Wednesday, 30 July 2008

The pipes are calling

Day shift: Four calls; all by ambulance.

Stats: 1 Faint; 1 cough masquerading as asthma; 1 partial amputation; 1 ETOH (drunk)

As usual with most of my fainted calls, the patient had fully recovered by the time I got on scene. The ambulance crew arrived soon afterwards and made their way, as I had, to the train station office where the young woman was chatting away to me about how this had never happened to her before and discussing how hot it was on the train. In response to this heat I presume, she stumbled off onto the platform and promptly collapsed, causing panic with the general public and a quick removal by the rail staff.

It was very hot today and my car began to feel like an oven because the air conditioning wasn’t playing ball. It was chucking out hot air and this, I felt, was an insult to me, considering I’d never done anything to offend it. I played around with the dial and the button until I reached a satisfactory compromise and the atmosphere changed for the better(ish).

The weather probably caused my next patient, a 25 year-old woman, to believe she had suddenly developed asthma because her cough (there’s a lot of it going around) was getting worse as she worked in her stuffy office building. She had no wheeze (not that I could detect anyway) but I gave her a neb just in case and that seemed to improve things. My diagnosis was the same though – bad cough.

A 17 year-old florist’s assistant was changing the contents of a heavy glazed vase at a hairdressing salon when it slipped over the sink. She attempted to grab it as it fell but it kind of exploded in her hands, cutting two of her fingers almost in half. The floor had a few good-sized pools of blood on it (pools are good because they mean venous bleeding, not arterial, which tends to spray and spatter) and the sink was pretty red too. She’d been bleeding onto a towel for a time and that too was soaked, so she’d lost a decent amount but not enough to result in shock just yet.

I had a look at the wound before quickly dressing it and elevating it in a sling. Two fingers had been torn through and one of them was so deeply sliced that it had almost been amputated. She’d need a good plastic surgeon to repair the damage and although she could move them, she had lost some feeling in them.

The ‘unconscious’ 30 year-old that I’d been sent to rescue was a drunken man who didn’t fancy getting into an ambulance, so he staggered away, leaving the poor MOP who’d called it in looking like a fool when I arrived on blue lights. Until then, the ‘patient’ had been unrousable. Sirens are like bagpipes I think - you either love them or you hate them.

Be safe.

Tuesday, 29 July 2008

Mud is slower than water...water wins

Day shift: Two calls; both by ambulance.

Stats: 1 Hypoglycaemic diabetic; 1 Abdo pain.

I’ve had a couple of strangely quiet shifts, probably because the computerised system, FRED, is now being used by the MRU’s (they used to self-activate). This means that the same number of calls is being handled by more resources in the area, which is good for the patients I guess but I honestly don’t think it will pan out in the long run. I have a feeling about it.

So, a 66 year-old diabetic man who’s not responding and has a BM of 1.1 (thus the lack of response can be nailed) needs urgent Glucagon to lift his blood sugar level. The man is an amputee and it looks like he will lose the second leg as a result of his disease soon; there are ulcers and signs of vascular breakdown all over it.

He responds well to the injection and within a few minutes he’s climbing out of his near-coma. Eventually his blood glucose reaches the dizzy height of 4.4 and all is well again. He still goes to hospital because his treatment regimen needs to be reviewed; he was only saved because his carer visited and couldn’t get a response when he knocked on the door over and over again. When he finally let himself in his charge was on the bed and almost out of the world.

A case of Polycystic Ovary (PCOS) caused abdo pain in a 20 year-old and she collapsed in a cinema with her friends around her. It was called in as a ‘fitting’ by the cinema manager who didn’t really check before she gave the diagnosis over the ‘phone, so the patient looked confused and I looked confused and it might have been funny except for the fact that she was in agony. I waited for an hour before an ambulance was available and I found that ironic considering the not-too-frantic day I’d had. I gave her pain relief and the crew arrived to whisk her away to hospital but by that time her pain score had dropped considerably and I figured she’d almost got over it herself (well, with the help of Mr. Morphine).

And so ended an action-packed day. To be honest, the rest did me good. I was able to catch up on stuff I needed to do, like reading and sitting in the car waiting for a call. Hasty sarcasm there, sorry.

Be safe.

Friday, 25 July 2008

Daylight robbery

I stumbled on this building by accident after a long night shift when I needed somewhere quiet to do my paperwork - built in 1567 would you believe and just off Lincolns Inn Fields. Go see it; it's amazing. And haunted...probably.

Day shift: Five calls; one refused, one assisted-only and three by ambulance.

Stats: 1 Minor injury from a RTC; 2 ETOH; 1 Head injury; 1 Leg injury.

I sat in the car and watched as two drunken lads slept, flat out, on the steps of a church. They’d obviously had a heavy night of it and were both dead to the world. It was 8am and there were other people around but that didn’t stop the gang of three who were passing from committing a crime right in front of me and other witnesses. As they strolled past, one of the men stopped when he caught sight of something lying next to one of the sleeping drunks. He went onto the steps, reached down quickly, picked something up and nonchalantly walked away. His two friends eyed the other man to see what he might have dropped or left on the ground. Then they all walked off. I had to assume that the slumbering man had just been relieved of his mobile phone.

A tall man stopped the three as he approached them; he had seen this happen too. He questioned the culprit about what had been taken but apparently (I spoke to this witness afterwards) he denied it and said the phone belonged to him. He didn’t explain why he had been on the steps and what he had lifted from the ground.

I thought it was pretty brave of this passer-by to challenge the lads at all, especially these days when a knife in the chest is more likely than a punch in the face but he couldn’t stop them from walking away and turning the corner. I left the car and tried to wake the men up but they were completely out of it. I shouted into one of their ears that they had been robbed but all I got was a confused grin and a relapse into unconsciousness. I also tried to follow the little gang but they had disappeared when I went around the corner. I called the police via Control but they didn’t appear for another fifteen minutes and by that time the thieves had long gone.

Meanwhile, the passer-by (who was staying to talk to the cops) and I had managed to wake up one of the two drunken lads. He understood what had happened and confirmed that his mobile phone was missing but he didn’t want to do anything about it because it would be ‘too much trouble’. Most people keep their lives on their phones so I was a bit surprised that he didn’t want to bother pursuing it. When the police arrived both men were up and staggering away, so the officers had to chase them, stop them and question them. When they’d finished they told me that nothing was going to be done because the two men didn’t want to take it any further. Sometimes I wonder if it’s better just to let crime happen.

A strange foreign woman called an ambulance after she stepped out in front of a moving van and it ran over her foot (allegedly). She was sitting in a bus shelter when I arrived and there were several people with her, including the van driver. They all seemed a bit excited because the woman had made a fuss about her injury and was demanding compensation. I inspected her foot and found nothing wrong with it but I told her that she could go to hospital in the ambulance when it arrived and get it checked out properly. I also told her that the police were coming to take details and her behaviour changed. She suddenly didn’t want to give her details and didn’t want to go to hospital. She walked (her foot seemed to function properly now) back to the shelter and demanded an on-the-spot payment of £800 from the van driver to cover the cost of her trainers. I saw her trainers and I can tell you they weren’t worth £80, let alone £800.

By the time the police had arrived, she was gone, having left the scene without her money and with no apparent difficulty in walking quickly. I spoke again to the witnesses at the bus shelter and one of them said ‘I think she didn’t stay because she’s illegal’.

A 60 year-old man fell from a tube train onto the platform because he was pretty drunk. He was given a thorough assessment by the CRU paramedic, who’d arrived with me and who was being filmed for the television series ‘London Ambulance’ (so I let him take over from me). The patient had nothing but booze wrong with him and he argued and disputed the need to go to hospital – he was on the verge of being asked to leave the ambulance when he capitulated, behaved and went with the crew to sober up. The footage will never be seen because the man refused to allow it to be shown.

A 3 year-old who fell at a train station and allegedly sustained a head and back injury looked perfectly fine to me when I got on scene. The crew was there too and so I left them to it.

A local alcoholic fell on his face in Covent Garden, so I was asked to attend and help him out. Security men were around him but he is a harmless 47 year-old drunk and there’s no need to have three large guys standing near him but it’s their policy I guess. Anyway, he needed no help from me, except to stand up. The crew arrived and together we managed to get him fully upright and walking again, albeit with a left-handed gait. Off he went, back to his hostel which was more to the right than the left...but he managed.

A plain-clothed cop flashed his ID at me when I pulled up outside a store in Oxford Street. He directed me to an elderly lady who’d slipped and gashed her shin open on the marble steps outside the shop. A first aider was with her and she seemed well looked after. A good dressing had been put on the wound and I didn’t really need to look at it because the description was enough and I’ve seen and dealt with lots of these. The skin on the shin bone of an elderly person tends to be very thin and easily peeled, so scraping injuries result in large flaps of skin coming away from the bone, almost like the skin of a cooked chicken. There can be heavy bleeding but sometimes there isn’t. In this lady’s case the bleeding had been self-limiting and the dressing was doing a good job of controlling it too. Her main risk factor was infection, so she was taken away by the crew a few minutes later.

The summer sales were on today and the shopping streets of London were heaving with people and bags. Once again I noticed the very nature of people changing as they clashed with each other on the crowded pavements and shop floors. Gone was any thought for others - gone were kindness, respect, manners and courtesy. All gone for consumerism. No wonder we can be robbed in broad daylight for a mobile phone that will be out of fashion in a year.

Be safe.

Thursday, 24 July 2008

Monday is the new Friday

Night shift: Nine calls; three assisted-only and six by ambulance.

Stats: 1 DIB; 4 ETOH; 1 Alcoholic fit; 1 Hyperventilation; 1 GI bleed; 1 Abdo pain.

We’ve been taking an average of 4,000 calls a day over the weekend and tonight (a Monday night) has been crazy. Don’t people have work to go to in the morning?

A 75 year-old man with DIB, cardiac problems, liver failure and cancer deserves my attention first off and I arrive to find him surrounded by worried family members as he lies on his bed wheezing. I put him on a nebuliser, which gives some relief, and carry out my obs until a crew arrives and takes him away. More family members show up and spill out onto the street as he is taken to hospital. I think they're expecting the worst.

Into Soho next for a 55 year-old ‘unconscious’ man who couldn’t be seen at first because people were sitting at tables drinking and chatting around him as he lay slumped on the pavement. Typically, nobody seems to notice him and the ambulance crew are about to call it a no-trace when I spot him, legs first.

He is an old queen and he is instantly annoyed by our presence as we wake him from his drunken slumber. ‘Go away!’ he barks before we can get a kind word in. We spend ten minutes getting him on his feet to move until he plants himself back down in someone’s doorway. A couple are trying to get into their flat but he’s obstructing them, so we move him again and this costs the NHS another three minutes. He wanders into a bar and is ejected very quickly. Then he finally shuffles off with his eye liner and painted nails; the only evidence that he was a coordinated person at one point.

A couple of colleagues were on a night out and I chatted to them as I did the paperwork for that patient. I left the scene wishing I was just another jolly MOP myself…a long night was ahead of me.

My next patient was a 35 year-old alcoholic who’d had a fit outside a gym and had been taken inside by the kind staff as he waited for the ambulance to arrive. He was face down on a massage bed in his own private world when I walked in to see him. He didn’t stir – I think he was asleep. He stank of booze and his clothes were filthy; he was giving the place a bad name – at least the regular clients were sweating for healthy reasons.

I got him to turn over and sit up and began my obs after establishing his name and what had happened. His clarity and demeanour made me doubt he’d had any kind of fit at all and this is a common enough game played by homeless alcoholics who just want a bed for the night, so what the hell. I asked him for his finger so that I could put my sats probe on it (the device slips on a finger and measures blood oxygen saturation levels (sats), normally they are above 94% in most people). He sneezed into his hand and offered me said germ-ridden mitten by reflex. I declined the offer and asked for a clean(ish) one. Since he had only one more to put forward for testing, I got that instead and a grin. I got no apology and I gave no blessing. Such is the straight-forward nature of this job sometimes.

It took me so long to get access to the road in which my next patient lived that she had recovered from her panic attack and was sitting on the sofa as if nothing had happened. Her friend had called the ambulance when she started to hyperventilate; she thought there might be a connection between the breathing problem and her mate’s bulimia.

The 25 year-old’s heart rate and blood pressure were low but this was normal for her and she was as thin as a rake (how did we get to that? Isn’t a shovel or a brush just as thin when looked at the right way? Oh wait, brushes are reserved for daftness, aren’t they?). She had recently fallen out with her boyfriend and this had triggered an emotional state in which her breathing rate had rocketed but she was absolutely fine now and I left her at home with her friend and a ‘get out of jail’ form. The ambulance had arrived with me earlier but I’d told the crew what was going on and that they weren’t needed.

Gastrointestinal (GI) bleeds can be life-threatening emergencies and the 74 year-old woman with abdominal pain, a low BP and who looked like death warmed up (pale, cold, clammy) was in real trouble. She had been reported as ‘not alert’ by her family and at times she wasn’t, otherwise she seemed to communicate quite effectively, insisting that she was in good shape, even though her body argued with her.

A patient I can only describe as a nutter on drink stormed off and walked into traffic, almost getting himself injured when I tried to get him to wake up from his ‘unconscious’ state on the pavement. The French 24 year-old and his gathering of equally French friends (who were all able to handle their alcohol sensibly I should say in their defence) had been out all day drinking but he collapsed on the way home and now no bus or taxi on Earth (or in London) would touch him. I know this because when he became aggressive and started physically pushing me and others around I called the police in. He was cuffed and told to behave, then one of the cops flagged down a taxi and I asked the driver if he’d be so kind as to convey the man and his buddies to the East (miles away). Despite the prospect of a fat fare, the cabbie declined, citing imminent vomiting and bad behaviour in the back seat as reasons for refusing. I had to agree with his perspective and thanked him anyway.

Earlier, the crew had turned up and I’d asked them to ignore this young drunken fiend because a) he was hostile and b) another collapsed person had been found down the street. They went to investigate what may have been a more serious running call while I waited for the police to arrive.

It turned out that the second collapse was a 15 year-old boy who was locked out of his friend’s flat – he’d been sleeping outside after attempting to wake his host up but it was impossible because the flat was on the first floor and there was no way in or up. And the host was obviously a) deaf or b) dead to the world in sleep, which is the same as deaf but with your eyes closed.

Meanwhile, my annoyingly obnoxious patient was un-cuffed and taken to the ambulance. He had become very, very pale, so he was going to hospital, like it or not. The 15 year-old was taken away to a safe place by the police and all ended well – I don’t think the Frenchman projectile vomited on the crew but I wouldn’t guarantee that.

A 50 year-old man with Liver problems and abdominal pain was given as ‘chest pain’ but I’m used to that now so I didn’t make a fuss – the crew was on scene soon after me, so I didn’t get beyond the basics.

Then a 40 year-old man who was ‘unconscious’ on a bus assaulted me as I tried to wake him up and get him off the vehicle. He didn’t like being prodded and pinched, so he swung at me and forced his way into my space – luckily I’m the world champion pinner-downer of such individuals (I’ve had a lot of practice) and he got no further than that with his aggression.

I waited with the driver for fifteen minutes and gave the drunken man plenty of opportunities to leave the bus but he refused and the police arrived to drag him off physically. He was less inclined to violent behaviour when they were on scene strangely enough but he remained lippy.

‘How old are you?’ asked one of the cops.

‘Ten’, the drunken man replied without a hint of humour. See? Alcohol does age you!

I wasn’t required for my last job – an unconscious 25 year-old man in the City – the crew was on scene and he was fully conscious.

Be safe.

Tuesday, 22 July 2008

Update on stuff

Just a quick note to let you know that I am aware that the poll has lasted almost two months but I wanted to get a bigger 'sample' on that one, so it's staying for a couple of months. Also, I have real trouble with the company that provides these for me...their software lets me down a LOT.

I'm writing another book and it will be radically different. Fiction for a start. If you haven't already bought my first book, please will help encourage me to carry on writing (which takes a lot out of me) and will help YOU to understand the terminology I use here. You'll also get to know me better. The book is NOT a copy of the blog; it's full of original material which has never been used here.

If you can't bear to part with cash, join the Facebook site that Pollyanna started - just type in 'A Paramedic's Diary' and it should come up in the groups section. That way you can 'talk' to me and other readers, as well as keep right to date on what I'm doing.

I'm still toying with the possibility of moving this entire site to my own domain but not sure if I'll cause more problems than I solve. Any help would be appreciated.

Am in the garden tidying up today (a rare day of rest) and waiting for Scruffs to re-appear after he ran off when I brought the lawn mower out.


Cycling drunk

For all you Scruffy fans - here he is with that famous penile cactus I showed you earlier in the year. The plant is growing well, as you can see and no longer resembles the meat and two veg that made some of you gasp (by email). Scruffs is not impressed, however.

Night shift: Seven emergency calls; one assisted-only; six by ambulance.

Stats: 1 drug overdose; 1 emotional; 1 high BP; 3 ETOH; 1 sickle cell crisis.

GHB and cocaine might make for a happy party at your house when a new friend has been invited to join you for the night but it can result in an ambulance being called for an unconscious stranger. As was the case with my first call. The two young gay men had brought a man they barely knew home with them and together they’d taken a cocktail of drugs, most of which was snorted and ingested by their guest. He now lay on the bed, completely unresponsive and with a less than competent airway.

The crew arrived as I remedied the airway problem and we got some Narcan into him before moving him. This had an effect and he became a little more active, although not fully conscious until he reached the ambulance, where he quickly relapsed to such an extent that he had to be ‘bagged’ in order to keep him breathing.

His hosts knew nothing about him, apart from his first name. This is the second patient I’ve had in the past few months in such circumstances. It’s a dangerous game to play and one day the guest is going to end up dead.

The 31 year-old was ‘blued’ in and the anaesthetist continued what we’d started. He wasn’t in good shape when I left.

An emotional 20 year-old woman lay crying on the floor when I arrived after receiving the call that she’d ‘fainted’. The crew was on scene with me and I left them to it. I compared her with my last patient and couldn’t decide who was more deserving of an ambulance – both were tax payers, one caused his own problem and the other couldn’t control her emotions and thought 999 was the answer. If we had one ambulance available and a 93 year-old with DIB came up and it was up to me, I know who'd get it first.

Those hallway timer switches that you get in shared flat buildings are very annoying when you are trying to get obs on the stairs. I had been called out to a 41 year-old woman with chest pain, a headache and high BP. She’d walked out to meet me and I’d asked her to return and sit down. Now I was struggling to see her as the light kept going out every thirty seconds. I ran between her and the push-button on the wall like a comedy paramedic. I must eat more carrots.

Falling asleep is natural (mostly and except if you never wake up). Falling asleep when you are drunk is expected, so when I got a call for a 43 year-old man who ‘keeps falling alseep’ at a hostel for known alcoholics, I wasn’t too wildly concerned. Neither was he because he was wide awake and disputing the need for an ambulance when the crew and I arrived to assess him. Inside his dirty, smoky, dark little flat there were a number of other, similarly drunk, people – the skinny people of wasted lives. All of them ganged up on the man to tell him to go to hospital for his sleepiness – none of them seemed to realise that alcohol might be the culprit (I ruled out the possibility of him having worked hard all day).

None of the lights were on and nobody bothered to use any of the switches for us, so we were standing in the dark and the hallway became a void of black space as we took the man to the ambulance. I’d had enough of the game however and switched on one of the lights – I had no idea why we were being so shy about it. Now we could see and the man stood at the top of the stairs, arguing with his mates. He looked much better with the lights off.

I went ahead to the car and watched as the crew brought the man and his friends out of the hostel. They loaded him on board and I thought that was that but as I drove down the road five minutes later, I saw two police cars arriving and a message appeared on my screen asking if the crew was still in the back of the ambulance or on the premises. I u-turned and headed back to the vehicle. I got a quick nod from one of the crew to say that everything was ok but I learned later on that one of the guy’s friends had kicked off and become aggressive and threatening towards them as they ‘treated’ the patient. More often than not we are put at risk for people with no medical emergency whatsoever; this was a good example. If the crew hadn't arrived with me I would have been up there with that psycho on my own in the dark until they did. I may or may not have been able to contain him myself - who knows. I really do get the feeling that time is running out for me.

For some reason I’m going through a period where I’m having difficulty getting a cannula into sickle cell patients. Their veins tend to be challenging at the best of times but I’ve had a run of fails and multiple attempts recently. So when I got to the 23 year-old sickle cell crisis patient and attempted to put a line in for morphine (entonox was working but only marginally), I had no luck and I’m wary of wasting a crew’s time by delaying the trip to hospital just so that I can prove a point, so I gave up after one attempt rather than try again. It meant my patient wasn’t getting the pain relief he should have received but it also meant I acknowledged the possibility of delaying hospital treatment. I’m sure it’s just a phase I’m going through – I don’t have any trouble with other patients, honest.

Then a Red1 ‘life status questionable’ where the caller was too scared to approach the patient, who was lying in the street motionless. As I drove towards it I knew I’d be wasting my time (or rather, a genuine patient’s time). He was on his back and reluctant to respond to me or the crew (they arrived with me) and we spent ten minutes trying to persuade him that we knew he was alive and well…and drunk. The MOP who’d called it in stood around with a can of Stella in his hands, nursing a long dead cigarette. I wondered why he couldn’t recognise a fellow drunk.

In the end, we hauled him onto a trolley bed and wheeled him into the back of the ambulance where a miracle took place. He sat bolt upright, stood up and walked off without saying a word. Not even a thanks. I have a theory - maybe the ambulance has a specific 'aura' for waking up faking drunks, or maybe they suddenly realise that once inside the vehicle, we have control...enough control to slip them down to the morgue to sleep it off.

He tried to rest himself in a doorway and I warned him to keep moving or the police would be called. This guy was going to generate calls all night if he didn’t behave. He shuffled off in a huff, leaving me and the crew with smiles on our faces.

At the end of a long night shift I am asked to find a cyclist who’s come off his bike and has sustained a head injury. The address is vague and when I turn up with the ambulance, we can’t see him. It takes a few calls to clarify the location and we find him fifteen minutes later, sitting on a wall with an off-duty fire-fighter (he identified himself) looking after him. The cyclist is very, very drunk. His bicycle has no pedals, just stumps of metal to rest his feet on and he has a heavy bag on him. I can’t imagine how he stayed on the bike for more than a few seconds but he must have cycled as far as here without coming off and his luck ran out on a dark residential street. Luckily, it’s 5.30am and there’s no traffic about.

The man has no recollection of what happened – the gash in his head has been bleeding heavily and nobody knows how long he’s been on the ground before he was found by the passing fireman. He looks like a student to me and if his bike is anything to go by, he’s a poor student.

We get him into the ambulance and the crew carry out their examination – they collar and board him because we simply don’t know how hard he fell and at what speed. We don’t even know if he’s been hit by another vehicle and been left lying there for hours. His body temperature is low but alcohol will do that.

The fireman offers to take the man’s bike to his house nearby and gives me his details to pass on to the patient. This is a kind act and I hope the man thanks him properly when he recovers and returns to collect it. I wouldn’t be at all surprised if he didn’t bother though – the bike is a wreck, much like he is.

Be safe.

Saturday, 19 July 2008


Night shift: Nine calls; all taken by ambulance.

Stats: 3 Head injuries; 1 time waster; 2 drug overdoses; 1 DIB; 1 stabbing; 2 ETOH.

The first drunken patient I was called to had walked into a moving car as he crossed the road. As he fell, he grabbed the open window of the vehicle (which was still moving) and clung on as he hit the ground, cracking his head open on the road. The driver got a bit of a fright and braked in time to stop his wheels from rolling over the inebriated 25 year-old.

Thankfully, his injury was fairly minor but he still needed to go to hospital because his wound would have to be checked and closed. His friends became obstructive at times and had to be told to quieten down. She was taking the ‘you are a public servant and will therefore answer my inane questions, even if it is interfering with patient care’ approach and I can’t stand people who do that. It ranks up there alongside ‘I pay my taxes and you will obey me’.

The Lithuanian alcohol-gel thief was back in action tonight and I only had to look at the call description to know it was him: ‘30 year-old male fitting, second fit worse than before’. It’s all getting so tiring now. I arrived with the crew and as soon as I recognised him and he recognised me (that strange exchange takes place where I acknowledge he’s wasting our time and he doesn’t give a damn) the game was up. The crew didn’t know him, so he continued to play on it for a while longer…at least until he was in the back of the ambulance.

A strange skinny man was seen ‘shaking’ and behaving oddly in some bushes outside a block of flats, so the neighbours called the police. The cops dragged him out of the hedges with his trousers around his ankles and he promptly collapsed. A crack pipe was found nearby but they weren’t sure if it was his or not. They called us out and I arrived to find him lying on the ground with handcuffs on. He was either truly unconscious or faking it really well.

I asked for the cuffs to be removed and carried out my obs, finding nothing untoward and deciding not to give him Narcan because he wasn’t at risk and I didn’t want him awake and aggressive. I waited for the crew and they arrived ten minutes later. He was hoisted onto the trolley bed and woke up immediately.

His recovery continued in the ambulance as the crew and police interviewed him. He wouldn’t tell them what he was doing in the bushes but I’ve seen this behaviour before (the man with the porn magazine underneath him who’d been found unconscious and half-naked in a doorway). It’s possible that after taking drugs, they become aroused and don’t care where they are when they act on that impulse.

A 70 year-old lady with DIB and sats in the high 70’s said ‘I’m not coming home, am I?’ as she was wheeled from her home by the crew. I couldn’t answer her because I didn’t want to lie. She wasn’t well and her breathing had deteriorated suddenly overnight. I had nebulised her but it had barely had an effect.

Stabbings are becoming common in London and my next call was to a random knifing on a 25 year-old tourist who just happened to be in the wrong place at the wrong time (if that’s even fair to say). He was walking down a street in the West End when a passing stranger allegedly lunged at him, stabbing him once in the back. That was it, no other exchange took place. The assailant walked off and he was left collapsing on the pavement. It’s frighteningly possible that it could have been anyone…you or me, your brother or sister.

Luckily for him, the wound wasn’t deep enough or near enough any vital organs to cause a life-threatening injury but that was just luck. He could just as easily be dying for nothing.

Drunken people’s drunken friends can be very annoying and very entertaining. Another young woman with no tolerance for alcohol – a 23 year-old, slumped in a doorway after being hauled out of a club had vomited a pool of yellow liquid then lay on the ground waiting for the world to go away. Her friends drifted in and out of the scene to make comments as I tried to get her to talk to me.

‘Oh my God, is she going to be alright? What’s wrong with her?’ a random friend asked in a shrill, high pitched and panicky voice (these are the people who won’t survive the next crisis in their lives).

‘Yep…she’s drunk’, I answered. I hope to inspire confidence but I really want to say ‘serves you right’.

This young woman had downed a bottle of Malibu on her own and now her friends were actually surprised to see her puking it all back up as the alcohol kept her in a semi-conscious state.

‘Yeah, I get like that sometimes. You know how you get so drunk that you can’t feel your own legs?’ the shrieker asked me.

‘No, not really’, I answered, wondering if she was decribing this or a stroke..

A cat fight broke out yards from us and this made the loud friends go away but it also made the area that little bit less friendly for me and the crew when they arrived. At least three women were scratching it out for who knows what reason and the men were, predictably, doing nothing to stop it. They were happy to form a circle around the battling females and grin en masse (this, I believe, is the same as chanting but in a more subtle, socially-acceptable way).

I got another mouthy friend later on when I went to deal with a drunken 20 year-old woman who fell on her head when she tripped over herself. She lay on the road with a bleeding scalp and her mate, who was probably twice as drunk as the patient, attempted to stand her up, pushing me out of the way to get to her. She had to be warned again and again to step back and let me get on with it but she wasn’t having any of it. ‘She’s my best friend’, she told me, as if that gave her a licence to make her condition worse. Eventually, one of the club doormen took her aside for a chat.

When she was loaded onto the ambulance, friend in tow, I climbed aboard to put a line in and give her fluids because her BP was low. Her friend was still misbehaving and was allowed to go to the toilet as we carried out another full set of obs on the patient. This pause seemed to cure her of bad behaviour and when she returned, she was quieter and apologetic.

As I tried to finish the paperwork on that last job, I was asked to go into the club to treat a member of staff who’d collapsed in the toilet. She was slumped on the floor and had been unconscious for a few minutes. She’d been given a drink or two by customers and now she could barely keep her eyes open or make any sense. It looked to me like she’d been slipped something in her alcohol – she certainly wasn’t drunk.

The toilet was like a sauna and I had to wait a fair amount of time before an ambulance came to get this lady out. I was sent another FRU pilot in the meantime and he helped me with obs until we could move her. Meanwhile, I was beginning to drip with sweat.

When the crew arrived and we got her out into the cooler air, she was taken to hospital straight away. If the drugs didn’t get her, the heat of that bunker toilet would.

In the late early hours I was sent south for a 25 year-old man who’d been shot. I passed the armed cops as they suited and tooled up in the street and I arrived to find other police officers pinning a man to the ground as he wept. I was told he was the assailant and that the victim was around the corner - I had no idea why he was crying like a baby. I drove a few metres and pulled up beside another man who was nursing his eye. He’d been hit by a bottle, not a bullet, during a scuffle in the street. He was in a state of shock because he couldn’t believe anyone would hit him like that after a minor disagreement (about what I know not). His injury was minor – he had a laceration above his eye – and he was lucky the other man wasn’t armed, especially in this neck of the woods where real stabbings and shootings take place.

I went home contemplating the random nature of the assaults I’d dealt with. It’s easier to become a victim of violence than ever before simply because there are greater influences on the instigators; drugs, alcohol, theft, anger, social circumstances, territorial jealousy. If someone wants to have a go at you he will and it may well be because you looked at him the wrong way. Of course the Press may not have helped by keeping knife crime in focus because this may have bred a culture of status among those who carry deadly weapons but we still can’t ignore the increase in violence proportionate to the growing discontent of our young in society. We give them little or nothing to aspire to.

Be safe.

Wednesday, 16 July 2008

Out of it

Maybe this registration will be easier to understand ( a few of you got confused over the last one!)
Night shift: Five calls; one assisted-only and four by ambulance.

Stats: 1 Unconscious ? cause; 2 ETOH; 1 assault with facial injuries; 1 Arterial bleed.

The start of my four night run of shifts – I don’t enjoy these at all and this weekend was set to become one of the busiest of the year so far.

My first call was for a 25 year-old man who was unconscious and had a history of sudden collapse for no medical reason…none that had been found anyway. He’d recently undergone an operation to have a bone implant hearing aid fitted (BAHA) and, according to his wife and mother-in-law, his ‘episodes’ had started after that. He would develop a headache, go to bed and not wake up until he was taken to hospital by ambulance, where he would remain almost comatose for up to eight hours.

I found him lying on his side on his bed, up on the third floor of the house. The stairs were narrow and crowded and I knew as I climbed them that we were going to have real problems getting him down if he didn’t wake up.

The crew arrived after I’d carried out a few obs and I secured his airway with an OPA. Deep pain had no effect except to make him posture decorticately, which usually means there’s a major neurological problem (but that seemed unlikely given my baseline obs). His wife denied the possibility of drugs but his pupils were pinpoint and his breathing, which I’d heard long before I saw him, was very noisy – this is what prompted the 999 call.

We spent two hours on scene with this patient. He was given loads of Narcan, which initially had an effect (he had been taking pain killers which may or may not caused this problem). I couldn’t figure out a connection between his bouts of unconsciousness and the recent implant, unless he had a brain infection but he’d been to hospital and they’d found nothing wrong with him, so it was a real mystery.

Eventually, after one failed attempt to get him into a chair for the trip downstairs, we called in a Delta Alpha (doctor). The patient was a huge guy – 22 stone in weight and it would have been very dangerous to move him while he was potentially able to unbalance us, even with the three of us there. More people would have been impractical because of the narrow stairs and he seemed to deliberately slide off the chair when we attempted to strap him in, so there was no option but to put him to 'sleep' so that he was safe to move. The doctor gave him Ketamine and he instantly relaxed. Now he was manageable but we still had to carry his large frame down those stairs and it took a lot of sweat to achieve that without everyone being injured in the process.

His wife stood crying as we got him out of the house. She was fed up not knowing what the problem was with him and I sympathised but there was something strangely not right with this. He had moved himself off the chair earlier, I’m sure of it and so was the crew. He seemed to know what was going on and what was being said but he didn’t flinch when pain was applied (and that included a few needles going in).

He was rushed to hospital and I tagged along to see what would come of this but even in Resus he remained a conundrum. The doctor wasn’t convinced he was genuine and if he wasn’t, why was he doing it? Also, if he was acting, then I applaud him because he’s bloody good!

They have a new born baby and the problems started with him soon after its birth, so if Munchausen syndrome is a factor it needs to be investigated. Strange but true.

An upset 22 year-old female at a hostel was lying on the landing at the top of the stairs (why don’t they ever go down a flight or two for us?) when I arrived on my next call. She’d vomited because she’d been drinking and her mates fussed around her until she decided she didn’t need anyone but them. I cancelled the ambulance and left her to deal with her emotions.

Two young lads requested the company of a local prostitute in Soho. They paid their money up front and the lady of the night disappeared, leaving them sitting outside the flat where all the action was to take place. Two men approached them and argued with them as they tried to explain that they were waiting for service. The men reacted angrily to the intimation that their flat was a brothel and beat the boys up, smashing one of them in the face. It was, of course, a scam and they were naïve.

I showed up on this call and the lads hid away because their alleged assailants were still nearby. Then, after I’d almost called it a no-trace, they approached the car and begged me to switch off the lights and ‘not make a fuss’. They wanted the police and they got me. Nice to know that if there’s a potentially violent situation I could find myself right in the middle of it.

The ambulance crew was waiting around the corner because they knew more than I did and when they appeared, the two men were put on board and checked out. Then one of the crew went into a club to tend to a female who’d somehow cut the tip of her toe off while dancing (how on Earth do you do that?). I went down into the hot, noisy cellar to see if I could help and he was dressing the wound. Her blood soaked sock lay on the floor and a puddle of the stuff lay next to it. She was in good shape and smiled at the irony (although I think her alcohol intake helped ease the pain). No doubt, in the morning when she’s sober, she’ll laugh less when she realises she’s lost a pretty toe-tip.

Between them, the crew managed all three patients and this was made easier when the two prostitute-scam guys decided not to stick around.

An ‘unconscious’ man on a bus demanded to go to hospital instead of doing the decent thing and just going home. He was drunk and the crew felt duty-bound to take him where he wanted to go. NHS taxis at your service.

Finally, a 21 year-old woman cut her calf during a drunken stagger, ripping open an artery and squirting blood around for a while until someone decided an ambulance might be a good idea. The crew arrived ahead of me and I had a quick look before leaving them to get on with it. I’m no good as an observer - I keep wanting to do something useful...then I get in the way.

Be safe.

Tuesday, 15 July 2008

Scrap for knives

Early shift: Nine calls; all taken by ambulance (for a change).

Stats: 1 DIB; 4 Fitting; 1 Hyperventilation; 1 Miscarriage; I ETOH; 1 Chest pain.

So the police have been told to crackdown on the theft of metal around the UK. Drain covers and school roofs are being nicked for the price of the scrap, most of which is going abroad (China is starved of raw materials for its expansion). Its costing £300m annually and the nationwide raids are being made a priority. Ironically, we have a major knife crime problem, so maybe (and I don’t mean this to slur the police who have no choice) all that metal is being used to produce more deadly weapons. Maybe that’s why the Government thinks it’s a good idea to raise the bar on property theft rather than death by knife.

An 89 year-old woman with DIB gets my attention at the start of the day. She is wheezing and I can hear the fluid in her lungs as she tries to breathe. Her family are around her as I listen to her history of cardiac problems, type II diabetes and high blood pressure. She gets oxygen and is put on a nebuliser; her sats are very low and she needs to go to hospital quickly. The crew oblige and I run to the next call.

I’m not required for the 40 year-old man who’s fitting at work because a crew is on scene and the patient is recovering well.

I’m not sure about the next patient at all, however. She was mistaken for a man by a MOP in the park when she was seen to fit then become unconscious on a bench. I reach her and she is coming round.

‘What’s your name?’ I ask her.

‘What’s your name?’ she repeats as if it’s a test.

She’s clearly confused and is reluctant to be helped in any way, so getting a baseline is problematic, even with the police on scene. In fact, she becomes very annoyed when an Officer tries to take her bag to look for ID, accusing him of theft and threatening to report him to...the police.

The crew arrive a few minutes later and she is eventually taken away to hospital. She may have suffered a stroke or she may have had a fit – either way, I’m not sure 'cos in London town there are plenty of eccentrics out and about. Some of them are unconventional...some of them are mad.

I was about to cancel the ambulance for my next patient, a 34 year-old woman who was hyperventilating at work. She didn’t really want to go to hospital and she didn’t need to but the crew arrived before I had a chance to stop them and she agreed to be checked out by them, just in case. They managed to get her to consent and off she went.

Up on the third floor of a Government building I carefully assessed a 39 year-old woman who was having a miscarriage. The baby was dead in the womb and she knew it. She had insisted on carrying on with the pregnancy however and now it had reached its terminal point…and she knew that too. She cried a little and her pain was palpable. Her husband stood by her not knowing quite what to do and in these circumstances we (men) are quite useless.

She’s had a miscarriage before but she has also given birth to healthy children.

‘How many children do you have?’ I ask.

‘Thirteen’, she replies.

I have to ask her to repeat that.

The next call for a ‘chest pain’ patient was a drunken patient. The 45 year-old woman is a regular caller (as I discovered during a conversation with colleagues later on). She always claims to have chest pain. I went in to her flat with the crew and she was staggering about the place, laughing and shouting at us. She’d opened the door for us and when asked if she’d called an ambulance she simply said ‘Yeah, whatever’ and led us into the front room.

‘What have you had to drink?’ my colleague asked her.

‘A lot’ she says, grinning like a child.

She didn’t want to be taken to a certain hospital because her father and brother had both died there she claimed, as if the hospital was solely responsible for that and she would be next. Medical community vendettas against whole families are thankfully rare, so I was reluctant to believe her. The alcohol was a convincing factor - why do drunken women shout? When I patrol around the West End at the weekend it's almost always the female voices, shrill and very loud, that I hear without trying.

A 20 year-old female collapsed and had a fit at a local beauty school and a gang of wannabe beauticians crowded around a classroom door to check out the excitement. It took a large colleague with a broad foot to keep them inside where they belonged. I think beauticians are naturally nosey, like hairdressers. I never know when my next holiday is going to be but they insist on asking, like they want to join me.

Again, I wasn’t required for the 50 year-old woman with chest pain (on the same street as the fitting beautician, ironically) because the crew was on scene and dealing with it.

I had a long break after that and spent an hour or so chatting to my MRU colleagues and drinking coffee (none of which I had to pay for). Rest periods like that are unusual, so I was glad of it.

I ended my day with a 50 year-old man who was recovering from a fit on a bus. He was dizzy and post ictal and didn’t look well at all. I left the crew to persuade him to go to hospital because he was adamant he wouldn’t.

Be safe.

Monday, 14 July 2008


Early shift: Eight calls; two no-traces, one conveyed in the car, one assisted-only and four by ambulance.

Stats: 1 sleepy head, 1 DIB, 1 chest pain, 1 RTC with head, neck and chest injuries, 1 abdo pain vomiting blood and one dizzy person.

The anniversary of 7/7 (how come terrorist incidents happen on neat dates like this?) is always a sombre occasion in London but this year it was a very low-key affair and I think the public memory of the outrage is being diluted, which is a shame. Nevertheless, I stood over the flowers at Tavistock Square and closed my eyes to think back. I wondered when this would happen again and how many would be taken next time. I wondered if myself and my colleagues would be in the firing line and if I would ever be standing at a memorial for emergency services staff.

I was assigned another observer for my shift today – a trainee nurse called Sue who wanted to experience life on the road, so to speak. She was due to ride out on three days, one with me and the other two with crews. I got on well with her and the company was nice for a change. She stuck with me until early afternoon then went home tired. I have that effect on people.

The first of two consecutive no-trace calls was for a bus vs. cyclist RTC. The bus was still on scene but the cyclist, who’d been clipped by it, was nowhere. She’d left the area an hour before but nobody thought to tell us and the call was made by the bus company anyway.

The second call was for a 25 year-old male ‘collapsed’, which means anything from cardiac arrest to staring into space these days. He too was invisible when we arrived. Sue was definitely getting to grips with this whole paramedicine thing!

A 22 year-old near-faint next. I took her to hospital in the car because she was just plain tired and when I left her at the hospital she lay down on the waiting room bench and continued what she’d started earlier.

The crew was on scene for the next call – a 79 year-old female with DIB, so I wasn’t required and did a quick about-turn after checking this was the case.

Off to a local hotel next to treat a hard working 41 year-old Lithuanian woman who’d developed chest pain and had struggled to carry out her duties as a domestic all morning. She had no previous history for this and the call had originally been given as a faint, so the chest pain was a bit of a surprise when I was told about it. She was taken to hospital but was smiling through her concern.

Mr C. is still making his daily 999 calls and I thought I was off to E1 (a long way out) to deal with him again. This isn’t his usual area but it wasn’t long before I heard another call over the radio concerning him, so I guess he’s moving around for a break. I got cancelled on the E1 call thankfully.

The next call was for a 41 year-old female who’d been hit by a car as she crossed a pedestrian crossing on a busy road. The lights were in her favour by all accounts and the car, a private taxi, was travelling at 25 mph when it went straight through red and into her. She travelled up on the bonnet before landing hard onto the road. She had head, neck and chest injuries. My main concern was that she had some difficulty breathing and complained of a tightening chest but I couldn’t see or hear any evidence of a pneumothorax, although that didn’t mean one wasn’t developing. She was collared, boarded and taken to hospital rapidly with me attending to her while one of the crew drove my car for me. She arrived in a stable condition, although her chest still hurt. At least I didn't have to contemplate doing anything nasty to her if she'd deteriorated.

Then a short drive north for a 17 year-old with abdo pain who claimed he’d vomited blood. His mates were busily moping around the small flat, smoking and puffing out of the open window. I didn’t see the point because the place stank of cigarettes and blowing it out of the window made no difference. I was a little uneasy in the place to be honest, there were a few of these young guys around and more kept appearing from different rooms. I’m never comfortable when I can’t count the people around me.

Anyway, despite the lack of evidence that he’d actually vomited blood and the fact that he claimed many other injuries, including acute deafness in one ear, he was taken to hospital. Hopefully he’ll grow up there.

Sue had gone by the time I got my last job of the shift, for a 16 year-old female ‘not alert’ in a shop. I arrived to find a perfectly alert girl who had suffered a short period of dizziness. That’s all. I asked her if she needed to go to hospital and she agreed that she didn’t. Her dizziness had gone and she was fine. I think she stood up too quickly or saw the price of the shoes and ‘took a turn’, as my mother would say.

Be safe.

Thursday, 10 July 2008


Early shift: Five calls; all taken by ambulance.

Stats: 2 Head injuries; 2 EP fits; 2 cardiac-related.

First call of the morning and I’m on my way to a tube station for an eighteen-month old boy who has fallen on the escalators. He was actually being carried by his father, who stumbled as he tried to stop his young daughter from falling. On scene, the family were gathered around the ticket office and a concerned underground employee was on stand-by but all was well. The little boy had a minor scratch to his scalp and the bleeding had stopped. Mum had a grazed knee because she also fell as dad attempted his over-burdened rescue of his little girl. It must have looked like a comedy sketch as the whole family began to collapse on the moving stairs.

A 23 year-old epileptic had a ten minute seizure before recovering. When I arrived, the worst of it was over and he was confused but stable. He’d been up all night drinking and his friends told me that historically, that’s what usually triggers his fits. Strangely, I knew the answer to the problem but I thought I’d leave it to them to work out as he was taken away to hospital for checks.

Cardiac problems can cause faints and sudden collapses where the patient becomes less alert than normal. This triggers 999 calls from relatives and worried friends, as was the case with my next patient, a 70 year-old man with a pacemaker fitted who’d become confused. The crew was on scene and he was taken to hospital, just in case. I didn’t see his ECG because the crew dealt with him for the most part. Sometimes my patient contact time is fleeting.

Another epileptic was fitting in the street when MOPs came to his rescue. He’d fallen hard and now had a bleeding head injury which needed covering up. I had driven onto a newly concreted pavement area and was aware of how messy my uniform was getting. I’m not sure how the workmen (and women) will react when they return to complete the paving and see tyre marks and footprints all over the place. I might go back and apologise.

My second cardiac-related problem led to weakness and near-faint. The 59 year-old taxi driver was in a small London hotel where he stayed whilst working to raise money for him and his wife, both of whom stayed abroad pretty much all the time. His BP was high and his pulse was slow; he had a headache and his medical history intimated possible cardiac concerns. His ECG was normal however but he worried about not being able to get to work. His evening would be spent in hospital – his occupation could wait until a stroke had been ruled out.

All of my calls were within a mile of each other today; all in the WC1 or WC2 areas. The last patient was particularly impressed by the speed of my response (every so often a patient will comment on how fast we are at getting to them). Little did he know that I was at the station when the call came through and his hotel was around the corner – in fact, it would have been faster to walk to him because I had to drive all the way around the block and that cost me another minute.

Be safe.

Monday, 7 July 2008

Punk with a poodle

Night shift. Seven calls; one dead at scene, one taken in the car and the rest by ambulance.

Stats: 1 Asthma; 1 High temperature; 1 SOB; 1 Purple plus; 2 Chest Pain; 1 Hay fever (!)

I took the 28 year-old man with SOB and no history of anything to hospital myself because he’d had a recent dry cough and his temperature was high. I really didn’t see the need for an ambulance.

A cancelled call next (and one that I didn’t list above) for a man lying in the street in a sleeping bag claiming to have sunstroke. I asked Control if they’d read the description at all and when they did it was generally agreed that I’d be wasting my time as the weather was inclement.

An off-duty Patient Transport Services (PTS) lady was flagged down by a distraught mother who asked for help with her asthmatic 2 year-old daughter. I was called soon after and I arrived to find a non-asthmatic, happy child with a bit of a temperature. It was beginning to look like one of those nights.

Then I am asked to travel a long way north for a 65 year-old deceased female. I saw no sense in this but, as we were clearly short of vehicles, I didn’t argue the point and made my way there to find a crew already on scene by a few minutes. (You should skip this story if you have a vivid imagination and a weak constitution).

The lady had been found upstairs in her house by her daughter who’d been taken up there via a ladder and in through the small toilet window because the doors were locked from the inside and her mother hadn’t been seen for more than a week.

The daughter was now in a state of shock in another neighbour’s house because what she saw will never be erased from her memory.

I climbed over the back fence with the crew and we entered the house by the kitchen window. Nobody had told us exactly where to find the corpse, so we searched the rooms one by one until the smell from upstairs became strong enough to divert our attention to a bedroom. Inside was the putrefied and blackened body of a woman. She lay back on the bed, half-in and half-out with one slipper on. She had obviously been getting in or out of bed when she died very suddenly.

The smell of decay was so over-powering that myself and the male crew member had to cover our mouths and noses. The female crew member had problems smelling so she had no trouble with this, apparently. The place was hot and dark and more than a few flies were buzzing around. This is what the daughter had walked in to see. Her screams were heard down the street and nobody else dared enter the house until we arrived.

While waiting for the police we searched for door keys so that we could open the front door and allow them access but we couldn’t find any. Neither could we locate the back door keys. Both doors had been secured from the inside and both sets of keys had been so carefully hidden that, despite forty minutes of looking in every conceivable place, we ran out of options and had to exit the same way that we’d entered. The only other place those keys could have been kept was with the dead lady upstairs and none of us really wanted to go searching her body, especially as the flesh was in such an advanced stage of decomposition that it was falling off the bones.

Eventually, after an hour or so, the cops arrived and used their own ‘key’ to break down the door. They spent as much time as we had looking for the proper keys but came out scratching their heads just as we had. It was a mystery.

A 47 year-old lady with chest pain probably had a pleuritic problem rather than a cardiac one, so I left her with the crew after seeing that her ECG was normal.

A 32 year-old woman who denied having asthma was suffering an asthma attack; I could clearly hear the expiratory wheeze when I listened with my stethoscope, so she went to hospital for a proper examination.

Alcoholics who’ve been at it a while develop ‘dead brain’ signs: permanently slurred speech, loss of balance and co-ordination and frequent visits to hospital for ailments that are often wholly related to their habit. My next patient, a 31 year-old man, staggered to meet me as he waited in the street after dialling 999 from a call box and complaining of abdominal pain.

‘What seems to be the trouble?’ I asked him as I got out of the car.

‘Well, lots of things really…’ and he went on to list them. His abdo pain was the dominant complaint today but he had a host of other organic ailments to draw on should the need arise for a warm bed and a meal.

‘Have you been drinking tonight’, I asked stupidly.

‘Yes but not a lot’, he answered, unbelievably.

He was a tall, gangly man but he posed no threat to me and, although I was in a rough area at 5am, I didn’t feel worried about spending quality time with him until the ambulance arrived to save me. The conversation was dying by then to be honest and I really didn’t want to be chatting about family and holidays with him.

I saw the punk walking along Westminster bridge at stupid o'clock in the morning. I didn't take his photo because that wouldn't be nice without his permission (and he looked hard) but he led a large poodle along (a standard poodle I think it's called) for walkies and I couldn't help but smile at the seemed a contradiction in fact. Still, it might have been his mother's.

I got to go home after trundling up to the City to save the life of a bus driver who was suffering from…hay fever. Yep, that’s right. He had the sniffles and was puffed up a bit. Oh and he had a blocked nose. Apart from that and his sense of urgency as he practically ran to the ambulance…

‘What about your bus?’

‘F**k the bus!!’

…he was absolutely fine.

Be safe.

Sunday, 6 July 2008

Robot children

Early shift: Nine calls; one assisted-only, eight by ambulance.

Stats: 2 asthma; 1 assault; 1 fit; 1 chest pain; 1 trauma; 2 fainted and 1 ETOH (I might drop these stats...they seem a bit superfluous).

Regular callers are part of the job and my first call, to a 61 year-old man having an asthma attack was someone I recognised immediately, although I haven’t seen him around for a while. He’d told underground staff that he was having DIB and had forgotten his inhaler but when I saw him his breathing was fine and he perked up even more when the crew arrived to take him away. Funny that.

A 29 year-old woman was crouched in the hallway of an expensive building of flats, hyperventilating after allegedly being assaulted by the man who’d taken her and a friend in for the night. The call had stated she’d had an epileptic fit and she confirmed she suffered from this but I’m not sure a seizure had taken place at all. The man had punched her out of a stool in the kitchen after an argument and she’d collapsed to the floor (thus the ‘fit’ I guess).

Police were on scene when the crew and I arrived simultaneously but they’d left her on the ground floor landing whilst they attended to the assailant, who was upstairs in the flat. It took us almost 30 minutes to calm the woman down and by the time I left she was smiling and hugging her friend.

My second asthma attack was a non-starter. The crew was attending to the 36 year-old woman and I wasn’t required.

A 2 year-old boy had reportedly had a fit at home and his mother called an ambulance because it had happened before and nothing had been properly diagnosed. I found the child lying in the doorway of the flat as his mother looked down at him – she didn’t seem too worried. He responded immediately to my voice and the crew, who’d arrived with me, gave him oxygen. As with all cases in which children have had a seizure, my first job was to get a BM, which read low. I gave him Glucogel and he absorbed enough over a short period to bring his BM back up to normal but that wasn’t the end of the story.

I’d asked about the circumstances of the ‘fit’ and the mother described a kind of drop attack rather than a seizure. This wasn’t his first collapse and I was suspicious about other factors. Two other kids sat like robots in front of the television and they didn’t smile when I spoke to them (I’m obviously not that charming) but I noticed they were sitting rigidly, not relaxed. It seemed unnatural.

As we got the boy ready to go to the ambulance the mother screamed at her other daughter, her eldest, when she appeared at the front door. She left the teenager to take care of the two robotic children and accompanied us to the vehicle. I asked the crew to do an ECG, which isn’t normally done with kids but I felt these drop attacks might have a cardiac origin. As soon as the strip printed off we could see a problem; there was an irregular rate and a complex dropped every five beats or so. This could possibly mean an AV conduction problem but I’d have to wait until we got him into hospital to find out.

He remained irritable and lethargic all the way to hospital and I wondered if he had been born with a problem or it had developed because of other reasons which I’d better not speculate on here.

In Resus he was thoroughly checked out and his ECG there confirmed what we’d found – he had a sinus arrhythmia of, as yet, unknown aetiology. Whatever else was going on in his little life, I was never going to know.

A long drive to a place way outside my area for a 61 year-old man with chest pain who walked to meet me when I pulled up. He had that ‘regular caller’ look about him and after I’d finished my obs the local crew confirmed just how regular he was when they arrived. He’d given me a pain score of eight and a half out of ten, which was kind of a clue.

Mixing alcohol with drugs is never wise. My next patient, a 55 year-old man, fell into the road and smashed his head after washing down his anticonvulsants with vodka. His wife and daughter, who were on scene, weren’t happy with him and remonstrated with him as he was loaded onto the ambulance. Alcohol, drugs and an unhappy family - nice combo.

I wasn’t required for the 22 year-old who’d fainted with ‘breathing problems’. The crew was with her.

Next, a 55 year-old woman who passed out in a restaurant after a near-choking event. Her BM was high and her ECG was anomalous, so there were other reasons to take her to hospital, even though the food she had choked on had cleared and she was fully recovered when I arrived.

I watched a pedibike (it’s a kind of taxi bicycle) brake hard as it careered towards a car at traffic lights. These guys drive them around like idiots sometimes. This time there was a man and two children on board and the braking pitched the whole passenger area forward as the bike tipped over, spilling one of the little girls onto the road. The man wasn’t happy at all and shouted at the ‘driver’. Then he took his kids and himself off the contraption and onto the pavement, where he waited for a proper taxi. Pedibike man didn’t seem fussed at all.

Finally, a 50 year-old man ‘unconscious with head injury’ turned out to be an alcoholic with a skin infection (which was bleeding) who was trying to sleep in a public place (they never learn). The cops were with him when I arrived and they moved him on after a quick check of his condition. He staggered off like a drunken shadow and found a better, more private place to sleep.

Be safe.

Saturday, 5 July 2008

Back from Croatia

Oops! Forgot to tell you all that I was heading back out to Croatia with some of my LAS colleagues...thus the disappearing act. I'm back now and you can check out the photo's taken out there on my facebook page. Again, great fun; a beautiful country full of lovely people but also very poignant, given what they've been through.

I'm back on duty too, so I have stuff to catch up on and new material to come no doubt.