Tuesday, 24 February 2009

Calpol call

Night shift: Ten calls; one treated on scene; the rest by ambulance.

Stats: 1 Asthma; 1 Faint; 1 Drug withdrawal; 3 Chest pain; 2 High temperature; 1 Fall with facial injuries; 1 RTC with neck injury.

I’ve got five of these nights to do this time round and this one kicked off with a call to a GP surgery for a young female suffering exacerbated asthma. To be honest, this wasn’t a life-threatening emergency and she'd been left alone in a treatment room with a nebuliser on her face. The only reason the doctor wanted her to go to hospital was because nothing she’d tried was working.

Out of area again for a 50 year-old man who fainted more than once in a pub. Initially I thought I’d be dealing with a drunkard but, although he’d been drinking, he certainly wasn’t drunk. He’d passed out, got up, walked to the bar, fallen down again and then repeated the whole getting up and falling down thing again until his friend finally gave in and called an ambulance. He had high blood pressure and this wasn’t like him at all, so the crew took him aboard to check him out.

On Euston Road a 37 year-old man who’d taken Heroin earlier was developing withdrawal symptoms and so he needed an ambulance. He’d called from a call-box and I couldn’t locate him, even though he’d seen me go past, apparently. By the time I got on scene, so had the crew. I was a second-responder.

Teenagers with chest pain are unusual and so the call for a 16 year-old at a train station who’d collapsed clutching his chest seemed unlikely. When I arrived he was in the first aid room. He was a tall, thin but muscular lad and this gave me a clue to the possibility of a spontaneous pneumothorax but his breathing wasn’t affected. His ECG had tall ‘R’ waves but you can get that with tall, athletic people, so it meant nothing. Hypertrophy is a possibility too and he wouldn’t be exempt from that, so he was taken to hospital.

I didn’t have to do anything except give a little Calpol (a drug I don’t believe should be given to kids as if it’s a sweet). The 4 month-old baby had a high temperature but his mother thought he was having breathing problems. The heat in the flat was up was too high and even I was breaking out in a light sweat, so I suggested that this might be a factor.

I left her reassured and with the necessary paperwork because she couldn’t go to hospital anyway – she had three other children in the flat and only a 15 year-old to take care of them.

Birthdays are for celebrating…or falling flat on your face on concrete steps at a train station because you are so drunk that you could kill yourself by accident. This is what my next patient, a 20 year-old man, did as he made his way home with his drunken, rowdy mates.

I arrived with the crew and we found him in a heap at the bottom of the first flight. He’d fallen about 3 meters and had a nasty deep cut on his chin where he’d landed. He had also been unconscious, according to his mates and because he was drunk and the mechanism was serious enough, he was collared and scooped for his own good.

‘I’m alright, seriously’, he kept saying.

Later on in the night – the early hours in fact – I was called to a military barracks to attend to one of the police officers in the guard house. He had suddenly collapsed after feeling unwell all night. He was on the floor and looked quite unwell; pale, sweaty…you get the picture. He had been suffering with the ‘flu on and off and I think it had caught up with him. This wasn’t ‘Man-flu’, this was real enough, so I kept a breath’s distance because I can’t afford to catch it.

On my way back from that call I watched a police car fly past on blue lights and I received another call almost immediately after it had gone. I was heading the same way and I arrived at a RTC that had just happened. A man was sitting on the pavement, cradling his head. His car had been side-swiped at speed on a busy junction and the force had spun it around so that it was facing the wrong way and crushed into a barrier.

He complained of neck pain, so I spent the next ten minutes waiting for an ambulance, with my hands around his head to keep him still. Working solo, that’s just about all I can do in these situations until help arrives. He too was collared and scooped.

During these proceedings the cops attempted to breath-test him but he just wouldn’t blow into the thing properly (I don’t know if this was deliberate) and five tries later, they gave up and told him he’d be urine tested later. He may not have had a drink at all but if you wait long enough without a test your blood-alcohol level will eventually creep below the illegal drive limit. A few hours in hospital would do it.

Sometimes we are given location for calls that are completely incorrect and I found myself u-turning when the City police advised me that the hotel I was trying to find didn’t exist where I was sent. We went back down the road and the ambulance past on the other side – the crew was heading the wrong way too. It took a few minutes for us to sort ourselves out and it’s just as well because this was a chest pain call and the woman was sitting in the lobby…fortunately stable.

Another chest pain and an awkward place to have it. The driver of a large lorry slumped forward onto his steering wheel in agony and his colleagues called 999. I had to climb into the cab and gather info and obs across the passenger seat. He was a big man and seemed genuinely in pain. He had no cardiac history but he got the same treatment everyone does with this complaint – GTN and aspirin, until a crew turned up to help me. There was no way I was going to be able to get him down from there on my own, so a trolley bed was positioned underneath his door and he was lowered down but he slipped and almost ripped my arm off because I was holding onto him. He landed on the road quite hard but wasn’t hurt.

His ECG was very normal and that surprised all of us – he had all the classic signs of a heart attack going on. Even at the hospital the doctor remarked on how convinced he’d been that this was an M.I. – it just goes to show you…

I’m a bit annoyed now because I think I left my wrist BP cuff in the cab of that lorry. I’ll probably never see it again and it wasn’t cheap and it wasn’t the ambulance service’s either.

Be safe.

Saturday, 21 February 2009

Spring in the air

Day shift: Six calls; one assisted-only; the rest by ambulance.

Stats: 1 DIB; 1 Renal problem; 3 eTOH; 1 Unknown problem.

The DIB call was wasted on me and the crew was already on scene, so I made no patient contact. From now on I think I will just record those calls as NPCs to make things easier and less boring for you.

But the 73 year-old woman who had renal problems got some of my attention until a crew arrived. She was in her hotel room with two of her friends – all of whom had Ileostomies. Hers was constantly leaking into the collecting bag and this was worrying her; she was ultimately losing all her body’s water. She was taken to hospital to be checked out and I discovered that the coincidence of the room's multiple-Ileostomies existed because they were attending an annual Ileostomy conference.

A long trip out of area for an 85 year-old that had collapsed in a charity shop. The staff knew him well – he was a known drinker – thus the collapse. He seemed in good health otherwise but the crew took him away to be safe. His age and the public place in which he chose to slump were against him.

My next eTOH patient was a drunk on a bus (DOAB). He had been dragged to the floor by the passengers when he suddenly slumped forward on his seat. After that he made no commitment to consciousness and so when I got there I spent a long time trying to get him to wake up. The crew joined me and he was eventually man-handled into the ambulance for the very short trip to hospital. Ironically (or as planned I think), he had lost it just as the bus was pulling into the stop across the road from the A&E department. That’s the second time I’ve been called to this spot. I think its part of the game plan.

Up to the local police station next for another show of melodrama. This time a 28 year-old was feigning unconsciousness and he waited until the crew had officially arrived before he sat bolt upright on the cell floor declaring that he didn’t know what was going on. He declined to go to hospital at first and then changed his mind when he realised we were accepting his refusal. The sceptic in me thought ‘funny that…’

It was sunny today…almost spring-like and as I sat on stand-by for a while I watched the tourists go by (the weaker pound is reeling them in). Sitting on a chair across from me was a bleach-haired, leather-clad bearded man. He was chatting face-to-face with someone else who was also sitting in a chair. Above him, taped to the National Gallery lower wall, was a sign that read ‘Life advice’.

My last call of the day was amusing enough to send me home thinking I might have made a difference. A 54 year-old woman collapsed in a hostel, telling staff she felt dizzy. She was very drunk and I knew her from before, so she wanted to be friends. She was quite funny and I got frequent toothless grins and guffaws when I made what I reasoned were half-decent jokes (some of my colleagues would dispute this about my quipping but I stick to my guns).

In the end the only reason she’d been so dizzy was that she’d spent an hour in a hot room with a full length leather coat on. Even her booze-breath and strong Irish accent didn't make me feel like I'd wasted my time. I left her in the care of her friend and the hostel staff.

Be safe.

Friday, 20 February 2009


Two photo's with one thing in common that really annoys me...can you see what it is?

Day shift: Four calls; one sent packing by police; the rest by ambulance.

Stats: 1 Chest pain; 1 Unwell adult; 1 DIB and 1 eTOH timewaster.

The only call I want to highlight is the last one of the shift. He is a 30 year-old Polish man who pretended to be unconscious in the middle of a very busy street in rush hour. People became concerned and I was called to the scene.

I knew he wasn’t unconscious because we have ways of determining this straight away but he was very good at acting the part and refused to open his eyes or communicate with me for a long time as I knelt beside him being reasonable.

I’d done all the obs I could and found that everything was normal, so I considered using Narcan to eliminate the possibility of a drugs overdose. There wasn’t a hint of an ambulance – no distant siren – so I told the guy what I intended to do if he continued to insist that he was unconscious. He reacted a little by moving his arm towards me and I thought he might be trying to communicate something but it was all a bit random and meant nothing to me.

I’ve seen conditions which mimic ‘unconsciousness’ in that the person is unable to move, speak or do anything of significance to prove they are aware but in every case there was always a way to communicate, even if that meant using eyelid signals. This guy, however, was unconvincing and there was a definite smell of Possum about him…as well as alcohol and stale cigarettes. If this had been a Friday or Saturday night, I would have concerned myself less about the possibility of making a mistake and misdiagnosing what I saw but in the middle of the day, on a crowded street, I couldn’t summon up a reasonable doubt in my head for his behaviour. He was faking it and I knew it.

I didn’t get any further forward with Narcan because using it on him would have been a negligent act – clinically I could no longer support any argument for it because he had reacted to what I’d told him and it was getting clearer by the second that he was staging this, so I tried to reason with him again.

I spent a long time kneeling on that pavement and a hundred or so people must have gone past – a few of them had asked if I needed any help and I politely declined their offers. I got as far as the middle of my second set of obs when he began to feign a seizure; it was a frank and disgraceful insult to anyone who has ever really had one. His limbs stretched and flailed and he made hard contact with my chest and arms several times as I struggled to keep him where he was. I think he was trying to escape by rolling away down the road.

I called Control on my phone as soon as I got a breather and requested an ETA for the ambulance. I also asked for urgent assistance with this man because he started to thrash around once again and this time I couldn’t hang on. The police were requested for me.

Asking for urgent police is something we do with great caution. We are all too busy to be wasting each other’s time and all of us should be able to keep ourselves safe up to a point but the man was getting out of control and his behaviour threatened me, passers-by and himself. I hadn’t yet ascertained whether he had a weapon or not, so I wasn’t prepared to let it go on any longer. Usually I will bear with it until a crew comes to help me out but this time I knew that an ambulance wasn’t coming – it was that time of the day.

A passing man asked if I was okay as he watched me getting bundled to the ground after yet another hit to the chest, this time with feet and I thanked him and said I was okay. I must have looked comically like someone who was in denial. I know I should probably have let go and left him to it but there is always that singular nagging voice telling you this might turn out to be a head injury or epilepsy or something real and that walking away would look really bad to the general public. So I knelt my ground with him until another man approached and identified himself as an off-duty policeman. Now, that was someone I could use to help me.

Between us we held the man still as he continued his pretence and I explained what was going on to the officer. His wife stood nearby with a bemused smile on her face – I think they were out for a lovely day in London town and she probably regretted marrying a copper. He was useful though – a bigger man than me and able to stay calm, as it should be with these things – there’s no point in getting all flustered about it.

Within five minutes the familiar low-growl siren of an armed police unit could be heard and as the car pulled up, the ‘patient’ suddenly came alive. He got himself up instantly. He had recognised that siren and it had scared the life out of him. Now he was cured.

Two cops ran from the vehicle and pulled him towards a wall. They had seen his recovery and they knew what he had been doing because everyone has seen this before. We have a small population of East European men who go around pretending to be unconscious or ill so that they can get a lift to hospital where they will steal alcohol gel and anything else they fancy – that is a fact and it is an embarrassment to every hard working person from that part of the world who lives here. Scotsmen used to have a bad image down here; alcoholic and violent, they would embarrass the rest of us with their behaviour. That doesn’t happen much these days and, in any case, that problem was home-grown – this one is imported.

The man pretended he had no memory of what had happened and stood on the street with the police around him (two more units had arrived). He was told in no uncertain terms that his behaviour and an assault on us was intolerable – they threatened to arrest him for being drunk and disorderly but we all know how much paperwork and time that will waste with the end result being very little or no real punishment, so he was given a long lecture and sent on his way.
I get punched or kicked routinely – a lot of us do, especially in the West End, so we don’t press charges. Instead we fill in a form and it gets recorded (if we even bother to do that). In any case, it’s not the ‘accidental’ clubbing I took from him while he danced on the ground that bothers me, it’s the fact that he knows he can do this and will probably get a free trip to hospital. I wouldn’t feel so bitter about it all if he worked, earned his drink, paid his taxes and contributed somehow to our now fragile and economically unstable little island. That would be nice. Living in the UK is like living in a lovely house you’ve worked hard to pay for and having the extended family over for a visit only to find that they stay permanently, eat you out of house and home and frequently abuse your hospitality. And it’s all okay because we are allowed to go over to their houses and do the same. Emigration looks more and more attractive to me these days.

A Duty Officer arrived as the dust settled, so much as I appreciated the effort, I had already dealt with the incident, with the help of the police.

I took myself off home late and prepared for another very early start. Maybe the next shift wouldn’t be quite so dramatic.

Be safe.

Thursday, 19 February 2009


Day shift: Eight calls; one false alarm; one assisted-only and six by ambulance.

Stats: 1 Vomiting; 1 Chest pain; 1 Faint; 1 Anaphylaxis; 1 Near-faint; 1 Assault; 1 eTOH.

A church hostel called us for a 65 year-old alcoholic man who was vomiting. He was very sweaty and demonstrated his illness by running to the toilet, vomiting violently and then crawling out onto the floor where the crew found him after I’d completed my history and obs. He was probably sick because of his habit but he went to hospital because nothing can ever be ruled out.

I arrived at the scene of a 30 year-old man with chest pain at yet another church hostel just in time to see the crew pull up, so I left them to it.

A 33 year-old woman met me in the lobby of her plush apartment building – she had fainted and was stressed out through lack of sleep and the fact that her neighbour was noisy and had done nothing despite her complaints. It was a domestic issue really and not one that warranted a 999 call. Even she admitted that an ambulance was too much fuss because she was fine now. That was all too late and the crew took her to hospital to be on the safe side.

The false alarm was a call to a private dental surgery. The surgeon had accidentally severed through a patient’s nerve, causing a lot of bleeding. I think they were finding it difficult to control, so they called us. By the time I arrived, however, they had no need of me and the female patient was out cold on the operating table with a dentist leaning over her. I hope she gets a decent discount for the scare.

A 15 year-old with a nut allergy reacted badly in the street while out with her family. Her mum injected her with an Epipen but her condition didn’t improve a lot, so I gave her some Chlorphenamine IV and that seemed to do the trick, although I wasn’t wholly convinced that her condition was life-threatening at the start and I think her mum may have over-reacted with the adrenaline.

Up north to an office block next for a 28 year-old female who said she had a fast heart beat and felt faint. Her heart rate was normal and she didn’t look like she was about to pass out either. She’d been in and out of hospital for weeks with these episodes but nothing had been diagnosed because all her vital signs were normal by the time she got there. She was awaiting the results of a blood test however and that may solve the mystery for her.

A loud rap on my window interrupted my writing as I completed my paperwork and I turned to see a distressed looking female there. She told me that her ex-boyfriend had assaulted her twice and was following her around, threatening her. She asked me to call the police, which I did and I waited on scene to make sure she was safe, although I had no real plan of action if the bloke decided to run at us. I’d be done for assault myself if I tried to bundle her into the car because I was using the Astra and there’s no room for another human being in there, so she’d have bruised herself on all the equipment in the back.

We waited for almost half an hour until two police officers wandered up on foot – their car hadn’t started at the station so they’d made their way ‘manually’. I left them to it as the woman gave them a description.

A call to a street in which an ‘unconscious’ man lay became immediately suspicious because the details included ‘opposite pub’. When I got there the crew was arriving and not surprisingly, we found ourselves waking up a drunken Polish man who’d gone for a sleep. It took a while to convince him to leave the area but as he walked off he rounded the back of the ambulance and stood at the door waiting to be shown inside. I thought that was a real cheek but the attending paramedic opened the doors and let him in - he is obviously a kinder soul than I.

We have definitely reached a point where abuse of the service is not only systematic among our drunken European friends – it’s predictable.

Be safe.

Tuesday, 17 February 2009

Truck work

Day shift: Five calls; one assisted-only; one stand-by; one transfer; the others by ambulance.

Stats: 1 Unwell baby; 1 Hyperventilation; 2 Faints; 1 Cardiac arrest; 1 Chest pain; 1 Allergic reaction.

Not only do we have a society in which a diminutive teenager can get another teenager pregnant and have loads of cash-paid publicity as a result BUT we need a follow-on story for the publicity machine – enter one or two…or three other teenagers who claim to be the real father of the poor child. Not only that but the mother of the ‘father’ faces charges because she let him ‘bunk off’ school! We live in a gutter-level place where self-service is the order of the day and no matter how its done, fame (or infamy) is the only way forward for a lot of people. If you can’t get yourself on a daytime talk show in which some smug, know-it-all presenter exposes your flaws and ignorance while the equally smug audiences look on and shake their heads in judgment, then go out and get some fifteen year-old pregnant at as early an age as possible, thus ensuring shocked gasps from the right-minded masses and a boot-full of money from the gossiping tabloids.

I was more surprised at seeing the photographs of proud mum and dad with the newborn than I was at the story itself. Not only did this mean they truly didn’t understand the consequences of what they’d done but they were actively happy to have done it. And if other lads are lining up to claim DNA fatherhood of the baby, not only does this little boy become an understudy if he’s found not to be the true dad but the girl who had the child officially becomes a target for those who want to dub her a slut. What the hell are these parents thinking of?

In the middle of all this rubbish is a newborn and perfectly innocent child who will have to live the rest of its life under this spotlight. Unfortunately, if it grows up in the same environment I will not be surprised to see it appearing on celebrity Big Brother in the future. Unless of course it is beaten by a ten year-old who gets a twelve year-old pregnant in the next few years.

I worked on an ambulance with my son Allan today. It was the first time we had worked together professionally and I was very proud to be with him. He is a calm, well-mannered individual and his manner with patients is excellent.

Our first call was a transfer; a two week-old baby needed to be taken from one hospital to another for specialist treatment. It was an easy job and took less than an hour to complete.

Then off to an underground station on stand-by because two trains had become stuck in a tunnel and people were getting hot. It was rush-hour and so we watched as police and underground staff shepherded hundreds of commuters through the train and onto the station platform, where bottled water and our assistance was immediately available. We didn’t have to do anything to be honest; only one wobbly-legged man appeared and all he needed was support until he’d found his balance again. They’d been stuck for 30 minutes or less and that wouldn’t cause too many problems, so once the train had cleared and the other one had been sorted out at the far end of the line, we were stood down.

A panic-stricken hairdresser had her boss call an ambulance as she sat inside an office in the basement of her salon. She was hyperventilating and a CRU colleague was taking care of her when we arrived. It took almost an hour to settle her down and return her to work with the necessary forms but the crisis was over.

It took us much longer than it should have to find our next patient, a 50 year-old woman who’d fainted. We were in the wrong building completely but the address that had been given was correct. It wasn’t until another call was made that we were re-directed twenty minutes late, to the poor woman. Of course by that time, she’d more or less fully recovered, although she had a very bad cough and shouldn’t have been at work anyway.

We took her to hospital because she continued to feel weak and unwell but I suspect that had more to do with her chest infection than anything else.

A Red call for a male who was fitting turned out to be a misdiagnosis. When we got on scene we found the MRU paramedic starting CPR on a man on the floor of a small training room. People were mingling around as if nothing had happened but I think this was the silent, deep shock thing that occurs in such circumstances.

We got to work immediately and had everything in place; Defib, IV line, tube, drugs…everything, except a second crew. We needed more hands because this was an active resus and there were awkward stairs to climb (we were in a basement area). A stretcher couldn’t be used, so the chair was going to have to do and that makes things even more difficult.

A paramedic on a FRU appeared and that was all we were going to get, so we made do and he became a valuable extra bod. The patient remained PEA throughout and even though the AED threatened to shock a few times, it never did, so things were looking bleak.

We continued to work on the man all the way to hospital and efforts were carried on for a further twenty minutes or so before it was finally called by the team in Resus.

The man was giving a lecture and suddenly stopped talking mid-sentence. Then he collapsed and didn’t get up again. Nobody knew what was going on, by all accounts, so he was left there for a few seconds before anybody checked him out. No CPR was initiated because none of them felt confident enough.

If you are ever caught out like this, please press down on the chest if you can’t do anything else. At least try something. We can only do some good if you start the ball rolling and it might not be your kin but it is somebody's, right?

After that call we went back to our normal routine and the next one, for a 30 year-old who’d collapsed, typified that. She had recently gone through a still-birth pregnancy and was now unwell at work. She looked distressed and claimed to have high blood pressure but I think she was still getting over her loss. This is something I fully understand and have sympathy for – miscarriage and the death of your newborn can never be an easy burden for a woman and I hate the system that exists for them...very little or no support is offered.

It is unusual for a 28 year-old to have heart problems, so I was a bit doubtful about the call for a female of this age with chest pain. She was standing in the street with her friends and walked over to the ambulance when we pulled up. The Polish woman told us she’d had this problem before; chest tightness and a feeling of weakness but that it hadn’t been diagnosed, despite the fact that she’d been to hospital several times about it. The fact that it was happening again and again warranted further investigation. We checked her ECG and there were abnormalities – it was also irregular, so we got her to hospital where her condition was taken a bit more seriously than in the previous places she’d visited.

And finally, a short hop to a theatre for a young girl having a very mild allergic reaction to painkillers she’d taken. I didn’t even see a rash on her skin but, as Allan was attending, it would be up to him to qualify the problem. Off she went with us to hospital and the shift ended soon after that.

Be safe.

Sunday, 15 February 2009

To test out souls

Day shift: Five calls; all by ambulance.

Stats: 1 eTOH fall with head injury; 1 EP fit; 1 RTC with minor injuries; 2 Faints.

Sometimes we make judgments based on very little; it’s a human characteristic and I am much more careful these days about unilateral thinking, especially as I am naturally inclined to dislike anything that is disproportionate or done at the expense of others (even though I have been guilty of that myself). That’s why, despite saying I would, I decided not to record anything about my feelings on the Gaza conflict and why today I was reminded, yet again, that my opinion means nothing until I get the whole picture.

Jade Goody has never been my favourite ‘personality’, mainly because I believe she has none. She got her fame on the back of one of the worst television programmes ever thought up for the bored masses and she rose through to so-called stardom without having to do anything special at all. But she did have mass appeal, if you like that sort of thing and the recent publicity of her cancer diagnosis and its progression made me think that she wanted to be pitied in return for compensation, as if people were duty bound to learn about every detail of her agony.

I sympathised with every cancer sufferer in the world who didn’t get such attention and who died respectfully with their loved ones close by…or alone and broke. It wasn’t until now, when I learned that the coverage of her illness had boosted the number of women being screened for cervical cancer that I softened my attitude. She also said, through her publicist, that she wanted to make every penny she could for her children before she died and that, after some thought, made perfect sense to me. After all, what parent wouldn’t want that? She has no other talent, other than her name and face, so without the fees from newspaper and television articles, she would have nothing much to leave them – I guess even the money she has in the bank would soon dry up when she’s gone and the publicity machine would quickly forget the Goody family.

It’s interesting for me to realise that Jade may never have achieved anything more in her life than being another nonsense celebrity but that now, through terribly tragic circumstances, she will probably be responsible for saving a lot of women’s lives. Maybe her destiny was shaped like that.

All of this reflection on my part helps me to carry out my job in as neutral a way as possible and, apart from those blatantly wasteful and selfish people we deal with out there, the vast majority of our patients need a non-judgmental approach. Even with my dislike for what Jade stood for, I still wouldn’t have put her on the same level as some of the nasty people I have met in my career. I hope she makes enough money for her kids to live a decent life because, clearly, that’s all she wants. And I sincerely hope, as I would with every terminal patient, that she slips away in her sleep when the time comes.

Sunday is all about picking up the pieces of Saturday night and so off I went to a night club at chucking out time to help a crew with a gay punk man who had fallen and knocked himself out, due to alcohol. His equally gay-punk friends were there to help him and regardless of my initial apprehension about going near them (I used to dislike punks when I was a teenager but I didn’t know them, so I was wrong) I ventured in with the crew to assist.

These guys wore the biggest boots in the world, so they all towered above us (well, not the crew paramedic because he’s already over 6 feet tall in his socks), making the scene a bit sinister if you aren’t clued up on the culture. They were also the nicest bunch of people I’ve encountered for a while and cared no less for their friend and for the need for us to do our job than the best of the lot we get on a daily basis. I have to point out, before you go on the boil with me, that I have no phobia at all with gay people or punks…or gay-punks – I just never realised they existed in combination. That has everything to do with the image I’ve always had of them since they first appeared in the 1970’s and my ignorance of the whole scene, since I was far too soft to become one.

My first revelation of this group of people was the discovery that spitting at each other was regarded as a compliment, not an insult. In my post from a few years ago, ‘Spitting Punks’, I mentioned one who ran at the ambulance and gobbed deliberately at us as we passed by. I had to do a bit of research to learn what that was all about…until then I was most offended. I always believed that a gang of punks would tear your head off if they approached you. The frightening garb, hair and makeup give the wrong impression – they are good people…just a bit taller these days.

Prior to that call I’d wasted my time getting on scene behind an ambulance from the same station for a 30 year-old man who was having a panic attack. He got a Red status for his breathing and a CRU was already on scene dealing with him. It was a blue light circus for nothing more than hyperventilation.

A couple of miles out of my area and I was communicating with an elderly lady who’d fitted in a large store. She fell down in an aisle and had a 20-minute seizure, which was unusual for her, even though she was a known epileptic. She was still stiff (tonic) when I reached her and could only answer my questions with her eyes (once for yes, two for no). People were busily shopping around her and there was no respect or courtesy given to her dignity and privacy, so I asked the staff to close down the aisle – this is perfectly valid in case she has another fit.

The woman recovered rapidly on oxygen and attempted to stand up. She didn’t want to go to hospital, that was clear and when the crew arrived - she struggled with them as they tried to relax her and put her on the bed. We can’t force anyone to go to hospital, except in certain circumstances but I think she was eventually persuaded by her husband. Unforgivably, I was told that a selfish customer actually complained to the manager for the aisle closure. Some people.

A two-car RTC caused some road chaos and had an ambulance, MRU and myself on scene with the police to assist but nobody was badly hurt – one woman sat crying on the kerb and a child in the front seat of the second vehicle was talking to the crew. It was all under control and I headed back to the station when my paperwork was done.

It was a few hours before I got my next call for a 65 year-old man who had collapsed in a theatre. He had a pacemaker fitted and he told me that it had malfunctioned before, so it’s possible he was having difficulties with it again. He’d fainted and now looked very pale and sweaty. He was also a bit nauseous but held himself together well as the crew wheeled him to the ambulance for an ECG (which is not of great value because of the pacemaker). The device seemed to be working properly but he’d need to see an expert, so off he went.

I ended the shift at Marble Arch, where an Islamic march had ended and hundreds of people, dressed in traditional black attire, were gathered. A 70 year-old woman had collapsed and fainted but she was recovering now. The ambulance couldn’t get near her because nobody was willing to give way, so she had to be wheeled through the tightly-crowded mass with a police officer shouting for space at the front.

As the crew got on with their obs, I stood chatting to one of the cops and we both watched in horror as a man attempted to run his family, including small children, across the busy road. Cars were flying past and the little ones would never have made it in one piece. He did this right in front of the cop, which elicited an angry response from him of course. He ordered the man to stop and use the crossing and all he got for his concern was a deep glare. I remember a time when, if a police officer raised his voice, you did as you were told. It’s not as if there wasn’t a very good reason for it.

Be safe.

Saturday, 14 February 2009

Punch your Valentine

Day shift: Five calls; one assisted-only and four by ambulance.

Stats: 1 RTC with back injury; 1 Assault with eye injury; 1 Faint with chest pain; 1 Asthma attack; 1 RTC with pelvic injury.

Valentine’s day is supposed to be the most romantic day of the year and it certainly promotes the romantic inclinations of the drunken few, so the night was destined to be busy and I was glad I wasn’t working it. Instead I was out attending to a young female jogger who got hit by a car at a very busy and very dangerous part of town for traffic. I don’t know if she ran into the path of the vehicle or a red light was run but she was lying in the middle of the road, surrounded by police officers, blue lights and onlookers when I arrived.

She had put a good sized ‘bulls-eye’ in the windscreen and I found out that most of her back had done that, rather than her head, which is a good thing. She was very emotional and that didn’t surprise me. She cried as she lay there waiting to be collared when the crew arrived and it took us less than five minutes to get her off the ground and into the warmth and privacy of the ambulance.

Twenty minutes after arriving on scene, I skulked off with my MRU colleague for a coffee until the next call came in.

Any illusion of the day being romantic was quickly dispelled when I pulled up on scene for a 20 year-old woman who’d allegedly been assaulted by her husband. She had been punched in the face and the police were with them – he was in the police van and she was sitting in the back seat of their car with a baby in her arms. It was a minor facial injury and I would like to think that she’d be reconsidering the type of man she’d married but, as experience has shown, they will probably make up over a nice Valentine’s meal tonight whilst he awaits his court date.

On Trafalgar Square a couple of elderly men preached over a loudspeaker from the base of Nelson’s Column. I listened to them because nobody else was and hundreds of tourists clambered around the plinth where they sat talking about God, Jesus and all the usual stuff we never hear properly. I’m not particularly into this kind of bible-bashing but I did catch something that interested me – a quote from the bible in which Jesus had said something about Prophets being listened to anywhere except in their own country and among their own families (I’m sure one or two of you will know the exact quote – I forgot to write it down). This had me thinking because, whether you believe or not, Jesus had a lot of things to say that make prefect sense even now.

People with anything to say of relevance will find enemies among their own; it’s a given and that’s why we are so fragmented as a society. Some of you may have a talent that is overlooked by those close to you but admired and understood by strangers. Large companies and organisations have the same problem – many of them cannot see the value of the people who work for them, even though everybody else can. Governments pay more attention to the outside world than the very people who elected them.

I had a salient point to make but in the midst of time between then and writing this now, I have mislaid it somewhere in my memory that I no longer have access to – I’ve forgotten the password. I probably lost track of my thoughts when I watched a young girl clamber up onto one of the lions with a peace flag in her hand. She waved it around at everybody and nobody, then slipped off and crashed to the ground in a heap with the flag flapping around her face – that’ll learn ya! (as Mrs G would say).

A stoical 78 year-old woman who fainted at a museum just after experiencing chest pain told me that she had suffered a few ‘twinges’ before but had ignored them. She wasn’t much for making a fuss, you see.

She lay on the first aid couch, pain-free and recovering from her collapse while I carried out a full set of obs and found nothing untoward. Her ECG could have been taken from a teenager and so, despite the strongest advice, she declined to go to hospital and decided to continue her day out with a friend to look after her.

A call to the underground next, for an asthmatic female who, on close inspection, didn’t appear to be having too much trouble breathing at all. Her sats were high and she was capable of speaking in full sentences but I continued down the route I must take if there is any chance of a clinical condition being present. Obviously I couldn’t hear her lung sounds because the tube traffic was relentless and noisy. With the help of the crew she was able to walk up the escalators and into the ambulance.

The shift ended with another RTC in which a motorcyclist was removed from his ride by a naughty car driver who’d stopped dead in the middle of a very busy lane just as Mr. M/C ran up behind him at 30mph or more. The damage to his fuel tank was severe, indicating that his lower parts had made significant contact with it as he flew from the bike onto the road. I found him lying there with police around him and I began to do what’s necessary – C-spine control.

Only after a few seconds did I realise there was another person on the road – he was lying flat on his face as if dead and I asked the cops around me who he was. ‘We think he was the passenger’, one of them told me. The second helmet on the road confirmed this and I left one police officer in charge of the first patient, who was conscious but in pain, to attend to the second one – just in case he was dead…or dying.

Thankfully, the second man was conscious and seemingly unhurt, although he was instructed to stay still until I assessed my first patient properly.

I spent a few minutes with the bike rider until a crew arrived and I asked them to split tasks between one patient and the other. The rider was collared and scooped whilst the passenger remained where he was during a secondary survey but as we were now tied up with the rider, who had a suspected fractured pubis symphysis, it wasn’t until the second ambulance arrived some minutes later that I was able to get back to him. During that time, he lay there like a drunk man, drumming his fingers as if bored (he probably was).

I sat the passenger up once I was sure that there was no need to worry about him (he hadn’t been propelled through the air like his mate) and he was taken off to ambulance number two.

The bike rider was blued into hospital and his passenger was trundled in behind him - as I left the scene the police asked me if I could check the driver of the car that had been rear-ended. I’d forgotten about him to be honest; I had my hands full. I looked at the small bruise on his head and advised him that I would arrange for another vehicle to come and collect him (I had to travel with the biker). I checked back later and was told that a FRU had arrived to an empty scene – even the police had gone. I guess he wasn’t too badly hurt then.

I hope you all had a happy Valentine’s day.

Be safe.

Monday, 9 February 2009


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

Stats: 1 Faint; 1 Near-faint; 1 RTC with arm injury.

So, my night shifts were interrupted so that I could attend court – I wasn’t upset about this at all!

I waited for over an hour before being called as a witness for the Coroner and I was ‘on stage’ for less than ten minutes giving my evidence. It was strange to hear the entire life story of a person I’d seen dead the first and only time I’d encountered them. More often than not we get very little detail about the human being whose body we are resuscitating or calling time on. It defuses the emotion you’d feel; the sadness of knowing the person as a living being, not as a corpse. In that respect not knowing their history is probably for the best.

By the time I got back to my station, the afternoon was upon us and I took the car out for a mere three-call shift, which was fine because the weather wasn’t (fine, that is). It poured freezing rain relentlessly.

My first call was to a female who’d fainted inside the reception area of a school. She was one of the parents and had been complaining of abdominal pain for a while before she passed out, according to the staff on scene.

I crawled to a halt outside the place as kids and parents were pouring out (great timing) and I had to wait until a stupid woman with her small children, including one in a pram, got out of my way. She was in the middle of the road with not a care about the traffic…or me and my blue-lights. I bet she’d be the first to shout at anyone driving too fast or too close to her precious cargo – it’s a shame her horse was higher than the pavement she should have been using because I would have spent time chatting to her about the stupidity of her actions.

Inside the school, little kids were bustling past with parents dragging behind and the patient lay in the recovery position, looking, for the world, like she was unconscious, as I attempted to get a story above the din.

The woman’s eyelids were fluttering and I asked her to open them because I knew she could. The crew arrived as I was getting a name and some details from her, so I asked for a chair to make life easier and she was taken out to the ambulance where it was child-free. Her own kid, incidentally, had been taken home by a neighbour.

I caught the obs and decided to leave the crew alone. She wasn’t in trouble and her faint had probably never been an actual event (more likely a near-faint), so I made my way back to the station, from where I launched myself for the rest of the day, given the unpleasant weather.

RTC’s are the last type of call you want to get on a day like this. Your uniform is going to get soaked and you’ll spend the rest of the shift damp and cold, unless Control allow you to change it and even then, how many trouser-changes are you going to get if the day turns out to be a RTC frenzy?

This one, thank goodness, for a 47 year-old male with a minor arm injury, required only an ambulance crew and there was one already on scene when I turned up. The man had been clipped by the car’s wing mirror and had been bruised as a result – no big deal. The hospital was a spit away, so I expect the crew simply walked him over to A&E. I wonder why he didn’t try that himself?

My last call of the day was to a 36 year-old who’d almost fainted at work and whose request not to have an ambulance called was ignored. When I got to her, she was sitting on her chair in an open plan office, smiling and looking sheepish about the whole thing. Thank God, she must have thought, only one yellow jacket. Unfortunately, she was in for a treat because I knew the crew had arrived on scene a few seconds behind me and were probably on their way up.

She told me that she had swooned off her chair after hearing the gory details of her friend’s recently fractured leg over the phone. I thought this was quite funny. She said that this was normal for her; she always faints or nearly faints when she sees or hears unpleasant things. I had two thoughts at this point: why did she listen to the gory details if she knew she’d pass out? And how long would she last in the ambulance service?

She was a nice person with a sense of humour about the whole thing - being in an open-plan space, there were plenty of people watching and I think she felt a little self-conscious. I didn’t, therefore, point out the fact that across the mezzanine, through large glass-windowed offices full of men in suits, an even bigger audience was considering buying tickets. I’ve never seen so many full-grown adults with better things to do, gawping at the possibility of something serious happening. Oh no, wait…yes I have…every weekend in Leicester Square.

Be safe.

Sunday, 8 February 2009


Night shift: Eight calls; two false alarms; two assisted-only and four by ambulance.

Stats: 3 eTOH; 1 Chest pain; 1 Asthma; 1 Anxiety attack

It’s still cold enough to make you wonder why people go out and get drunk when all they have to look forward to is a slow, frozen journey home…if they make it home at all.

My colleague was two hours late for the shift changeover because he was tied up on a call in which a 13 year-old boy drowned in a canal. I used the time I had by delivering a vehicle to a crew and then got stuck on the way back when they received a call for a pregnant woman who simply walked out into the LAS taxi she’d demanded.

I got back and took over the car later and my first call was to a 25 year-old who was ‘unconscious’ outside a club. She was drunk, of course and no more unconscious than me but she had to go to hospital because she wasn’t fit to walk. Her annoying, fag-smoking friend kept yelling out for her as the crew tried to do their job and I had to usher her away from the back of the vehicle. The police were on hand to remind her that she wasn’t – definitely wasn’t – going with her mate to hospital in the ambulance. There’s nothing more irritating and potentially dangerous than carrying a full cargo of drunken people.

The chest pain call was for a 43 year-old man with no cardiac history and a recent chest infection. His pain came on only when he breathed, so it was unlikely to be related to his heart. He felt as cold as ice, even though his bed-sit was relatively warm but his core temperature was normal. I suspect he’d been outside too long.

The next drunken patient of the night fell asleep at an underground station, prompting a Red3 call for an ‘unconscious’ person. Try to remember that, according to our computer system, that patient is more important than you if you have broken an arm. The crew was ahead of me and woke him up. He left the scene and I was advised not to bother. So I didn’t.

Two false alarms; the first of which was to a 17 year-old who was ‘fitting’. I was cancelled on an earlier call for this as it was a higher priority. The trouble was that she wasn’t fitting, nor had she ever been fitting. Apparently – and this was from the patient’s relatives – they had been advised to let an ambulance come to her even though they’d said they didn’t need one.

The girl was lying across her bed when I got there with the crew. She had been out with friends and had suffered a mild panic attack which included shaking. This movement had been blown way out of proportion when the call was taken and so an emergency response kicked in. Meanwhile, the call I’d been cancelled on (palpitations) was probably still waiting for attention miles away. I hope I’m never in an accident on the way to one of these spurious calls. I do not want to be injured or killed on duty because some over-zealous person pressed the panic button for a call like this.

The next false alarm was a RTC involving a car and a pedestrian. The car had hit this person deliberately, allegedly, then an argument broke out between the driver and the victim. The police had removed one of them from the scene to their station and when I turned up it had all blown over with nobody actually hurt.

A regular caller made his way into a hotel lobby and announced that he was having an asthma attack. He does this every time and is in and out of hospital on an almost weekly basis. He’s so well known to us all that we nod and say hello to him whenever we see him out and about. Soon enough we’ll be swapping Christmas cards.

His condition was stable but he tried hard to push a wheeze or two through his windpipe to convince me that all was not well with him. It didn’t matter because he was going to hospital – he always goes to hospital. That said, he demonstrated his understanding of our willingness to comply by specifying which A&E unit he’d prefer to visit.

Another drunken female was being propped up outside a club by one of the security people. A nearby woman waved her cigarette in my face and generally got in the way. She’d obstructed the car on the way by blocking my path as I tried to park in the tight little street. I let her know I wasn’t pleased with her behaviour and she swore at me to let me know she didn’t care.

The drunken girl was completely out of it and had vomited a few times on the pavement. Nobody was with her initially and when the crew arrived she was lifted onto the trolley bed with no-one to worry about her. She woke up and became startled by what was happening, as if oblivious to her state and the reason we had been called.

Then, as if by magic, people started to appear around us with concerned faces and claims of knowing her. One of them pulled open the back door as she was being treated and I had to push him back from the vehicle as he tried to get in. ‘Read the sign’, I told him, ‘knock and wait’. I closed the door and a second later, there was a knock. I asked for that really, didn't I?

The cigarette-smoking rude girl eventually calmed and apologised. ‘I know you hate me’, she said, ‘but I was the one who found her’.‘I don’t hate anyone’, I replied, ‘I just don’t like being treated rudely when I’m trying to help someone’. I think she understood. We were best mates now. Another Christmas card on the way I expect.

I spent my rest break at the station and an hour or so after I’d put my feet up a call came in for a patient having a panic attack in the flats across the road. I definitely met ORCON with that one – it took me ten seconds to get on scene. I could have walked but the law of Sod would probably have given me a cardiac arrest to deal with and no kit to my name.

The woman was in her toilet and was very edgy. She had psychiatric problems that were ongoing and depression was one of them. I sat and spoke with her for a while as she calmed down and then the crew arrived to help me talk her back to reality. Her husband lay in bed sleeping – he’d lived with this for so long that he didn’t get up til later when we were taking her to the ambulance for a long chat and more obs.

The lady remembered me from a call I attended at the same building a few years ago and even more surprisingly, to me anyway, she still knew my name.

She was very nice but very scared and it took a good hour to settle her and convince her that she could go back home with her husband and sleep. We all got a thank-you kiss on the cheek. I think that’s allowed.

Be safe.

Saturday, 7 February 2009

Too cold for work

Night shift: Six calls; one sent packing; one assisted-only and four by ambulance.

Stats: 1 Chest pain; 1 Abdominal pain; 1 EP fit; 1 RTS with shoulder injury; 2 eTOH.

Back on the dark ones and its freezing out there, so I was hoping for as many ‘inside’ jobs as possible but Friday night being what it is, that was going to be unlikely. I only have two to do instead of my usual four because I’m a Coroner’s Court witness next week and so I’ve been stood down for that.

A 51 year-old Albanian man suffering chest pain decided to do nothing about it when he first experienced it last week. He continued to suffer the pain for almost three hours tonight again before his worried family called an ambulance. He wasn’t the type to make a fuss, they said.

He took a paracetamol but it didn’t help, so now he was getting GTN and an aspirin, courtesy of the NHS before being taken into the ambulance for an ECG when the crew arrived. His Q-T intervals were prolonged and that can mean something or nothing, since a small percentage of us have the anomaly without necessarily suffering any ill-effects. I would also have expected him to feel faint if this was his problem. There was no ST elevation to indicate a heart attack but, again, who knows until a thorough check has been done, so off he went.

DIB for an abdominal pain next and the 42 year-old Indian lady, who spoke no English and had to have everything I said (and she said) translated by a younger member of the family, stood in her bedroom clutching the offending belly part. She had no DIB and had never had DIB but when asked on the phone, the 999 caller is bound to say YES to the question and so it goes red.

She had a history of ulcer and that was probably causing her more misery now and yes, ulcers can be life-threatening, so yes, she went to hospital.

Unconsciousness cannot be faked by amateur street drunkards and so I asked the 23 year-old fool lying in the street to sit up because I knew he was pretending. The police were on scene and the two officers had been trying to get him to respond ever since he was seen lying there by a passing driver who called 999. A couple of his mates were there too but I don’t know how long this little charade had been going on.

It took me 30 seconds to convince him that the game was up and as he fluttered to life, the cops gave him an ear-bashing. ‘Sit up or you’ll be arrested for wasting police time’, the taller officer said.

‘You can’t nick me’, said the moaning man as he sat upright.

‘You want a bet sunshine?’ the cop replied.

I like it when police officers adopt a no-nonsense approach; it reminds me that there are still disciplines between people that can be reinforced. Of course, a 'right-minded' person would probably think it unprofessional for a cop to shout at someone like that, but I don't. I think its necessary and effective.

This prompted the young drunk to request the officer's shoulder number so that he could make a complaint. A complaint about what exactly, I don’t know but me, the cops and the crew that had just arrived for nothing, were very cold and not in the mood for this tonight. His parents may have taught him that 'they can't touch you' and so he has lived his life like an ill-behaved child as a result BUT he wasn't spending any more of my hard-earned tax money and that was that.

He saw sense and walked off with his friends, who must have been more than a little embarrassed by his behaviour.

Immediately after that call, when I pressed the green button on my screen, I got another one. I was going a short distance south and when I arrived on scene I was windmilled to a spot on the pavement where an 18 year-old lad was fitting violently. He’d managed to call his friend out to help him on his mobile phone and was still clutching it as he writhed and jerked on the pavement. It took most of my strength to keep his head off the ground – he would have bashed it open otherwise.

Although he was seemingly fitting, he could talk every now and then and could answer questions with a nod and by the time he was taken into the ambulance, his behaviour had become very odd. Now, he may well have been having a partial-seizure – his legs and arms were certainly busy all the time or he could have taken something earlier.

I asked his now growing gang of friends (they were all arriving at the back doors of the ambulance) if he took drugs and they all, to a man, denied that he did. I believed them because they didn’t hesitate and they looked genuinely concerned for him.

The crew fought to get a line in as he flapped about on the stretcher but eventually it was done. He was blued in, still convulsing and with no explanation for it – he had absolutely no medical conditions as far as we could ascertain from him (when he spoke) and his friends (who never stopped).

On the way back to the station I was asked to assist an EMT who was attending a 30 year-old woman who’d been knocked off her bike by a car, which had then sped off, leaving her lying in the road with a shoulder injury. I was told that she needed stronger pain relief than entonox and I went there to give her morphine.

The woman was sitting in my colleague’s FRU, screaming in pain. Her shoulder had either been fractured, dislocated or both…probably both and she was 10 out of 10 for pain. I prepared her for the morphine as she sat in the car and when the ambulance crew arrived, they helped me to complete my task. Again, there were a few friends hanging about – all girls and all cyclists who’d been with her when she was hit.

After a long battle to calm her and relieve her pain, she was taken to hospital with 10mg of the good stuff in her system. She was actually quite chirpy when she arrived at A&E, so it must have been effective. Her constant sucking on the entonox mouthpiece may also have contributed. I think she emptied the cylinder. By the time I left she and her mate, who'd travelled with her, were eyeing up the young men in the department.

Whilst in hospital a ‘blue call’ was received and in came a young man who’d been involved in a fight. He was taken straight to Resus with a deeply cut throat. I went in to see him (being nosey as we all are) and I couldn’t believe how lucky he’d been – his throat had been opened all the way around almost to the back of his head. Someone had used a broken bottle or glass to do it. He also had a head injury which, my colleagues reliably tell me, bled more than the potentially fatal neck wound. The slash had missed all of the vital structures, including his carotid artery, which could be clearly seen through the gaping hole.

I honestly think someone had tried to behead this man. No amount of alcohol or aggression is worth it. Now someone out there may be charged with attempted murder but he will more than likely be done for ABH or less, such is our legal system and the difficulties of proof. To my mind an act so violent as to almost kill someone, regardless of whether it is planned or not, should be sentenced accordingly.

A DOAB at 4.30am when all was just getting quiet and all I had to do was wake him up. He was unsteady on his feet and completely lost, so I directed him to the nearest bus stop. ‘I don’t want to sleep, I just want to go home’, he bleated as I held him still on the pavement. Don’t we all, I thought.

Luckily he didn’t fall down and managed to stagger off in time-honoured fashion.

Be safe.

Tuesday, 3 February 2009


These boots are made for gripping...

Day shift: Eight calls; all by ambulance.

Stats: 2 Faint; 1 Chest pain; 1 Hypoglycaemic; 1 Asthma attack; 1 EP fit; 1 RTC with Spinal injury; 1 Hypothermia.

Back to normal and I use slush to describe the weather as well as the working calls – not with disrespect of course but as the best descriptive comparison of the last two shifts. With snow, you know what you are getting but slush is a mixture of all kinds of stuff...including contaminants and rubbish.

The snow covers were removed from my car and I slid about a bit but not so much that I couldn’t keep control under 30mph on those icy side streets that still hadn’t been touched by grit or salt.

The fainters are back on line. The first call I received was for a 27 year-old who’d almost passed out in his University Halls of Residence. He’d also claimed chest pain but this was easing as his emotional state relaxed. As I approached the rooms where he lived I noticed various signs that were posted on the walls. One of them pointed in the direction I was heading. It read ‘rubbish’. I hadn’t made a personal judgement yet but I had to smile at the irony of it.

The second call of the morning was also a faint but a crew was on scene for the 20 year-old female who’d passed out in an underground station.

Another chest pain call for a young person turned out to be a bit more interesting than usual. The 24 year-old woman suffered from Wolfe-Parkinson-White Syndrome. She had palpitations and was breathless as she lay on the floor of her boyfriend’s room (again in a Halls of Residence). This condition can quickly convert to a life-threatening VF if not treated but that only happens in rare cases (less than 1%), although at her age she was at higher risk, so it was all taken seriously.

She’d had an ablation treatment for it a few months ago and had seemed fine until today. Her ECG had all the expected waves and forms and there was no evidence of a new problem (no shortened P-R or Delta waves, for those of you inclined to care for the technical stuff) but it would be down to a cardiologist to determine that, so off she went to hospital and straight into Resus.

I felt sorry for her; she’s too young for that kind of problem and it may or may not resolve itself in later life. I could only hope that the former was true in her case.

A 51 year-old lady fell out of her bed and I was sent to her on an assist-only mission. She was a large woman with MS and weakness of the legs as a result. This made my valiant attempt at lifting her on my own rather useless, so I requested another FRU to help me. At this point an ambulance wasn’t really necessary and she wasn’t interested in going to hospital but when I checked her BM as part of my basic obs, I found it to be very low (2.2). I tested her again because she wasn’t diabetic and had no other issues apart from a recurring UTI. The reading was still low. I had to change my mind about the ambulance. Either my properly-calibrated meter was faulty or there was a new problem that needed checking.

When the crew arrived the woman was munching on a chocolate biscuit that I’d given her from her personal stash in the kitchen. I noticed that she also had tubs of sweets and chocolate bars at her bedside. She was obviously a sweetie monster, as we say in the Homeland. I can be one too, I must admit.

This in itself did not make her a candidate for hypoglycaemia because with a high intake of sugar I’d expect to see the opposite if she was developing diabetes but her condition was clearly serious, if taken on face value, and a trip to hospital was now required to sort it out, one way or the other.

Before leaving her flat, I carried out another BM test using my colleague’s meter and the reading was normal (4.4), so there could have been a problem with mine or giving her the biscuit may have been a mistake as it may have skewed the reading, although I’m sure one biscuit wouldn’t cause her glucose level to rise by so much so quickly (within ten minutes of the second check). I was torn between allowing her blood glucose to remain low, thus disallowing any aberrant influence and treating her condition. Clinically, I had to treat her, so the biscuit was given. Oh and the finger I tested on had been cleaned prior to lancing (just in case you leap to any conclusions).

Asthma and hyperventilation can sometimes go hand-in-hand and sorting one out from the other is usually clear-cut but my next patient, a 25 year-old asthmatic who was at work when she suffered an attack, had me making a choice for the benefit of the patient. She was obviously upset and there was a slight wheeze in her chest but I wasn’t entirely convinced that she was having a full-blown attack. Nevertheless, I gave her Salbutamol by nebuliser as a substitute for her non-effective inhaler and this took care of the wheeze and calmed her down. I have seen the psychological effect of this drug many times before and would never advocate its use in an absolutely clear case of over-breathing but there is sometimes a fine line and, again, a clinical decision has to be made on the spot. Peak flow and sats help to make that a simpler task.

The epileptic fit call was to an 18 year-old girl who had a witnessed 2-3 minute seizure at an underground station. A South African paramedic gave me a sterling handover and then promptly disappeared, which is the done thing, when I took over.

The young girl was recovering but told me that she often had more than one fit, so as soon as the crew arrived, she was taken on board. She’d also hurt her ankle, most likely during her fall to the floor, which was seen by one of the station staff members.

I asked her what she did for a living because she'd mentioned going into work tonight. In the din of the station my ears heard her say 'restaurant' and I assumed she was a waitress, being so young, so I said 'you'll be on your feet a lot then', referring to the association between her job and her injured ankle.

I got a peculiar look - nothing more than a bemused glance from her. It was only later, when I asked her to confirm what she did for a living that I realised what I'd done. She worked for an escort agency...

My next call took me back to a road junction I had been to a few days earlier. I'd helped a motorcyclist who'd been knocked off his bike at the exact spot where a man now lay on his back in the filthy slush. He'd been seen to stagger or slip backwards into the road and his head hit a van as it drove past. The van driver didn't know what had happened so continued and disappeared, according to a taxi driver who'd witnessed the whole thing. Now the man was concussed and complaining of severe neck pain; even the slightest touch set him off.

As usual in this area, there was a lot of traffic moving past. I am particularly careful in this area because the vehicles get very close. Once again I found myself on my knees in the middle of the road, holding someone's neck still until backup arrived.

I'd asked for the police but a Camden Guardian was helping out with the traffic for me until they arrived. In the meantime, I spent fifteen minutes with the man, unable to do much else but monitor him until a crew pulled up. By the time he was moved into the ambulance, he had become very cold, despite the blanket I'd put over him. Most of the cold you will feel when lying on the ground will be from below.

I was on scene for an hour and accompanied the ambulance to the hospital, where I sat inside my car doing the necessary paperwork. That's when I was approached by two women who told me that someone had collapsed around the corner and that an ambulance had just gone past him. They thought the crew may not have seen him, so could I do something to help.

I called it in and offered to go and check it out. This would be my last call of the shift.

Around the corner a man was leaning against a railing and swinging his arm in and out as if punching the air. He was fairly young and looked out of his head. A newspaper vendor had called us because she'd been watching him behave bizarrely for the past half hour.

I went up to the man and spoke but he didn't communicate. Instead he swung his arm out towards me several times. At first I thought he was being deliberate but the more he did this, the more convinced I was that it was a repetitive action. He may have taken drugs or there may be another reason for his behaviour.

I waited for five minutes, attempting to get him to speak but his railing-clinging, arm-swinging continued without rest or interruption.

When the crew arrived (three of them - a paramedic and two trainees), we managed to get him into the ambulance and when I jumped aboard a few minutes later he was sitting up and talking. It was a miraculous change in his demeanour but he still wasn't quite right.

'Can I go now', he said, moving towards me at the door.

There was no way to stop him. Our duty of care doesn't extend to the forceful restraint of a person who wants to be left alone but he wasn't 100% and we watched him as he staggered down the road, at one point stalling in the middle of the pavement like a short-circuited robot.

None of us believed he was drunk but drugs were still a possibility. It wasn't until he collapsed in a doorway and became unconscious that we discovered what might be wrong. The crew took the opportunity of getting obs while he was sparked out. I had called the police because we needed to get him into hospital for his own good and while we waited for them, I was told that his temperature was reading below 30 degrees Celsius. In fact, I recall the number 28.7 or thereabouts being used.

Severe hypothermia can bring about odd behaviour, unconsciousness and death. It all fitted with what had been happening and I found it unbelievable that someone like that had become so cold. He may have been on the streets but he didn't look like he was (which is generalising but they do have a certain distinction).

When the police arrived, he was off again and wandering down a busy street, the crew on his tail trying to persuade him to get into the warm. The police officers had to struggle with him when he became aggressive on seeing them. He was eventually cuffed and brought back to the ambulance.

It's all a bit brutal, I know, because the poor man had done nothing illegal but leaving him to wander the streets until he finally died was not an option for any of us.

Be safe.

Monday, 2 February 2009


All snowed-in with nowhere to go.

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

Stats: 1 Cardiac arrest; 2 EP fits; 1 Febrile convulsion.
The phrase ‘extreme weather event’ had been used by the media to describe what was coming but still we were ill-prepared for it. A snow storm, lasting all day and laying down up to 40cm in places, left us with very few ambulances and an ORCON nightmare.

I started out at 5.30am and slid, crawled and slithered my way to work on virgin snow and untreated main roads. I saw cars that had been abandoned and some that had simply crashed to a halt before their drivers left them where they rested. Although there was traffic on the road – more than I had expected – the going was very, very slow and I eventually got to my station a little late for my shift.

A handful of my colleagues were there. The usual early morning buzz of people, motorbikes and ambulances was missing. All was relatively quiet and a single on-duty officer busied himself with the task of trying to put crews together. The whole day reminded me of 7/7; not since then have we been forced to tell the public that we would only answer life or death calls, so only Red1 and Red2 emergencies were being passed to us. Everything else was being carefully screened by clinical desks and patients were being told to deal with their own ailments or make their way to the G.P. or hospital. Why we can't do this all the time is beyond belief.

I’ve never seen so many people walking about in such quiet conditions. Even cyclists were attempting to brave the weather, to the cost of many of them as they fell off their rides. I saw no motorcycles today at all. You’d have been a fool to consider it. Neither were there any buses - for the first time in their history, every London bus was out of service.

My first call was a cardiac arrest with no ambulance available to run on it. My FRU colleague, who’d just finished his night shift, offered to stay and help out until we got our manning levels up. He came with me and we ran the four miles on blue lights at no more than 30mph. Even with the snow covers on my tyres, traction was unreliable and the car slid more than once on the way.
When we got on scene we found that no-one at the Nursing Home had attempted CPR on the woman. She wasn’t very old and had no terminal conditions, so something should have been done. Twenty minutes or so had passed without a single one of the ‘registered nurses’ putting their hands to the task of saving her. It meant my hopes of reversing her suspended state were virtually nil.

My colleague and I set to work and the crew arrived soon after we’d started but it was hopeless and I called it after a decent attempt. In my opinion, nobody deserves to use the title ‘nurse’ if they refsue to carry out this basic duty of care. That said, there is much more to this story but I can't get into it here I'm afraid.

What I will say is that the nurses I know and work with are true professionals and not one of them would shy from their responsibilities at work. It is disgusting that we have so-called nurses and carers out there who neither nurse nor care for anyone. It is wrong and has to stop.

A 7 month-old baby having an epileptic fit was attended by a crew as I pulled up at the address, so I wasn’t required. The trip had taken me four minutes but the location was only a few hundred metres away from where I’d set off. The roads were still treacherous to drive on.

Another EP fit, this time a 3 year-old that I’d attended before, was called in as a Red1 ‘cardiac arrest’ but the mother’s screaming and the father’s panic had created confusion. This little girl fits regularly and often eight or nine times in a day, so it was understandable. For a few minutes though I considered that my day might consist of suspended patients of all ages. We really were being used as a genuine emergency service for once.

When I got on scene, a crew was with me and another FRU had already arrived ahead of us. Before that the call had been downgraded to a Red2; the patient was fitting but not in cardiac arrest, thank God.

It took a while to find the address, even though I’d been there before the estate had many access design flaws and reaching the pertinent block proved stupidly difficult. We had to ask a group of teenagers where it was and that delay (if this had been a Red1) may have cost the little girl her life. It’s all very well building security into these places but it makes emergency access slow.

The child was recovering and we swept her up and got her into the ambulance quickly. As I said before, I knew her and I knew that she could fit again at any moment. She has a big-eyed amile for everyone and shows no fear. It's heart-breaking to think that sooner or later her condition may prove too much for her young body. I really don't want to be the one who arrives first when she truly suspends.
She had another seizure in the ambulance, despite being given Diazepam and it took a few minutes before she settled again. The crew blued her into hospital for the nth time in a short period.

Some smart Alex decided to sculpt this onto the roof of my car while I was inside the station. It was a shame to knock it off when I got a call.

Finally, as the snow began to fall again for the evening’s rush hour, I was sent to a 20 month-old girl with a fever who’d just had a convulsion. Febrile convulsions are common and perfectly normal – usually without hazard – but all children suffering them should go to hospital just in case.

The Grandmother was well aware of this and had called because she was concerned that the Calpol she’d given hadn’t worked to reduce the baby’s temperature. I had no way of knowing, apart from palpating the back of her neck (the baby, not the Grandmother) because my thermometer wasn’t working as a result of the cold weather.

There was no big fuss and no screaming relatives; the Grandparents had seen this all before and it made life a lot easier for me and the crew when they arrived to take the child away.

Then off home and into a mini-blizzard. Luckily the traffic was light and most of the main roads had been gritted so, apart from one near-miss when I skidded toward the pavement (containing two nervous pedestrians), I got back in one piece.

Be safe.