Thursday, 29 October 2009


Carved this one myself.

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

Stats: 2 Head injuries; 1 Cut finger; 1 eTOH; 1 NPC; 1 Chest pain; 1 Asthma; 1 Labour; 1 Suicidal.

This was my second night shift since taking leave over a month ago and as soon as I hit the streets I got a bad feeling about it. Sometimes that happens; I get a sense of something not quite right and I keep an eye on myself, so to speak.

The first call took me to Leicester Square and the remnants of a fight that had broken out amid the crowds. One Asian man had allegedly set upon two Chinese men, laying into them with a broken bottle and smashing their heads. There was no evidence of a bottle at all, except for glass fragments in the hair of one of the assaulted men but all three had injuries – the assailant had a nasty cut to his finger and the other two had cuts to their heads and the cops were trying to figure out just what had taken place. It seemed that the bottle had cut the assailant when it broke but, as I said, there was absolutely no sign of the bottle fragment or glass in the area. I guess the actual assault took place elsewhere.

I asked for two ambulances because the assailant would have to go to a separate hospital, as is standard practice and while I waited, after treating all three for their wounds, the cops discovered a large knife on one of the men. ‘That’s not mine’, said the man sheepishly and quite unbelievably. I asked that the other two be searched because I had been in close contact with the guy with the demon blade and I didn’t fancy exposing myself or my colleagues to that risk again.

After the men had been removed and things were being cleared up, I chatted to one of the cops about what had happened and we discussed whether the injuries were life-threatening or not. As we talked, an angry white van man demanded that the police move their vehicle so that he could enter the square to make a delivery. Normally I get the brunt of such impatience but I couldn’t believe that he was confronting a police officer who was busy at a taped-off scene of a crime. Absolutely nothing is respected these days.

As I completed the paperwork for that call another came through as a General Broadcast. It was behind me, a little way down the road, so I took it and headed the hundred metres or so to the location. In a theatre doorway a man had settled down on the ground, causing the door staff to call us because they thought he was ill. He had told them he was ill. A police officer was with him and I was soon told that he had said he was passing out all the time for no known reason. Right at the outset I knew there was something not quite straight with him. He refused to get up until the police officer insisted and helped him to his feet and when he went to my car to wait for the ambulance, he became abusive towards us (the cop and me). A quick radio check on him (by the cop of course) revealed a long history of aggression and violent behavior and when the crew arrived, having been pre-warned of the nature of this man, the EMT was given a bruised arm when he grabbed at her as he left the car.

No patient contact for the French man who cut his leg on broken glass in a club. The crew was already on scene.

On two occasions tonight, as I blued my way to calls in the West End, I had to avoid colliding with police Armed Response Units on their way, in the opposite direction, to calls. Even driving to calls was going to sharpen my attention on this shift. And when I arrived back at my station for a cuppa, I was greeted with a fight which was going on at the bottom of the road. I walked down to see if I could slow it down or stop it and watched as another man got in the middle of three teenage boys and a teenage girl as they argued and hit out at each other with belt buckles (the new weapon of the streets). To be honest, the girl was doing a lot of screeching and mixing it up but when the man who tried to stop it became the victim of their combined violence, she got in there with feet and fists, just like the boys.

I had shouted for the man to get away from them because even I wasn’t going to get in the middle of it – these young kids weren’t even aware of me or anyone else, such was their red mist for each other. The consequences for the man who tried to help were fairly predictable – he got rounded on and beaten up right in front of me. I had already called the police and they arrived just as the fight broke and all parties wandered off but they were able to get a hold of two of the assailants and the girl, as well as the man who’d tried to stop them.

I was the only witness to this violence (other bystanders had cleared off) and as I stood with the cops, waiting to give them any information they might need, the girl walked over to the assaulted man and threatened him. ‘I know where you live’, she said. She did this twice, in front of the police. Then she flicked her cigarette across my face after I’d offered to get an ambulance for one of the young lads who’d suffered a fractured cheek. He’d refused and she was showing her contempt for anyone but her own. Somebody, somewhere actually loves this vicious, disrespectful little girl.

A call to Soho for a 43 year-old man who’d collapsed with chest pain in the street next and a passer-by told me that he’d called an ambulance because the man was in a lot of pain. The ex-crack-cocaine addict had been smoking cannabis earlier and now he had central chest pain and felt weak. When the crew arrived a woman appeared in front of us and listened intently to what we were discussing as I handed the patient over. I assumed she was an observer with the crew and they assumed she was with me but she wasn’t.

‘Can I help you?’ I asked.

‘I’m a doctor’, she said with an accent that could have been German or Dutch.

Once again, the phenomenon of helpful-foreign-doctor types rears its head for the night.

A crew joined me minutes after I’d arrived at the home of a large woman with asthma who was suffering DIB because she couldn’t get to her medicines. She was sitting on her bed, struggling to reach her inhalers, all of which were a mere two feet from her on a table. Her little dog was deeply concerned for her (you can always tell when a dog is worried) but her husband, who is her paid registered carer, was in bed asleep in the next room. ‘Why didn’t he come and help you?’ I asked. ‘He doesn’t give a damn’, she replied sadly.

We nebulised her until she felt better and then left her with advice on keeping her meds nearby; she could reach the phone to call us but she couldn’t get to the medicine she needed and that was a dangerous paradox we had to bring to her attention.

I thought I might be delivering a child in the early hours of the morning. The call stated that the woman was 41 weeks and her contractions were two minutes apart. In fact her contractions were five minutes apart and she was nowhere near dropping a sprog just yet. However, this lady had given birth to three children before this one and that always changes the timing, so I asked for an ambulance and prepared my Matpack just in case. I’m still in paternal mode clearly! She should have taken a taxi.

My last patient of the shift was described as ‘violent’ for some reason and I asked for the police to join me, believing that Control obviously knew something I didn’t. When I got on scene the suicidal 32 year-old was waiting for me and signalled to me with a meek wave. He stood outside a phone box and introduced himself, explaining that he had tried to cut his wrists with broken glass and had taken 12 paracetamol in a bid to end his life because he had lost everything and was at the end of his tether.

His wrists bore superficial evidence of his attempt, which was nowhere near a vein or artery and a dozen paracetamol isn’t likely to cause him great harm, so I reasoned that this guy was looking for help.

As he sat in the back of my car (I had cancelled the police because he was as gentle as a lamb) I listened to his story. He’d lost his business and gone downhill via alcohol. He had no living family except distant relatives in the north and he felt he had no prospects because nobody was willing to give him a start. There was probably a lot more to it – there usually is but I could see how easy it must be to lose it all and then find it impossible to climb back out of the hole. No bank is going to finance you, no employer will look at you and benefits can be a trap that you simply can’t get away from. I couldn’t believe that a man with such intelligence and character couldn’t find some way of getting help though – there are lots of wonderful organizations out there and the support is around if you want it. It still left me feeling sad.

I watched him walk away with the crew and wondered if he’d get his life sorted out now or if I’d meet him again in a less healthy state.

Be safe.

Wednesday, 28 October 2009

DOAB night

Day shift: Nine calls; two by car; three assisted-only; four by ambulance.

Stats: 1 RTC; 1 Asthma; 2 eTOH; 1 Head Injury; 2 DOAB; 1 EP fit; 1 Drug o/d.

While chatting to a CRU colleague, he received a call to a RTC in which a man had fallen from his moped. I offered to tag along and help out in case the injuries were minor enough to warrant a trip in the car, so we both left the same spot for the trip less than a mile away and I arrived to find that I had been beaten to it by the two-wheeled speedster. This says a lot for the efficiency of cycle lanes in London – at least, that’s how I will look at it.

The moped rider was sitting on a step, chatting to my colleague and looking like a minor casualty. His face, hands and feet were cut and grazed but otherwise he was well. The fall had taken place at 30mph he said but then everyone involved in an accident in a 30 mph zone will say that, even when they have injuries that are more consistent with a higher (or lower in his case) velocity.

I took him by car to A&E while his friend took it upon himself to ride the moped and check that it was still safe. It was.

We could do with a minor injuries unit in this part of town.

After a long run up to the north just so that I could be cancelled as I entered the street where the call had originated, I was off to a 62 year-old asthmatic man with DIB. He had already nebulised himself at home when I arrived but his breathing was still labored and short, so I gave him Atrovent to see if that would improve things – unfortunately it had no effect and his peak flow remained very low. The crew arrived to take him to hospital and I was glad of the timing because, short of more drugs and reassurance, he was heading for trouble and a quick trip to hospital was what he really needed now.

My order to ‘return for break’ was rescinded when I received a call to attend a 40 year-old Polish man who was in a callbox claiming chest pain. I am deeply cynical about such calls I’m afraid because invariably they produce drunken street dwellers with no reason to call ambulances except in order to secure a warm bed and a free meal at the expense of the tax payer. This is my experience and when I arrived I was rewarded with just that – a disheveled drunken Polish man who kept repeating the same two words ‘chest’ and ‘hospital’. In truth, he named the very hospital he knew would give him no-questions asked accommodation – they all do.

Now, I’m not saying he didn’t have chest pain but it is difficult to assess when the patient is so drunk he can barely stand up. Furthermore, when people have genuine chest pain, for the most part, they refer to it often because it hurts. This man only referred to it once when I spoke to him initially and once again when I was obviously badgering him with my questions in a language he knew little of. My Polish isn’t yet at a stage where I can carry out a full investigation, so we were kind of at an impasse once I’d completed all my obs and found nothing untoward. I had to wait for the crew to arrive as he sat in the back of my car attempting to go to sleep.

This is a major problem for us all. We simply can’t take the risk with claims of chest pain in anyone, so we have to cater for everyone, which is the right thing to do. However, society is supposed to behave responsibly when making such claims and so, with the easiest method of abusing the system wide open, we can quickly become overwhelmed by nonsense patients... and then, of course, when they do become seriously ill there is a question mark over them until proven legitimate.

And so to prove the point, my next call, almost immediately after the chest pain, was an ‘unconscious, shallow breathing’ man on a bus. Yes, again, experience over the years has shown me that these calls are rarely genuine emergencies. In fact, only once in the past five years have I had to open my bag and do anything for someone who was out of it on a bus and she turned out to be a drug addict. So-called unconscious males on buses tend to be drunken sleepers or those with nowhere else to go for a kip. They also tend to be located at the back of the bus where they think they are invisible.

This man was no different and I asked Control not to task an ambulance on the basis that I would more than likely be waking him up and sending him off. The bus driver assured me that he had tried ‘everything’ to wake him but the old trick of shouting and moving them into an upright position hadn’t been considered. It always works for me and within a few seconds I had him staggering off the vehicle wondering where his slumber had brought him. Obviously I asked if he required an ambulance and I got the usual stock answer – ‘no’.

Inebriated stumbles are also far too common and tonight every student on Earth is out getting drunk in celebration of Halloween – some of them have even gone to the trouble of getting all dressed up before they fall down. But my next patient was dressed like a normal person and wasn’t a student, so he didn’t fit tonight’s profile. Where he did match the circumstance for an ambulance call was in his staggering drunkenness and the fall onto an escalator step which took a small chunk out of the back of his head.

When I arrived train station first aiders were dressing the wound, which had stopped bleeding. His mate was with him, so, after the usual questions and a quick check of his obs, I decided he could travel in the car for the two minute trip to A&E. The wound would need to be cleaned and closed.

I asked that the ambulance assigned be cancelled and was told it had, so I spent five minutes with the patient and his friend, gathering info for my paperwork as they sat in the back of the car. I looked in my rearview mirror and saw that an ambulance had pulled up and the crew had decamped. They hadn’t seen me in my car, so they went into the train station. They’d find nothing of interest there.

I waited for the return of the crew and apologised to them for the hiccup in comms but they, like all of us, are used to these errors and they were glad to get back to their own area… if they managed to do that at all.

As I drove the men to hospital, the patient kept whispering something and his mate repeatedly shushed him. I don’t know what they were up to but I kept an eye on my mirror for the whole trip. Maybe they were ambulance pirates.

In the small hours I was asked to check on a man in custody at the local police station. He was complaining of left arm numbness and the cops wanted to be sure that he wasn’t having a heart attack. As soon as I woke him up in his cell he began spitting about how the police had ‘jumped’ on him and that was why he had a sore arm. His tirade was ceaseless and meandered through stories of assault against him to more personal issues that I had no desire to learn about. Soon enough I had done all my checks and decided that his pain, if it existed, was muscular. He had no history and there was no chest pain involved. He was drunk and aggressive, so he stayed where I found him. He didn’t want to go to hospital anyway because he had a long list of accusations against the medical staff too.

None of us like the thought of running on a Red call for a fitting teenager because hard lessons in the past changed the way we respond to them and the death of a child as the result of delays and miscommunication is not something any of us want to have to live with, so I motored north as fast as I could in the early morning fog to help a 12 year-old epileptic girl who was having a seizure. Thankfully when I arrived she was recovering and had fitted as normally as she does every time she has an event. Her older sister held her in the front room as mum looked on. Both she and her sister were crying as I scrambled through the cluttered hallway and lounge to get to her. If she’d been in trouble, I would have had a very difficult time working in that environment – there was no room to move.

The girl was shaking and upset but otherwise fine. She’d bumped her head on the way to the floor and for that reason the crew, when they arrived a few minutes after me, took her to the ambulance for further checks. She’ll be taken to hospital, even though she doesn’t really need to go but we all want to do the right thing and we all want a happy ending.

And so to a meeting with a large drunk and drugged up man who decided to flop down on the pavement for his coma, right in front of foreign revelers who became too concerned to leave him alone, so they dialed the nines and got me after a General Broadcast produced no takers. He pawed at me and stuck his fist my way a few times, so I gave up on the professional Samaritan approach and asked for the police.

The cops arrived fairly quickly and I was able to give the patient a Narcan injection – there was little doubt he had taken something – soon after his attempted bout with me he became a slow, shallow breathing floppy doll. It only took a few seconds for the Narc to sort that out. Soon enough he was wide awake and answering questions pertaining to his name, age and address for the benefit of the police officers.

Then the ambulance came to take him away. He was still too unfit to walk the streets, so a sleep-over in hospital (and possibly more Narcan) was necessary for his own good. He wasn’t a drug addict; he didn’t seem the type. He was just a silly man.

Another DOAB next. The 40 year-old man was slumbering on the top deck of the bus and, as usual, had been diagnosed as ‘unconscious’ by the bus driver. Once again, I asked that an ambulance be avoided because I knew I could wake this guy up and send him on his way. So, there he was, fast asleep, ticket still clenched in his fist and a Harrod’s bag at his feet containing a large Sombrero and other fancy dress items. He was easy to wake and easy to walk off the bus. He shook my hand, thanked me (for saving his life) and sauntered off in the general direction of the next bus that would take him home. DOAB’s are too easy.

Be safe.

Tuesday, 27 October 2009

Bus versus Canadian

Night shift: Ten calls; one false alarm; one assisted-only and the rest by ambulance.

Stats: 1 RTC; 3 eTOH; 1 Kidney pain; 1 Panic attack; 1 Chest pain; 1 NPC; 1 Fall; 1 Swine Flu.

A 16 year-old Canadian boy was lying on the pavement after having been lightly clipped by a bus as it pulled into a stop so the natural reaction of British onlookers was to put him in the recovery position, even though he had nothing to recover from. He was much more frightened by the arrival of sirens and yellow-jacketed paramedics than the prospect of any minor injury he may have sustained as the result of his close encounter. I was reminded of the scene in ‘The Holy Grail’ in which one of the characters is persuaded that he is too injured to get involved in a fight even though he protests that he is fine.

To scare the boy even more a woman leaned over him, placed a large hand on his shoulder and whispered ‘God bless you and preserve you’. He must have thought he was going to die.

A free sandwich and coffee was all that a local alcoholic wanted when he feigned epilepsy in the street for the benefit of kind MOPs. He was munching away on it when I arrived and his tell-tale can of lager was by his side. The crew had to take him because the call stated he’d ‘had a fit’. Somehow I highly doubt that.

Off to a restaurant in Chinatown (guess what type of restaurant) for a 44 year-old Chinese lady who was propped up against the wall with a protruding tongue which she unconsciously bit down on and a large piece of vomited meat in her airway. Her work colleagues were concerned that she had drunk too much because she wasn’t responding. Well, no she wouldn’t because she was choking to death.

As soon as I cleared her airway she began to vomit the rest of her dinner up onto the floor of the little landing, in full view of anyone eating nearby and to the annoyance of blokes who simply wanted to go to the toilet but had to step over her in order to do so. Tsk! How dare she obstruct their right of way. It took a couple of reminders from me before the management got control of the traffic in the area and I could stop swaying to one side as yet another pair of boots came towards my head.

The woman had certainly had too much to drink and was still out of it when the crew arrived and scraped her from the floor. Maybe next time her friends will try to recognise when she is in serious trouble.

A 75 year-old man with a history of renal failure claimed that his kidney pain disappeared after I’d palpated his back. I asked him not to publicise this miracle because I don’t want a rush of business as a result. His BM was high but otherwise his obs were normal.

Up north next for a 22 year-old female having a panic attack outside a club she’d been in with her friend. They waited patiently for me on the kerb but neither of them thought to indicate who they were when I arrived, so I had to reason that they had called when I saw them. They had that ‘just called an ambulance’ look on their faces. I wish people would stick their hands up or wave more often when they see the car.

An ‘unconscious’ 35 year-old man wasn’t. He was drunk and belligerent. In fact, he chased after the concerned man who called an ambulance for him when he was found collapsed in a doorway. Then he tried to put his filthy hat on my head as a gesture of friendship. Prior to that he’d been quite aggressive and physical, so I left him, as did the crew, to make his own drunken way home.

After a night out celebrating his 75th birthday, a man collapsed in the smallest toilet in the world belonging to his female friend. It was hard work getting into it and I had to bend my way around the door to reach him. Luckily he was conscious – if he’d been in cardiac arrest this would have been the start of a nightmare. He was complaining of chest pain but the more he indicated where it was and the more he cried out every time he moved, the more convinced I was that it was muscular. Still, he had to be treated as if it might be cardiac, so he was given aspirin and GTN as required. Then he was taken away by the crew, moaning about the pain but still able to insult his girlfriend as he left.

A no patient contact call for sickle cell crisis. The ambulance was right behind me most of the way. The button-pushing targets are achieved this way and I must have given the hierarchy a five-second advantage.

A call given as ‘still on floor behind locked doors, fitting’ was in fact an assist-only job in which myself and the crew, who had to gain access by finding the master key to the door in a sheltered housing building, picked a woman from the floor of her bedroom and put her back into bed. The disabled lady had wet herself accidentally when she fell from the bed attempting to get to her commode. She got a new sheet and clean nightie and was left safe and sound on her mattress.

I was twenty minutes from finishing and had gone back to base in readiness but a Red call for chest pain sent me all the way back into WC1. Fair enough but the call description stated that the patient was 20 years old and had recently had Flu. This was not going to be a cardiac related call.

When I reached her she was in bed with her friends standing around her. She had Swine Flu and had only been diagnosed the day before, so now I was exposed to it without a mask. She had barely started her course of Tamiflu and now she was worrying about symptoms that she was bound to suffer. Her chest pain was caused by her coughing and a likely viral invasion of her lungs. I wasn’t pleased to be made late and neither were the crew who turned up because they too were supposed to be going home after a hard 12-hour shift and they had been dragged miles to get here. Of course, this is the nature of the job but us humans just get grumpy when we can't get enough sleep between shifts.

Be safe.

Thursday, 22 October 2009


Day shift: Five calls; three by car; two by ambulance.

Stats: 3 Head injuries; 1 Drug o/d; 1 DIB.

The first head injury of the morning was a 23 year-old blonde cyclist whose saddle had come off as she rode her bike, causing her to lose control and go over the handlebars. She sat on a step with a kindly passer-by, mopping the blood on her scalp with a tissue. Her blonde hair had a red streak in it and I told her that it looked fashionable – anything for a cheap smile. She seemed to take that on board, so it’s possible I will see her riding around in the future with a dyed line in her mop.

I took her to hospital by car because her injuries were very minor and a kind man from across the road, who’d witnessed the accident and was at work, offered to secure her bike until she could return to claim it. His name and number were taken and passed on to the patient, of course. Then I drove her to hospital and deposited her on a seat in the waiting area, where all minor problems listen for the call of their names.

I thought I had another fall from a bike job as a running call a little later as I wandered through Soho towards coffee and cake. A woman was lying on the ground quite still and people were gathered around her, looking concerned, so I stopped and called it in.

A bicycle was leaning against a post next to the supine woman and I assumed, like everyone else, that she had fallen off it and knocked herself out… or that she’d had a seizure because she did not respond at all initially.

I requested an ambulance and by the time I had returned to check on her (I had left my student with her to start obs), she was conscious and the police were telling us that she was a drug addict that they’d just turfed off another street for violent behavior. Now, at least I knew what we were dealing with.

A crew drove past on their way to the same assignment that I’d been carrying out and I asked them to help out, which they did. They got the necessary bits and pieces out of the ambulance, including the stretcher, and the patient became annoyingly agitated when we tried to support her neck (on the theory that she’d fallen from the bike remember) and attempted to tear away the collar we’d placed for her protection. Now we could see what state she was in; her pupils were pinpoint and there was a fresh injection mark on her already punctured and tracked veins. I decided we’d give her some Narcan because she kept slipping in and out of annoyingness.

The police stood by in support and an attempt to give her the opiate-reversing drug failed when she, once again, became combative. She was lucid though and that meant she had the right to refuse, so I accepted her refusal to be treated and asked the crew to let her go if she wanted to. We all knew that she wouldn’t make it more than a few feet before collapsing again.

Her drug support worker appeared (she resided in the local hostel) and he tried to persuade her to co-operate but she was having none of it. ‘You are trying to experiment on me’, she moaned. She was free to go of course but when the decision to allow this was made she promptly became unconscious again, so she was given Narcan IM, which worked almost immediately, and taken to hospital on a blue call. By the time we got to hospital with her, she was back in the land of the living and giving the hospital staff all sorts of grief.

She hadn't fallen from the bike. She didn't even own a bike. She'd stumbled over a bicycle on her way to wherever she goes and people had assumed she'd taken a tumble from two wheels. We figured all this out when we saw that the bike was chained to the post.

Having an accident that requires hospital treatment can be inconvenient, so the 70 year-old man who tripped and fell, bashing his head, in a coffee shop wasn’t too pleased when I took over from the CRU paramedic who’d handed him over to me. Giving someone with an appointment at the House of Commons (an appointment that he’d been arranging for months apparently) advice to go to hospital and run the risk of being late, didn't go down well but he accepted my advice and went along with it. He had a minor head injury but at his age and given that he needed the wound closed it was in his best interests.

A pleasant 52 year-old man fell outside his place of work at a posh club in the West End and sustained a head injury. He’d collapsed for an unknown reason so I dressed his head and took him to hospital in the car. The only medical problem he had was high blood pressure and maybe there was a connection, although all of his vital signs were normal. Still, he was concerned about himself and so were his work colleagues, who gathered around him before we left.

Continuing with the theme of wealth, I was called with an ambulance crew to a very plush flat with a view of the Houses of Parliament to deal with a 65 year-old woman who had DIB and possibly pneumonia, which had been given a cursory look over by her GP earlier and diagnosed as a chest infection. She was given antibiotics and told to go home and rest. Now she couldn’t breathe without pain in her lungs.

Both she and a male colleague who resided in the marble-floored flat were employees of the people who owned it. Apparently it is the rich owners’ ‘London pad’ and they seldom visit it, so the two members of staff; my patient and the man, who acted as bodyguard and chauffeur, were allowed to live in it while it was empty, which was pretty much most of the year. Alright for some I thought as I made my way back to base for the end of the shift. I need to write a bestseller and get myself a London pad, then I can sleep more when I am between night shifts.

Be safe.

Wednesday, 21 October 2009


Day shift: Seven calls; two assisted-only; one false alarm; three by car and one by ambulance.

Stats: 1 Cut foot; 1 Head injury; 2 eTOH; 1 unwell; 1 Abdo pain; 1 Faint.

A very minor injury to start the day with. A 46 year-old migrant worker caught his heel on a large metal cage that he was rolling from one place to another in a Government building. The skin was torn from the heel and now he was sitting on a box being tended to by the first aider. The wound had stopped bleeding and there really was no need for him to go to hospital but he insisted, so he did. He was wearing the wrong footwear for the job and a sturdy ankle-protecting pair of boots would have gone a long way to preventing this little injury. Instead, his flimsy shoes had offered no defence.

At a dance studio, I found a 19 year-old girl lying down on a bench, recovering from a kick to the head delivered to her by one of her dancing friends. She was in no trouble at all and, once again, there seemed to be no common sense at work with respect to what might be seen as an emergency and what might not. Her tutor assured himself that she was doing fine now that I was there and left the room, saying that he was needed elsewhere. It was a ruse because no sooner had he gone through the door than someone ran in to report a ‘collapsed person’. I went out to the corridor and there he was, fainted against the wall.

He came round within seconds and told me that he had a low tolerance for injuries and often passed out if he was exposed to even the lightest trauma. The fact is, the girl on the other side of the wall didn’t even have an injury – she’d been smacked in the head with a soft dancing shoe containing an even softer dancing foot at the end of a lighter-than-air dancer’s leg!

A man described as ‘violent’ by the MDT was hidden behind a screen inside a church and the police were dispatched to help me remove him if necessary. He’d been found by the priest, who met me as I pulled up. He was lying in a pool of his own (I assumed) urine, which smelled very strong indeed. It smelled infected.

He wasn’t violent but he was awkward, preferring not to cooperate with me or the cops when they showed up a few minutes after I had entered the building. The crew had to physically scrape him up, soaked through, and take him to their ambulance. I suffered no more than a few minutes inside the vehicle while they carried out their obs because the stench was overpowering and no amount of sucking power from the vents in the ambulance roof seemed to reduce it. I’m sure the Latvian drunkard had a UTI and he wanted us all to know how unwell he thought he was. ‘I’m dying’ he repeated. Well, eventually, yes… like we all are.

We have been issued with special masks for the upcoming Swine Flu onslaught and I had to take it in with me just in case, when my next call, for a 37 year-old woman who was ‘delirious’ and ‘hot’ came through. She had been diagnosed with the virus but had been treated – now she was weak and feeling unwell at work after a week or so to get over it. I didn’t don the mask because the horse had bolted anyway and she didn’t have Flu; her right side was weak and she had a headache, so I took her to hospital on the basis that something else may have happened to her. She may have had a TIA, she may have simply relapsed as a result of the residual viral activity in her body.

A 61 year-old woman ran through an Underground station with a heavy suitcase, then fainted at the end of her adventure. I was called and she was recovering by the time I got there. The staff, as usual, were very nice to her and, after all my obs had cleared her, they offered to make her tea and settle her down before she continued on her way.

Despite my criticism of how some individuals abuse the Service, I went to see a 69 year-old man who’d called us because he had abdo pain and felt a lot of sympathy for him. He didn’t have any pain, he admitted – he just wanted company and reassurance. He wept repeatedly as I spoke to him, assessed him, asked about his life and then guided him to the car. He had a history of bowel problems and was losing weight rapidly. His tiny flat was littered with the stuff he loved; books about planes and boats and he seemed genuinely concerned about himself, so I occupied his mind with his favourite subjects as I looked for a reason for his sudden weight loss and took him to hospital.

In Trafalgar Square later on, I watched a lone man standing with a placard and a handful of leaflets, which he was handing out to all and sundry. His purpose wasn’t clear initially and he looked like the least offensive type you’d ever meet but his placard read ‘End Islamic Regime’ and I decided he was probably looking for trouble. I moved off the Square and away from him before a riot broke out and busied myself instead with six Polish alcoholics who surrounded me in a small park as I tried to persuade their belligerent friend, who’d collapsed and refused to move (prompting a Red2 ‘unconscious’ call) because he couldn’t get a drink from anyone.
I stood my ground as they shouted and pushed and physically abused their mate in an effort to prove to me that (1) the police really weren’t necessary and (2) the man on the ground would move away from the area and stop being an idiot in a public place.

After fifteen minutes of arguing and general stupidity, they moved off, dragging their buddy with them. He’d stand and walk, only to fall down dramatically every few yards for effect. He was picked up, dragged and walked right across the length of the park as I watched from the car. It was a drunken chess game.

Be safe.

Sunday, 18 October 2009

Power trips

Day shift: Four calls; one treated on scene; three by car.

Stats: 1 ? fractured foot; 1 Head injury; 1 Nosebleed; 1 abdo pain.

Getting drunk means you can pretty much forget the damage you cause yourself in the course of merriment but the consequences of trauma will always catch up with you, and so my first patient, a 36 year-old man who woke up after a boozy night out and a broken foot, discovered first-hand what alcohol can do, even indirectly. A heavy table had fallen on his toes the night before but he’d ignored the possibility of injury and gone back to his hotel room to sleep it off, only to arise the next day with a very swollen foot and cold extremities. He was lucky there was a pulse at all and that his foot hadn’t dropped off in the night.

He hobbled his way to the car and sought no sympathy bar the minimum required to keep him smiling as I drove him and his friend to A&E for repairs.

At a coach station I encountered a rude supervisor who insisted I move my car a few feet so that a bus could park in the area where I was trying to examine a woman who’d fallen and sustained a head injury. I said that I would move as soon as I’d dealt with my patient and was sure she could make it to the car (her injury seemed minor but still needed to be assessed). This did nothing to dissuade the Super from nagging me. ‘We have people who have arrived from the airport and the bus needs to stop here’, she said over and over again.

I relented and drove ten feet out of the way but only after I’d asked her what she would want me to do if it was her mother who had been injured. ‘My mother’s dead’, she said in the hope, I think, that this would elicit a profuse apology from me for being so obtuse. I gave her nothing in return because her attitude was so off and her priorities were at odds with mine, given that I was on an emergency call.

‘I was a paramedic’, she told me as I got into the car. I wondered why she wasn’t now. I wondered why she was the traffic warden for buses these days. I expect a complaint will be lodged against me but my poor patient had to walk a few more feet than necessary to get into the car as a result of this nit-picking power trip. Ironically and annoyingly, no coach arrived to occupy the space I’d just vacated. In fact, a taxi rolled into it, disposed of its passenger with all the time in the world and then drove off.

We get a lot of this behavior. I know that others have things to do and coaches to park but when someone is ill or injured, there should be a little more consideration. The patient, her husband and the man who stopped to help her up when she fell were utterly disgusted by that inconsiderate display.

Nosebleeds are common in children and sometimes they can occur spontaneously. Sometimes they are heavy bleeds but mostly they don’t last too long and resolve within minutes. But if you are a well-off person with children who are clearly not used to being challenged by nature, then it must seem disastrous. A famous model panicked when her son’s nose bled for about three minutes, triggering an ambulance call. She admitted that it had all been a bit OTT but also said that she wasn’t sure if something more serious was going on. The child had no health issues except a history of ear problems, so that’s where the epistaxis originated I’d guess. Nothing more to be done apart from mopping up and setting things straight for them.

Then a 14 year-old German girl with abdominal pain demanded my attention after a CRU had been on scene too long to be of any use to her. The mystery pain had been affecting her since she left home and she was living in the UK with hosts in Essex. She’d never been away from home before, so I’m guessing her condition had more to do with that than any underlying medical problems. I took both her and her friend to hospital just in case. She was, inevitably, much better by the time she arrived at casualty.

Be safe.

Saturday, 17 October 2009

Good neighbours

For those of you who are asking me if Scruffs is still around - yep,
he is!

Day shift: Five calls; two assisted-only, one by car and two by ambulance.

Stats: 1 eTOH; 2 Falls; 1 Seizure; 1 Unwell adult.

Every now and then I will whip up a bit of controversial banter; it’s stimulating and educating, so forgive my wanderings on the subject of how our children are not being taught. Science and religion will always be contraindicated around any table but it was interesting to ‘hear’ your differing points of view.

I’m back at work and this first shift demonstrated that nothing has changed out there. Well, except for my callsign and the general re-arrangement of everything around the station. Oh and a lower than normal morale among my colleagues.

The first call, to a 35 year-old man ‘unconscious’ on the pavement is actually a drunken man who has decided to fall asleep in the middle of the roadworks. The noise of heavy vehicles around him has not made him inclined to think again about his position and so I arrive to find him in deep slumber amid the signs and cones that tell every other sensible (and sober) living soul that this is not a Travelodge.

He wakes up with a few prods and some encouraging words from me and I manage to get him to stagger off into the distance. The far distance...that distance which makes it impossible for me to see if he has just fallen over and gone to sleep again; we call that 'far enough'.

Then an 89 year-old lady falls in her hallway and can’t get up again, so her neighbour, who has become concerned when she didn’t show up for her usual tea and chat downstairs, calls the emergency services for a ‘trapped behind locked doors’ after popping upstairs to check on her and, on peering through the letterbox, spying her old friend on the floor – conscious and breathing. This call activates the Fire Brigade and me but, of course, I am beaten to the scene by the LFB. It wouldn’t be natural if they didn’t get there first, right?

So I climb the stairs of the block of flats and there are three or four LFB bods outside the front door of the old lady’s flat. She has been talking to one of them through the letterbox and I can see that she is sitting up and apparently okay, except that she can’t stand up again. She had locked the bolt high on the door, so the spare keys were useless. The door glass couldn’t be broken because the lady was too near to where the glass would land, so a side room, with a small window, was broken into and entered by one of the Firefighters. In the process of getting in, he has to clear the contents of the window ledge and surrounding area; he hands bottles, jars and tins to his colleagues and it becomes clear to us all that this is the old lady’s ‘larder’.

When we finally get into the flat, she is fine. All she needs is some help onto her sofa, a thorough check over and at least three opportunities to refuse to go to hospital. Her neighbour is a great support and offers to get her shopping, make her tea and visit her frequently to ensure that she is safe and well.

The Council quickly dispatches a man to repair the broken window and I advise her to change the way she walks, consider the clutter around her and refine her footwear because she is in constant danger of slipping, tripping or stumbling every hour of the day.

A daytime drunk next; the 40 year-old man lies in a doorway and two very concerned MOPs explain that he has had a fit. Now he’s unconscious and his jaw refuses to relax so that I can deal with his airway. Two large cans of lager inhabit his filthy pockets and the smell of booze overwhelms me as I get close to him. He remains in this state when the crew arrives and, although his level of consciousness various from time to time, he is generally out of it. So, he’s blued in on the basis that we can’t decide whether he is a drunken epileptic, a drunken head injury or a plain old drunken drunk.

He arrives at hospital, opens his eyes and starts to thrash about. We decide that he is a drunken drunk. In fact, he stands up in Resus, announces to the world that he needs to pee and, without much warning, proceeds to unzip, unbridle his unwashed penis and urinate straight into the sink, which thankfully he didn’t miss. The doctor has left the room rapidly and returned with a pot to piss in but the nasty drunkard has already completed the task and the little 'wash your hands to prevent the spread of germs' sink is now is dire need of a sterile makeover itself. I feel sorry for the porcelain.

The nurse knows him and this is his second or third acting Master class apparently but the doctor wants to be cautious, just as we were, and he gets the full, first-class NHS benefit of the doubt until he ends up on the floor with security around him. It’s nice to be back.

A pair of hot, blackened diseased legs and feet greeted me when I arrived at the 85 year-old man who had fallen over. His neighbour has called and it was clear that the cause of his loss of balance was an ongoing and ultimately terminal (for his legs at least) infection.

A demonstration had marched itself up to Hyde Park and in amongst the anti-something people I found a regular face. He calls us almost every day and claims to have had a fit. Well, actually he doesn’t call us – he gets others to do that. In this instance, he had elicited the sympathy of the police and they were convinced because they didn’t know him but their worried looks fell off their faces when they saw my lack of concern for the ‘patient’. I explained that he had other issues and that none of them were physical. He’s harmless enough and I don’t mind trundling him to hospital (which he usually chooses) because otherwise he is vulnerable.

He doesn’t get drunk, he takes no drugs and he carries a letter telling anyone who reads it that he will make certain claims but that they are not true. Nobody reads the letter and acknowledges the contents; they panic themselves into doing the right thing and call an ambulance anyway. If the demo he’d found himself in the middle of was against the rising cost of NHS healthcare, the irony would have been musical.

Be safe.

Wednesday, 14 October 2009

Fact and fiction

Richard Dawkins exposed a major flaw in our education system, here and in the US. If you don't know him, he's the author of 'The God Delusion; the evidence for evolution', a book that I have read and fully appreciate. This post isn't intended to upset those of you with firm religious beliefs because, at the end of the day, science can always be attributed to 'God's' devine plan, or at least that's how it was moulded around the arguments when they began in the great scientific revolution of an earlier age. No, I'm writing this piece because his delivery of the recent Channel 4 programme 'The Genius of Charles Darwin' revealed a shocking truth about our so-called sensitivity to other people's beliefs, even if they fly in the face of scientific facts - in many schools our children are not being taught about evolution and the mere possibility that it could be true is being swept under the carpet in favour of not upsetting anyone.

If you believe in God, that's fine and is entirely your right but there is no measurable evidence for His existence (I've capitalised the His because that is how its done, right?). There is, however, lots and lots of evidence (despite that so-called missing link), even down to DNA, that life progresses through survival and adaptability - if you have to fly to make it as a species, then you will grow wings - that sort of thing. Pedants refuse to acknowledge this and that, as I said, is fine but when school science teachers - men and women of scientific understanding, whose sole reason for becoming teachers in the first place was to impart their knowledge and share the truth that they know - avoid the subject of evolution because some of their pupils come from religious backgrounds where such science is disowned because it clashes with the God theory, then I respectfully suggest that we are heading into an abyss of medieval ignorance. Our kids are learning a lot about the bias and oppression of religion and political correctness and nothing about the process of natural selection.

In the programme Dawkins interviews a number of individuals who deliberately sieve out the truths known about evolution in favour of a vague and almost totally unbelievable biblical view of how life on earth originated. This is being taught to children with no room whatsoever for another possibility. The woman being interviewed remained on her elevated soapbox as Dawkins attempted, again and again, to reason with her but she simply would not compromise, stating 'you people', meaning scientists, 'won't accept any other truth'. Dawkins pointed out that the only reason she would accept that the world was round and not flat was because there was just too much obvious evidence to support it.

More shocking was the interview with The Archbishop of Caterbury in which Dr Williams found it impossible to answer a simple question about the correlation of science and religion - he came out with a long-winded and totally indecipherable diatribe ending with 'of course it could sound like I'm trying to avoid a tricky question'. Yes, you are.

This blog isn't about religion and it isn't about television but, from the point of view of a British parent, I was shocked to see science teachers running for cover with lame excuses about the sensitivities of others when their job is to teach facts. I already have lots of experience with schools in which common sense and factual reality have been replaced with this 'duck and cover' mentality. We are being ruled over by pigeons and our kids are being taught (in some schools) by avoidance.

Not good enough.