Tuesday, 31 March 2009

Drunken Schoolgirls

Night shift: Eleven calls; one false alarm, ten by ambulance.

Stats: 2 Collapsed ? cause; 1 Croup; 1 eTOH; 1 ? Drug overdose; 1 DIB; 1 Hypoglycaemia; 1 Chest pain; 1 RTC with ? # wrist.

Two and half hours to change a light bulb… that’s the answer. I waited for a minor repair to the car before being shipped off miles away to another area for a tail light, then it was business as usual for a night shift.

A crew was already on scene for a female who’d collapsed on a rail station concourse. She was laying curled up and refused to communicate with anyone, despite her obvious consciousness (her eyelids were flickering a lot). Then she suddenly broke out of her mood, grabbed my legs and wrapped herself around my lower half, crying out for her mother. She wouldn’t let go for some time and I wondered if she’d had some kind of emotional crisis, or perhaps had been robbed or assaulted – her behaviour was strange.

For another 30 minutes she kept mostly silent – even in the back of the ambulance when a female police officer was requested to talk to her (just in case that would help). She wrote down bits and pieces of information but otherwise refused to tell us why she was causing the fuss.

In the end, and with the crew exasperated by her stupidity, she was taken to hospital. I heard later on that she was told to leave after saying that her only problem was that her boyfriend had left her. This was a grown woman with issues.

Croup is characterised by a ‘barking’ cough and affects children at a young age. When I arrived at the home of a 7 year-old girl with such a cough, I recognised it immediately, as did the crew who heard her from the street. She had a history of ‘viral cough’, according to her parents, who’d had the foresight to put her in a steamy bathroom to ease it, but this was a bit worse than a tickly cough and she’d need to be seen at hospital.

Teenage drunks are becoming more and more common. My next call was for a 15 year-old who’d had too much to drink and who’d been found collapsed and unconscious in the toilet of a McDonald’s restaurant. Police were on scene and a crew was already there, so I wasn’t really required, except to assist. The girl’s mother had been called and she’d apparently told the police that her daughter ‘doesn’t usually drink a lot’. There was no anger or embarrassment in the statement.

Unfortunately her pride and joy was leaving the place with her trousers undone, vomit on her clothes and in her hair and the ‘floppy doll’ look in an ambulance carry chair. If only she could be sent video footage to cherish for years to come.

A call to an unconscious male at a pub provoked a rather over-the-top response for my request for police assistance when the man began to thrash out at me after I’d attempted to get him to wake up. He was slumped over a table in a quiet bar but I was told he hadn’t had a lot to drink, so I guessed he was homeless or very, very tired. I wasn’t in the mood for any aggression tonight, so after a few near-misses from his flailing fists I called for extra hands. For some reason, despite my answer to the standard question ‘do you want urgent police?’ being no and a further explanation to Control that I was okay but just needed cops in to help me control him, I was sent half the Met.

At least six police officers, including two armed cops, filed in to the bar, doubling its popularity – if they hadn’t been on duty the barman would have broken into a song.

Luckily, I needed at least three of them because when we woke the man up again, he lashed out even more. He was big and fairly strong, so it took a bit of effort and shouting (from the police) to keep him in check while I figured out what his problem was. As he slipped back into a deep sleep, I looked at his pupils – they were pin-point. This can mean nothing of course but given his demeanour it was best to delegate an option, so when the crew arrived I gave him IM Narcan. Within five minutes he was wide awake, abusive, aggressive and being dragged down the stairs to the waiting ambulance.

It always amazes me to see the clutter and untidiness of other people’s homes. I don’t mean general disorganisation – I’m talking about real trashy piled-on-high rubbish and as I struggled to get into the basement flat of my next patient, a 62 year-old woman with DIB, my bags knocked books and magazines onto the floor. I thought there was little chance of getting a chair in if we needed it (which we did) but somehow the crew managed to squeeze around the blockade. The woman wasn’t having any difficulty breathing anyway – she just said she did. She was quite rude at times; one of those well-spoken types that feel we are simply servants.

Hypoglycaemic patients are not a major issue for me and I have my own routine for treating them, especially if they are still conscious but difficult to manage. A call to a 50 year-old man who’d become semi-conscious when his blood sugar dropped to 1.3 (on my meter), meant I was struggling to keep him still as he periodically sat up, cried out and pulled away from me and the two people with him. Placing an IV line wasn’t going to happen until I had help, so I started him off with Glucagon but the crew arrived as I was about to give it. Things didn’t change with him though. He’d settled down a little but I’d been with him a few minutes now and he didn’t stay still for long, so I continued with the IM injection, giving only half – the dark room and stupid little syringe had combined to make me think all of the liquid had been drawn when it hadn’t – still, some was better than none and it would be in his system while I tried to get a line in.

Predictably, he struggled hard as I tried to put a cannula in and it was soon torn out of his vein as my colleague set up the 10% Glucose line I’d be putting in. Another half bolus of Glucagon would have been a good idea, especially if getting IV access was going to prove impossible. He needed to mobilise his own glucose if I couldn’t give him any of mine.

In the end, a second cannula went in and I managed to stick it in place long enough for 150ml of Glucose to run into his bloodstream. He recovered within a minute with an improved BM of 3.9 and from then on was completely manageable.

A MOP called an ambulance for a homeless man who had requested one for his chest pain. The MOP was cynical about it all and seemed to know what he was talking about; his handover was professional, so I figured he was a doctor or a nurse…or a medic. The man on the bridge just wanted a place to sleep and the crew obliged.

‘I just want checking out’, said the 49 year-old woman as she leaned against her kitchen table. She had suffered a panic attack earlier on and now had chest pain – well, it was more numbness down her arm, she admitted. She had no medical history of significance but I think depression was on the menu.

I wasn’t required for the ‘unconscious’ male on my next call because he wasn’t. The police were on scene and the not conscious man was walking away into the sunrise.

And again I wasn’t required for the 21 year-old female who collapsed for some unknown reason (her boyfriend probably left her), so this was another NPC.

I assisted a crew with a 43 year-old man who came off his motorcycle after colliding with a car on a bridge. There was a temporary traffic light system operating, allowing only one lane to run at a time but a private taxi driver chose to ignore his red signal and ploughed into the poor bloke, throwing him off his machine at speed. Now he was being collared and boarded for the ride to hospital. By the time I had finished my paperwork, the sun was up and I was going home.

Be safe.

The new book

The Street Medic's Survival Guide.

This is the next title and it should be ready at the end of April for launch in May this year. It's aimed at student paramedics and everyone with an interest in the profession and I hope it will serve as a useful reference in highlighting the realities of the job. Here's a quick synopsis!

The Street Medic's Survival Guide has been written by an experienced frontline paramedic to fill a void that exists for everyone embarking on the journey into the profession. Even if you are just thinking about becoming a paramedic, this book will take you through the realities of the job - the stuff they don't tell you in training school or university.

Written with humour and common sense by the author of 'A Paramedic's Diary - Life and Death on the Streets', the book will open your eyes before you embark on the long, arduous training programme that is standard for paramedics-to-be. Everything you need to know about 'out there' is in here, including:

> The recruitment and training process
> Salary and work conditions
> How to use the radio properly without making a fool of yourself
> How to wear uniform properly, including how to iron it!
> Call types and how to handle stress

With illustrations and real-life examples throughout, this book is destined to become the 'how to' bible of paramedicine.

You can pre-order the book by emailing me (not through the comments section please) or going to SP services and, hopefully by the middle of April, Amazon and all the usual outlets. The book will cost £9.99 - a bargain!

Once this book is out I'm going to get my head into the novel, which I hope to finish by Autumn this year - hopefully before I have a heart attack.


Sunday, 29 March 2009

Blunt trauma

Day shift: Nine calls; one treated on scene, three taken by car, the rest by ambulance.

Stats: 1 Punctured foot; 1 Collapse ? drugs; 1 Abdo pain; 1 Faint and sprain; 1 Febrile convulsion; 1 Bleeding PR; 2 Falls; 1 Chest pain.

I was in another TV studio this morning; this time it was the live-feed room where dozens of monitors decorate the walls. I was there to see a 34 year-old man who’d been on the roof of the building (adjusting something) when he stood on a blunt metal spike (see pic - the tape marks how deep it had gone into his foot), which travelled through his trainer and into his foot. The wound was small and had stopped bleeding by the time I arrived, so all I had to do was dress it and advise him about Tetanus. He declined to go to hospital and I agreed that he could wait until later on – it wasn’t life-threatening and his foot had good movement and sensation. That must have been painful though.

A man collapsed in a gay sauna and I was asked to join the crew to investigate. I arrived and found the male-female crew standing in a small crowd of naked men. Not half-naked but naked. Gay men aren’t shy.

I spent most of my time doing what the female crew member was doing – looking at the pretty walls and averting my eyes. Meanwhile the man who’d collapsed was recovering but it looked like he’d taken something, probably GHB. He was taken to hospital after a long, persuasive conversation.

An art gallery next for a 55 year-old woman with severe abdominal pain. She had no medical history and the pain seemed to be located over her Liver, an area that was particularly tender to palpation, so I gave her entonox and walked her carefully to the car with her friend. By the time she was at hospital, a big smile had replaced the grimace of pain. Entonox has some unusual psychological side effects.

Heat was also the theme for this next call, to a 31 year-old woman who’d fainted during a ‘heated yoga’ class. On the way down, she’d twisted her ankle badly and now had a sprain to cope with. I arrived to find her being nursed with ice packs and elevation (a good combination for this kind of injury). She found it impossible to weight-bear and getting her to the lift (we were in a basement) proved slow and painful, so I gave her entonox for a few minutes before we set off again.

On the way out this well-spoken young woman described the feeling of having the gas as ‘custard on her lungs’, which I found highly amusing and original. We chatted all the way to hospital – she had a soft voice and I thoroughly enjoyed listening to her talk.

I left her in the care of the x-ray department and bid her farewell.

A NPC call for a 2 month-old baby who was fitting next. I wasn’t needed at all because there was a MRU and crew on scene but I guess all the bases were being covered.

Two minutes from a hospital, a man sat in the doorway of Burger King complaining of a PR bleed and that he was going to faint. At first, to be honest, I didn’t think I could take him seriously but he seemed to have a genuine history. He’d bled on the toilet last night and now he felt that it was ‘all wet’ down there. He worked out in the gym five days a week and I wondered if he’d ruptured something or if a prolapse had occurred. In the middle of the day and in a public area, I don’t think it would have been prudent to have a look, so I got him into the car and took him up to the end of the road and into A&E.

A lovely 84 year-old granny was showing her grandson around London when she tripped and fell, cutting her hand open. She was at an underground station and I dressed her wound and joked to her about the possibility that she might have done it deliberately to get attention.

She was quite cold but otherwise not too concerned about her injury, so I took her and the boy to hospital.

My next call was also a NPC. A crew and MRU colleague were on scene with a 29 year-old man who’d fallen asleep while standing at the edge of a railway platform. He fell onto the tracks, got up and clambered out. He was very lucky not to have touched the live rail or timed it to coincide with a train coming. I wonder how many ‘suicides’ have died accidentally this way.

My last call was for a 28 year-old man with chest pain. He’d had an MI before as the result of cocaine use, so I was taking him seriously when he told me that his left arm was numb, just as it had been before. The crew was on scene as I carried out my obs and his ECG didn’t show anything alarming, so he was taken to hospital without fuss.

I’m finding that working on the amber car is so much better for my stress levels. I am talking to clinical human beings and not being pushed around like a pawn. I’m working in my own area and seldom have to travel miles away into other sectors and I get to spend time with my patients, something I miss when working on the sector FRU. I now have three nights coming up and will have to contend with working that way again for a while.

Be safe.

Friday, 27 March 2009

The fall guy

Day shift: Seven calls; six taken by car, one by ambulance.

Stats: 1 Unwell person; 1 Panic attack; 4 head injuries; 1 Cardiac arrest.

A 34 year-old woman felt unwell at an underground station but she had no medical history. She was cold and had numb hands – she’d almost fainted too. Now she was recovering, apart from the numbness, so I took her in the car to hospital, where I doubt anything of significance will be diagnosed.

Having a large family at a young age is bound to be stressful – a call to a 28 year-old woman who was having a panic attack took me to a flat in which three children were running around and another two were somewhere in the area but too young to be noticeable. The mother was slumped on the sofa as her boyfriend attempted to keep a rein on the family Von Trapp as they shouted, screamed, cried and noisily stomped about.

I could see this lady’s depression without diagnosing it. She would speak and cry intermittently, often repeating the phrase ‘but I’m alright, really’. If I touched her hand, even to take her pulse, she’d weep. She was clearly unable to cope with her present situation, so I convinced her to go to hospital with me – even if all she got was peace and quiet it would help, I thought.

The flat was bare-floored and the stairwell was open, so the toddlers could toddle right on over them if they wished. I think her state of mind left the children vulnerable but I was going to leave that to the judgment of the doctor.

Falls seem to be the theme this week. I went to the aid of a 68 year-old man who fell at a train station, cutting his forehead open. He wasn’t knocked out and had no other injury, so I took him to A&E for the benefit of a few stitches.

I overheard a call on the radio in which five police officers were trapped inside their vehicle after a RTC involving another car. It sounded serious and a lot of resources were sent, including some that had turned up without invitation. As soon as a job like that is GB’d, you can bet the green-mobile button will be pushed on dozens of vehicles.

My next fall was a 68 year-old woman who’d tripped on the pavement and smashed her nose and forehead on the concrete as she landed. Her husband was with her and I travelled three miles to get to them, as they sat on a wooden chair by some skips in the road. The lady was a little distressed but her bleeding was controlled and a dressing wasn’t required. I took them both to hospital across the river. Obviously I used the bridge.

Then a call for a collapsed woman in a large toy store came through as I sat on stand-by. It was cancelled then re-sent as a Red1 cardiac arrest. I got on scene to find a MRU colleague and another FRU paramedic working on a woman who was now breathing for herself, albeit agonally. She’d arrested and been shocked back to life after a couple of customers (who happened to be nurses) had initiated CPR. This action had saved the woman’s life without doubt but as I assisted the medics and another crew appeared to take her away, I wondered where the first aider for the store was. Nobody had created a corridor through the mass of customers so that the trolley and equipment could be moved and it was business as usual outside as a clown (or some sort of dressed up character) blew bubbles into the air.

When the poor woman was taken to the ambulance, not only did the crew have to fight their way out the door but bubbles landed on top of her as she was taken away. When they arrived at hospital (I had gone in the car because the MRU paramedic would need to go back to his bike) a nurse opened the back doors of the ambulance and bubbles floated out into the air as the critical patient was brought out!

If this had been my mother (her daughter was with her and witnessed everything) I would have been livid at the indignity of it all.

Another head injury and this time the man just wasn’t looking where he was going, although I have a feeling he wanted to use his minor wound as an excuse to sue McDonald’s. The 40 year-old was walking up the stairs and avoided the cleaner, who was at the top, by moving to his right a little. A barrier, secured at the end with foam and striped tape to warn people of its existence, made contact with the top of his head and the only way that could have happened is if he had been watching his feet instead of where he was going (in my opinion). As if to prove my theory, on the way to the car I had to warn him several times to look up as he bumped into people and almost walked straight into a post.

Two helpful young women waited with a 79 year-old woman who’d tripped outside a shop and fallen, cutting her forehead. It was a very minor injury but the patient was unable to walk properly as the result of a knee problem, so she stayed where she landed until I arrived.

I helped her to the car and took her to hospital, after thanking the ladies who had taken the time to care for her as the security people in the shop simply stared out vacantly.

Be safe.

Thursday, 26 March 2009

Labradors are thick

If warnings have no consequences, the result is always the same.

Day shift: Five calls; all taken by car.

Stats: 1 Epistaxis; 1 Testicular pain; 1 Abdo pain; 1 eTOH; 1 Allergic reaction.

Another nosebleed start to my day. An Italian man stood in his kitchen with his wife and a large, fat chocolate Labrador, as he bled into tissues. The sink was covered in blood and many more crimson tissues lay inside it. He’d been bleeding for over an hour and couldn’t get it to stop.

The man had a cardiac history and was on anti-coagulant drugs but he’d been able to stop the bleeding when it had happened before. He was due to see an ear-nose-throat specialist about his recurrent epistaxis.

As the chunky dog attempted to jump up at me (unfortunately he was too fat to get his two front paws very far off the floor) I packed the patient’s nostril and swathed his nose in a dressing. That seemed to do the trick and I got him ready for the short car journey to hospital.

As we left the house (his wife accompanied us) he told me how much he loved his dog but that it was ‘thick’...'lovely but thick', he said. I agreed that the friendly mutt was thick in terms of its waistline but I couldn’t comment on its intelligence as I hadn’t had a conversation with it.

On the way to hospital, through ever-slowing rush-hour traffic, the man began to cough and splutter as blood leaked into his throat and through the dressing. I advised Control that I would be pushing through the traffic on lights because I didn’t want my patient to pass out in the back of the car and that got me to A&E within three minutes (it may have taken ten or fifteen otherwise).

A 42 year-old chef had an acute onset of testicular pain which radiated into his groin and perineum. He’d had this before but his GP had diagnosed nothing, so he was left to wait for the next attack, which was now.

I found him on the floor in agony, bent double and cupping his scrotum with his hand, just like you do when you are hit there with a football...or a boot. If you are a female reader, please refer to any manual on the pain of childbirth and get back to me on this.

I asked him if it was similar to the pain you get when kicked there and he shrugged his shoulders. Every other male in the room knew what I was talking about but he, apparently, had never been hit there in his life. I found that strange. Even a light tap to the area can produce agonising pain for a short time...every boy knows this.

Anyway, there he was on the floor and I had to get him up, walk him out and put him on entonox before he finally calmed down. He had no medical problems and denied any recent traumatic event. My guess at the time was testicular torsion but my cursory exam of the area couldn’t conclude on that theory as it’s an internal problem.

Remember when you were growing up and all sorts of aches and pains plagued your body until somebody used the phrase ‘growing pains’ and it seemed logical? My next call was for a 13 year-old girl with chest pain and I knew I was running to an inaccurate call description, either in symptom or age. The young French-speaking teen was in an art gallery with her teacher. She was sitting on the floor, chatting away and looking healthy. I used my minimal French to start communication with her until I ran out of steam (and the French language) and had to refer to her English teacher for translation.

The girl had muscular pains of a general nature – not chest pains. Her earlier hyperventilation had produced other symptoms and that’s what prompted the emergency call. I suggested growing pains because she was very tall for her age and looked like she was heading for over 6 feet in height when she stopped developing. Her muscles must be under a lot of stress as they stretch to catch up.

I took them both to hospital in the car. You can never be too sure with these things I guess.

A drunken homeless man broke into a ‘secure’ television news centre and I was sent to get him out. He had somehow snuck in and settled down on the toilet in the executive loos, much to the consternation of the suited managers as they came and went. Security tried to deal with him but he demanded an ambulance.

He was slumped on the loo seat with a sandwich on the floor beneath him; laid there like a loyal puppy at his feet – a bacon and lettuce puppy. I woke him up and he told me he had ‘ligament pain’ so needed to be in hospital. I cancelled the ambulance and decided to take him myself. He was smelly and generally unclean but the trip would only take ten minutes and the options were limited – he could go by ambulance and waste tax-payer’s money or I could simply take him outside and leave him but he’d generate another call for sure. The police could come and collect him but, apart from trespassing, he’d done nothing wrong. So, the only viable option was to take him to a place of safety - still a waste of tax money but cheaper than an ambulance and crew.

During the trip (which lasted forever because of the traffic), he mumbled to himself. Sometimes he spoke to me but I didn’t really listen to him; I was keeping a wary eye on him in case he decided to misbehave and the smell was blurring my focus. So the journey dragged on and all I could hear eventually was mumble, mumble, mumble...snore! The cheeky git was asleep and it took me ages to wake him up and get him out of the car when I got to A&E.

A late job (again) for a 19 year-old girl who was having an allergic reaction in the street. Her friend was with her and, although they were both going to hospital in the car, their boss didn’t believe them, preferring to think they were skiving for the night. He’d called to find out what they were doing and when the situation was explained to him (I’d even offered to speak to him myself but he wasn't interested), he was more concerned about losing a client. I guess in today’s economic climate that’s understandable but the girl’s skin was covered in an urticarial rash – there was no way she could work behind a bar like that.

She had an Epipen but knew not to use it unless her airway was threatened, which it wasn’t, so I scooted her off to A&E for the necessary antihistamine she’d require. Unfortunately (and this has happened to her before) by the time we got there, she didn’t look as if she needed anything – her rash was disappearing. She and her friend had to sit in the crowded waiting area. They’d be there for hours and probably not get anything more than the evidence they needed to convince their mean boss that she was actually unwell.

Be safe.

Wednesday, 25 March 2009

Two-wheeled collisions

Day shift: Ten calls; two taken by car; eight by ambulance.

Stats: 1 Epistaxis; 2 RTC; 1 Head injury; 1 Near faint; 1 SOB; 1 Actual faint; 2 Chest pain; 1 Fall with ? broken nose.

Nosebleeds are not usually emergencies (although I have seen one patient die as he bled out) unless the patient has a particular vulnerability, such as so-called ‘blood thinning drugs’ or high blood pressure, so I usually convey them to hospital myself. My 62 year-old patient was on Warfarin and Aspirin, so fell into the vulnerable category but he had only been bleeding for 30 minutes before I arrived and had no significant clinical signs or symptoms to worry about. The trip was fast and easy for him. I had packed and dressed around the left nostril and this brought an end to his drama.

My first RTC of the day was a motorcycle versus a cycle. The crew was on scene and another call had come in reporting yet another cyclist on the road after being hit, so I freed myself up (this patient had few or no injuries) in case I was needed elsewhere…

…I was but in a police cell for a 30 year-old man who’d deliberately banged his head on the wall, slipped to the floor and pretended to be unconscious. He wouldn’t speak at all but he mumbled convincingly. His mumbles were meant to say ‘I am having a fit’ but he clearly wasn’t. The cops weren’t buying it but they were being cautious. He was known to be violent (a fact they kept from me until I had provided a bit of pain to get a response), so I was suspicious about his motives.

The crew arrived and delivered a bit more pain than I was willing to after the ‘violent’ revelation. He sat upright, opened his lazy eyes and stared with contempt at the paramedic who had cruelly snapped him out of it. I didn’t mind; I wasn’t wimping out, I just had time to play with because he wasn’t going in the car with me.

He continued to play the part and was taken to hospital. I was still unconvinced and later learned that he tried to abscond after lashing out at staff. Told you, didn’t I?

The next RTC involved yet another cyclist and another motorbike – it was obviously day of the Lemming cyclists or day of the demon motorcyclists (they should really wear a badge so that I can tell what kind of day it is). The cyclist and motorcyclist veered toward one another in an attempt to miss each other on the road but ended up sandwiched together... and into the back end of a car they went. The car driver, a lovely lady who helped no end and tried to get me a free coffee but was refused (thanks Costa), was a bit shaken up and even more so when she was read her rights, along with the two competing two-wheeled idiots. She had done absolutely nothing wrong – indeed she was accosted by the two vehicles while her car simply obeyed the law but the police are required to cover all their bases. I felt sorry for her as she sat in the van getting the third degree.

The cyclist had minor scrapes to his leg but because he was the only injured party, he used this as an excuse to get the hell out of there by ambulance. While I was attending to him the two men argued the toss about who was to blame. Meanwhile the poor coffee-cadging woman stood nearby wondering what the hell was going on. Bless her.

A 70 year-old man almost passed out as he wandered an art gallery. It had happened to him before after a run (not bad at his age) but he had no heart problems. His ECG wasn’t normal and his blood pressure remained low so he was taken to hospital.

An interesting chest pain call at a walk-in centre produced a hidden problem that screamed to be diagnosed. The middle-aged man had gone in after a few days of chest pain, followed by progressive weakness and shortness of breath. He was pulling away on inspiration when I got there but he said he felt okay now. His obs were good except for a consistently high BP. His lungs seemed fairly clear, although I detected a small area of possible fluid in there, so I asked the crew to give GTN and nebulise him. This had the effect of reducing his BP and making him feel better about his breathing. The BP reduction wasn’t good enough though and I had already ruled out LVF, so what could it be? His ECG showed a T wave inversion on a lead where normality should be seen, so I had them swapped over to check again and there it was.

We blued him in even though he said he felt much better and a diagnosis was soon given – he had a Pulmonary Embolism. All the signs were there and so I should really have opened my mouth to say it but we are all a little shy of being smart arses to doctors sometimes.

A 60 year-old who fainted in a pub had a high blood pressure too and although she was recovering when I got there, she remained ill-looking to me and the crew, so she went to hospital. I thought it was a bit cruel to send me to a busy pub at lunchtime when I had already asked for a break and was starving. Plates of food were being sent out all around me and I might have stolen something if it wasn’t for my good manners and professionalism. And fear of arrest.

In the pouring rain and howling wind the last thing you want to do is wander around a horrible housing estate trying to find the flat number you need. As usual, the one I wanted was in the very last block, at the very top (no lift) and at the very end of the balcony. It was one number short of the easiest flat to access downstairs on the corner I had come in on.

I huffed and puffed my way up, mainly for effect and through annoyance, to the 65 year-old lady with a history of AF and flutter who’d claimed chest pain. She was on the sofa in the correct pose for ambulance assistance but all her obs were fine. Her pain had gone but the family remained concerned nonetheless. Of she went to hospital – carried down all those wet stairs by the valiant (and I mean that) crew that had also lost themselves in the weather trying to reach us.

Back to that walk-in centre for a 63 year-old man with chest pain and a pacemaker that might not have been pacing at all. He had left arm and shoulder pain but seemed reasonably stable. His pacemaker had been fitted only 6 months ago, so there may be a problem with it.

I conveyed my last patient of the day. She made me late home again but I forgive her. She had been drinking all day and fallen flat on her face, breaking her nose. I asked her why she had been drinking at this time of day (it was entering rush hour) and she said ‘Oh, you know…just because’ and that answered my question. She was depressed or angry about something and it was very likely something to do with the engagement ring on her finger.

She was a type I diabetic and her blood sugar was high. I told her how silly she was and she giggled acceptance of that fact while holding on for dear life to the back seat because she thought the car was spinning and leaning out of the open window preparing to vomit in the street. I asked her to put her head into a clinical waste bag and hold back the tears if she could. She ended up in A&E reception, sitting on a chair with her head so well buried that she looked like she had a yellow plastic bag for a face. She cried anyway.

Be safe.

Sunday, 22 March 2009

One of ours

Day shift: Seven calls; three taken by car; four by ambulance.

Stats: 2 ? Food poisoning; 1 RTC with chest injury; 1 Fall ? injury; 1 Sprain; 1Kidney stone; 1 Faint; 1 Assault.

Although I have noted two cases of possible food poisoning they both occurred on the same call and bizarrely were unrelated – two Hungarian women were complaining of vomiting since the evening before and were now at work in a hotel. Although they both knew each other, they had eaten separate meals containing chicken at separate times and in different locations. Both had similar symptoms which had started at the same time. It was one of those odd coincidences and I conveyed them both to hospital in the car...at the same time.

A member of LAS staff was knocked off his motorcycle on the way in to start his shift and I was asked to attend, along with another FRU. The staff member was, ironically, a Motorcycle Response Unit paramedic and he’d been hit when a car pulled out in front of him on a very busy road at rush hour. He was thrown from his bike and lay unconscious, according to witnesses, for a few minutes. He was at high risk of being run over but MOPs ran into the road and attempted to drag him to safety.

When I arrived he was up and around and an EMT was attending to him. A few minutes into the call an ambulance arrived, along with a Duty Officer (as is required for these incidents). Police were already on scene.

He was very lucky – badly shaken up and complaining of some chest pain which, being a paramedic himself, he quickly diagnosed as muscular. He was still collared and boarded as a precaution, just like everyone else.

An angry driver shouted at me as I walked into the flat of a regular caller who’d complained of chest pain. The crew had pulled up and we were about to attend to the patient when I heard the loud, angry voice swear at me for parking across his bay. I had nowhere else to go and I try not to park selfishly, even on emergency calls like this but this guy didn’t care at all and I asked him if he could wait until I had seen the patient but I got more abuse for that request. He could still be heard outside as we entered the flat. I thought at one point (and so did the crew) that he was going to come in with us or vandalise the car.

The patient was fine – he was just lonely and drunk, so I wasn’t required and I went outside, fully expecting an argument with the irate driver but he’d gone. Parked and gone.

I was in a park again for my next patient, a 31 year-old female roller-blader on her first lesson. She’d fallen and twisted her ankle. A MRU colleague was on scene and he radio’d a request for me to come and take her to hospital. I arrived to find her with a friend, head bowed and sitting on the ground. I took a look at her ankle and told her it was a grade II sprain (well, I told my colleague what I thought and she reacted) – she started to cry. This woman is 31 years of age. She was crying because she knew she wouldn’t be able to run in an up-and-coming race she had been booked to do.

Grade II sprains aren’t that bad but because the ligament is torn it will take while to heal and should be rested or at least exercised gently over a few weeks following the rupture.

I took the unhappy lady to hospital with her friend and tried to reassure her that the world had not ended. She was smiling by the time she got to A&E.

A very strange call to a pregnant woman who was suffering kidney-stone pain turned into a fiasco when, as the crew turned up, she began to writhe and gag as if choking. This came out of the blue because she had been talking to me and calming down. Suddenly her entire family was coming out of the woodwork to demonstrate their extremely over-the-top fear that she might be dying. I stood and watched with my mouth open for a few seconds before it registered that I’d better be seen to do something. So, I told her to calm down and behave.

One member of the family, a young man, remonstrated with us about having to lie on the phone to get an ambulance. Apparently ‘they’ had told him that an ambulance wasn’t available and ‘they’ had refused to get one, so he had called back to say she had severe DIB, which she didn’t. Although I sympathised with her pain and, yes, she did need to go to hospital, I thought it was unlikely the caller had been told this – more than likely he was told that there would be a delay and that someone would be there as soon as possible.

Amid this little crisis, we calmed her down until she began to behave more rationally. She was given entonox for her pain (morphine is too risky in pregnancy) and that seemed to do the trick. The melodrama subsided and the family, including young children, were ushered out of the room, leaving the patient, myself, the crew and one or two members of the family who could cope with it.

I have no doubt a complaint will wing its way to LAS as a result of what the family saw as neglect on the part of Despatch but I think its unfounded, based on what I witnessed. There was a point at which it even became threatening and that’s not right.

South next, for a 60 year-old lady who had become ill after a heavy meal with her family in a pub. She was slumped over the table, dessert half-eaten, looking very pale, sweaty and unwell. Her blood pressure had dropped, resulting in a near-faint but she had no medical history and its possible the meal itself was to blame for her condition – the stomach needs blood directed to it when its full, so there would be a temporary disruption in available circulation to other organs, including the brain. It explains why many heart attacks occur after eating.

The crew checked her out and she decided to go home because she was feeling (and looking) much better after twenty minutes of care.

A 16 year-old girl who had been assaulted by her druggie boyfriend earlier in the day developed a swelling on her neck, where her Carotid artery lies. She also complained of a headache. It looked like a haematoma had grown out of a leak there. He’d punched her on the neck, allegedly, so the force may have ruptured the artery or the muscle around it.

She was stable enough to convey in the car and I took her and her friend, both of whom lived in a hostel, to hospital.

Be safe.

Saturday, 21 March 2009


Day shift: Seven calls; five taken by car; one treated on scene and one by ambulance.

Stats: 1 ? # Humerus; 3 Fall with head injury; 1 Migraine; 1 ? # Wrist; 1 Sprain.

We are trialling a new system with the car – much the same, in fact, as we did when I first started on it and it was called the ‘amber car’. Basically our instructions are now given via the Motorcycle Response Unit (MRU) desk, so we are talking to clinical people and being tasked in a much more (in my opinion) logical basis to calls that could be conveyed by car instead of an ambulance. So far, as you can see, it is working very well.

So, my first call for a 61 year-old woman who’d fallen heavily with an out-stretched arm, producing a possible fractured Humerus, was taken in the car. She was in pain but that was controlled using entonox – otherwise, she was perfectly stable and with her consent, a speedy trip to hospital in the FRU saved an ambulance for something more life-threatening. Possibly.

The only ambulance journey for any of my patients today was for an 88 year-old who’d fallen from a step ladder as she tried to put ornaments on a high shelf. She was upset, obviously, and had a scalp wound that had stopped bleeding by the time I arrived. I would have taken her to hospital myself but the crew had been assigned and got there just after my head bandage had been secured.

A 24 year-old female with a migraine (and a history of it) could really have taken herself home or gone to a doctor (or pharmacist) but she dialled 999 instead because it was ‘worse than ever before’. This was a truly deserving case for the back seat of my car and when she got to hospital she was sent to the waiting area, inevitably, which was packed. She had a three to four hour wait ahead of her. It would have been quicker to go home and lay down in a darkened room.

I treated a very nice 79 year-old man for a small cut to his forehead, which he earned after tripping over a bench on the pavement. He had been taken into John Lewis’s by the very caring staff and I was called to attend to his wound. He didn’t want, or need, to go to hospital and we stood at the beauty counter (his wife was with us) chatting away about life and the universe…and trying to get a freebie moisturiser for his good lady.

One of the most amazing things about this man was that he had survived a cardiac arrest a few years earlier. He had gone into VF and been shocked and resuscitated back to life by the LAS crew that had attended to him. It is rare to meet someone who has been that close to death and he was very, very grateful for his second chance. From our short conversation, it sounds like he and his wife are living life to the full. I left them to get on with their shopping and I walked to my car with a smile and a warm, fuzzy feeling.

Then two teenage girls approached me as I did my paperwork. One of them handed me a wallet and told me that they’d found it lying on the road by a pedestrian crossing. It contained Euros, ID and credit cards, all of which I showed them to verify what was inside. I took their contact details and handed the wallet in to the local police station on their behalf. I really hope they get a reward because honesty is unusual and teens get such a bad rap these days that someone, somewhere needs to reinforce good deeds like this by acknowledging them. Personally, I was proud of what they’d done.

A 15 year-old boy was practicing his gymnastic flips in the park when he misjudged one and fell awkwardly, fracturing his wrist. His friend rode with him in the back and they both looked suitably sheepish about the whole incident.

Another fall, but this one took place hours before the 71 year-old lady decided an ambulance would be needed – or her husband did. They were both in the theatre watching a show when she suddenly felt ill and went pale. She didn’t pass out but was quickly ferried into the corridor to wait for me. There was no ambulance available for this and I waited long enough before making a clinical decision to take her myself.

She told me she’d fallen on a boat four hours earlier, tumbling down 12 – 15 steps apparently and bouncing, according to her husband as she went. She was recovering from her ‘turn’ but I felt this needed to be treated seriously. She refused to be collared and she didn’t want an ambulance but was persuaded to go in the car.

All the way to hospital she remained alert and stable.

Back to the park for a skateboarding 35 year-old female who slipped and twisted her ankle. She could have hobbled to A&E but she didn’t know where it was, so I was recruited to be her saviour. She had a sprain and the journey without blue lights back to the hospital made me late going home… but that’s life.

Be safe.

Monday, 16 March 2009

Indoor camping

Somebody put these plastic flowers in the ashtray part of this bin. They were either friendly, Greenies or drunk. I'm going for drunk.

Night shift: Eight calls; all by ambulance.

Stats: 1 ? SAH; 1 Abscess; 1 eTOH with head injury; 1 Drug o/d; 1 High temperature; 1 DOAB; 1 Vomiting blood; 1 Thrush infection.

The concept of indoor camping is hilarious to me...not because it is obviously a fun pastime for the kids when they are bored but because (and I am told this by a reliable witness) some patients have been known to indulge in this crazy childish activity as they wait for an ambulance to arrive. Is it possible the indoor arena in which they choose to pitch their tents exacerbates their asthma?

Subarachnoid haemorrhages (SAH) are life-threatening events, with poor prognoses if not detected quickly. The 80 year-old woman I’d been called to attend - whose only complaint was a headache (although it had been given as chest pain) had been healthy all her life and apologised for the call but couldn’t bear the pain any longer. Her son was on scene and he had called us because he was concerned about her.

She had leaned forward to answer the phone when the headache had suddenly struck. Now she felt nauseous and unwell with it. I would normally have left this to the crew but I stuck with it because there was something about her condition that didn’t warrant the usual ‘it’s only a headache’ opinion. She had neck and upper back pain and the history, her demeanour and everything else about it seemed familiar.

I jumped aboard with the crew and we carried out a full set of obs. Her blood pressure was very high and an ECG was on its way when she complained even more loudly about the pain and how sick she felt. She was given a vomit bowl and her head slumped into it as she threw up but I noticed something else; her eyes were glazing over. You can tell when a person’s brain is no longer functioning properly and hers was going - it's like watching a lightbulb become dim. She rapidly lost consciousness and the ECG was abandoned as we suctioned her airway, secured it as best we could against gritted teeth and prepared to resuscitate if necessary. Her respirations dropped and she was ‘bagged’ on oxygen for the blue light journey to hospital. Her son was in the back with us and he remained strangely calm as I explained what we were doing and why.

There was nothing I could give her – I have seen many SAH events before and I was sure this was another. I also knew that time was critical for her, so a cannula was placed en route but nothing else was given until we reached Resus, where her GCS wavered between 3 and 7 at best. Within ten minutes of arriving at hospital she stopped breathing and had to be put on a ventilator. I left the team working on her and spoke to the son (at the doctor’s request). I explained what had happened and reassured him but I felt less sure of the outcome for her than my words may have intimated.

A DIB call for a 46 year-old woman was nothing of the sort. She may have been breathing a little fast but that was because she was overly distressed about a painful looking abscess she had on her neck and the high temperature that accompanied it. She’s already been seen by her GP and advised to call an ambulance if she began to vomit, which she had done, apparently.

The large swelling covering her neck and the area beneath her ear had been drained and she had been given antibiotics and painkillers but nothing was helping her. I sympathised with her pain – if it was indeed an abscess then there was a lot more work to be done on it. If it was more sinister, she’d need to be seen urgently, so off she went to hospital.

In the City, a smartly-dressed man held his drunken wife as she vomited in the street outside the pub they’d both just left. She had leaned forward to get something from her handbag and forgotten completely about gravity, which helped her to the ground and onto her head with a thud. Now she had a bleeding head wound.

‘I’m alright’, she insisted.

They all say that.

A routine looking call to Piccadilly for a 20 year-old female, slumped in a doorway, could have been just another drunk and I was ready to be cancelled when a crew arrived on scene before me but I kept running and no cancellation came through. Just as well because the paramedic and his two brand new trainees were resuscitating the girl in a doorway. She had been found in respiratory arrest after overdosing (probably on heroin). Her belligerent boyfriend interfered with the process of saving her constantly and I called for police support to keep him at bay.

While the crew bagged her I got IV Narcan going. This produced a fully conscious drug addict within five minutes – that stuff’s a real life-saver. Her clothes had been cut away, much to her boyfriend’s annoyance but it didn’t stop him rifling through them to get whatever it was he was after (more than likely the rest of her stash). He may have been looking for something else – something innocuous but I’ve seen addict’s partners behave like this before – the drug is always more important than the life.

If you are a new parent, try to read up on the difference between a fit and a feverish, shaking baby – it will stop you dialling 999 every time the poor child has an infection that can be treated at home. The well-to-do parents of a 1 year-old girl with a temperature of 39.1c and a known illness, couldn’t determine whether she was fitting or not, so called an ambulance. The poor thing was scared enough to have me and a crew around her, never mind ending up in hospital when close supervision, cooling and parental love was all she needed at that point. I have argued this for years and will continue to do so – Calpol is NOT going to make your child better…it will simply make the illness last longer. Personally, I would only use the stuff if the temperature is very high and won’t come down with physical cooling. Paracetamol in any form is not a sweet for kids!

The DOAB of the night was on the back seat of the top deck of a bus with his trousers half way down his backside. He lay face down in slumber until I interrupted his coma and pulled him upright (its one of the effective ways to wake them up but has the drawback of a possible punch in the face if you are not careful). A loud voice is also useful because it alerts them to the fact that you are not the bus driver. This one left without the threat of police but he insisted that his foot was painful and therefore needed to go to hospital. What he wanted was a free bed for the night and he got his wish.

The bus driver smiled and said ‘I don’t know how you guys do it, I really don’t. They’re the scum of the Earth, they are’. I though he was being rather harsh, especially as this DOAB hadn’t threatened me, spat on me or raised his voice at me – he was just drunk and homeless. I guess if you drive a bus and have to call an ambulance every day for a sleeping drunk, you form an opinion of one that tarnishes all of them.

A 56 year-old woman with a history of duodenal ulcer and obstruction lay on the floor of her flat after suffering an acute bout of bloody diarrhoea and vomited blood. Her husband had preserved the evidence for me and, at 4am, I found myself looking into a toilet bowl full of thick red faecal matter and a toilet floor with large pools of clotted blood on it. For those people who call ambulances because they are ‘vomiting blood’ when all they’ve done is thrown up red cabbage, a scene like this would soon shut them up.

The unfortunate lady was very weak, as you can imagine, very pale and very ill. Her blood pressure was initially too low for her to be moved onto the chair, so she was given a few minutes to recover and then gently lifted up and out to the waiting ambulance.

Finally, into a Hell on Earth concrete estate with solid security gates at every entrance and every level on every block (thanks Islington Council) for an 87 year-old man with ‘DIB’. Remarkably, after telling the call-taker that he couldn’t walk to the door and making us wait outside until the sleeping security man arrived to unlock the ‘prison’ gate, the crew and I found the front door open. He’d got up to unlock it, gone back into bed and then told the call-taker that he was too weak to walk.

Despite his DIB, he spoke non-stop, ranting on about that ‘lazy bastard’ security man and how he was always asleep. He lay in his bed, surrounding by rubbish and chocolate as we listened to him go on. Oxygen cylinders littered the hallway and bedroom and he was connected on 4lpm to one of them. Most of the O2 he was breathing was being wasted on expletives.

He recognised me (patients tend to know me or think they know me) and I recognised him. I had been here years before for much the same thing. He was lonely and frail and unwell but there was no cure for his condition. He suffered from Asbestosis and a bad attitude, for which forgiveness from me was instant. As he said in his own oxygen-fuelled words ‘I should just die. What’s the point of living a life like this?’

‘Here, have a look at that’, he said, pulling his pyjama trousers down and exposing his testicles to me. I had asked him why he needed an ambulance today and this was his response.

‘I’ve got really bad thrush’, he declared.

He was right too; his scrotum was suppurating and red. We were all aware of his hands from that moment on and I could hear the familiar sound of gloves being donned in a hurry by one of the crew.

Be safe.

Sunday, 15 March 2009

Slippery customer

Night shift: Eight calls; one assisted-only; one no-trace; six by ambulance.
Stats: 1 Drug o/d with head injury; 1 Hypoglycaemic fit; 1 eTOH fall with head injury; 1 DOAB; 1 eTOH; 1 RTC with head and chest injuries; 1 Rash.

On a corner of a street near The Oval, four men were holding a tall, wiry man down on the ground as he struggled against them. I had arrived after a short delay during which I was completing my VDI and I fully expected an ambulance to be here, if not nearby. The man on the ground had staggered and fallen onto his head, cracking it open. He’d fallen earlier and further down the road, according to a witness, so he had multiple head wounds and blood was spattered here, there and everywhere. The men holding him down were doing it for his own good because he was clearly off his nut on drugs.

I spent twenty minutes struggling with him too – the men (and one woman) stayed with me donning gloves I had issued to each of them, so that I could maintain control of this very strong and seriously damaged patient. We all got a little bit of his blood on us as a reward – he spat and sprayed it all over us but I was very thankful for the help because I would have been no match for him on my own in this dark little street.

I had requested police help as soon as I knew he was going to be a handful and they arrived very quickly to take over from my helpful MOPS. ‘Shall I cuff him?’ one of them asked me. ‘No, not unless he becomes a real danger’, I suggested. He was difficult to handle at times but he didn’t deserve to be restrained with cuffs.

The crew arrived after a short time and we loaded him onto the trolley but he wouldn’t have it. He struggled and screamed and tried to get away and I was very uncomfortable with the process. I don’t like being forceful with an injured person but I knew it was the drugs (whatever he’d taken) that were affecting his mood – or the head injury, which could also cause this aggression.

I gave him Narcan in one of his quieter moments (he’d slip into unconsciousness every so often) but it had no affect and I stayed in the back of the ambulance as we ‘blued’ him into hospital.

He was taken into Resus, where he started to thrash and fight again until slipping back into unconsciousness. The medical staff took a small bottle of liquid from his pocket and handede it to me. I opened it and smelled it – it was GHB, so now we knew what he’d been taking all night.

In the fashionable Riverside area, I attended a 60 year-old man who was lying on the floor of a restaurant, recovering from a hypoglycaemic fit. His BM was normal but that was probably because he had eaten 15 sugar lumps and a couple of glucose sweets when he felt ‘low’, according to his friends on scene. He hadn’t been fast enough to save himself from a seizure but he had managed to get his own blood sugar level up enough to get through it without compromise or intervention from me.

The St. Patrick’s Day celebrations spawned a number of drunken people tonight, including a 75 year-old Irish man who collapsed in front of a rubbish bin and cracked his head. Police were on scene just ahead of me as I waited for an inconsiderate private taxi driver to unblock the road so that I could get near him. He was conscious and adamant that he was okay but his bloodied scalp was making contact with the filthy bin as he leant against it and he was in danger of contracting a nasty infection, if nothing else, from his fall, so he was persuaded to go to hospital when the crew arrived twenty minutes later.

During the time I waited with him and his now bandaged head, he ranted about the state of the country – much like I do – and set about putting the world to rights. It was an interesting one-way conversation.

A DOAB next and this one was quite aggressive to start with. The drunken Polish man refused to budge until I had actually requested police assistance, then he stormed off the bus.

There was no trace of the supposedly verbally aggressive 45 year-old man who had collapsed outside a pub. He had picked himself up and gone, which was a relief to be honest.

I have dealt with a number of ‘bleeding from penis after intercourse’ calls and was about to set off on another when I was cancelled for a nearer vehicle, probably crewed by two females.

Near the Meat Market, in the very early hours, I was directed to a man who had slumped in a doorway and then slid down onto his face. He was lying in a pool of his own vomit and I approached him with a view to getting him up and walking him off if possible. He ignored me to begin with and then smiled, blew a long raspberry and fell asleep again. The 30 year-old child had to be man-handled into the ambulance because he wouldn’t or couldn’t move. His wallet was lying next to him on the ground and I am surprised it stayed there all the time he’d been out – it might have taught him a lesson if someone had relieved him of it.

Near the end of my shift I was called to a RTC involving a car and a tree. The vehicle was a mess and smoke was billowing from the engine when I arrived but the female driver was out and standing nearby with other people, one of which was her friend who’d been driving in another car behind her. She’d watched as her jet-lagged mate (she’d just arrived on a flight from New York), swerved suddenly on the empty road and careered into a tree without braking. She’d obviously fallen asleep at the wheel. In fact, as she was being prepared for the board, she closed her eyes on more than one occasion in an attempt to continue her rest.

The pavement was littered with debris from the wreck; the impact had been ferocious. I had asked for LFB attendance and expected one truck to arrive but they must have been bored because four fire engines turned up for this. All that was needed was a safety check and an oil spillage to be cleared up.

Some places feel unsafe as soon as you step foot in them. A man who’d called an ambulance for a rash on his groin (he’d had this for 24 hours and it wasn’t itching or burning) opened his door to me and I instinctively felt unsure about going into his flat. His behaviour and mannerisms were suspicious – he was covered in what looked like oil, although he told me he’d had a shower and shampooed his body. A knife lay on the floor beneath the chair, where he sat and exposed his groin area for me to inspect (not a request I’d actually made). The floor of the place was also slippery as if grease had been put down and I found my footing a little less sure than normal.

The call descriptor had stated that he was ‘very quiet’ on the phone and he was whispering most of the time as I attempted to get details on why he needed an ambulance for what looked very like a sweat rash caused by his clothing. The hospital was literally two minutes walk from where he lived, so the whole 999 thing was unnecessary.

He didn’t pose a direct threat to me but there was just something about him that made me uneasy – loners in slippery flats with knives on the floor tend to do that when you work solo at night.

Be safe.

Saturday, 14 March 2009

Pillow vomit

This confused pepper made me think about personalities and how often they are split, even in the so-called right-minded.

Night shift: Ten calls; one treated on scene, two assisted-only, one declined, one false alarm and the others by ambulance.

Stats: 1 eTOH fall with facial injuries; 1 Stoned drug addict; 2 eTOH; 2 DIB; 2 DOAB; 1 Hypoglycaemic; 1 Asleep!

The long trip out to deal with a drunken person who’d fallen on his face turned out to be a NPC for me because the crew, predictably, go to him as I pulled up.

One of the seediest hostels in my area, and one that the police don’t relish going to either, produced a call for me and I found myself talking to a thin young drug addict who was lying on his filthy bed out of his skull. There was a lot of shouting going on around me and the staff looked useless for control if I needed it. The call had been initiated by a member of staff who was convinced that the man was dying but, with a syringe by his side and the paraphernalia of drug use strewn around the room, it was clear he need no medical attention…yet.

The shrillest sound I heard came from another skinny drug addict – his wife, so she claimed. She leered in at him with almost no teeth and spat profanities at him; she almost convulsed with hatred, this woman. ‘F**k off you’, she shouted at me from about two feet, ‘he’s my ‘usband!’ I had only asked her to back off so that I could check the man’s condition. ‘Just doing my job, ma’am, just doing my job’, I didn’t say.

During the process of listening to the spaced-out man (who denied taking anything and said he was just tired) decline my help, the rat-woman from hell spoke over my shoulder and through my hair. ‘If you’re gonna die, before you go, tell me why you f***ed that fat slag’, she spat eloquently. I felt there was a domestic brewing, so I looked for help towards the door, where a staff member stood, but all I saw was neutrality and disinterest.

The aggression grew and her volume overtook the background clatter that resides in these places. Then she was joined by a Scottish druggie; he decided that a fight was in order and I decided I’d had enough. I packed my stuff, gave the skinny man on the bed as much advice as he would listen to and bid farewell to all in that delightful hovel. I was pestered out the door by the Scottish loud-mouth who had an opinion or two to share with me. I think he detected my lack of concern for his troubles at this point, so he stood at the doorway and completed his attitude novel on his own.

The ambulance was pulling up but I told the crew not to bother and explained how hostile things were inside. They sensibly agreed (they knew the place too) and moved off. I asked Control to inform anyone else who might be called to the place later to consider police backup.

I was cancelled on a call for a drunken female who’d fallen outside a pub – ‘no longer required’ my MDT said but I made the mistake of rolling past the place on my way back to the station and was immediately hailed, like a cab, by frantic people who’d gathered around a lump on the ground. A man came running up to the car and said ‘how can we get her into your car mate?’

‘You don’t’, I said (and I’m not your mate).

The woman was emotional; she obviously had other things going on (booze amplifies depression), so I persuaded her to go home with her friends in a taxi, so long as she promised not to throw up all over the driver. One of her friends told me she that was a nurse – big mistake really because she was the one who’d made the call and demanded an ambulance for someone who was quite obviously in no clinical need of hospital care. All she needed was a new life.

They were all grateful that I had pulled off this miraculous recovery (I got the drunken woman to stand up) and one of the men (equally drunk) asked me where the nearest charity was. ‘Eh?’ I said. Then he tried to slip me a fiver, you know, like you do with a waiter. I don’t take money from patients or their drunken friends, so I refused and suggested he walk down the road to HQ and make a donation to the ambulance fund or HEMS or something. A fiver buys quite a few Mars Bars and they would see me through this night but I wasn’t losing my job for it. The gesture was empty anyway; if he hadn’t been so drunk I would have taken the compliment and still refused but he was just trying to be patronising.

A 71 year-old gentleman I know well had an asthma attack and was quickly nebulised before being taken by the crew to hospital. I’d spent a few minutes in his flat looking at his shrink-wrapped TV remote controls with curiosity. He told me he did it to avoid getting infections from germs off his hands (and his wife’s hands). I wanted to tell him he’d get them from the plastic instead but I thought it would be cruel and petty, given his current state.

Here’s what bothers me and everyone else on the frontline – A call for a 100 year-old lady with DIB (so you can believe that it is genuine) was cancelled for a higher priority call as I made my way. I thought it must be a cardiac arrest to take me away from an old, frail, DIB lady. It was a Red2 for a drunk on a bus! It was given as ‘unconscious’ but they always are, so the poor old lady’s Red3 DIB had to wait. If she died because of the delay, there would be nothing done about it.

When I got on scene the police were there and they told me that he’d got up and walked off the bus. It’s truly disgusting and we need to sort it out. Almost every ‘unconscious’ person on a bus, especially if they are young, is asleep, I promise you.

Luckily the next patient, an 82 year-old woman with ‘general malaise’, according to her GP who I met on the way in (he was leaving), got my attention, and that of the crew without a cancellation. She was very poorly, weak and looked on her last legs. She was dehydrated and had a low BP. She lay on the sofa, trying to speak but without the energy to summon many words. I left the crew to take her away to hospital.

‘F**k off!’ was my welcome as I tried to wake the next DOAB I encountered. This one, East European and belligerent, wasn’t happy to see me and wouldn’t move for me until I threatened him with the police. I usually have to make the call to Control before they shift and, predictably, he reacted. Off he went, lit fag in hand, into the darkness.

A night club for a drunken, vomiting young girl next. I arrived and a private cab merchant asked me if I could park my car somewhere else because he couldn’t get the cabs to his customers. ‘No’, I said, leaving him with his mouth open in the background. I don't have conversations with people when I'm on a call.

The drunken 18 year-old was lying in the basement of the place with a first aider on scene and a couple of security guys hanging about. She had taken in a litre of vodka, so I’m told, although I found it hard to believe. My obs were done and the Booze Bus crew arrived to take her away. She was wheeled out on the chair for everyone in the queue to see. I hope she isn’t local because she’ll never live it down. The jeers and cackles that rang out around her will echo in her intoxicated little head for years to come.

A call in the small hours took me to an unmarked tower block in an estate undergoing renovation. The thoughtless Council neglected to put temporary signage up identifying each of the identical towers in the area, so my instruction to go to a specific one left me standing in the middle of them all, looking up and hoping for the best.

The call was for a 42 year-old man who was ‘not alert, possibly drunk’, outside his own home. I waited and waited for someone to tell me where I was going. I called Control but all I got was ‘look for a yellow building’. Even in the dim light of the morning, there was no way I could identify the colour yellow on any of these drab, horrible buildings.

Then a shrill voice sounded out over the quiet air. It drifted down to me but I had no idea in which direction I needed to look. I knew up was a good start but I didn’t know which block the voice was coming from. After a few moments of searching in the dim light, I finally saw a frantic arm waving from about the sixth floor of one of the towers. I shouted out that I had seen the signal and walked toward the building.

Inside, on the threshold of his own flat was a very drunk Glaswegian man. I knew he was from Glasgow because he spoke with a slurred accent that I recognised and he wore a Rangers T-shirt. His wife (well, I thought it was) and 15 year-old daughter were there and I was told that he was diabetic, so I did a BM first...it was low (2.2). The man was conscious but not fully – he reeked of alcohol as if the stuff had been doused on his skin; I could probably have set him alight with a single match if I’d had that cruel intention within me.

I got him to eat a tube of Glucogel, then I asked his ‘wife’ to get a chocolate biscuit or something – she produced a Mars Bar and I was instantly hungry. If he didn’t eat it, I would.

I half-forced the Mars bar into his mouth, through his gritted teeth and he began to chew, like a cow with grass. He kept pawing me and saying stupid things. Little giggles would escape him every now and then but I knew his hypoglycaemia wasn’t doing that, his alcoholism was.

‘Is this normal for him?’ I asked the trodden-looking Filipino woman who was standing at the door watching my every move – her daughter had gone back to bed.

‘Yes...every week now’, she said in the high-pitched, almost shouting voice that is indigenous with Filipinos. There was no smile and no background emotion when she said it. She was living this misery and had no power over it. Whether this was a better lot than the one she'd left behind in her mother country, I don't know. Her face didn't tell me. All it said was servitude and sadness. The poor woman had suffered a stroke too, a year earlier. she had no use of her right side and her arm lay limp at her side.

The man on the floor began to stir but he remained stubbornly drunk in his behaviour, even though his sugar level was rising. Using Glucagon would have been useless, incidentally, as alcohol negates its efficacy.

I managed to get him to stand up and walk into his front room. I continued to ply him with sugary drinks and that Mars Bar, which he slowly sucked away at like a child. When his BM reached 4.0, I decided I’d had enough. I’d been with him almost an hour and he was starting to get lary, wanting to be my friend and to know all about me (he’d recognised where I was from). So, I went to get my PRF so that I could leave him with a copy. He didn’t want (or need) to go to hospital, so I spent a nice quiet ten minutes in the car doing paperwork.

When I was ready to go back up I headed out and was met at the main door by his daughter. ‘He’s fallen and cut his head now’, she said in a voice that, if it had owned a face, would have looked pissed off with it all. I think I sighed out loud and I'm sure she heard me.

I went up to find him in the toilet with blood all over his face and a little pool of it on the toilet seat and cistern. He’d fallen forward while peeing. I dressed his wound, which was thankfully minor, and advised him to go to bed. I presented the form to his ‘wife’ for signing and that’s when she announced that she was ‘no wife...just friend’. She backed away from the PRF as if it was possessed; the word ‘wife’, which I had ticked, seemed to terrify her.

I persuaded her to sign when I changed her title to ‘other’ and bit my lip to restrain myself from asking why they had a teenage daughter if they were just friends. Someone else’s voice in my head told me it was none of my business – I think it was an immigration officer.

Anyway, I bid farewell to the drunken Glasgow man and noticed something familiar hanging on a rail as I turned to go. It was a high visibility jacket, much like mine. It bore the word AMBULANCE on the back.

‘No way’, I thought.

But it was true. He worked for a private patient transport service (PTS). This man handled frail old people on a daily basis. On a weekend he couldn’t even handle his drink or his own blood glucose levels and he cared nothing about the state his family was in. I had no respect for him at all. To cap it all, on my way out of the door he shouted ‘Rangers or Celtic?’ which, in Glasgow terms, is another way of asking my religion ‘Protestant or Catholic?’ I shouted back ‘Rangers’ and got the inevitable hooray for being a good boy. If I’d been Catholic and returned a ‘Celtic’ to him, he would probably have chased me out the door and had a shower afterwards to rid himself of contact with me. Thankfully, this breed of ignorant men is dying out and modern Glaswegians are aware of the possibility that not everyone shares the same viewpoint.

My last call was Red2 because it had been passed back from Clinical Telephone Advice (CTA) on the basis that the caller insisted on an ambulance. His reason was that the ‘patient couldn’t be woken’. Fine, I thought, I’ll have a look. I went there knowing that this would be stupidity.

Inside the flat two Chinese men were looking anxiously at another man who was lying on his side in bed. He had vomited and one of the worried man pointed at it and said ‘look, on his pillow’.

I walked up to the sleeping man, pulled him onto his front (I had seen him shrug his friend’s hand off him as I walked in) and he opened his eyes. ‘Wake up and stop play acting. Your friends have had to call an ambulance for you’, I said. He looked instantly ashamed and apologised. He was wide awake now, stinking of booze and covered in his own puke. His pillow had a large pool of vomit on it and, by turning him over, I had inadvertantly (possibly) placed him on top of it.

My guess is that he was due to get up for work and after a heavy night of irresponsible drinking had decided he didn’t want to. His panicky friends could think of no other way to get him out of bed but to dial 999. Remember, I don’t get annoyed because I have to do this job, I get annoyed because I know that as long as I am tied up with chores like this, I can’t be available for real emergencies, like 100 year-old DIB's, which actually happen. I want to have a book of tickets that I can write, fining people who treat us like this.

‘Right, your friend is now awake. Please pay this fine to the ambulance service within seven days. It will be £50 if you pay within that time and £100 if you are late. Bye now and have a lovely day.’

Be safe.

Friday, 13 March 2009

Two bus drivers for the price of one

Night shift: Fourteen calls; one treated on scene, three assisted-only and the others by ambulance.

Stats: 1 Allergic reaction; 1 Hypoglycaemic; 2 eTOH; 1 DIB; 1 EP fit; 1 Asthma; 1 RTC with Fractured clavicle; 4 Assaults; 2 Panic attacks; 1 DOAB

Friday night and its all going a bit mad. A 55 year-old woman thought she might be reacting to her medicine but she didn’t appear to be – she seemed to be emotional. I left the crew with her.

Then a pregnant diabetic Japanese woman, who made me stand outside her flat for ages before finally coming down with her husband, sat in the car while I treated her mild hypoglycaemia with Glucogel. It was all sorted out in half an hour and she went about her business with a caution to take better care of herself.

I came across the notion of ‘eye peeling’ for the first time when I met my next patient, a 32 year-old Californian in a hotel room who was suffering from a panic attack. Her heart began to beat faster suddenly and her hands were numb. This scared her into calling an ambulance. She had been walking around London all day long and, by the sound of it, had covered quite a few miles, so maybe her body was fighting back. At first I thought she had a nasty rash around her eyes but she explained that she’d had them peeled and that this was the Californian thing to do – it reduces fine lines apparently. It may do but it also makes your eyes look kind of assaulted for a while.

You will be awarded a Red2 if you get so drunk you can’t stay conscious and so I sped along to an 18 year-old who was with his father and workmates outside a bar. He had vomited quite a bit and was fairly groggy but conscious enough to understand what an idiot he’d been with alcohol. At times his much older colleagues, all of them builders, were unhelpful as they shouted encouragement to him. He had to go to hospital; he wasn’t fit for anything else (including work the next day). His dad was somewhat embarrassed by it all, as you can imagine.

A poorly baby with a chest infection and a high temperature next. His mum was concerned about his breathing and when I examined the 4 month-old, it was clear he was struggling with it, so off he went as soon as the crew arrived.

I had to assist with the removal of a large man who’d had a fit in a record store (I say record because it sold vinyl, so that’s valid). He’d collapsed and hit his head on a shelf before convulsing on the floor – he must have pulled at the stock because there were albums all over the ground.

Finding the exact location of a call can be tricky if the caller isn’t clear, so I went around in a circle until the crew, who’d joined me in the search, stumbled upon him. The 16 year-old was claiming an asthma attack but he didn’t seem to be having any real trouble with his breathing, although I won’t judge it one way or the other. Nevertheless he was treated for it by the crew. He’d been standing in the street waiting for us, bent over in a posture of pain...without any of the valid signs.

A call given as two unconscious people in the street turned out to be a RTC involving a bicycle and a pedestrian, both of whom had been knocked out. The Booze Bus was already on scene and dealing with the only injured person, the cyclist, who had a broken collar bone. The other person was fine and the police landed to sort the incident out but it seems like a simple accident had occurred. I left the broken clavicle man with the crew after checking that his pain was manageable without morphine.

Boozed up young men who’ve been given a kicking will often want to retaliate, especially when we arrive. I think they get courage from the fact that a punch-up is unlikely when blue lights are around. I wouldn’t place a bet on it though. The man had been beaten up after challenging someone to a fight (he lost, obviously) and got himself a cut lip, bruised eye and a lacerated head for his trouble. Police were on scene and he was reasonable enough to me – well behaved even- until, on several occasions during my wait for the ambulance and even on the way to the ambulance, he summoned up the nerve to shout out more challenges to the people involved in his beating. I guess he hadn’t learned his lesson.

Immediately after this call, I went back to the same area to see a 50 year-old woman who was sitting in the doorway of a casino with worried friends around her. She’d had a panic attack – she knew it, I knew it and her friends knew it but the call was Red and given as neck, back and chest pain. She didn’t want to go to hospital, which was a sensible decision and I cancelled the ambulance. She was recovering well and went back to her hotel with a mate in tow.

In Victoria, a 41 year-old man was attacked by a gang of thugs, dragged across the road and then beaten up. He was standing with police when I arrived and his face had been battered so hard that his nasal septum was deviated and he couldn’t breathe through one nostril. He also had a swollen eye and felt that his contact lens might have slipped up into the orbit, which he found uncomfortable. The men who’d assaulted him had hailed a taxi to make their getaway, the cheeky gits – I wonder what the cabbie was thinking.

My drunk on a bus slapped my arm away a few times before I won him over and he stomped off the vehicle like a stroppy Polish child. I get lots of these calls, as you know, but this time I arrived to find that the bus driver himself was asleep at the wheel as he waited for me!

A very confused and stupid drunken man collapsed and vomited outside a tube station, triggering an inevitable 999 call. He spoke nonsense most of the time I was with him and continued to speak it when the Booze Bus arrived. He didn’t want to go to hospital and he didn’t need to either, so we let him catch a taxi home. Whether he knew where he lived or not is a mystery.

A double assault on bus drivers next – one had a facial injury and the other had been kicked in the chest, so he was coughing all the time. Neither was critical but both needed to be in hospital for a check up. The police were there and this was my last call of the night. I went home in a low mood though because sometimes even the busiest night can't distract you from other things on your mind...

Be safe.

Tuesday, 10 March 2009

Date with a dying woman

Day shift: Five calls; one gone before arrival, three conveyed by car and one by ambulance.

Stats: 1 DOAB; 1 RTC with head injury; 1 Chest pain; 1 Fall with facial injury; 1 ? Sprain.

I’m running a survey on the number of drunks on a bus (DOAB) calls we get as a unit, I want to prove that the vast majority of them – probably all of them – are just sleeping inebriated people. I want to convince our bosses that they don’t require an ambulance and that a solo can investigate it before all the alarm bells are rung. I will suggest we send a car or bike on them and if they are what we suspect them to be, then it will be a simple case of waking them up and getting them off the bus, if they won’t go then the police can help us. These people are a complete waste of tax-payer’s money.

My DOAB of the day was gone before I got on scene, so I quickly cancelled the ambulance. The bus driver was waiting for me and he told me that the guy wouldn’t get off the bus and lay slumped in a seat on the top deck. As the driver sat at his wheel waiting for me to arrive, his slumbering passenger came down the steps and tried to grab the cigarette that was behind his ear. Then he challenged him to a fight. The driver told him to leave the bus and he stormed off down the street.

I conveyed most of my patients today, something I used to do a lot when I worked on the so-called ‘amber car’ if you remember. Hopefully I will be getting back to this sort of work because it saves ambulance resources. The call for a cyclist who’d fallen from his bike as he rode to work, for example, is a perfect ‘load and go’ car job. The MRU desk despatched me on this directly and, because the young man had no more than a bump to his forehead, a cut lip and a broken tooth (all perfectly survivable), he could go up the road to hospital with me in the car. Easy.

If the same call had been sent through the system and picked up by FRED I expect it would have been categorised as Red because of the ‘dangerous body area’, yet when a real human being with clinical expertise is on scene to assess (it was a running call from a MRU colleague), there is no drama.

After I’d handed over the cyclist, I was sent around the corner to a clinic where a 37 year-old man with HIV was suffering chest pain. Well, he wasn’t when I got there, it had been intermittent over the past 24 hours and it was mainly right-sided, so I wasn’t too concerned. He was with a couple of the doctors from the clinic and all his obs, including an ECG had been done for me.

I spent ten minutes chatting to him as I got him to the car and up to A&E. He was initially fearful of the pain, thinking he was having a heart attack but I think he was reassured by my argument that it was the smaller of many other possibilities.

My break was interrupted for a Red1 call, ‘ineffective breathing’. I expect to arrive at a suspended patient if the details are correct on these calls but I also know that people have a funny way of being directed into saying yes or no by stupid leading questions and so I wasn’t surprised at all when it turned out to be nothing more than an elderly man who’d fallen onto his face and who'd bled a bit on the carpet of a posh club.

The only interesting aspect of that call, which cost me sandwich-eating time, was that I got stuck on lights and sirens behind the Prime Minister’s convoy, which is made up of police motorcycle outriders, a couple of Range Rovers containing cops (or SAS) and a couple of heavily secured luxury cars, one of which contains the man himself. Now I know that every one of those cops is ‘packing heat’ and God knows what’s inside the Range Rovers for defence, so I was very cautious as I crept up behind the line of vehicles as it snaked its way south to Downing Street. Every vehicle has its blue lights on but sirens are not used – the motorcycle cops blow whistles to stop traffic and control the route; the idea is to keep the convoy moving and therefore reduce the risk.

I’m at the back of this with my sirens blaring but of course, Red1 or not, the PM isn’t going to pull over and let me past. I could have swerved around the column but I think I would have been seen as a security risk.

The column is going at 20 mph and I am trying to get to my potential cardiac arrest at the same speed, although I know for sure that I could zip past and build up another 20 mph but I decide not to be brave (or stupid) and not to embarrass the Service. What if I’d caused his car to career into a bollard? I would be standing by my vehicle with ten guns pointed at me….

‘What the hell do you think you’re doing?’ the angry cops would ask.

‘Actually, I’m trying to make the target set by the Government’ I would cheekily reply, before being shot for insolence.

My last call of the shift was for a 54 year-old woman who’d fallen earlier in the day and twisted her ankle. This was translated as ‘chest pain and DIB’ by the wonderful computerised system we use to keep ourselves stressed and over budget.

I cancelled the ambulance and took her to hospital myself. It took almost an hour to travel less than three miles because the traffic was so heavy and rain had slowed everyone down. I wasn’t on lights because this wasn’t an emergency – this was a Green call really – a Green call masquerading as an emergency.

On the way I chatted, as I do, to my patient and we had a laugh or ten before arriving at A & E, where she was promptly put in the waiting room to sit for hours before being seen. She asked me if I could come and get her when she had reached old age and was in her last hours. I thought that was a strangely lovely compliment. I said I would but I knew I was lying…being realistic, so did she.

Be safe.

Monday, 9 March 2009

Bike versus taxi

Day shift: Four calls; all by ambulance.

Stats: 1 Dizzy female; 1 RTC with fracture and ?spinal; 1 Faint ?fit; 1 DIB.

I know what you’re all thinking – the last few shifts have been very slow, with an average of four calls a day for me. It’s true that I’ve only attended a few recently but the Service as a whole is busy…if not busier than usual. There are a lot more motorcycle units out and about with me on my day turns, so the workload is spread evenly among us. When there are no bikes, or very few of them, then I tend to deal with double the number of calls.

It’s all good for my mental health. I get more time to think and less time stressing through heavy traffic behind the wheel of a target-driven FRU. The slack won’t last long, however. As the weekend approaches in the short term and the weather improves in the long term, I will be run off my wheels again, regardless of the number of cycles and motorbikes that are working.

A 56 year-old lady became emotionally upset when she began to feel dizzy as she shopped. She developed a facial twitch on one side for a short while apparently, but it was gone by the time I reached her. She had a history of hypertension but her obs were good and there was no associated headache or other symptom present. I think when I arrived, she’d got over the worst of whatever she had experienced and it was just a case of bringing her down from the height of her crisis.

On the other hand, she may have had a small stroke, so she went to hospital with the crew when they arrived.

I expected to see a motorcycle colleague racing towards the next call with me (in front of me of course) because it was a RTC on a busy road, involving a taxi and a biker. An ambulance pushed its way through heavy traffic en route and I thought it was going to this call too but it turned left when I went straight ahead. Unless the crew knew a quicker way to the scene I was on my own.

I arrived to find another ambulance crew on scene and dealing with a motorcyclist who'd thrown himself from his bike when he realised it was about to collide at 35mph with a U-turning taxi. The cabbie had made the turn without looking (or seeing) the motorcyclist approach and, in order to save himself from imminent death, the man on the bike had ditched, causing his body to land on its side and slide along the road with his machine, which embedded itself into the bottom of the taxi (pic).

Now he had a broken collar bone, which may or may not have punctured his lung. He also had a possible spinal injury because he had pins and needles in one leg and severe back pain.

An off-duty GP appeared and offered her help. The crew was busy with other things, like obs and collar, so I got on with setting up fluids on a line. I used the doctor’s skilled hands to stop the vein from leaking too much when the cannula was withdrawn and to prepare and hoist the fluid bag for me. Then I remembered her pay scale and transferred the job of drip stand to a police officer who wasn’t busy.

The man on the ground was stable but in a lot of pain. He was also beginning to get cold because all his clothing was coming off in a frenzy of shears. If his collar bone had gone through his lung, he could develop a serious problem and so I asked the GP to stay just in case we had to do something drastic.

I also called for another pair of hands and requested MRU backup. My colleague arrived very quickly but, again, I was surprised that he hadn’t been despatched to this initially. To be fair, we were generally busy and it may well be that resources were being kept ready for other things…like the RTC that happened an hour or so after this call in which a woman was run over and crushed by a large truck - a call I heard about a lot and just missed because I was on this next one…

…A 25 year-old woman collapsed in a pharmacy and had what the pharmacist described as ‘a little fit’. When I arrived, the lady was sitting on a stool behind the pharmacy counter, glass of water in hand, phone to her ear and tears in her eyes. She was clearly upset by the experience.

When she finished her conversation, I asked her what had happened but she didn’t remember much. She told me she’d had a similar experience when she was younger and her mother had told her she’d fitted but, strangely, nothing was done about it and her GP wasn’t told. She also told me that she had frequent experiences in which dizziness occurred and a dark shadow sometimes descended over her vision but that she’d got over them each time…until now.

I waited with her in my car because the ambulance was a distance away and she was well enough now to walk. Her BP had initially been low but it was better by the time I’d completed my obs. She too was a pharmacist, ironically but she didn’t work in the place where she fell – she was just shopping.

Her inside bottom lip had been pierced by one of her front teeth when she landed on the floor and there was a little hole in it. The swollen tissue was making her uncomfortable but I think she was very concerned about her long-term health. She worried about the possibility of epilepsy. So did I but I also thought of other causes and considering the past events she’d described, some of them could be sinister.

But my mission was to elicit a smile from her and I did eventually, even if it wasn’t until I said goodbye and closed the back door of the ambulance. Maybe seeing the back of me made her feel happy.

I returned to a patient I haven’t seen for a few years. I treated him when I first started working for London and I have seen him once or twice since but I think the last time I went to his home was about three years ago. Each time I’ve been there he has been critical. He always gets blued in to hospital.

He’s only 14 years-old but he suffers from severe physical disabilities and epilepsy which can spiral out of control when he’s fitting. His airway is a nightmare to keep clear and he has to be suctioned all the way to hospital if his condition is bad enough. I was surprised to see that he was still around to be frank.

I spent a short time with him and his caring family until a crew showed up. I told my colleagues about him and, once again, he was blued in. He had a chest infection and it was causing problems with his breathing – his respirations were up in the high 30’s, as was his temperature. Despite antibiotics and a recent visit from his doctor, the infection clung to him and he continued to suffer, without being able to tell anyone. His physical and mental incapacity made it very difficult to diagnose anything.

When I got back to base I was told more about the RTC involving the woman and the truck. Over the radio I’d heard a colleague say that the injuries were incompatible with life (in other words, it would be useless to try and resuscitate) but that changed when she began to show signs of brain activity. Her ECG showed PEA from asystole, so now they were rushing her into hospital on the slim possibility that she might survive after all the invasive treatment she’d received at the roadside. I was told that her injuries had been massive – the heavy lorry had rolled right over her chest and mid-body, crushing her ribs and limbs. If she survives that, I’m not entirely sure if she will be grateful but I have seen people with devastating injuries recover, if not to normal then to something resembling it.

Be safe.