Tuesday, 27 January 2009

Coughing, not choking

Day shift: Eight calls; all by ambulance.

Stats: 1 DIB; 2 Faints; 1 ?TIA; 1 Cough; 1 RTC with multiple injuries; 1 RTC with minor injuries; 1 Suicidal person.

Plenty of cancelled on the way calls for me today and a few ‘not required’, including an 84 year-old man with DIB. The crew was on scene for that.

My first faint was at an underground station, where a 35 year-old man was slowly recovering on the platform as staff helped him. He’d passed out once before, so this wasn’t new to him but he’d never been checked out properly, so the crew took him for an ECG and on to hospital.

One of my MRU colleagues was with me and when we went back to our vehicles a security guard from one of those cash-collecting trucks had a go at us for parking in the bay that he and his crew mate needed in that location. He shouted at us and I noticed that his van was parked quite dangerously at an angle in the road, almost nose to rear with the motorcycle.

‘We are on an emergency call’, said my colleague but it fell on deaf and ignorant ears. Once again, someone who’s relative was not the focus of our arrival was hell bent on making our morning miserable by giving us verbal abuse just for doing our job. Nice.

I travelled a log way out for the next call, to a 74 year-old man who’d collapsed outside a tube station and had been taken inside by the staff. He was sitting on the toilet in their office when I arrived and he wasn’t very responsive at all. Then he began to lose consciousness, so I pulled him to the floor with the help of an underground bod.

He’d lost bladder control and the tell-tale stain on his trousers made me think that this probably wasn’t because he hadn’t made the loo in time. I did all my checks and came up with a low BP and pulse rate. He was very pale.

I asked for a first aider just in case he suspended on me before the crew arrived; I’d need the extra help, and a lady materialised within seconds, gloves on and ready, if a bit pale herself. Luckily she wouldn’t be needed because when the man’s head reached the floor, he suddenly became alert, almost as if he’d been faking it all.

He was lucid enough to answer my questions and I found that he had no medical problems.

When the crew arrived we took him to the ambulance and he began to repeat the same thing over and over again. ‘I need a crap’, he said. He seemed genuinely desperate to go to the toilet and purge his bowels but we insisted that he should either hold on or just go where he was and we’d clean him up afterwards (its all part of the service but don’t try it deliberately because we know the difference).

During the second set of obs he kept asking to empty himself and it became very odd. I didn’t think his behaviour was normal, regardless of his need to go to the loo. I suspected he’d had some kind of neurological event, possibly a stroke, so he was taken to hospital quickly.

I was asked to call the doctor in charge of this patient later on and he asked me questions about what had happened to him and how long it had gone on. He too felt that the man had suffered a stroke.

A two year-old boy who was supposedly choking required my assistance at a doctor’s surgery miles away but his mum walked him out to the door when I arrived. The doc had ordered a blue light response for this and it was given a Red3. The little boy had a week-old cough but the medic felt he might have a partial obstruction, so needed an x-ray. Even the mother thought I was there to trundle them to hospital and no more. Instead a crew did it. This, in my opinion, was a routine transfer and not an emergency. Sometimes abuse of the service comes from professional sources.

A motorcycle was hit by a taxi and the bike rider ended up on the ground with C-spine tenderness and pain in his ribcage and hip, so he was collared and scooped from the ground, as was necessary. He lost his leather jacket and trousers to our shears but no visible injury could be found.

He was given pain relief and taken to hospital on blue lights in case we’d missed something but I honestly don’t think he had anything more wrong with him than bruises (which were invisible). The speed of impact was low and he had flung himself to the ground when the cab hit. I'd be visiting this exact spot again within a week to scoop another RTC victim from the road.

My second faint took place at a bus stop. The 22 year-old man had a low BP and the crew was already taking care of him when I showed up, so I just took note of the numbers and left the scene.

Up in Oxford Street, where the traffic crawls almost permanently, a cyclist clipped a pedestrian as she crossed the road. She had minor facial injuries and was badly shaken by her experience but she’ll definitely survive.

Just as I made my way back to go home, I got a call and turned around to head for a pub, outside which the police had taken a man into the back of their car for his own safety. He had threatened suicide in the pub and people had taken him seriously enough to call 999. I didn’t make contact with him because I felt the police officer already had his trust and if he was fragile, I could upset the balance, so I waited until the cop told me what was what.

‘I’ll try to convince him to go to hospital of his own accord and if he doesn’t want to, I’ll section him for his own safety’, the police officer told me.

Fair enough, so I waited for the crew and when they arrived I advised them of the plan but it looked like he was going to comply and the fuss wouldn’t be needed. I left the crew to it and headed back on overtime.

Be safe.

Friday, 23 January 2009

Break in

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

Stats: 1 RTC with head injury; 1 Chest pain; 1 eTOH; 1 Pain in side; 1 RTC with chest pain; 1 Assault with neck injury; 1 Unable to cope.

A varied shift tonight, starting with a call to an hotel given as ‘fainted’ with the caller refusing to check the patient’s breathing (sometimes that’s understandable but I find it irritating that people will call and then do nothing to help). In fact, when I got on scene I was shepherded through the place and back out onto the busy main road at the other exit. It was a RTC; a car had hit a pedestrian and now he lay on the ground with a minor head injury. An ambulance was pulling up and a FRU was already there, so I called Control to clarify the situation. I wasn’t sure if I had been taken to a separate call at the same location, such was the disparity of the detail.

I left the crew to deal with it when I was told that no other patient was there and I hoped that nobody was languishing in a room somewhere in need of care.

My son Allan is regularly ‘on the road’ now – he’s doing his three year training programme and he’s let loose with an experienced crew mate as he learns the trade, so to speak. He arrived with his ambulance on my next call and it took two glances before I recognised him! My patient was a 56 year-old man with chest pain who, quite frankly, seemed to be playing up for his audience (a frantic, crying woman and a quiet man, both of whom were with him in the dingy flat).

We took him on board and checked him out but, despite his insistence on pain, our tests showed nothing untoward. His ECG was normal enough but we all know that means nothing if the patient says so. I gave him morphine for his pain but his condition appeared to improve regardless of the short amount of time that had passed since it had been administered.

When we got to hospital, he continued to complain of pain (but louder now that he was being watched) and the doctor, after a thorough examination, decided he wasn’t in any trouble. The last I heard he was being demoted to the waiting room…or the outside world.

Another pretender was my 19 year-old drunken student who was carried over to me by his friends in Leicester Square. To look at the drama they created you’d think a soldier-buddy had been hit during a conflict. As soon as I started to speak to this ‘unconscious’ young man, he grinned and quipped. I wasn’t pleased at all. We were busy tonight and the last thing we needed, especially the hospitals, were comedians who thought an ambulance trip would be funny.

‘I just wanna go ‘ome’, he said in a broad Brummy accent.

But no cab or bus would touch him and this meant I’d either have to leave him with his friends or he’d be taken to hospital to sober up and learn to walk again.

The crew (Allan and his mate) arrived and he was wheeled off to the ambulance. His apologetic friends looked on sheepishly as they realised what a fuss they’d created over nothing.

In the ambulance the student continued to be amusing and almost sober. His behaviour would be clocked immediately by the hard-driven A&E staff and they’d turf him into the waiting area, or outside, depending on their workload and mood.

‘Don’t tell my mum, she’d kill me if she knew’.

Too right, I thought, as would I if you were my son. Shame on you.

I left him to the crew and before I closed the back doors of the ambulance I gave him one last piece of advice, which I hoped he’d remember and act upon. ‘Grow up’, I said.

Around the corner, five minutes later, I was asking a homeless Somalian man why he had called us from the phone box he was standing near when I arrived. ‘I have pain down my right side’, he told me. His doctor had already seen him about this and given him mild analgesics and no diagnosis. He was perfectly capable of walking to the nearest GP surgery or drop-in Medical Centre, if he wanted to wait but he didn’t.

What he wanted was a warm bed but I doubt he got it. His condition wasn’t going to make anyone worry because it was historical and non-urgent, so he too would probably join the queue in the waiting area.

Another RTC later on and again a crew was already on scene, as were the police. Two cars were involved; one allegedly side-swiped the other and the airbags had been deployed in the one that had taken the brunt of it.

A well-spoken young Asian man protested at the recklessness of the other driver; he was the one who’d been hit and now his car looked like an expensive repair bill, even from a distance. The other driver had neck pain and was being checked out by the crew. All I had to do was take care of the emotional man who sat in the back seat of my car until the police had finished their checks, statements and two breathalyser tests – both of which were negative.

I left the crew to deal with an assault on Oxford Street where two men had allegedly fought each other by trying to strangle one another with their belts – very bizarre. It must have been a hoot to watch on CCTV. Now one of them was complaining of a neck injury and had demanded an ambulance. The police were on scene to give sympathy. Or possibly not.

I ended the shift outside the flat of a 95 year-old lady who had called us with an unknown problem. Her door was locked and there was no warden available to help us gain access. I arrived with a crew and we ventured into the secure building. We could hear her from the other side of the door and she seemed fine, although she told us that she was unable to walk, so couldn’t open the door.

After a twenty minute attempt to get the keys or a helpful warden (where are they when you need them?), I called Control and requested police assistance. We can’t break doors down unless there is the possibility of loss of life, so the police need to do it for us in circumstances like this.

When they arrived we discussed the options, found that there were none and the door was forced. A hell of a loud bang rang throughout the building and I don’t doubt a few of the residents were rudely awoken. With an average age of 75 years-old in that place, it’s no wonder we didn’t get another call for chest pains after the noise.

It took one charge at the door and it simply gave in without a fight. The old lady was in bed, shaking from the scare she'd got. She had been warned that it would happen but I guess you can never be ready for it when it does.

All she wanted was someone to give her a drink. She’d been left there all night because her scheduled carer hadn’t appeared, so now she was dehydrated and worried.

‘I think I should go back to the nursing home. I just can’t cope. I’m 95 you know’.

We knew and we all understood. She’d need proper care. She couldn’t manage an independent life any more, the poor woman. She’d even been laid into the bed the wrong way round because when I pressed the button to make the head end rise so that she could drink the glass of water I’d brought over from the little table across the room, her feet went up!

I’ve said this before. We don’t take care of our elderly in this country. We seem to have lost our way.

Be safe.

Thursday, 22 January 2009


Night shift: Seven calls; one left at scene; one taken in the car; five by ambulance.

Stats: 1 eTOH; 1 Purple plus; 1 ? Fit; 1 eTOH with hypothermia; 1 EP fit; 1 Back pain; 1 Psuedo-choking.

One of our MRU colleagues was hit by a car tonight – he’s in hospital with a fractured rib and possible spleen injury. The man is a friend of mine and well respected in our complex. A sense of shock at yet another MRU collision pervades the place at the moment. Incidents like this, involving the MRU team are not common but they are becoming more frequent and unless other drivers slow down and take care when they see one approach, more are likely to occur until someone is seriously injured or killed in the course of their duty.

A woman sat slumped on the steps of her college, unwilling to speak to anyone and obviously drunk until the staff had no choice but to call an ambulance for her. It’s not the first time she’s behaved like this by all accounts and she stubbornly refused to communicate or even look at me as I tried to reason with her. She wasn’t medically ill but I’m sure other issues influenced the way she was, apart from alcohol. The crew took her away to hospital…again.

Death seems to be the theme for the first month of the year for me. I was called to a dead man who was found in his flat by police after they broke down the door of his flat. Nobody had seen him since November and it’s very likely he’d been on the floor of his kitchen, bowed over as if in prayer, for the past two months. There was certainly plenty of evidence of him being long deceased; the overpowering smell as you entered the lobby, the blackened skin, which was virtually melting onto the floor and the presence of hundreds of flies – generations of them lay dead on the floor and the more lively ones buzzed around the light bulb in the hallway.

A crew was with me and more of us turned up but this was an open and shut thing, requiring only a pronouncement of life extinct – paperwork for the police.

A neighbour had called the police after the smell had been detected in the building. They were told that mouse dropping could be seen all over the carpet and the police themselves thought that’s what it was when they peered through the letter box. In fact, it was a mass of deceased black flies and I had to walk onto them to get a close look at the man in order to satisfy the procedure required for the paperwork.

'He sticks to the floor when you move him', one of the cops said.

We all looked at each other. None of us were about to test that comment. The Coroner would deal with this one.

I was cancelled on top of a call to a 65 year-old man who had collapsed in a pub, so I pulled up and started writing it up but the crew who’d been called and were 'on scene', according to Control, rolled past me on the way there and I got a look from the attendant as if to say ‘why aren’t you doing this one?’. I followed them just in case they needed help but there was no drama and the patient only needed two people and an ambulance. Still, I had to apologise in case they thought I was sitting it out deliberately.

Off to see a 45 year-old man who was ‘very drunk and collapsed’ next. He was drunk but he wasn’t on his knees – he was standing outside a women’s hostel and two of the residents had called an ambulance stating that he was on his last legs. I found that out when I asked Control why this had been given a Red2. The women told me that it wasn’t an emergency and that they’d specifically told the call-taker that. Obviously, they’d told a lie to get rid of him as he stalked the entrance to their secure place.

He was very cold and my first thought to have him go and find a warm dry place to sleep (he told me he had nowhere to go) changed when the crew arrived and his temperature was taken. I expected it to be low but at just over 33 degrees it was best if he went to hospital. He had been in the day before – we knew that because he was still wearing his name band and he sported the tell-tale sign of someone who’d walked out before being treated properly – a cannula in his arm.

I removed the dried up piece of plastic tubing from his vein and the attendant covered his wound. If he walks out again tonight, nobody will have any sympathy for his plight.

When the ambulance had gone, I made a point of referring him to London Street Rescue, so hopefully he will get a place to lay his head out of this awful weather.

A 25 year-old epileptic woman was fitting in a restaurant after downing ‘a lot’ of alcohol, according to her friends, who were quite drunk too. She lay on the floor telling me that she was fine but when the crew got there she fitted again twice, before recovering as she was taken into the ambulance and out of sight of her mates. She became immediately lucid after that – kind of unusual for someone who’s had so many seizures in a short space of time. She wasn’t even tired.

I’ve helped my Control colleagues out many times by attending to one of their own when they become ill or injured at work, so I wasn’t phased to be asked to take a young woman with back pain to hospital. It gave me a chance to have a chat with someone else in green for a change.

Many people call us thinking they are choking when they have a lump in their throat or a partial obstruction caused by food that can easily be cleared. More often than not the lump they feel is in their oesophagus and not the trachea, with no chance of an imminently life-threatening event but they dial 999 in panic. A 51 year-old Chinese man was taken to hospital by the crew when he complained of such a lump, whilst being perfectly able to talk. I stood by to offer any help they might need but there were three of them (a trainee crew and their supervisor) so I just killed a little time on scene instead.

Be safe.

Private parking

Don't panic - it's a stock photograph!

Night shift: four calls; all by ambulance.

Stats: 1 Faint; 1 DIB; 1 Assault with nose injury; 1 Hypothermia.

It rained most of the night, so people were disinclined to go outside and get hammered. That meant I had a fairly quiet shift. That and the fact that we had a million ambulances on the road and no less than three cars were working in my area. Unfortunately (and before anyone starts ranting about how little we do) this is just the calm before the storm. When the weather improves and/or the weekend approaches, things will get back to normal and we will be dealing with 4,000 calls a night.

I met someone I haven’t seen for at least a year tonight. I was in Leicester Square watching the place being packed up after Tom Cruise had graced it’s pavement for his Premiere, when a little guy in a wheelchair rolled up with a big smile. He’s been around for years and I’ve commented on him several times on this blog.

He’s a helpful type; a first aider, he says. He loves to get involved in calls when we are around and he’ll direct traffic and move people out of the way, even though it isn’t necessary. I asked him how he was and what he was doing. He was dressed smartly with a shirt and tie on and I suspect he was hoping Mr. Cruise would take notice of him.

‘I’m working now’, he said.

‘Doing what?’ I asked.

‘I’m a street performer’.

I looked at him in his wheelchair and tried to work out what kind of performance he would give but gave up and asked him instead.

‘I’m a wheelchair break dancer’, he told me with a proud grin.

Theatres are places in which one can see a good (or bad) show, enjoy the company of several thousand other people, (if you are into that sort of thing)...and faint. We get lots of calls for people passing out in those old, hot places. So I wasn’t surprised when I was called to a 60 year-old who’d collapsed in one. She was recovering in the cooler lobby when I arrived and within minutes a crew had turned up and she was taken into the ambulance for an ECG and further checks. She was taken to hospital on advice.

I drove for miles in the mucky rain and in poor visibility just to find a crew on scene with the 82 year-old UTI patient who was suffering from DIB. I wasn’t required.

Later on, off to Trafalgar Square for a 23 year-old man who had been assaulted. A crew was searching the area when I arrived and the police were none the wiser about the location of the alleged victim.

Eventually, he was found and taken aboard the ambulance with a minor nose injury after having been punched in the face at random.

My last call gave me a bit of a fright. I was crawling down a dark street at five in the morning, with the rain making things difficult to see. I was looking for a man who had been found ‘unconscious’ on the ground. As I continued down the street, I began to pull over so that I could see the house numbers better. I had been given a number outside which the man was supposedly laying. Just as I drew closer to the kerb, I noticed a light-coloured lump and identified a human shape, a few feet from my wheels.

The man was lying in the road...in a parking bay! I could have killed him. I was a matter of seconds away from running over his head with my front wheel. This was a close call and if I hadn’t been looking in the right place at the right time, I wouldn’t be writing this.

Working solo in the car means driving slowly and looking out for your patient or the windmill at the same time. It takes concentration and you have to stay alert. That’s difficult to do at 5am on a dark, rainy morning.

I wasn’t pleased with him. I knew he was just sleeping...they usually are. The fact that a hostel was just around the corner meant that the chances of him being homeless and possibly alcoholic were high.

I woke him up, took him to the car and that’s when my dysfunctional windmill appeared. He wandered out from his building and said ‘Yeah, I called you. He’s been there for ages’.

I thought why didn’t you wait with him and wave at me when I came down the street? I wouldn’t have had my close call if you’d done that.

Anyway, the man was very cold – 34.6 degrees and the crew took him to hospital when they arrived five minutes later. He was a cold and wet, homeless alcoholic and he almost became a dead one.

Be safe.

Wednesday, 21 January 2009

Book worm

I've started 2009 with LOTS of enthusiasm about writing new stuff and I will probably kill myself doing it. I want to write at least two new books this year...possibly three. I am working on a fictional novel called 'The Station', based on real calls in and around London and using characters I know well BUT I don't know if I should produce one big book or create a periodical short story series, like a soap opera. Let me know what you think.

I'm also writing a street-wise guide for paramedics-to-be and anyone else interested in the profession. This should be finished by the Summer.

Finally, I want to start work later in the year on a compilation of the funniest, stupidest stories that paramedics around the world have to tell from their own experiences. I'd like you to submit (by email) any stories you think may be fit for a book - I can't pay you 'cos that would be financially impossible BUT I will credit you (and if you have enough stories of your own, I may even give you a chapter with your name on it) Oh and you'll get free copies, the number would depend on your contribution and the publisher's discretion.

I have hundreds of professional readers around the world, so it would be great to hear from you. Remember you must submit them by EMAIL and they must be true...obviously you may elaborate a little to disguise the identity of people and places.

So, tell me what you think. This is going to be very hard work and my wife isn't pleased with me (she thinks I take on way too much) but I will go for it if there's a demand.


Tuesday, 20 January 2009

Forked off

A deadly weapon in the wrong hands...

Night shift: Eight calls; one assisted-only, seven by ambulance.

Stats: 2 Unwell adults; 1 Faint; 1 Cold person; 1 Stabbing; 2 Panic attacks; 1 Unconscious

A 64 year-old Slovakian alcoholic sits on a wall as his three mates prop him up after calling an ambulance, claiming he has chest pain. When I arrive he seems cold and out of it. He hasn’t had a drink all day, I’m told, so he may be ill as a result of withdrawal symptoms, although they usually kick in after a longer period without alcohol.

I find it very difficult to communicate and resort to using a Polish translator from Language Line who can speak some Slovakian. I get enough information to determine that there is no chest pain and that the man is just generally unwell…cold and sick.

The crew arrive as I am trying to launch a conversation via the phone and we get him into the back of the ambulance with a struggle because he is unwilling or unable to put one foot in front of the other. His previously concerned drinking buddies disappear as soon as we move him. Unfortunately his trousers begin to fall off, so his dignity disappears too.

Then on to a 75 year-old who has fainted in a lecture hall with hundreds of his peers looking on. The man is a doctor and so is his wife and this makes life problematic as I try to ascertain what’s happened to him. His wife has taken control of everything before I get there and he’s being hauled into a wheelchair to be removed from the hall and the gaze of everyone in it. So I wait until he’s out in the corridor and I ask a few questions.

‘What exactly happened to him?’

His wife begins to talk at a hundred miles an hour and she is adamant he’s alright and that he doesn’t need to go to hospital. ‘This happens to him all the time’, she says. I don’t doubt her but he is very pale and very sweaty – I’m concerned about the possibility of a cardiac related problem.

When the crew arrive we manage to get him into the ambulance but his wife is still being stubborn about him going anywhere. I reassure her that he won’t be taken to hospital if that’s his wish…but it has to be his wish, not hers.

In the end he went because he began to feel faint again in the vehicle and that was enough to convince us all, including Mrs Doctor, that he wasn’t well.

The calls kept coming in at a steady pace and my next one took me to a flat where an 86 year-old was ‘not waking up’. Of course I thought the same as the crew when they pulled up beside me on scene; this might be a suspended - but it wasn’t. The entire family had gathered in the small flat to witness their mother/grandmother being surrounded by yellow jackets as she slept. She opened her eyes and looked around. She may have been unwell but sleep doesn’t count as cardiac arrest.

A regular caller said ‘chest pain’ and he got the response he desired. I arrived with the crew and at first we couldn’t locate him but eventually, after a quick area search, he appeared from a callbox, waving at us in time-honoured fashion. He was cold and wanted somewhere warm to sleep. The crew knew him and I recognised him vaguely. The man has learning difficulties and this is how he gets home.

I thought I was on my way to a serious call when I was given the details. ‘Man stabbed in neck’ turned out to be a restaurant manager who had been assaulted by someone with a fork. It had been planted in his cheek; hardly life threatening but still a shock to the system I daresay. The police were there in number of course and I had to cancel any other resource that may be sent to it, such as HEMS, just in case the paying customers became outnumbered by uniforms. It’s hard enough to eat when one person is watching you, right?

The first of two hyperventilating panic attacks was a 40 year-old woman who’d woken up with DIB. I suggested sleep apnoea may have been the cause (she’s a self-confessed snorer) and that she should see her GP about it. She didn’t want to go to hospital and really didn’t need to because she was fully recovered from her fright.

The second panic-stricken person was a drunken 19 year-old who had gathered with his friends on a corner after being out celebrating his first class honours degree. Unfortunately he took a turn for the worst when he couldn’t cope with the emotion of it all (alcohol does that) so he had his mates dial 999 for him. I found him breathing way too fast and crying whenever he could. He was taken to hospital because try as we did, the crew and I couldn’t settle him down fully and he wasn’t fit for the streets. His habit of spitting on the ambulance floor and at random into the air didn't enamour any of us either.

Two MOPs found a 27 year-old smartly dressed girl lying on the pavement of a busy street. One of them used the young woman’s mobile phone to find out who she was and what might be wrong with her. She was on her side as if she’d gone to sleep there but she was unconscious and even deep pain couldn’t get a response from her at first. She was getting very cold too.

When the ambulance arrived, we put her in the back on the trolley bed and she began to stir a little; her eyes were open but she still didn’t acknowledge us or the world. She’d been drinking after a long dry spell (according to her mother, who I spoke to on the phone) and that probably caused her to collapse and blank out in the street but I suspect she’d simply laid down to go to sleep not knowing that she was in danger. It’s not the area to be sleeping in at four in the morning, especially if you are a female. She was lucky to have two caring people passing by to help her.

Be safe.

Sunday, 18 January 2009


Day shift: Three calls; one assisted-only, two by ambulance.

Stats: 1 eTOH; 1 Fall with head injury; 1 EP fit.

I had a whole day of virtually nothing to do but wait and it dragged on forever. We have plenty of resources out and about and the call volume has dropped post New Year, so as a solo in a FRU I don’t get assigned many calls unless there is a need for me. Lots of coffee gets consumed on days like this but I’m also glad of the break in pace.

The morning started with a 25 year-old propping himself up against a wall. He was drunk and in no need of an ambulance; someone else had seen him and decided he needed one. The caller even came across the road to tell me and the crew (who’d arrived at the same time) that he was unconscious. He was the most alert unconscious person I’ve seen.

Bemused and irritated, the man refused all help from us – he was drunk and had nowhere to go for the moment. He was advised to move on though because he would certainly generate more calls if he slumped to the ground and went to sleep.

A lovely 85 year-old fell against a door and bumped her head so she pressed her alarm and the care people arrived to help her. They decided she needed an ambulance so we were called. I met the two men who’d helped her onto her chair as they left the block of flats and they told me how she was.

I walked in to find her ready and waiting to go to hospital with a big beaming smile on her face. I smiled back and we had a conversation about her mishap and, with her permission, a feel of the bump at the back of her head. There was no bleeding and she hadn’t been knocked out but her age was against her, so the crew popped her on a chair and off she went, still smiling.

Back to the same police station as yesterday for an HIV+ drug addict who claimed he was epileptic and had been fitting. The police officers confirmed that he’d had three fits but when he became glassy eyed and silent during another event, I didn’t buy it. Neither did the crew. He could have been experiencing an absence I guess but when he was in the ambulance with us he was animated and completely with it. He didn’t have another 'fit' all the way to hospital.

‘I was a landscape gardener then I came down here to visit friends and ended up a junkie’ he told me as if the ease with which he ruined his entire life was inescapable.

‘So why don’t you clean up and go back to working?’ I suggested, ‘others have done it.’

‘I’m going to, definitely.’ He said unconvincingly. I'll see this man dead or in a bad way soon enough if he doesn't heed his own sense.

The 30 year-old Glaswegian caused a bit of concern when, as my colleague attempted to flush the cannula inserted in him, fluid spurted out and onto his face. None of it hit his mouth or eyes but he wouldn’t have been at risk because the fluid was just a backflow of saline from the obstructed cannula, not the vein itself. It’s a sure sign that the cannula won’t run. Still, those moments are nerve-jangling when they happen and my colleague continually wiped his face as if there was something nasty on it.

Be safe.

Saturday, 17 January 2009

People are too be busy to be sick

Day shift: Five calls; all by ambulance.

Stats: 1 Asthma; 1 Hypoglycaemic; 1 Hyperventilating; 1 Chest pain; 1 DIB.

Another demonstration in London and another day of violence and aggression against innocent people and property but I will comment on that later…

I wasn’t required for the 4 year-old boy with asthma because the crew was on scene as I pulled up so I made my way back to the station for breakfast.

The local police station needed us later on and I visited a Polish man who was hypoglycaemic in his cell. He hadn’t eaten he claimed, and was now in need of sugar. This was being provided in the form of sugar-water by the police officers when I arrived, so he was already recovering. I checked his BM and it was on the up but not quite there yet, so we kept giving him drinks until a further check in the ambulance revealed that it was back to normal. He was being bailed anyway, so there was no need to cuff him for the trip (a precaution the police will routinely take unless we ask them not to for medical reasons).

Again, I wasn’t needed for the 29 year-old man who was hyperventilating. The crew was dealing with it and I would have been nothing but an observer.

Outside a café in Central London a 67 year-old man with chest pain was given star treatment by me, a MRU and an ambulance crew. I left early in the proceedings – too many cooks and all that.

The day just seemed to be about my driving and nothing else because my last job required nothing of me but the ability to stop the clock before the 8-minute danger zone. A motorcycle paramedic was dealing with the 37 year-old asthmatic in the street. All I had to do was connect the neb and get her breathing properly.

Be safe.

Friday, 16 January 2009

A purple week

Day shift: Five calls; two left at scene, three by ambulance.

Stats: 2 Purple plus; 2 Chest pains; 1 RTC with ? spinal

Every so often (and you’ll know this now if you are a regular reader) my day starts with a dead person. Today was one of those days. The 75 year-old had perished sometime in the night and was found by his carers when they opened the door and called out to him first thing in the morning.

The man had terminal cancer, so his death was expected but he had also been refusing to take his regular meds and this may or may not have accelerated the process – his choice.

A MRU had been sent to assist me because the call had simply been given as cardiac arrest, so we went in there prepared to resuscitate. The man’s body was pale, cold and stiff and it was clear he’d been impossible to save for some time. All I had to do was record a flat line on the ECG, note the time I had done this and recognise him as 'life extinct'.

I covered him up and organised the police and his GP to attend the scene. The police showed up because they always do but I was very surprised when his GP actually physically appeared within ten minutes. In fact, I couldn’t remember ever being with a newly dead person and meeting the doctor on scene. This GP obviously had the time and inclination to complete the task of certification and that was a change to see.

I left the flat after everything that needed to be done had been but there was one little ironic reminder of life left behind next to the dead man in his bed – his mobile phone was flashing and had been since we got there – it read ‘Remember today’s meeting’.

I chased the rain for a few miles on a call for a chest pain/DIB that didn’t require my attention. The crew was on scene. Another crew was on scene when I got a separate call immediately afterwards for a 52 year-old male with chest pain. I was chasing my tail today.

It was a few hours before I got a job on which I would land and do some work, prior to that I had bent sent and cancelled, sometimes metres from the scene. But now I was heading to a RTC in Trafalgar Square. A bus had apparently hit a man who’d fallen into the road.

This kind of accident happens occasionally and I expected to find the usual minor injuries in a sitting, talking person but I arrived to see a MRU paramedic dealing with a man who was almost face down on the pavement with a little pool of blood by his head. At first it looked like a significant injury was possible but when I shouted out to my colleague and asked if HEMS was required, he shook his head and I got that look; the look that says ‘it’s not serious enough’.

The man was very drunk and very Irish and I’m sorry to say this but it’s more often true; the combination made him aggressive most of the time. We could find no injury, apart from a minor scratch or two to his head. He complained of having a ‘broken arm’ but that turned out to be a phantom, then he suggested he couldn’t feel his legs. He did this after he’d been collared and boarded for the trip to hospital. Before that he’d been moving his limbs well enough.

This man had allegedly assaulted a passing MOP, simply because he didn’t like him. The MOP punched him back and when he tried to retaliate, he staggered, lost his balance and fell right into the path of an oncoming (and thankfully slow moving) bus, cracking his head off it. There was little sympathy for him in the gathered crowd of police and paramedics – he was nasty and abusive most of the time and he insulted the female paramedic when he was on the ambulance. He didn’t care that a police officer was standing there. We, of course, are still duty-bound to treat someone like this – even if he does call his carer a bitch.

The shift ended just as it started – with death. The police called for urgent ambulance assistance when they entered the home of an elderly couple who hadn’t been seen for some time. They had a deceased male and a female who was barely conscious on the premises, so I got over there as fast as I could with a MRU at my tail.

An ambulance crew was on scene and when I entered I saw that they were treating an old lady who was on the floor in a foetal position. Her husband lay dead nearby. The lady was scared and upset – she was also very, very cold and had a nasty gash to her leg. The body was almost naked and looked to have lain there for some time – when I examined it I found rigor mortis and although that can mean very little in terms of time of death, the fact that he was elderly suggests the possibility that he had died more than 12 hours earlier. Neither of them had been seen for 3 days and they had missed several doctor’s appointments. It's entirely possible that he died days ago and she'd been with him in that terrible state ever since.

From the story that unfolded, it sounds like he died quiet suddenly, probably as they were getting up from bed and she tried but failed to get help. Eventually she just curled up under a table with her husband’s body next to her. It’s a heartbreaking thing to think about and I went home pre-occupied by the misery and pain she must have felt as she waited for either death or rescue.

Be safe.

Thursday, 15 January 2009

The tipple cure

Beats an injection I guess...

Day shift: Four calls; all by ambulance.

Stats: 1 Chest pain; 1 Faint; 1 Frequent flyer; 1 ? TIA

Remember when (please refer to any old black and white movie) it was considered useful to drink brandy for ailments? Even doctors used to recommend ‘a tipple’ and, of course, there is something beneficial in it for some conditions…but not for chest pain indicating angina. I was on the street with a 67 year-old man whose two sons had insisted an ambulance was needed when he developed chest pain. He had a history of heart attacks and they were taking no risks with him.

‘I’m okay now’, he told me, ‘I’ve had a drop of brandy’.

‘That’s a very old-fashioned remedy’ I suggested.

‘I’m an old man’ he said, ending the debate.

His pain was all but gone by the time the ambulance arrived but he was taken to hospital for good measure (excuse the pun).

When I finished with the brandy-drinking man, I wandered towards Oxford Street and got a call for a 30 year-old female who’d fainted. I was only a minute from the location and was on top of it when I got cancelled for ‘a nearer vehicle’. This nearer vehicle was, in fact, half a mile down the road from me. I called Control to suggest that maybe I was nearer but by the time I’d explained everything, the crew was on scene and I became a third leg.

A call for a 42 year-old man who was ‘about to fit’ rang a bell. I’ve posted several times about this frequent flyer – this is his M.O. but we always run on the calls because we can’t be sure. Maybe simply asking for his name would help…but nobody ever seems to do that before we are despatched and even then I’m sure we wouldn’t take the risk in case he genuinely fits – something none of us have ever seen, despite the claim that he is epileptic. Every call is the same – ‘feels he is about to fit’.

I wasn’t sure it was him but when I got on scene I found the ambulance crew already dealing with the patient on an underground platform. It was indeed the frequent flyer I had suspected from the call description and he was resplendent in a suit and clean shoes for a change. He was also much brighter than normal and I’m sure the presence of three females (underground staff) had a lot to do with that.

He always goes to hospital because if he didn’t, another call would be generated later on. As far as I’m aware nothing is being done about his frequent calls.

The shift ends with a call to a 75 year-old man who was discovered by two shoppers slumped over his walking stick in the street. He was confused and vague when I asked him questions and he insisted that he was fine but his behaviour was consistent with a possible TIA, so he was taken to hospital for his own good, after some gentle persuasion.

Be safe.

Wednesday, 14 January 2009

All in the head

Day shift: Four calls; one left at scene, three by ambulance.

Stats: 2 Head injuries (1 serious, 1 not so); 1 Purple plus; 1 EP fit

A smelly start to a shift, especially when the memory of breakfast is still in your taste buds, is not a pleasant way to begin the day and my first call was to a hostel in which I would enter a world of waste and toxins.

The crew was with me on this one – a 34 year-old man was reported to have ‘chest pain’ and was also ‘bleeding from his nose’ – a combination that made no sense. Only when we arrived on scene did we get further information from Control that he’d been seen by a crew the previous evening and he’d refused to go to hospital to the point of being aggressive. I honestly thought this would be a waste of time for us – even more so when we were told to wait for police attendance.

The very lovely hostel ‘nurse’ told me that he’d actually suffered a head injury and yellow or watery blood had been coming from his nose. We decided to go and see him before the police got on scene – his aggression may have been due to this head injury, caused, it would seem, by a fall.

We were led to his room and the stench of rot hit us well before we reached it. Inside was a rubbish tip of paper, cigarette packets, empty ‘White Lightning’ bottles and God only knows what else – it lay a few layers deep all over the floor and we almost had to climb over it all to get to him.

He was lying on his side on one of the grubbiest beds I’ve ever seen. At first he didn’t respond, then he spoke but only to dismiss us and say that he didn’t want any help. We could see that his eyes were both black and very swollen and we persuaded him to let us get near enough to carry out some obs.

I stepped onto his bed and made my way around the edge of his mattress – my boot soles were sticking to the surface in places. He had defecated in his clothing and the smell was overwhelming at times so an assessment of wind direction was required every now and then.

I could open his right eye but his left remained tightly shut – it was so badly inflamed that I wouldn’t be surprised to find he’d lost the use of it, temporarily or permanently. The damage to his head was so severe that it looked like he’d been used as a punch bag by someone; none of us could believe that a single fall had produced such injuries. His nose was clearly broken right across the bridge and he’d been bleeding from it earlier – red-stained tissues littered the place around him.

The man was so adamant that he didn’t want to go to hospital that the police, who’d arrived ten minutes after us, invoked section 136 of the Mental Health Act (a place of safety order) to take him forcibly. This is perfectly reasonable if there is the possibility of a threat to life. I couldn’t persuade him to come with us and when I gently lifted his arm to get him to sit up, he threw me off balance. The last thing I needed was a punch that early in the day…or to be lying on that mattress.

He was taken to hospital, still sticking to his story that he’d fallen and the medical team had just as much trouble with him as we did. I left as the doctor attempted to put in a needle in the drug addict's arm. 'You've no f**king chance!', he bellowed at her. He’ll be scanned for a possible skull fracture and bleeding into the brain – I’ll try to keep you posted.

The next call, to a 63 year-old man who was ‘beyond help’, took me to a familiar estate where the crew was just pulling up as I arrived. We went into a small flat which had been broken into by the tenant’s friend when he saw him lying still on the floor. We found the man dead and naked next to his mattress. He was a drug addict and he’d been complaining of feeling unwell for days apparently. Now he was stiff and purple and there was nothing we could do for him. The police were called and I left him to the crew.

When someone has an epileptic fit a paramedic will always be sent, even if that means taking one from another sector. I was sent miles away for a 32 year-old female who was reportedly having multiple fits. I arrived to find a FRU already on scene – he was an EMT, thus the need to send another car with a paramedic on board but he was surprised to see me. He was tending to a woman who was lying on the floor smiling. She was fitting and he was dealing with it. All he needed was an ambulance to convey his patient, so I left the house and told the crew what had happened when they appeared a few minutes later. They are considering allowing EMT's to administer rectal diazepam so that this kind of nonsense stops.

I drove all the way back to my own area and got sent to where I’d just been for another call – this time an 11 year-old boy had a head injury after falling. It took me ten minutes to find the address – I wasn’t lost, I was on scene and inside the estate block but the numbering was a nightmare and the place was a maze of corridors, stairs and ramps. To cap it all, every time I tried to get out of the internal parts of the estate, I found myself locked in by security gates. I was wandering around like an idiot. But I didn’t feel too bad for long because the crew arrived and they too were confused.

After asking several people in the estate, including a young girl who looked bewildered but whose door bore the number we were after, we got a solution.

‘Ambulance’ I said as she opened the door, quickly tying up her robe (I think she’d been in bed asleep...I think).

‘What for?’ she asked, looking at the three of us as if we were mad.

I asked her to confirm the address we were given and she explained that although her flat was the same number, it was in a different block, so we were re-directed to the other end of the building.

‘Can you tell me what to do about my sore throat?’ she asked as we walked off.

I shouted back an answer (gargle with aspirin, if you’re not asthmatic) and she seemed to think I was kidding.

‘No, really…what shall I do?’ her faint, pleading voice cried out from a distance.

Eventually we found the flat – it overlooked where we’d parked our vehicles – the caller could have helped us a little by guiding us in when we arrived.

Her boy was lying on the sofa sleeping. He refused to wake up and answer my colleague’s questions and he played it limp and dozy for a while. He had been sent back home from school with a note for his mother informing her that he’d bumped his head while playing football. The note instructed the mother to call a doctor (by default that’s a 999) if anything untoward worried her – like sleeping. The boy was very overweight and I reasoned that he normally slept a lot anyway (I know that seems cruel but there you have it).

It took five minutes to get this lad to play ball. We all knew he wasn’t suffering the effects of a head injury – he was playing up because his mum was there and an ambulance had been called. I wouldn’t say it here if I wasn’t absolutely sure. You can usually tell when a child is really ill or injured – especially after a head injury. In this case, once the game was up, he sat there chatting away with the crew.

'Do you want to go to hospital then?' they asked him.

'No', he replied.

'He's going', said his mum. So there it is...the reason adults call ambulances for everything - their mum's can't cope with uncertainty.

I left the crew to deal with it and made my way back to a couple of cancellations, including one in which I was taken nearer and nearer to an RTC, only to be cancelled three times. It's frustrating and dangerous.

Be safe.

Sunday, 11 January 2009

Two long days

Day shifts: 5 calls; one assisted-only, four by ambulance.

Stats: 1 eTOH; 1 Hypoglycaemic; 1DIB; 1 RTC with neck injury; 1 Fall with ? fracture.

Well, when there’s nothing much for me to do the shift seems to drag on forever. Over these two shifts I spent a lot of time managing vehicle swaps because of defects – moving equipment back and forth, washing and VDI’ing. There was also a weekend of protest going on in various places – the Israeli-Gaza conflict, if it can still be called that, has ignited emotions long suppressed by British Palestinians and Jews and although the embassy mini-riot took place out of my area, the Trafalgar Square demo was on my doorstep.

But my first day shift involved heading out to a 25 year-old man who’d fallen and hit a pole because he was too drunk to stand – gravity got the better of him and I didn’t deal with him – an ambulance was on scene. It also involved taking my regular car off the road when it developed a high pitched whining sound from the engine. The power dropped as I crossed the Euston Road (not the best place to slow down) on blue lights on my way to a diabetic man who was ‘not alert’. I could tell it was a transmission problem – the gears weren’t changing on cue and the engine was revving way too high to be healthy. Nevertheless I got on scene and dealt with the patient before I called the problem in. Luckily the diabetic man had recovered and all I had to do was take a couple of sets of obs and check that his BM was back to normal.

The man’s wife had called because he wasn’t making sense and his BM was 1.9, which is pretty low. She fed him cakes and sandwiches whilst waiting for my arrival. Good thing she did because it’s what he needed and it brought him back to normal very quickly. I told the crew I could deal with it when they appeared at the door ten minutes after me and they were happy to leave me to it.

The man’s insulin had recently been changed and now his BM was all over the place. He’d been managing his diabetes all his life and now, at the age of 50, he was struggling with it, often waking up in the night feeling hypo. I suggested he get back to his GP about it.

I got a handshake and a smile as I left (always warm and fuzzy) and went back to the car in the hope that switching off the engine had miraculously cured the problem. It hadn’t; the engine whined just as badly as before every time I used the accelerator, which is obviously a lot or I’d never get anywhere.

I wasn’t getting anywhere fast in any case – it felt like I was stuck in first gear. I could see the numbers scrolling on the digital panel in front of me – first, second, third, fourth…but the higher gears didn’t equate to the movement of the car. I tried not to look left or right in case people were wondering what the hell I was doing as the car screamed its way back to base.

I took it back to the workshop and the mechanic checked everything and told me I was a liar. Well, he didn’t say that but it was in his eyes. ‘The car’s fine’, he said.

I took it back out and it gave me trouble straight away. I had to turn around and go back for a second opinion. This time I invited the mechanic to test drive it himself. He did and he declared that I was right – the transmission was rubbish. The car would have to go back to the manufacturers for repair…or a funeral.

So I hunted for a replacement and discovered that our only spare car had been borrowed by another sector. I was given a lift to get it but when I got back to base, washed the muck from it, re-kitted it and prepared to start work again, I found a blown bulb on one of the rotating blue lights (yep, its an aging vehicle). So, a failed VDI and another off-the-road call to Control. I bet they thought I was playing games with them. It was now late afternoon and I’d gone on two calls, only one of which was creditable.

The RAC man appeared an hour later but couldn’t find the right bulb for it, so he offered to cannibalise the yellow lights on his van for me. By that time the next pilot had shown up for the start of his night shift and I had to explain everything that had gone on and why he faced the prospect of spending twelve hours working in a smaller, less tidy vehicle with an RAC light bulb fitted to it.

I went home and hoped the whole vehicle mess would be better in the morning.

Our second Zafira was back home when I got in the next day, so I did another vehicle swap, cleaned yet another car and went to work. Sorted.

A 43 year-old DIB patient was placed in the hands of the crew as I arrived, so I left them to it and waited a few hours at the station (and on area cover) before my next call to a RTC at a busy junction.

The car had swerved into a barrier – the front of it was crushed and mangled. Two people were in it and a SJA ambulance crew was on scene providing aid. A collar had been fitted to the driver but nobody was holding his neck still, so I asked one of the SJA bods to get in the back and do this for me while I looked in on the passenger, an elderly lady who seemed none the worse for wear.

The car had been travelling at less than 30mph when the driver got confused by his navigation system and tried to correct his turn. It was too late for him however and he travelled towards the pedestrians on the pavement, only to be stopped abruptly by the safety barrier. Nobody was hurt...except the driver, who complained of neck pain...thus the collar.

The crew arrived a few minutes after me and we set about extricating the man from his vehicle – it was a very tight fit because the car was so small and none of us wanted to call the LFB out to cut the roof off (it seems so dramatic), so the man was eventually taken out on a board via the back door of his little hatchback. More personnel had shown up; officers from the incident teams that had been deployed locally for the anti-war march and another LAS crew. They helped us to achieve our objectives – one man free of his damaged vehicle and one elderly lady safe and secure in the back of the SJA ambulance. Neither could speak good (or any, in the case of the lady) English but I managed to get an interpreter on the line from Language Line so that the Cantonese they spoke could be translated. So, all in all, a good job by the team I think. Unfortunately, the traffic chaos we left behind with the police meant that not everyone was impressed by our professionalism and skilled planning!

Before I went home I was sent to an alleyway behind a large museum to tend to a head injury sustained by a staff member who had fallen down stairs inside the building. I don’t know about you but museum buildings have always had a creepy kind of atmosphere for me – especially at night. It was getting dark now and I was driving well into the bowels of this mini-fortress. I wasn’t uncomfortable – that would be stupid – but I think my inner child remembered how I felt about these places when I was younger. I guess it’s the thought that so many dead things are in them. Old and dead.

The man was fine; he had a possible fractured cheek but he hadn’t lost consciousness and was alert and stable. The crew was on scene within five minutes and I was released into the wild again so that I could continue my trip homeward. I crept along the same dark and narrow alleyways I had come in through and not one mummified corpse attacked me. Not one.

Be safe.

Monday, 5 January 2009

New Year - same stuff

Night shift: Eight calls; one assisted-only, one by car; six by ambulance.

Stats: 1 ? drugs; 1 Chest pain (non cardiac); 1 Assault with facial injuries; 1 Cut wrist; 1 ? Pseudo chest pain; 1 ? Chest infection; 2 eTOH.

The economic climate will bite harder this year I think. I was told of a paper boy who was ‘made redundant’ from his round and given a £20 redundancy package, now that’s a telling tale if ever there was one. It seems nobody is safe.

Not long after my wheels started rolling I was on my way to an 18 year-old who had fainted at a bus stop. I got there and saw him verbally abusing the very people who were trying to help him. He saw me and slumped over the seats, for effect I guess. He wouldn’t communicate with me, preferring instead to loll around and roll his eyes. I’m pretty sure he’d taken something, with or without alcohol but I’m equally sure he didn’t need emergency care.

When the ambulance arrived I’d already walked him to the back seat of my car; it was too cold to stand around playing with him as he feigned unconsciousness. He lost the power of his legs however and when we transferred him to the ambulance he had to be carried.

A 28 year-old man with chest and back pain (there’s a lot of it about) was told by his GP that he probably had stress but he called 999 tonight because he had a ‘heavy heart’, so he went off for a second opinion.

Unprovoked attacks by maniacs can occur anywhere and to anyone but it probably doesn’t help if you are German. A 36 year-old was punched in the face three or four times by a man on a bus who just didn’t like him. He and his wife were minding their own business when the man launched at him as he left the bus. There were plenty of witnesses (a bus load in fact) and police were on scene in numbers when I arrived.

The man got away with a few bruises and a cut above his eye but he was badly shaken, as you would be after such a ferocious assault. I took him to hospital in the car; it was a two minute trip and no problem for me. Hopefully the man and his wife will visit the UK again and not consider the episode to be indicative of the behaviour of most of us. Even the English still get a bashing from the more ignorant Scots who just can’t let a three hundred year-old battle go.

Then a stupid 20 year-old Chinese man punched a café window in anger later in the night. He was of course drunk but he was also aggressive and unpleasant to the crew and police on scene. I arrived as the ambulance pulled up and watched as he was led to the vehicle to have a dressing put on his sliced wrist. The shattered remains of the window lay on the pavement and the owner of the premises stood in the doorway with a shocked look on her face.

The man’s injury was very deep and had bled a bit – he was very lucky not to have severed his radial artery when he chose to demonstrate his rage on an innocent window.

Last year I went to a call off the Marylebone Road, at a specific location for a man who’d called from a phone box to say he had chest pain. I remembered the call as I went back to that same place on a Red call for a man with 'chest pain and bleeding PR'. I recognised the name and the details gave a precise description of him. He’d had the time to go through this on the phone, even though he was supposed to be in agony. I always find that a bit suspect.

When I arrived the cynic in me took over and I asked him if he recognised me – he did. He lived in the south and he claimed he’d been to a concert with friends some distance from where he stood now. He had lots of bags with him but he wasn’t unkempt or unclean, so he probably didn’t live on the streets (no offence to those of you who do - the clean and tidy ones anyway). Neither was he drunk but his demeanour and the fact that this call had the exact MO of the one last year made me very suspicious of his motives for calling an ambulance.

The bus had brought him here, to a terminus, so he couldn’t go any further but it was nowhere near or in the direction of his home, so what exactly was he doing there? I stopped asking him questions about why and how because I could see he was becoming irritated by them. I think I needed to unravel this one because I’m sure he has a habit.

A 19 year-old girl was diagnosed with asthma by her GP, without a peak flow test or the use of a stethoscope, according to her family. She woke up with DIB but it didn’t look like an asthma attack to me, she was lying in bed hyperventilating, complaining of pain in her chest and back. She was genuine about her discomfort but something had been missed.

The first crew to arrive told me that their vehicle had died on them, so I waited for another ambulance as I carried out a second and third set of obs. Then the chair in which she sat as it was wheeled out to the not-dead vehicle got stuck in the smallest lift in history – it just wouldn’t fit until it was wedged in place against the back wall. Some calls take on a calamitous nature whether you like it or not.

In the small hours a man called claiming DIB, then hung up. I was sent to the address given to investigate and an update informed me that he’d been called back. This time he burped into the phone and hung up again. It sounded like a real emergency…

The crew arrived behind me at the address and I leaned on the buzzer, expecting a voice but got nothing. We all stepped back into the street to look up at the flats in the hope that a window would open or even be lit but it was all dark and quiet up there.

I called Control to request another ring-back. When the radio voice returned to me I was told to go to a different street entirely because now he was saying he’d been assaulted. Just how had he pulled that one off?

We trundled round to the alley given and found the police leaning over a tall thin man who was virtually crying in the unlit corner. Another patrol car had joined us just as we parked up. The man said he’d been hit, then changed his mind and said his drink had been spiked, then he said he was too cold. The only thing that was sure about him was that he was drunk.

We moved him to the ambulance and the crew settled him in with a vomit bowl and some inco pads, lest they have a nasty vehicle to clean later on. I chatted with the police outside and another man appeared out of the darkness and began to pull at the ambulance door. We asked him what he wanted (pretty much in unison) and he said ‘open the f**king ambulance door right now’.

I stopped him before he could break in and asked him who he was. ‘I’m his cousin and he’s going home with me’, he replied. He wasn’t nice about it.

I got in the back of the ambulance to let the crew know he was there and he tried to pull the door open again, this time with me holding onto it. I had to physically push him away from me. The police officers launched at him and all went quiet behind me.

When I got back out, a tall officer was telling him the rules about aggression and backchat, so now he was stepping back and offering his hands in prayer, apologising for his behaviour. He still wanted to take his drunken relative home but the crew had decided otherwise. Neither were they having him on board to keep the patient company, so he was sent away with instructions on how to become a good citizen. I doubt he'll absorb any of it.

I should point out that none of the apologies made by this man were intended for me or the crew but I didn’t feel hurt or offended, I know there are people out there who think we are just jumped up authoritarians. Maybe they should come out for a shift or two and see why we become what we appear to be.

The fiasco continued when another ambulance showed up for this call. Why this happened, I don’t know but they weren’t needed and neither was I, so we all departed after the dust had settled.

My first drunk on a bus (I think I shall dub them ‘DOBs’) of 2009 and it was a simple matter of hopping on, shaking him awake, (with some risk of assault) and then walking him off. He had been a little aggressive to start but I kept my distance and lowered my voice when he was conscious – that seemed to get me out of trouble. As I left, I saw him attempting to re-board the same bus. Probably for another nap.

Be safe.

Friday, 2 January 2009

Hi's and Lo's

Night shift: Six calls; one left in police care, five by ambulance.

Stats: 1 Hyperglycaemic; 1 Faint; 1 Hypothermia and eTOH; 1Chest pain (non cardiac); 1 eTOH; 1 # ribs.

It’s freezing out there.

I managed to get to the 17th floor of a tall building, courtesy of the guidance of two young girls who had been sent downstairs to wait for me, despite there being enough adults in the flat to do that. So I entered a place that seemed full of kids – they were crawling, running and generally being noisy. Four adults, only one of whom spoke any English, stood over a woman who had been fitting on and off. She’d had a seizure earlier when the first 999 call was made - then it stopped, so I was cancelled. Then she had another and I was sent again. I'd travelled twice the distance to get to the same place.

One of the girls – the oldest at about 12 – took charge of the proceedings and I had to translate everything via this child.

The woman on the sofa was floppy and unwilling to communicate. I was told she spoke no English, so I did all my obs, starting with a BM which I found to be high. My meter simply read ‘HI’ as if to prove the point.

The patient had been diagnosed as anaemic by her GP but she’d been generally unwell for a long time and as I stood waiting for the crew, almost falling over little kids around me, she had another fit. It lasted about a minute and it was clearly not epileptiform in nature. Later on I was able to confirm polydipsia and polyuria - both of which had been ignored for some reason when she saw her doctor - ignored or not queried. This woman was diabetic and was suffering the consequences of a possible misdiagnosis.

The crew arrived a few minutes after she’d recovered and we took her down to the ambulance, where I put fluids up. She had another seizure and then another on her way in to hospital. Astonishingly her English became clear and fluent when she was in between fits – I guess her friends and relatives were wrong.

She continued to have fits at hospital and I left the medical team to sort her out.

Treating a patient in a cramped theatre during a show is not ideal and I found myself squatting on the steps of the balcony trying to make sense of what had happened to a 58 year-old man who’d passed out. The call was given as chest pain but he vehemently denied ever saying that when I spoke to him. The conversation had to be whispered, which I found strange as this was supposed to be an emergency but the play unfolding on stage seemed to have a higher priority than the medical condition of one of the punters. Understandable because you don’t expect them to stop and light up the theatre for a conscious person. I suppose.

The man was unhappy to have his obs carried out – he seemed embarrassed and annoyed by the whole fuss. A first aider on scene was concerned about doing the right thing; he’d just passed his course apparently.

I walked the man out to a quieter area just as the crew came to take over and he was taken to the ambulance where his ECG confirmed my obs on his pulse rate; slow. He had a sinus bradycardia and a low BP, both of which would have caused his collapse but he needed to be checked out because there will be a reason for his slow heart rate. It took the crew a little while to persuade him to go – he wanted to get back to the play. ‘Oh, alright, let’s go then’ he said unhappily. His wife looked fed up.

I was flagged down by a man with a cigarette in his hand on my next call for a 37 year-old who was ‘hyperthermic’. I knew it was unlikely to be the right word, so I assumed it meant hypothermic, given the below-zero conditions outside.

‘He’s hypothermic and he needs to be warmed up’, the smoking man said with a very boozy breath as he leaned in through my slowly descending window.

‘How do you know that?’ I asked.

‘Well, I’m a paramedic’, the man said unconvincingly.

The patient was sitting outside a pub with a tall woman who I’m sure was a man (deep voice, manly features, long dress). He’d been told by the landlord to get lost and I think this was their way of ensuring he left the area.

Sure enough, the thermometer I popped into his ear read ‘LO’, so the smoking man was correct. The ambulance turned up and he was led to warmth and safety, as per recognised procedures.

Later on I set off on a call to a council CCTV control room – a veritable wall of screens – to help a 36 year-old man with chest pain. He apologised again and again for calling an ambulance because he had seen what we have to deal with on his monitors night after night.

His pain was pleuritic, not cardiac. He’d had a cough and chest infection for a while but still struggled into work, so now he was paying the price. He was a large affable man and he apologised all the way to the ambulance. In a world where timewasters and drunks don’t always deserve our attention, it’s very disarming to hear an apology, even when it comes from someone who has no need to say it.

A rude and abusive girl sat outside a night club after her friends were arrested for fighting and breaking a parked van’s window. The crew was on scene with me and we tried and tried to get sense out of her (the call had been given as asthma) but she refused to be nice. The police were also on scene and the officers looked tired of her. We left her there after establishing that she wasn’t a pleasant human being and that, forgive me if I'm wrong, is not a medical condition.

In the late early hours I was called to a 35 year-old man in a tiny hotel room (for which he probably paid a fortune, given that it was in the West End) who was complaining of severe rib pain and DIB as a result of turning over in bed. He had been diagnosed with three fractured ribs, one of which was unstable, after he was beaten up by a drug’s gang (by his own admission). He was pleasant and friendly, shaking my hand when I arrived and when I left him with the crew and bravely allowed me to feel for the offending rib during my exam.

His pain was real enough and he’d need to go to hospital and get his injuries re-assessed so he was taken by the crew and I made my way back to the quiet of my station for the last few minutes before the car was taken over by the next pilot.

Be safe.

Thursday, 1 January 2009

An end to the year

Day shift: Five calls; all by ambulance.

Stats: 1 AF; 1 Haematemesis; 1 ?TIA; 1 Flu.

Atrial Fibrillation (AF) is an arrhythmia that is perfectly survivable, especially with early treatment. I went to the aid of a 52 year-old female who’d recently been diagnosed and told that should her heart beat too fast for too long she was to call an ambulance.

She and her husband were visiting London from the north and were staying until the New Year celebrations finished, so obviously both were concerned about her new bout of tachycardia. We chatted about the condition for a while (there are so many people out there who don’t realise the heart has its own natural pacemaker) and I think it reassured her to know that I wasn’t overly concerned about her.

The crew arrived and she was taken away to hospital after a fairly normal ECG had been done (it was irregular but otherwise everything was in place). I’m sure she and her husband will enjoy New Year by the river.

A gang of Italians in an Italian restaurant met me at the top of the stairs leading into the kitchen and dining areas. A 67 year-old non-English speaking man was on the floor after vomiting blood. A translator was at hand and his wife stood anxiously in the doorway. The man on the floor was very pale but otherwise alert and in no pain. Coincidentally the vomited blood was kept in a little plastic cooking tub for me to inspect, courtesy of another Italian gentleman; an off-duty surgeon from Verona I think. They do that in Italy – medical people proudly announce the school from which they sprang – us Brits don’t like to lay claim to anything that might make us look big-headed.

The contents of the plastic container included something red indeed but it was mainly tomato sauce with various lumps mixed in. There was some blood there but not a lot. I disposed of the vile stuff down the toilet – there was no need for it to be left in a working kitchen.

The crew arrived and the man and his wife were taken to the ambulance shortly after my obs were completed. There was nothing amiss but his near-faint and blood-tinged vomit had to be investigated.

During a bridge tournament at a hotel one of the players became weak and faint. He hadn’t been playing well, despite being an accomplished ‘bridger’ and his game was off because of more than simple fatigue I suspect. He told me he’d been feeling unwell all day and that his mood had been ‘snappy and aggressive’ at times. He’d had a headache and very little concentration until the moment he felt like he was going to pass out – that’s when an ambulance was called for him.

The 62 year-old was sitting at a table among hundreds of people who were busily playing their games when I arrived. His friends tried to help and fussed around him but he clearly wasn’t in the mood. He’d recently been diagnosed and treated for prostate cancer but this new porblem had little to do with that he thought. His blood pressure was high and the events of the day strongly suggested he’d suffered a neurological insult; possibly a TIA.

The crew was on scene for a 43 year-old woman with ‘flu and a cough. I wasn’t required and I wondered why people still called us for these things after all that’s been said and publicised.

For some reason I was sent after the ambulance had left the station to a 68 year-old woman with pneumonia at a medical centre. Obviously by the time I arrived I wasn’t needed, so I did my paperwork and sloped off. After that the shift wound down with nothing new to report.

Be safe.