Saturday 1 September 2007

Overturned

Ten emergency calls – one deceased and left on scene, nine taken by ambulance.

A strange shift that ended as it began. My first call was to an overturned car in a Sainsbury’s car park. The driver’s foot had jammed on the accelerator as he reversed, causing the vehicle to travel backwards at speed. It clipped another car and was flipped over, rolling a few times before settling down on its roof. There were three people inside; the driver, his wife and his daughter.

When I got on scene, the LFB were pulling up in front of me. I saw that all three people involved were out of the car (they had pulled themselves free); two were sitting on the ground and one was lying flat. I ran a quick triage and established than nobody was seriously injured. They had all been very lucky, escaping with headaches and emotional shock. The car was one of those little compact things with barely enough room for two adults, never mind three. The fact that they had been tightly contained whilst the vehicle flipped and rolled must have been in their favour – if they had been thrown around, I doubt we would be dealing with minor injuries.

I requested another ambulance (one was on its way) and the police pulled into the car park. There was already a crowd gathered of course and a number of staff members from the store were on hand to help – none of them were first aiders as far as I was able to establish but there were plenty of foil blankets being used.

I left the scene when all of the patients had been taken to hospital. I followed one of the ambulances in and did my paperwork at the A&E entrance.

On my way out I greened up and received a call for a 41 year-old female who had DIB and was ‘slumped over a table’ at a nearby pub. I got there to find a woman who had no difficulty breathing at all. She had been drinking with her friend and suddenly become ill. She had vomited a few times and then slumped forward (she claimed her head was too heavy to lift) prompting her friend to call an ambulance.

She had no significant medical history and her vital signs checked out, so she may have been ill as a result of drinking too much or she had a separate problem. She was taken to hospital. She didn’t look the type to waste our time.

I was sent on an errand after that job. I was asked to convey a member of the HART team to his base station. During the trip I was diverted to a call – a 32 year-old pregnant woman was bleeding from a vein in her leg. I expected I’d see a ruptured varicose vein; a common problem in late pregnancy, especially when the baby is causing increased pressure on the Inferior Vena Cava.

I got on scene, paramedic passenger in tow, and another FRU arrived. The call had been doubled up for some reason. We exchanged call signs and the second FRU pilot left.

A few people had gathered at the base of the stairs to the block of flats and they waved frantically for us to come over. We made our way to the second floor and found a pregnant lady on the ground on the balcony. She was bleeding from the back of her leg but it was very dark up I could barely see the wound when I removed the dish cloth that had served as a makeshift dressing. It was only when my colleague pointed out that blood was shooting out of her leg and around my boots that I noticed the source. I quickly applied a sterile dressing and tied it tightly. The bleeding was under control.

Varicosed veins bleed profusely and people have died as a result of massive blood loss, so they need to be dealt with immediately. Lots of pressure and elevation will do the job in most cases.

After the ambulance crew had taken her to hospital and I completed my mission to deliver the HART paramedic, I swung around to get back to my own area but I was defeated by the south again and received another call, a few minutes away for a 77 year-old ‘deceased’.

The housing complex I arrived at was a nightmare and I couldn’t find the address. This would have been a tragedy for anyone who hoped to have their loved one resuscitated and the design of some of these places frustrates us all. Even the ambulance crew, who were from the area, didn’t have a clue about the exact location of the flat. I had to call Control and ask for someone at the address to come out and meet us.

Eventually, we were found by the son of the deceased. The ambulance sped off (to the other side of the estate) and I followed with the man in the back of my car. He explained that his mother had passed away about 20 minutes ago, so I knew there was little chance of us doing anything but recognising life extinct.

When we got to the flat she was lying on the sofa. She had been suffering heart problems recently and had gone suddenly and peacefully. The family were crying in the kitchen.

We did our usual checks (breathing, pulse, heart sounds, ECG, body temperature and rigor) and covered her back up. I then left the crew to complete their paperwork because I simply wasn’t needed.

I got back to my own area and was dragged right back out of it to attend a call a few miles away. A 44 year-old female was apparently fitting behind locked doors. The police were on their way to gain entry and when I arrived a crew were on scene. I wasn’t needed for this call because they were a paramedic crew. I stuck around to help though and they told me they had been trying all the buzzers on the front door to get someone to let them in with no luck. There was someone in the basement flat, so I crossed into the little garden in front of the window and looked inside. There was a man sitting watching TV, cans of beer around him. I tapped on the window and he looked up.

‘London Ambulance. Can you let us in please?’

He shook his head vigorously. I couldn’t believe it. I pointed at the badge on my stab vest.

‘We have a patient in urgent need of help. Can you please let us in?’

Again, he shook his head. He was definitely not interested in helping. I continued to call out to him, my voice growing louder and a little more annoyed each time I made the request for access but he ignored me and did something extremely childish and bizarre. He put his fingers into his ears and sat like that until I gave up. In fact, he was still sitting, staring at his TV with his fingers firmly plugged into his ears when the police arrived to help. I hope he missed his favourite programme.

Ironically, after all that fuss, the patient buzzed us in just before the police got out of their car. We all went up to the flat and she opened the door. She hadn’t been fitting at all. She claimed that her care line had called the ambulance, not her. She looked distressed that we were all there. I knew when I wasn’t wanted, so I left and made my way back north of the river.

A 19 year-old female fitting at a club in Soho next. I arrived to find the crew inside and dealing with her. She was conscious and lucid so we took her to the ambulance for a check-up. She wasn’t epileptic but had suffered several seizures without consulting her GP, so there was a strong possibility that she would fit again. She asked to go to the toilet because she gets desperate to urinate after these episodes, so the crew allowed her back into the club to relieve herself. Within a few minutes, her friend ran out and told us she had collapsed again.

We ran into the packed and very noisy venue to find her slumped on the toilet floor. She didn’t look like she was having a fit but her legs were shaking and she was hyperventilating. I began to wonder about this whole act to be honest. She was getting a truckload of attention from her friends and I think she needed it.

Back in the ambulance I put a cannula in her arm and advised her that I would have to give her diazepam if she had another fit. She wasn’t happy with that and started to cry. She was scared of the effect the drug might have on her, a natural enough response...especially if there is nothing really wrong with you.

I hate to be such a cynic but I think I have earned the right to be one at times, as do my colleagues. When she arrived at hospital she was completely calm and alert; no evidence of anything amiss at all. She remained like that throughout her stay as far as I am aware.

My second bleeding vein was attached to an 85 year-old woman whose relatives had frantically called an ambulance when they saw her foot bleeding badly. The old woman was not completely alert when I arrived and her pulse was extremely slow. Her foot had bled into her slipper, which was now soaked through and heavy with blood. She looked as if she was ready to pass out.

I dressed the wound, began my obs and the crew arrived to take her away. She fainted as we were about to move her into the chair. I think her family thought she was dying – they were pacing around and worrying themselves about her. She is obviously well loved.

She recovered as soon as she was given oxygen. In fact, she was quite talkative in the ambulance.

Then a 73 year-old female who had collapsed and vomited at home. Her husband and daughter were on scene when I arrived. She was lying in the hallway of the flat, a pool of vomit around her. She was very pale and sweaty and looked ill from a distance. I began my obs and ask my usual questions. The daughter told me she had an abdominal aortic aneurysm (AAA) and that concerned me. This is a dangerous and potentially lethal condition. If it ruptured she could bleed to death in seconds. Although she had complained of initial abdominal pain I didn’t know if her present condition was related to her AAA or not (her blood pressure was normal) but I wasn’t taking any chances.

When the crew arrived we got her onto the chair as quickly as possible. She vomited blood immediately. Luckily she remained fairly stable all the way to the ambulance, where she felt sick again. Her colour had not improved but there was nothing critical going on with her vital signs. It was still necessary to get her to hospital quickly, however.

She was taken into Resus when we arrived at hospital. She seemed stable when I left.

I am still trying to come to terms with people who call ambulances and answer yes to any appropriate question just to get a fast response. I was on my way to a 55 year-old man with ulcerated feet at a railway station. He also had ‘chest pain’ incidentally. Where is the connection? The crew arrived ahead of me and the EMT got out, shook his head and I knew I wasn’t needed. Just as well.

And almost as if I needed to round my shift off, my last job is an overturned car. This time one of the drivers went through a red light (allegedly) and T-boned a private taxi heading across the junction. It must have happened at a decent speed because the damage to both cars was extensive and the people carrier had been thrown onto the pedestrian railing.

Again, as with my first job, nobody was badly hurt. The young driver who had allegedly run the lights complained of mild neck pain but he was up and walking around when I arrived. He hadn’t been wearing his seatbelt and there was a bull’s-eye in his windscreen, so he would need a collar. The taxi driver was shouting down his mobile ‘phone, so I knew he didn’t need any help. LFB and police were on scene and two ambulances arrived, despite the fact that I had called in to request only one.

The neck injury was taken to hospital and the mobile 'phone man refused all help.

As I sat in the car completing my paperwork, the young man’s parents arrived, knocked on my window and asked if he was alright. I can imagine it is quite a shock to see the wreckage of your child’s car on the road and not find him there. I reassured them and directed them to the hospital where he had been taken. Relief spread across their faces and I felt happy to be delivering good news for a change.


Be safe.

1 comment:

Anonymous said...

The more I read your blog the more I feel how special you are, dealing with all that you do during the course of your shift.