He also looked disinterested but maybe he was just scared. He had allegedly been shot outside a youth centre – he had a bullet hole in his thigh. There was no bleeding and the hole was very small, with no exit wound. He was lucky I guess because, apart from the small risk of an artery being damaged, he was going to survive this.

I dressed his wound and asked him questions, none of which he bothered to answer. This isn’t just a different generation or culture, this is a different world. School kids use guns in this part of London just to settle scores – it’s not always about drugs. I could almost see him planning revenge as I patched him up and handed him over to the crew. His two mates wanted to travel with him but the crew refused (quite rightly) so I offered to take them to the hospital, thus removing the hassle the crew were getting and solving the problem. The trouble is, I wasn’t too sure about what I was doing carrying these two, possibly armed, teenagers in my car, so I made it clear that I wanted them to behave and that I was doing them a big favour – I didn’t feel as brave as my words so I also stuck very close to the ambulance as it made its way to the hospital.

I unpacked the lads from the car and watched as the resus team went to work on the injured boy. Armed guards were posted at every entrance to the A&E department in case the shooter decided to return and finish him off.

Last year I was at this same hospital when a fatal stabbing came in. The young boy died in resus and there was a massive response by his friends – they descended on the hospital and blocked up the ambulance ramp and parking area. It was a very threatening couple of hours and the police sent reinforcements to counter it. We are entering a new era of healthcare – fortress hospitals.

A 22 year-old drunken female, collapsed on a tube station platform next. She looked like a rag doll in the carry chair as she was lifted out into the world. Her boyfriend looked bewildered by her sudden loss of function.

Things started to get a lot more frantic after that. I was asked to run a long way out of my area (I didn’t even know where I was when I arrived) for a 25 year-old woman who was unconscious in the street. She was drunk and her friends had gathered around her in shock. I was now in a part of town where this sort of thing doesn’t happen very often and they were a bit upset that I was not taking them seriously. “She’s drunk” I said. “That can’t be, she must have had her drink spiked”, they replied, although not in unison – that would be like some bizarre opera.

She had been lying there for almost an hour and was now very cold. Her temperature was 34c, so I wrapped her up as much as I could with a quilt borrowed from a nearby resident who had come to help. In the West End, if you are drunk and unconscious people walk over your body, here in this part of London, people came out of their houses to help. The patient wasn’t wearing anything on her lower half and nobody had an explanation for this. No wonder she was cold. Had she really gone out drinking with a spangled top and no skirt?

A crew arrived after an even longer journey than I had and we bundled her into the warm ambulance; alcohol and cold are potentially fatal. I put her up on fluids and led the ambulance to the nearest A&E. She was still completely unresponsive when I left.

My next call was to a 25 year-old male who was found by two passers-by, lying on his back in the street, completely unresponsive. He looked dead.

I spent almost an hour with him, struggling to get him to respond. He was a tall man; over six feet and I couldn’t move him on my own. Control had no ambulances to spare and I made it as clear as I could that my patient was too cold to stay out here much longer – his temperature was 34.1c.

I wrapped him in blankets procured from the last hospital I visited and his temperature began to improve, resulting in a response from him at last. I managed to persuade him to stand up and go to the car where it was warmer but he shut down again as I propped his tall and very heavy frame in the door of the FRU. I couldn’t get him to stay awake long enough to follow my instructions; this was more the effects of hypothermia than of alcohol.

The two lads who had found him had stuck with me to help and they managed to get him into the car. He woke up again and this time he spoke to me. I explained what was happening and he agreed to let me take him to hospital. I could tell he wasn’t going to be aggressive, so I would take the risk.

Meanwhile, Control sent another FRU to my rescue but it was too late. I had already got my patient ready to go. I took him to hospital and into an A&E department that just didn’t need any more people. It was almost full.

Then off to a 15 year-old who was allegedly punched and kicked in the face during a mugging while standing at a bus stop. It was 4.30am and she was drunk and could barely walk straight. Her parents must be so proud. Again, armed cops all around us. She had minor injuries to her face and head.

My last call of the morning took me to another tall, grotty tower block for an 81 year-old with DIB. She didn’t have any real breathing problems but there was no way she should have been living like she was, so she was taken to hospital and to a cleaner environment. At least some good came out of this shift.

Be safe.

Saturday, 16 June 2007

Gold fish

Six emergency calls (all requiring an ambulance) and two running calls.

There is a goldfish in the fish tank at my base station whose sole objective in life is to hog one of the upper corners all day long. If another fish comes anywhere near, it attacks and runs them off its ‘territory’. One particular fish, another goldfish, approaches the guarded area over and over again. He is chased off every time he gets close and yet he persists in goading the aggressive fish by trespassing repeatedly. Some drunken people are like that; they just never learn.

The guard fish has fin rot.

Before I had gone as far as the bridge I was approached by a woman who told me that a man was collapsed in a heap at a nearby tube station. I couldn’t ignore her request to help in some way, although I might have been tempted – especially as her last words were “he looks drunk”, so I radioed it in as a running call and made my way to the location.

I pulled up to see a very drunken young man being propped up in a standing position by another man as he vomited all down his suit and onto the pavement. The stuff was splashing onto his brief case and over his shoes. He was a fine sight for public viewing in broad daylight – it was only 7pm.

I stood with him as he vomited over and over again (some people have endless stomachs) and then sat him down to complete the ordeal. I thanked the man who had propped him up (otherwise he would have fallen flat on his face) and took over from there. I asked the drunken man a few questions, such as his name and he responded well. He was still unfit to travel and so, very reluctantly, I asked Control to send an ambulance. He may as well be vomiting in hospital while he dries out. Meanwhile I cleaned up his case and clothing – I also wiped the vomit from his mouth, nose and eyes. To the rest of the world I was one of London Ambulance’s finest – a paramedic with a mission. Babysitter.

I apologised to the crew when they arrived. I had to really, the vomiting drunk probably never will.

Then off to a 36 year-old female who was having a fit at a large department store. There was a crew on scene already but I was asked to attend because paramedics are always sent to seizures now, even if that means a ten minute blue light journey during which the crew could have taken the patient to hospital. I got to the scene to find the patient in the ambulance and the somewhat bemused crew dealing with her. She showed absolutely no signs of having just had two fits, as was reported. She was more conscious than me in fact. Not only that but she carried a medical letter confirming that her fits were a mystery to the scientific world and that she was allergic to all medicines, including diazepam, so I wouldn’t have been able to help her much anyway.

Maybe it’s the sceptic in me but I’m extremely suspicious of people who have acute medical emergencies that require instant removal from shops, especially if they haven’t bought anything. I feel we have a complicity in something that’s not right.

After a quick (half consumed) cup of coffee, I was sent to the north for a 60 year-old man with DIB. When I got to the estate, I looked up at the grim flats to see a young boy hanging off the edge of the third floor balcony. He had a little group of people with him (all safely inside the balcony confines) and they were quite happy – amused even – to see him perform his act. I don’t know if he was doing it because I had just pulled up and he wanted to give me the extra work, or if he was normally stupid but I found myself considering what I would do if he fell. He wouldn’t die but he would break a few bones, including his head. Would I rescue him immediately, saying “there, there, don’t worry I’ll help you” or would I ignore him and deal with my genuinely ill patient upstairs, possibly ‘phoning in for another vehicle to scrape the young fool off the ground?

As a fun game, I’ll let you guess.

Anyway, my patient was quite ill. He came to the door and his problem was more SOB than DIB. Shortness of breath is more characteristically defined in specific acute conditions, such as cardiac problems. I would describe a patient with difficulty in breathing as one who is breathing in and out fully but is struggling to do it. I see shortness of breath as more of a ‘puffing’ type of breathing, where the patient is not completing breaths either in or out, or both. On that basis, I would say DIB for hyperventilation and SOB for asthma, DIB for gas or smoke inhalation and SOB for Pulmonary embolism. This man was experiencing SOB, especially when he lay flat.

The patient had a history of cardiac and blood pressure problems and had suffered two heart attacks, his first when he was only 30 years old. He had also had a recent chest infection and that may or may not have been relevant to his present struggle. His inhaler had run out and his condition was only relieved when we (the ambulance crew arrived shortly after I started my obs) nebulised him with salbutamol. I should point out that he was not a diagnosed asthmatic but his G.P. had given him an inhaler during his chest infection.

In the ambulance his ECG was abnormal, although not critically and he was taken to hospital where I’m sure he will recover fully.

I went back to my car, glanced up and noted that monkey-boy had reached a sensible decision – he was back behind the balcony barrier, grinning at me. I tried to look impressed with his stunt but I wasn’t, so I gave up and left the scene.

A 36 year-old female who screamed like a banshee every few minutes and grappled, clawed and kicked at anything around her was my next delightful assignment. She had been drinking heavily, although she doesn’t normally drink much (they all say that) and had suddenly become incoherent, nonsensical and aggressive, cycles that were punctuated by periods of hallucination and quiet staring. Now, I don’t know about you but the combination sounds more like the effects of drugs rather than alcohol. So I pursued my line of enquiry in that direction. Her colleagues barely knew her – she was quitting her job and this was her leaving party but none of the seven or eight people around her could help me with personal details.

I attempted to reason with this howling woman as she lay, pinned down by her friends, on the sofa of the bar (I’ve noticed that a lot of these clubs and bars have sofas). During my quiet, professional chat with her she lashed out at me, with the only arm that wasn’t being restrained, catching my eye with her fingernail, and it hurt. My eye watered immediately and I lost vision for a few seconds. I had to step away from her in case she launched a second wave of attacks, possibly on my other eye, while I recovered. My eyeball was burning and continued to hurt for a few hours afterwards.

I called Control to ask when I was going to see (however blurred) an ambulance crew and they told me that nothing had been assigned - great. I requested one and also asked if the police could drop by because I thought the crew may have problems controlling this lady.

I spoke to the woman’s boyfriend on the ‘phone a couple of times and he seemed neutral about the whole problem. At first there were denials about the possibility of drugs and then a few facts were made available to me to support my theory. Even a combination of prescription drugs and alcohol will send you off the edge like this but you are much more likely to be affected if you are depressed.

I had been on scene with this erratic patient, now held down by four of her colleagues, when the crew arrived to take her away. I noted the lack of police officers and was told that Control had cancelled them. This I didn’t understand, they had been requested for the safety of the crew. In the end, they were able to convince her to walk to the ambulance, although she had to be restrained and supported all the way. Inside, she calmed down and began to talk to us, even though her speech was slurred and rapid.

I have seen this before – wild, aggressive and abusive behaviour after the consumption of alcohol which suddenly switches off when colleagues or friends are no longer around. She was compliant and communicative when I left her with the crew.

My second running call was to Charing Cross Underground station where there had been a report of smoke in the tunnel. This prompts a heavy response from the fire service and they sent three vehicles, including a command unit to the scene. I waited until given the all clear and made my way back to my usual stand-by location. I didn’t go onto Leicester Square much tonight, it was just too busy.

My next call was to a 55 year-old Falklands veteran who had been down from Bedfordshire, celebrated with his old buddies from the war and then got so drunk he couldn’t get back home again. He missed his last train and fell on the pavement, splitting his lip and chin. He staggered into the station with his badges and medals, covered in blood. All the time I was with him, he cried and coughed (he coughed a lot and it prompted me to ask about his lung-health). His only clear communication with me was to tell me he was in the Falklands and that it had been 25 years. This I knew but I did feel sorry for him. I deal with a lot of drunks and some of them never learn their lesson – they go on being losers all their lives. This man had fought (whether you support the idea or not) for our country in the last true war we have ever had and here he was, unable to cope with his situation and obviously alone. His path had been carved out before he got back home from those islands.

A 19 year-old female, drunk in bed and surrounded by her worried family presented me with a challenge; do I leave her to sleep it off in her own room, or do I stretch the NHS resources even further tonight by introducing her into the hospital system? If her airway had been more stable (she was vomiting a lot and some of the larger chunks were not clearing very well) then I would have let her stay where she was and told her parents to keep an eye on her. She was, after all, only drunk. Her father was drunk too though and her mother spoke very little English. The girl’s brother was the most sensible of them all, sober and he communicated well but he was too young to take care of his sister, so my mind was made up by collusion of circumstance and risk.

When the crew arrived, she had been vomiting for almost two hours, including the time that I had been on scene, so I put her up on fluids before she left for hospital. This would help her replace water and salt whilst chucking it up and remind her of how foolish she had been when she comes round and sees the line hanging out of her arm.

Five o’clock in the morning and there’s a drunken man sleeping on a bus. Of all the calls I deal with, these are the ones that make me feel like I am just a public servant. My colleagues from my station were on the bus before me and they seemed to have solved the problem. He woke up and appeared to be going on his way. The crew left but I hung around with the bus driver (who never left his seat). Sure enough, the man went straight back to sleep. I shouted him awake and told him to get off the bus. He grinned (they all grin) and tried to go back to sleep. I shouted him awake again and thought this might go on all morning. Luckily the police arrived and helped him on his way, grinning obviously.

Be safe.

Thursday, 14 June 2007

Biking mad

Ten emergencies; one conveyed, one hoax and eight taken by ambulance.

The shift started with a call to an 80 year-old who had fallen out of bed and was stuck between the bed and a wall. She was confused and not really making sense so it was likely the fall wasn’t her only problem. The crew were on scene at the same time and so I assisted with the careful removal of this lady from her temporary resting place on the floor to the ambulance trolley bed, during which I helped with lifting the chair-bound patient. I like to help with lifts wherever possible because one of the main criticisms about being on the car is that you don’t get much, if any, patient lifting practice.

A 61 year-old woman with pain in her arm and hand due to a trapped nerve got an emergency response because she said “yes” when asked if her breathing was difficult. Once again a major triumph in telephonic diagnostics. I didn’t even go into the flat – a crew was on scene just behind me and I really wasn’t required for this one.

Those crazy cyclists are at it again – today bore out much of what I have been saying about many London cyclists; they are dangerous and flaunt the law at every opportunity. I was called to a 20 year-old cyclist who had slammed into a lamp post at full speed in an attempt to navigate his way around traffic. The traffic was moving and he was cutting in and out between cars, which isn’t clever. He fell foul of one when it almost clipped him - he lost control and hit the post without braking. Although lucky not to be killed, he sustained a head injury (he wasn’t wearing a helmet) and a badly broken collar bone. Obviously he was in some pain but he was stable with no neck pain or other significant injury. There was plenty of blood around from his head wound but a first aider had rushed out from a nearby office and put a large dressing on it. This good Samaritan also offered to secure the man’s bike for him when he was taken to hospital. His acrobatic cycling had almost cost him more than his bike and he made one sensible comment as I treated him:

“I think I’ll take the bus next time”.

An emergency call for a 32 year-old female, heavily pregnant and bleeding badly had me rushing up and down a busy street looking for the address, which was inaccurate and had become a guessing game both for me and the ambulance that showed up soon after I arrived. This few minutes delay may have cost a lot more than inconvenience on a call like this and I wish someone, somewhere would verify exact details. Sometimes I get sent to a street – that’s it; no number, no precision, just a street name and I’m left to crawl the length of it looking for a likely suspect.

Luckily, in this case, the nature of the call was inaccurate too. The woman was pregnant and she was bleeding but not a lot and not in any way life-threatening.

My second cyclist of the day got off scot-free when she had a confrontation with a lorry. Again, this cyclist had tried to nip in between the large truck and the pavement, just to save a few seconds of time, rather than stay behind it. The driver of the lorry didn’t see her and managed to crush her bike underneath a wheel. The woman was caught under the lorry too but a bystander stopped the driver and told him to carefully move back a few inches, allowing the trapped cyclist to free herself without an injury. She was very lucky to escape (as you can see from the photo).

Not all cyclists are mad. A few of them behave properly on the road and stop at red lights. Unfortunately in Central London, the majority of them ignore the law and some of them are just downright dangerous, to themselves and others. I have seen cyclists speed through pedestrian crossings when people were on them, completely ignoring the danger they put others in. I spent a shift counting the number of cyclists who ran red lights and over active crossings – of the 33 that I noticed, 30 broke the law. Do they think that just because they can weave in and out it is okay to behave like that? I don’t and I will point this out whenever I get a chance to catch one out. Read The Thin Blue Line for a police officer’s perspective of this problem.

An abdo pain next. A 38 year-old who was having an asthma attack, triggered by abdominal pain was sitting in the ladies toilets of a public building when I arrived. She was panicking and a little wheezy, so I gave her some salbutamol and a lot of reassurance. The crew took over a few minutes after I started treating her.

Then a 24 year-old female who had fainted at work in a hotel. A training crew arrived with me and I let them get on with it while I chatted to their Training Supervisor, a colleague from my base station. Everything was under control and there was no need for the extra body, so I left a short time afterwards and had my break. I was starving. Unfortunately the HQ canteen had stopped serving hot food and I had to settle for a Twix. I’m sure I needed the sugar.

I went up to Trafalgar Square for my late afternoon stand-by stint in the sun after that. I drove onto the square and noticed a small black camera case on the ground with a bottle of Sprite next to it. Nobody was near these items and I couldn’t find the owner. Other people had been looking at them with suspicion. Now this seems paranoid but in this day and age, in Central London and with two police helicopters hovering overhead watching everything in this area, it seemed a little worrying that I should be the one who checked these items out. The bottle was sitting very close to the case and had liquid in it (probably Sprite). I stood over those isolated things and thought about my options. If they were just as they seemed I could pick them up and either throw them or find an owner. Otherwise, I could be blown up and look like a fool (posthumously of course) for not knowing any better.

I could also look like a fool for standing there wondering what to do. It was a weird few minutes but I was saved from making a decision by a lady tourist who scampered over and claimed responsibility for the items. I was not happy with her at all.

After that close call I was told by a passing Londoner that a building had just collapsed in Victoria and asked why I wasn’t dealing with it. I replied that I hadn’t been told anything about it. I felt a bit embarrassed because he seemed to think that, as a uniformed on-duty paramedic, I should be aware of a major incident occurring a mere mile or so away!

I called in a request to go and help with the collapsed building but I was refused; there were lots of resources on scene already. I was about to find out how true that was.

I was sent to a back pain next. She was standing outside her workplace and described sciatica to me when I asked her what was happening. She had been like this for 4 hours and decided to call an ambulance because she ‘couldn’t walk ‘. Strange because she walked to the car when I arrived. She could have gone to any walk-in centre or A&E department by now.

She refused the entonox I offered because she claimed it made her pain worse and she would not sit in the car, so I could do nothing else but wait for an ambulance to take her away. Luckily, there were still a few around and I was relieved within ten minutes.

As a result of the depleted local resources I was asked to go on a non-emergency call and check the status of a 66 year-old lady who had tripped over in a hotel and hurt her wrist. The poor woman had been waiting for an hour by the time I was despatched – they could have just asked me earlier. When I examined the lady she had an obvious fracture of the wrist, probably involving both long bones (radius and ulna). She wasn’t in a lot of pain, which was just as well and she walked to the car and allowed me to take her to hospital. The shortage of ambulances as a result of the building collapse was beginning to tell.

My last call of the shift was for a female who had been stabbed in south London, so I raced across the bridge – well, I say raced, more like a weaving dance. The traffic had been brought to a standstill around Whitehall because of the recent incident and I had to trace a path through the gridlock. When I was almost on top of the RV I was updated and told that the police suspected firearms and that I was to stay well clear of the location. I did as I was told but was cancelled at the last moment because it was discovered the call was a hoax.

More and more ‘firearms’ calls are hoaxes in this area of London. One day, a call like this will distract resources from a genuine shooting. Well done idiots of the World.

Be safe.

Wednesday, 13 June 2007

Some you win

Six emergency calls; all requiring an ambulance.

Part of my job involves chore-like activities, such as running down to the comms people to get the radio repaired. Doing something like this is fraught with risk – it can take hours to change a fuse down there. I hate hanging around doing nothing, as do many of my colleagues when they are subjected to the same miserable fate.

I found my radio dead this morning. It was lighting up but no sound was going to or coming from it; my radio was in VF. I let control know and they instructed me to get the car battery checked out. Now, I’m no mechanic but if the thing is lighting up I’m guessing there isn’t a power deficit but I wasted an hour on the escapade anyway then took the car, myself and my dumb-struck RT buddy down to the radio hospital where they would tinker and meddle and offer some kind of lame explanation before replacing the whole lot out of spite.

It took almost three hours to escape the clutches of the radio men. I had read, and got bored of, a book and a couple of magazines by the time they released me from the hell I was in. There were at least four other LAS vehicles and crews down there – all with minor problems that required hours of mucking around for reasons none of us understood. Maybe we pay these guys by the hour.

Eventually I started my shift with lunch time nipping at my heels and my first call was for a 31 year-old who had been cycling along the road when he came to blows with a lorry. He lost. After the incident he jumped into a taxi and delivered himself to a police station, complaining of abdominal pains and requesting that they call an ambulance – half an hour after the RTC.

Is it me or could this guy have delivered himself straight to hospital just as easily? Could he possibly have waited at the scene of the incident for police and ambulance rescue? It just goes to prove that you don’t have to be drunk to be stupid.

I checked him out and the ambulance took him away.

A 52 year-old female who had fainted a couple of times was already being attended to by the ambulance crew and I was not required so I got myself out of sight and completed the paperwork, which amounted to me writing ‘not required’.

Once again the walk-in centre called on us to get them out of trouble. An 83 year-old man had presented himself for a routine appointment but passed out during his chat with the doctor. He man regained consciousness and she took his blood pressure; it was very low. She called an ambulance. Fair enough, he certainly needed to go to hospital.

When I arrived nobody knew what I was there for, so that caused a delay. Eventually, they sent me upstairs and the doctor greeted me at the door of her surgery. The man was inside. He was sitting slumped in a chair – unconscious. His wife was with him and she looked confused. I was confused too – why wasn’t he lying down?

I dragged the chair and the man over to the examination couch and hauled him onto the bed. I know I could have dragged him to the floor but I thought it would be easier to transfer him from couch-height when the crew arrived. I asked the doctor to elevate his feet whilst I opened his airway and continued to try for a response. After a few seconds he opened his eyes and acknowledged me. Within a few minutes he was ‘back in the room’. He looked ill and had a medical history to accompany his current problem, so he was definitely going to hospital.

His BP improved somewhat but it still wasn’t great and when the crew arrived to take him away a fluid supplement was being considered. I still don't know why the doctor did nothing about her chair-bound unconscious patient.

I wandered into the West End (the weather is improving) for a cruise around when I received a call for a 27 year-old, suspended. I looked again at the age and considered the odds. This was probably not as given but I heard Control giving details of the job to a motorcycle paramedic and the word suspended was used again, so it was probably for real. I stepped up a gear to get there as fast as I could; if this was genuine the patient had minutes to survive (it wasn’t made clear if CPR was being carried out).

I found myself behind an ambulance that was on the way to the same job and armed police guided us into the area. I wondered if this was a shooting because there were armed cops everywhere. Later I realised they had nothing to do with it; the origin of the call was behind an embassy building. A few of the police officers were soon roped in to help us though.

I went into the house and there were already a number of people dealing – two ambulance crews and one MC paramedic. CPR was underway on a young woman lying on the floor and I offered my help. Most of the people on scene were paramedics, so every skill role was filled, except the drugs. I got my drugs pack out and selected what might be needed for the patient just as a shock was called and delivered. This single shock changed the young woman’s fate – it brought her back. She began gasping and convulsing. Her airway was a mess and the paramedic attempting to intubate her before the shock had found it impossible to get a clear view. It was moot now – she could be supported with an airway and a bag and mask.

I suggested we load and go because there was nothing else we could do at this stage; she needed to be sorted out in hospital. I brought the trolley bed in with the help of an armed-to-the-teeth police officer and we lifted her onto it and wheeled her out to the ambulance. Absolutely no more time was wasted and I travelled with the convoy to the nearest resus room, where she continued to struggle for survival.

The woman had just collapsed and gone into cardiac arrest without an obvious cause. I suggested checking her BM but it was normal, then I saw her convulse and posture on the resus bed and it reminded me again of the little boy we had saved a few months ago and the woman I had been told would probably not survive after her sub-arachnoid. I think this woman was suffering a brain bleed. I also think she will survive and that made me feel good about the team effort. I know I played a small part in this one but it’s still nice to witness a recovery.

After that job I got a little time to rest, replenish kit (not that I used much) and clean myself up a bit – can’t have the general public thinking we are an untidy lot. I went back out on ‘patrol’ and got sent to a female who was vomiting in a car in a McDonald’s car park. Nothing unusual in that surely, I thought.

When I arrived, she was sitting at the wheel looking very off-colour and sweaty. She had vomited on the ground and had driven into this establishment to use the toilet (she had diarrhoea) – we call this combination of bad fortune D&V (never the other way round). It is written this way to make things easier on paper and also because diarrhoea is one of those words that most people simply can’t spell!

It all sounded like a touch of food poisoning and her presence in the McD. car park was not helping publicise their products, so an ambulance took her away to the nearest hospital. There was an old man with her and he couldn't drive so he was left with the car (for security) – he kept wandering up to me while I completed my paperwork and chatting about stuff – mainly the weather. I nodded where appropriate and smiled where necessary but I really had to get on with it and small-talk isn’t my thing – it really isn’t.

My shift was about to end and I had a mere thirty minutes to go when Control sent me a 19 year-old female (not literally) with DIB and chest pain. Once again, given the age of the patient I was a little sceptical.

I arrived at a house inhabited by a large family. The kids were outside waiting for me and shouted excitedly to invisible people upstairs that I was there. The young girl had a history of DVT after recently giving birth and was given anti-coagulants by her doctor. This information changed my attitude – I had to take her obvious shortness of breath and chest pain seriously. It’s possible that a clot had travelled from her leg and settled in her lung, where it was occluding the blood flow and creating her current condition. It can be potentially life-threatening if left unchecked.

I gave her oxygen and gained IV access (just in case) but there was very little else I could do for her. She needed to go to hospital. Unfortunately for me (and her) there was a delay in getting an ambulance; at that time of the day a lot of crews have gone off-duty early because they haven’t had a break, so there is a shortage until the next shift starts - up to half an hour later. I had to wait with the patient for almost 30 minutes before a crew arrived to take over. All the while I calmed her and chatted to the family gathered around. I think I have honed my ability to lower stress in a room. I have seen this skill used many times to good effect by some of my colleagues – it’s the ability to change frowns to smiles and concern to confidence. My jokes are rubbish but they do the job.

Be safe.

Sunday, 10 June 2007


Ten emergency calls. Three assisted at scene, one gone before arrival, one treated at scene, one false alarm and four ambulances required.

A frantic night. We were short of vehicles. Not crews, vehicles. There were five crews at station when I arrived and only one ambulance between them. Too many are off the road for repairs or are short of equipment, or something else is wrong with them. I was one of only two FRU's running so there was going to be a lot of slack to pick up before my colleagues were able to assist.

My first call came in before I had drawn breath for my VDI. I was running to a pregnant female who had fainted in the street, at least that's what the call description read. When I turned up (along with the only ambulance available), the 'pregnant' female turned out to be a fat drunken woman from Scotland. Nothing warms my heart more than a fellow Scot proudly showing the colours on English turf.

She needed nothing more than a prod in the right direction - that's the opposite direction to us - and off she stumbled, groaning all the way. I think she liked me; she gave me a gummy grin before she left.

So, a waste of all the resources available for a so-obviously not pregnant (or sober) woman. Some of these calls are generated by the public just so that they can have an eyesore removed from their doorsteps. There was a pub across the road and the locals probably didn't want her spoiling their evening drink, so a call for an ambulance is very convenient. I remember going to a call for a 'dead man in the street' just to remove a sleeping drug addict from the sight of the snooty lady who had called us out. She didn't like the fact that he chose to slump across from her window. She didn't like to have her view spoiled by another, less well-orf, less informed and less clean human being.

My next call was for a diabetic, possibly hypo, in a shop in NW1. I found him alert and fully recovered. He had eaten something to sort himself out and the call had been made by panicking shop staff who thought he was going to die on the floor. Again that would be terribly inconvenient, so reach for the phone and dial 999. The guy's blood glucose had dropped a little and he had become confused, that's all. He hadn't demonstrated any desire to keel over and snuff it but I guess the judgement of the panick-stricken few is somewhat skewed.

As soon as I completed my paperwork I was off to Islington for a 35 year-old male who was fitting in a pub. When I got on scene, he was recovering on the floor. He is a known epileptic and normally his condition is quite well controlled but he had been drinking and not eaten very much, thus asking for trouble. He was still post ictal when the crew arrived to assist but he was able to stand up and walk for us. On the way out, he decided to finish his pint, so we stood at the door with our mouths open in disbelief. He wasn't willing to give up the alcohol he had paid for just because of a little seizure. We could wait.

One of the pub staff came out to walk her dog while I was preparing to do my paperwork for the epileptic pint-finisher. He was a lovely little Jack Russell puppy and he sank his excited teeth into my gloves as he bounced and rolled his way back and forth on the pavement. I thought he might wet himself if he doesn't calm down, so I let him be and got on with my job.

I was half way back to my own area when I got dragged back up to Islington for a call to a 4 year-old boy with a head injury on a bus. This one sounded serious, so I did a quick 360 and headed back up the road.

The child was unhurt. He had no head injury and had simply been bumped into by a man who was getting off the bus when the driver hit the brakes a little too hard. The adult lost his balance and collided with the little boy as his mother stood him up to leave. He was sitting in his buggy and I spoke to his mother about the incident. I remarked that he didn't have any injuries and that taking him to hospital would be pointless. The boy's little head nodded sagely as I spoke. His mother told me that he was two years old in fact and I was shocked to notice how in tune he was with what I was saying, so I directed my conversation at him.

He was an incredibly clever young man for his age and he described, in some detail, the reasons why he might want to see his doctor whilst acknowledging my sensible explanation about a trip to hospital being a waste of time and likely to upset him more, let alone the unnecessary use of precious resources. I was so taken with him (as were the two police officers who showed up) that I stuck around for a while just to chat to him. He was very entertaining.

After completing my forms for the mother I said my goodbyes and left the bus. I did have one last thing to advise before I went though. I suggested he might want to use the buggy less and his legs more if he didn't want to end up overweight and unfit. He seemed to understand. I noticed his mother walked him off the bus after that.

I found myself in a grotty estate after my pleasant encounter with the boy. I was looking up at a block of flats that may, or may not have been the one I was looking for. There was no name plate and it was covered in scaffolding and nets. I asked a teenage girl who was walking through the vestibule area if I had the right place and she blanked me completely. It was a simple, courteous question but I got nothing from this rude moron. She did turn around when I shouted "thank you for that" sarcastically. She noted my annoyance and said "Yeah, it is" to answer my original question. Life would be so much easier if we all went back to real parenting.

Anyway, I got into the lift and it opened and closed with the sound effects from a horror movie. I'd rather have the smell of urine than the gothic creaking and groaning that emanated from this tin box I was getting into. I got to the relevant flat and spent thirty of your tax-paying minutes calming a hyperventilating, panic-stricken 44 year-old female who is 'sensitive to stress'. I told the crew I would handle this one myself and set about re-programming her breathing with a long chat about life and the Universe. I bored her into submission and she was cured when I left. Oh and no oxygen used for that one. I played it by ear.

I got back out of the lift from Hell and thought I might need to wear a long black cloak and fangs for this job soon.

Next up, another hyperventilating female but this time I lost her and the crew. The address was completely wrong and the ambulance (there were a few more on duty now) showed up just as I was searching the area for the hostel in question. The crew had no better luck than me but they weaved their way down the street and I followed. However, when I got to where they had landed I found them gone - already with the patient, I presumed. This was tricky. They were a Tech crew and if the call was not as given I would have to rely on one of them to come out and get me if things were serious and I was needed, either that or I could search for them, which I did without any luck. So I waited behind the ambulance like a lemon in the car.

Luckily the call was exactly as given and the crew appeared with a young girl and her mate, both looking healthy and in good spirits, so I left the scene and got on with it.

Once or twice I've had to search for a bus that just isn't there. A call for an unconscious female on a bus had me driving up and down Waterloo Bridge and the Aldwych, scanning for something big, red and with the same number on it that I had on my screen. Unconscious people on buses tend to be drunk and fast asleep - bus drivers will not touch them to wake them up, they'll shout a couple of times or throw things from a distance and then call us. We are the removal service for buses. We need to start charging a fee for our professional services methinks.

Control eventually tells me that the 'unconscious' person has alighted then decided to get back on the same bus to go home. An ambulance arrived as I received this information. The crew were just as pleased to hear the news as I was.

Someone put a hi-vis jacket and hard hat on one of the Gormley statues standing on Waterloo Bridge. I didn't get a chance to photograph it but I took one 'au naturelle' for you. I can't wait until summer kicks in to see what these poor defenceless statues get done to them (I'm sure various forms of fancy dress are in the pipeline).

I got a sniff of coffee at my home station then went to another estate to help a 70 year-old diabetic recover from his hypoglycaemic confusion. He was sitting in his flat, surrounded by his concerned family, smacking his lips and staring at whatever took his fancy. His BM was 3.1, which isn't critical but its low. He wouldn't take anything orally and had a strong grip, which he demonstrated every time I tried to coax him to eat.

I injected glucagon and waited a few minutes. He ate some glucose gel after that and became a little more lucid as time went by. The crew arrived but their role was going to be supervisory; he wouldn't need to go to hospital.

His family made him some sandwiches and by the time I left his BM had risen to normal - he was thanking us and tucking into some life-saving bread. The crew stuck around to ensure he was 100% recovered.

I got a break after that job and spent an hour or so replenishing my own sugar supplies. My next call was for a 22 year-old, unconscious in his cell at a police station. These calls are rarely as given and this one was no exception. The police officers had tried to wake him up as he lay sparked out on the filthy cell floor but had no luck getting any response. I pinched his shoulder muscle hard and he wriggled away from me, opening his eyes just enough to size me up. I did the same again and again until the police officers, the crew (who had just arrived) and the Forensic Medical Examiner in charge were convinced that my theory "he is sleeping it off" held water.

Just as I was putting the lights out in my head for the shift I was given a call that I was sure would keep me busy well past home time; a Red1 for an 'overdose, needle in arm, not moving'. It sounded like a classic heroin overdose - they die so fast the needle they have just injected themselves with is still in position. I was sure this was going to be a messy resus.

I arrived to find that the people in charge of the place had locked themselves out. They were banging on the front door and screaming for someone to let them in. I thought the call was going to descend into farce. I knew the location - I had been there a few times before. It's a hostel for the lost and unlikely to recover individuals of society. It houses drug addicts, alcoholics and ex-cons who inhabit its squalid rooms in singles or pairs, depending on whether they own a dog or not. This guy owned a dog.

He was sitting outside his room and he wasn't dead. Neither did he have a needle in his arm. He told me that he had injected himself with heroin (he thought) and that he had also taken a load of prescription pills of various colour and type. I checked him thoroughly and thought it was unlikely he had taken anything in fact. He had taped a note to his door reading 'by the time you read this I will be dead - take care of my dog for me'. Poignant but pointless, I thought.

The man was generally unpleasant and his cry for help was just one of many he had tried in the past. Without counselling, advice or structured support he has nowhere to go but down. On the other hand, not to dismiss the good people out there who do offer these services, maybe he just doesn't care. Drugs do that to people - they lose the self-interest they need to improve their lot.

I popped my head around his door to say hello to his dog. On the floor, wrapped in a blanket was a well-mannered and frightened mongrel. I offered him my apologies before I left the scene. I think he understood although I could still see deep misery in his big brown eyes.

I gave my handover to the crew and the police, decided I needed to do nothing more here and drove south to my car, my civvie fleece and the long, horrible journey home.

Be safe.

Friday, 8 June 2007

Sugar and spice

Six emergency calls. One treated at scene, one conveyed and four taken by ambulance.

My shift started out with an introduction to a feisty ninety seven year-old Irish woman who was suffering from heart failure. Despite her DIB, swollen ankles and obvious discomfort (“I’ve been better” she says when I ask how she feels), she is still able to rail against the inevitability of her condition.

I climbed into the back of the ambulance after carrying out my initial obs at her bedside and prepared a diuretic for her. This would ease her breathing and during the treatment she made a request, after complaining about the needle in her arm:

“Can I have some brandy in that?”

If it was legal and I had any, she would have been more than welcome to it.

I completed the paperwork on my aged Irish comedienne, left the scene and got about a mile down the road before I was asked to turn around, go back and assist with a crew who were working on a suspended alcoholic.

He was only 45 years-old and had been found in bed at his hostel, vomiting blood as a result of a massive internal bleed (gastro-intestinal). This brought about a cardiac arrest in front of the key worker who was trying to help him. When I arrived the crew were busily working on him on the floor. There was a good deal of blood around and his airway was a mess. The paramedic was attempting to intubate and I could see it wasn’t an easy job for him but he got the tube in and secured it while I set about gaining IV access and preparing the drugs that would be needed. I have to say that there are some jobs you just look at once and decide there is little or no hope. This was one of those jobs.

We frantically ventilated, compressed and drugged him until another crew arrived to help with the removal to hospital. I had been on scene for about ten minutes and there was absolutely no change in the man’s condition. The ECG showed persistent PEA and the prognosis was poor.

We prepared to move him down stairs (he was a large man and the stairwell, as usual, was very narrow) and tidied up our equipment. I asked the key worker and another member of staff to help carry the bags as we moved the resus effort from upstairs to downstairs and then into the ambulance. The first crew on scene conveyed the man to hospital and I took the key worker in the car so that he could pass on next-of-kin details to the hospital staff.

In the Resus room, work continued and many more people got involved but it was called by the doctor in charge and the man was pronounced dead forty minutes after he arrested.

I went back to the flat with the key worker because I had forgotten one of my bags and the place looked like it had been raided, the detritus of our effort was everywhere and there was plenty of evidence of recent death; blood on the floor, a crimson pillow on the bed and a little trail of the stuff leading from the flat to the outside world. In the bathroom, the man had prepared his shaving kit for the next day, not knowing that he would not live to see it. I always find those poignant little things very sad.

The doctor at the hospital told me that he was glad we had been working on him first because he would have found the job too messy and very difficult to manage. He praised our team, which is rare.

After a short interlude to replenish my drugs and equipment, have my much needed coffee and complete my VDI (I had no chance when I came on duty) I wandered back to my home station north of the river. I had just set foot in it when I got a call for a diabetic who was possibly hypo at his workplace. It was late at night but a lot of people work through the night in London, especially printers and graphic designers, who find the relative quiet and lack of traffic a reasonable alternative to the rat race. In fact, I have been called to quite a few diabetic problems in workplaces at odd times of night.

When I arrived and entered the premises I could see four men; one who was working at his computer, one who was thrashing around, looking ever so pale and sweaty and two who were holding him down and trying to reason with him. I'm not sure if the guy at the computer even knew there was a commotion two feet behind him.

After establishing whether or not the thrashing man was capable of aggression or had been violent, I checked his BM – 1.4 – not good at all. I set about preparing Glucagon; he was far too active to tolerate an oxygen mask and his friends had already tried to make him eat but he had almost bitten their fingers off. I decided to use Glucagon to start the ball rolling, raise his sugar levels and then give him something sweet. It usually works very well.

He struggled against me but I gave him the injection with the help of his restraining friends and stepped back to wait for a result. Glucagon takes between ten and twenty minutes to have an effect but within a few minutes I was able to give him oral glucose. He nearly bit through my finger and caught my glove whilst chomping down on the plastic tube but he ate almost all of it (the glucose, not my glove).

After a further five minutes he began to relax and recognise his surroundings. He took a little more glucose and I asked his friend to pop out and get him a sandwich or crisps so that he had the necessary ‘slow burn’ carbohydrate to finish the job. All the time I worked alone. No ambulance was available at first and I cancelled it after the first ten minutes when I realised progress was being made. Recovered diabetics usually refuse hospital treatment (and don’t need it anyway) after an uncomplicated hypo.

I rechecked his blood glucose level and it was now 4.3 – much better. He was making sense, although still unsteady on his feet and he told me that he probably doubled up on his insulin injections today, which would explain his condition. It’s likely, I suggested, that he was already becoming hypo when he injected his first dose of insulin. This would have made him even more hypo and the confusion would have led him to believe that he needed more insulin. Or he had simply forgotten.

He was fully recovered and quite embarrassed when I left him half an hour later. I like hypo calls; I can do something about them almost immediately and in almost 100% of these jobs we gain a certain satisfaction about having ‘saved’ someone. It’s one of the easiest life-saving procedures we carry out and it is extremely common.

Back up to my home station for a break then out to a 52 year-old man with urine retention. He was in a lot of pain when I arrived and he apologised for calling an ambulance because he knew that this was not really an emergency. He was already being treated for a UTI and his retention amounted to nothing more than difficulty peeing. However, I recognised his discomfort and he wasn’t play-acting, so I thought a trip up to the hospital (ironically where he works in the finance department) wouldn’t do any harm.

This call had come in as an ‘aggressive diabetic’ but the only aggression I perceived was aimed at CAMIDOC who had failed the man. He had tried calling them for help but the line was ringing out, so he had no recourse but to dial 999. It’s a familiar story.

I conveyed him and his wife in the car after cancelling the ambulance (there weren’t any available anyway). Once I handed him over I reminded him that he should consider releasing some of the money upstairs for the nurses and doctors who were currently putting him out of his misery. I think he smiled but it may have been a painful grimace.

A few hours sailed by – well, they never sail when I hit a quiet patch, they crawl on arthritic limbs – and I was sent to King’s Cross station for a female with chest pain. I searched and searched but couldn’t find her. Nobody waved at me and the crew, who turned up a few minutes after I did, had the same problem. Just before the ambulance pulled up, a man wandered over with half his finger hanging off and blood dripping onto the pavement.

“Can you put something on this, or shall I get it dealt with at hospital?” he said drunkenly

I glanced at his partially-amputated digit and decided chest pain over-rode it. I told him I had another patient to deal with but he was persistent...and bleeding near my boots. So, as I scanned the area for a possibly dying heart-attack patient, I bound his exuding extremity in a dressing and pointed out the hospital (at the end of the road), instructing him to go to A&E and get his finger stitched back on.

The distraction meant that the crew were somewhat confused and bemused. They left me to deal with Mr. Finger whilst they searched inside the station. It occurred to me that I hadn’t even bothered to ask the man how he had come about ripping his limb off in the first place.

I joined my colleagues in the station but they were looking lost. It was quiet; rush hour was still an hour away, so it should have been easy to spot a lady in agony. Nothing.

Then, as we all made our way to the exit, a woman, who had been sitting on a bench watching the entire spectacle, raised her hand. The ambulance attendant asked her if she had called us. Yes she had. It didn’t take much experience to determine the lack of crisis here. She was a homeless Romanian woman (and there will be many more soon). She just wanted a bed for the night and knew how to play the system. I think there is a special school somewhere in which the great British system is explained in detail. All the tricks of the trade are taught in this school but it is strictly out of bounds for tax payers. Sorry.

I was across the bridge and less than a mile from freedom (going home) when I was turned around by the wicked FRED and sent to an assault in the opposite direction. I sped off, arrived and was flagged down by an Italian windmill. His friends had been gathered in the street (the tourists come out very early to catch their buses and trains home) when a drunk stranger happened by and punched one of them in the head for no reason. The young man’s head was bleeding a little and there was a gash in the back of it, so the ambulance crew took him off to hospital.

It’s nice to know that, whatever time of day it is, you can rely on someone to represent this great capital city of ours. Welcome to London chaps.

Be safe.

Wednesday, 6 June 2007

Fuel for the fire

Seven emergency calls, all requiring an ambulance.

A short, sharp kind of night shift – the City’s bodies are moving in familiar circles, preparing themselves for the drunken binge that we know as summer (and they call fun). Already there has been a tragic death as a result of alcohol-fuelled stupidity.

My first call was to a '42 year-old man with chest pain on roof'. I thought I was going cherry-picking again. The man was a construction worker who was up on the roof of a department store when he began to feel unwell. He had abdominal pains, not chest pains and they seemed to be more muscular than cardiac in origin but, with caution on our side, the attending crew and I checked him over thoroughly and he was taken to hospital where they would get to the bottom of it.

Then on to a 77 year-old man who had collapsed in the street. When I arrived there was a little crowd of people around him, including his wife who was quite anxious. He had been walking home with his spouse when he suddenly stumbled and fell, hitting his head on the way down on a wall. He had been drinking earlier on but not much, I was told. He had no obvious head injury but he did not look well at all and, as I proceeded with my obs, he stopped responding and closed his eyes. I couldn’t get him to open them.

He was still breathing but it was shallow and his pulse felt weak and thready. This man had either suffered a stroke or he had simply fallen and the bang to his head had complicated things. He was a little cyanosed but, at that age, it’s difficult to determine whether that is because of an acute event or age-old hypoxia. I presumed nothing and put him on oxygen while I waited for the ambulance to pull up.

When the paramedic from the ambulance approached for a hand-over I asked for the trolley bed – it felt rude not to start off with a “hello, this is...” statement but the man still wasn’t responding properly and he had to be taken off the street and into the vehicle as quickly as possible. When he was inside and an ECG started, he began to respond and was soon back to normal(ish); his skin colour was still bad and he was diaphoretic and limp.

His ECG was abnormal and he was taken to hospital on blue lights.

A baby with a high temperature was my next patient. He was lying on the floor, surrounded by his concerned family, only one of whom could speak English, so I was left to communicate my requests and reassurances in broken language, facial expressions and gestures – it makes for much harder work when treating someone. As it turned out, the baby had a history of high temperatures and was simply restless with it; his temperature was 38.1c but his grandmother had made him shiver with cold by flannelling him for too long with a cold, wet towel.

He went to hospital, where they will probably dole out more Calpol and Nurofen because without evidence of an underlying, treatable cause, there’s not much else they can do.

I was being bounced back and forth into the EC1 area of London all night for some reason (probably a shortage of ambulances and personnel). Most of my calls were in this region and my next job, a 70 year-old Chinese man who was suffering DIB, was no exception. I found him sitting on his bed in a small, cramped flat, shared by a few other Chinese residents. His young friend told me he had flown in from Hong Kong recently and was doing martial arts, as he always did every day, when he suddenly collapsed with breathing difficulties. He also described a sharp pain in his chest.

When I examined him, he was restless, was having great difficulty in breathing, with very low sats of 82% and was off-colour and sweaty. He had a history of high blood pressure but had no problems with it normally. The martial arts exercises were gentle, I was told – no more than Chi in nature.

The crew had arrived with me on this call but were a minute or so behind me while they gathered the stuff they needed from the ambulance. I had gone ahead to start the assessment. All the basic signs and symptoms were there for a PE and the additional information about the recent long-haul flight and his propensity for high blood pressure lent weight to that diagnosis. There was always the possibility of infection too, so I asked questions relating to recent illnesses and contact with birds and fowl. I discovered he had been treating himself for a recent chest infection, so that couldn’t be ruled out either.

During the shift, I saw this man in Resus and asked the doctor about him. He was being investigated for a PE and his condition was poor, although he is likely to recover after treatment. He went up to ITU later in the night.

I responded to a Red3 for a ‘female with pain in her lower body’ before I thought of questioning it. Normally I would radio in and asked what in the nature of the call made it such an emergency. This time I was on scene and chatting to the newly arrived crew before it dawned on me that it was a mistake. The crew had received this call as a Green, which means it is not an emergency and that makes sense. For some reason I got it as a Red, so the result was an over-resourced call and an unnecessary risk to me and other road users during my run to it on blue lights and sirens. Control apologised for the error, so I won’t harp on about it.

After a quick five minutes at the station I was heading out to a local club to deal with an 18 year-old female who had collapsed after possibly having her drink spiked. More likely, however, she was drunk.

When I arrived I was ushered into the back of the club, where she lay on a couch, out cold. Her friends were with her and they stood back and looked on as I tried to persuade the drunken girl to respond in some way. She had been out in the sun all day drinking and then come to the club with her mates to drink some more. Initially, she was completely unresponsive but after a few minutes and during my obs, she moved and reacted a little.

By the time the crew arrived and she was hauled into the chair like a big sleeping rag-doll, she was becoming a little more aware. In the ambulance she began to nod and shake her head in answer to questions, which is just as well because I had opened my bag and was about to put her up on fluids.

The police had been called because there had been a suspicion of drink spiking or drug use but the crew and I confirmed that she was simply too drunk to function, so they left knowing that they had much less paperwork to do for this one.

The girl later recovered in hospital. Her mother and aunt appeared and sat with her for a few hours the prepared to take her home later on. I spoke to them and her aunt turned to the girl and said, “don’t worry, think of it as life experience to learn from”.

Or you could just not drink so much.

My last call of the night was for a male with a head injury. He had allegedly been accosted by someone outside his flat when he was dropped off by taxi in the early hours. There was a good size pool of blood in the street, just where he would have been dropped off and little splashes led the way into his apartment complex. If he had been hit over the head, then it had happened immediately after he stepped out of the vehicle, which didn’t make sense unless the taxi driver did it (I imagined).

The crew were on scene with me and I stuck around to assist if need be. He appeared at the door of the elevator after his sister had shown us in. His mother was with him and together we all went back down to the ambulance.

His head was matted in blood and he had a long, fairly deep gash in the back of it. He had no memory of what had happened. He just remembered waking up with his head covered in blood. So whoever hit him had left him in the street – he could have died for all they cared.

His money and personal items had been stolen.

This wasn’t an alcohol-fuelled crime, as with the story I highlighted earlier but it was certainly assisted by alcohol, given that the young man had been out drinking and probably looked less aware and alert to his attacker(s), so therefore an easier mark. His loss of memory is probably a direct result of the blow to his head but it could also be an exacerbation of alcohol.

It’s unlikely the police will find who did this to him but he was lucky. If he hadn’t regained consciousness he would have been lying in the street, bleeding from his wound, for a long time before anyone found him.

Be safe.