Monday, 30 November 2009


It's that time of year again and I'm up for a Health Blogger nomination. Last year I did well and have obviously been able to get free meals and hotel stays in all the top places as a result of my new-found fame (yeah, right).

I may have left it a bit late this year... possibly too late, but it would be nice to update the little winners medals on the blog, so please click on the button and VOTE FOR ME. See you at the next movie premiere :-)

And while am at it... can you please drop a review on Amazon for either A Paramedic's Diary or The Street Medic's Survival Guide if you bought one. I'm beginning to look like a poorly-read author.

Ta very much.

People's HealthBlogger Award - Help Stuart win!

Friday, 27 November 2009

Madness and mayhem

Here's a photo (taken with permission) of a fightfighter at one of my jobs. I thought my female readers might appreciate it. And he seemed chuffed about it anyway.

Day shift: Six calls; three by car; three by ambulance.

Stats: 1 Fall; 1 Sickle cell crisis; 1 Abdo pain; 1 Hypoglycaemic; 1 Allergic reaction; 1 Festering ulcer.

More car trouble, so the regular vehicle is once again off the road and I am working with the secondary unit, which is no better to be honest. My MDT crashed on the way to my first call, which was to assist a crew who had a 67 year-old lady on the floor after a fall. They needed an extra pair of hands to get her up and onto the trolley bed, so I was happy to help. I had to imagine my way to the location though and did pretty well, considering I’m not a pigeon.

Then south of the river for a 20 year-old with Sickle Cell Crisis; a painful and debilitating condition brought about by the 'sickling' of red bloods cells in the body. When I arrived she was lying on the sofa with her family at hand. She had moderate pain from what I could assess, so I gave her a little bit of Oramorph and that seemed to work. It was my intention to take her to hospital in the car because her legs were unaffected by the crisis but a crew showed up and invalidated my very existence on the ‘Amber Car’.

Then a miracle occurred. A human being with good medical instincts started to task the calls and I solved the mystery of the lady with abdominal pain – the 22 week pregnant 27 year-old at a train station – (that one), by telling her that these things would happen now that she was pregnant and ended up taking her to hospital anyway. She was sent to the waiting area and a large black woman with (possibly) mental health issues sang loudly and incredibly out of tune for me and a few others as she stood outside her cubicle in A&E.

‘Well done, three yeses – you are through to the next round’, I said as I passed by on my way out. I like to stir things up then leave while others have to contend with any chaos that ensues as a result of my meddling.

Then I was asked to check out the condition of a 75 year-old man who’d walked into a chemist and began to ‘behave confused’, according to the pharmacist, who related the story when I arrived. The tall man was standing at a strange angle against a counter with the pharmacist and his assistant propping him up as if he was going to fall. I tried to communicate to the man but all he said was ‘I think I’m ok’ but he didn’t look right at all; very diaphoretic, weak, hardly responding and unsteady on his feet, which is why the next thing I did was virtually force him onto a chair so that I could assess him properly.

I asked the pharmacist if he knew him. ‘Yes, he comes here for his prescriptions’, he told me.

‘What does he take medicines for?’, I enquired.

‘Oh, lots of things’, the pharmacist said. I’m not sure if he thought I was asking him to reveal something covered by the Official Secrets Act, so I asked him to be specific.

‘He has meds for cardiac conditions, high blood pressure and he takes insulin’.

‘Oh’, I said, waiting for the pharmacist to get it, which he didn’t.

I checked the man’s BM and it was 1.1 – now I knew what I was dealing with and I requested an ambulance for backup because if he didn’t recover, I couldn’t take him anywhere in the car.

I injected Glucagon and set up an IV Glucose drip, the way I always do with hypo’s. The crew was with me within five minutes and I got extra hands to help out as the man slowly began to recover. His BM improved to 3.2 by the time I’d set up the Glucose and he was smiling and fully communicative by the time he got into the back of the ambulance. All good, except for one major problem in my view – I teach every pharmacist in London first aid as part of their pre-registration training and they all know that they have a legal duty of care if someone becomes ill in their place of employment but, even though the pharmacist here knew what meds this man was on, he couldn’t work out the problem nor see the solution. This is no criticism against him because he doesn’t have to be trained in first aid but if he has the right drugs (Glucagon), he could give them in order to save a life.

The man’s BM was critically low and this was a potentially serious omission on the part of a professional person, so I think, despite the basic training they receive, more needs to be done to educate pharmacists on the use of this type of drug because it’s so easy to save a life with them. This pharmacists was quite mature, so I doubt I trained him but even those that have had first aid training would probably benefit from a short session on the use of Glucagon, Epipens and possibly Narcan for emergency use. He freely admitted to me that he had no confidence because he'd never actually had to use Glucagon and didn't know how to. I shall think about this...

During this call and just as the crew was taking over from me, I was asked to rush off to another job near the West End. A 25 year-old woman was reacting to something and her throat was ‘itchy’ – she had a very persistent cough too and when I looked inside her mouth I could see her throat swelling slightly. She was in no immediate danger but she’d need an antihistamine and I only offer IV, so I took her in the car. That cough became more and more annoying as we travelled I can tell you. I was tempted to turf her out and let her get the bus.

Back to that train station later on for a drug addict who’d been arrested for (allegedly) shoplifting. His pupils were pin-point and he was trying to fall asleep, so I made a judgment call and decided he’d recently used. His favourite drug is heroin and he looked smacked out on it, although he strenuously denied this when Narcan was mentioned. During his arrest and subsequent hand-cuffing he’d offered the only illness he could think of to avoid the cops and get to the nearest hospital – he had septicaemia. Apparently his groin had a suppurating ulcer on it, no doubt a resident resulting from the constant puncturing of the skin and veins in that area. He offered to let me see it but I declined on the basis that (1) I believed him and (2) I had my dinner to look forward to later on.

When I checked his bag (later in the hospital and at the behest of the police) I found no fewer than 30 unused needles, 5 used needles, paraphernalia and a single condom... for when you get lucky after a good session with heroin I guess.

The bottom of the bag was a lake of filthy liquid from God knew where and floating around as scum was the remnant of some kind of solid food, like a big cake. On first inspection it looked like he had vomited into his bag. Whatever he’d done, the needles were all now filthy – even the wrapped ones – and had to be thrown.

I left him in the care of the police officers guarding his cubicle and walked out to the various off-tune and shouted airs from that mad black woman who was still occupying cubicle 1.

Be safe.

Wednesday, 25 November 2009

The kindness of strangers

A lucky escape.

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

Stats: 1 ? #Leg; 1 Arm injury; 1 ? Spleen; 1 eTOH; 1 French person

On my own again for a few shifts.

I drove at 1mph trying to reach a RTC that had taken place a mile up the road I was travelling on. That’s the trouble with some of these road accidents; they can cause such a tailback of traffic, especially in rush hour, that even the emergency services have trouble getting to them.

An ambulance was fighting its way through the same mess that I was but we both arrived at the same time at the scene of a lorry vs lorry vs car RTC. The first lorry had ploughed into the back of the second at 30mph. The second lorry was stationary when hit and was shunted off his brakes into a small car carrying a mother and her two young kids. Luckily nobody was badly hurt and all we had to concern ourselves with was the passenger of truck number two because he’d bashed his head on the dashboard and, more significantly, the driver of truck number one, who was trapped by his left leg because the entire front section of his vehicle had come into the driver’s cab, pinning him.

It took a long time for the LFB to pull away the dash and steering wheel so that the driver could be freed – they had to work very carefully, as always, so that they didn’t inadvertently injure the patient. Meanwhile another two ambulances were requested to take away the head injury and the kids (just to be sure). I considered HEMS because the lorry driver’s injured leg had been squashed against his seat for some time now – going on an hour – and I was concerned about crush syndrome. But the leg didn't look too badly pinned and once he was freed, another, more thorough, physical examination ruled out any immediate threat.

I gave him morphine for his pain and we immobilised him for good measure. He’d been very lucky and if he’d had a passenger, he’d have been trapped next to a corpse.

Next, a 68 year-old lady from New York was hit by a speeding motorcyclist as she stepped from the pavement. Police were on scene and she was sitting in a shoe shop insisting that she was okay. She was a feisty 'New Yoiker' type and didn’t look her age at all – it was given as 50 by the system and I believed it.

She wanted to get on with her day and visit the theatre and my advice to go to hospital for a proper examination of her arm, which was swollen and bruised after the hit, was met with mild resistance. Due to fly home the next day, she clearly didn’t want her day to be spoiled by a mere broken arm (if she had one), so I agreed to take her to the local minor injuries centre for assessment. She was happy to do this and invited me to join her at the theatre later on (she’d also offered to take the female police officer who’d been dealing with her back to New York – for her son). I declined her generous offer on the basis that I was too bury with my shift, otherwise I might have been tempted.

This was a pleasant lady with friends in high places (judging by the names she quoted when phoning around) and she was sensible enough to know that her injury may or may not be significant enough for hospital but that she’d take responsibility for herself.

She was deemed fit to carry on (the nurse and I came to an agreement) and so I drove her to the street she’d had her accident in, where she could get to the theatre on time and without fuss. She got the best treatment the NHS could offer and I got a peck on the cheek as a thank you.

Ironically and coincidentally I had been asked by my last patient if accidents like hers occurred regularly on that particular street. I confirmed that they did and, as if the point needed to be made, another call came in for yet another collision at the same spot. This time a pedestrian had been hit by a cyclist who’d run the red light. His handlebar had hit the 30 year-old woman at 20mph, punching into her left lower abdomen, exactly where her Spleen lies and this is what concerned me.

She was sitting on the pavement as police officers interviewed the cyclist and I was given a short handover by an A&E nurse who happened to be passing at the time of the incident. The patient had no significant pain, other than in her abdomen and there was some tenderness on palpation of the area, so I decided I would not be conveying this one in the car and asked for an ambulance. The Spleen is an organ that can be damaged without much in the way of visible changes in vital signs and so I wanted to play it safe with her.

I witnesses a demonstration of the frustration that real patients feel when they take themselves to hospital but don’t get seen because it’s too busy and priority appears to be given to those less worthy.

I had been called to a collapsed 40 year-old man and I found the police around a human lump with a blanket over him and a bottle of wine at his feet. He was drunk and had already been assessed as being so by a crew earlier on in the day. I knew that he was playing the winter game because it was cold today and he was dishevelled and shivering, so I asked him if he needed to go to hospital and got the expected response – an enthusiastic nod of the head. I agreed to take him in the car if an officer accompanied him because he had a record of hitting the police, so I would be fair game with my back to him as I drove, should he decide to kick off.

We arrived to a packed A&E and I apologised for what I’d brought in because it was clear they had bigger fish to fry but as a vulnerable drunken man who’d go on playing his game until a dozen ambulances had been called for him, I was left with little choice.

I sat him down on the seats in A&E and two women who had been waiting there (one of them had been crying), stood up and walked off. To be fair, he did stink of urine and I wouldn’t want to be unwell and in his proximity either. Then one of the women collapsed in pain and I had to steady her until other medical staff helped out. She had a serious headache and had been sitting waiting for attention for hours after having come by taxi and booked herself in. Now I understood the look of disgust she had given me as she stood up to walk away from my offensive friend. As far as she was concerned, a drunk would get higher priority than her. After all, he had arrived by ambulance. For all we knew that poor woman was suffering a serious condition (subarachnoids can present as severe headaches initially).

Meanwhile, out in reception, an impatient patient stormed out of the waiting area to complain about how long she’d been made to wait, only for her name to be called while she was away. She had to sit down again and wait for even longer. This annoyed her, so she got up and stormed off once again to complain. I walked into reception to hear her name being called again and the staff’s amazed reaction that she had missed her second chance at being seen. She might go on all day like that.

Calls can often be a little strange and my next (and last) call of the shift sent me east for a 26 man who had abdominal pain and a headache. He had collapsed in the street but two young ladies found him and taken him to their 5th floor flat in a nearby tower block. This strange action was carried out in the name of humanity and kindness I can assure you because when I got there, three young men and two young women were standing over a doubled-up Frenchman in their kitchen. He was like a sick stray cat, except, as I pointed out for their benefit, he wasn’t and they didn’t know what he might have been up to. He spoke very little English and my French is just about good enough to get by in an emergency, so they didn’t even know what his background was.

I found, through fumbled broken Francais, that he had broken up with his family in France and had run away to London, where he’d spent two days on the streets, penniless. His abdo pain and headache may have been real enough but I think his underlying problem was being lonely in a strange city.

I took him to hospital in the car because he was another vulnerable case as far as I was concerned but I had to keep checking him in the mirror – he was behaving oddly and I had that ‘I’m not sure why but I’m not comfortable’ feeling with him. I imagined him reaching over with a huge knife or attempting to strangle me with my own seatbelt but this mild paranoia probably had more to do with my instinct and natural wariness of people who behave oddly than any actual threat, otherwise I would never have conveyed him, right?

A&E was packed and I had to wait a long time before I got to book him in. All the while, he sat in a seat, looking pain-free and watching everything and everyone around him as if he was expecting something. Maybe I’d behave the same way in a strange, foreign environment if I was alone and desperate.

Be safe.

Sunday, 22 November 2009

Locked out

Day shift: One call (but technically two); All by car.

Stats: 1 Head injury; 1 Abdo pain.

I drove in this morning to lashing rain and lightning, which always looks more sinister in the very early hours I think. The weather changed late afternoon yesterday and it had been raining ever since. Less than half the people I would normally expect to see crowding the streets in Central London for the way-too-early pre-Christmas spendathon were out as a result. This meant I had a quiet start to the day.

The first call came in the afternoon and we were off to an ice rink to attend to a 3 year-old girl who’d fallen – not on the ice but on the walkway leading to the rink. She had a nasty bump and cut to her forehead but she was otherwise alive and well. Mum wasn’t too fazed but the first aiders on scene felt she needed an ambulance and called us. Then they completely ignored the fact that we’d need access to the area and we found ourselves outside locked gates with nobody to meet us and no idea where we were to go. This is fairly typical of large scale events when the staff is not properly co-ordinated.

We wasted ten minutes communicating back and forth with Control until somebody finally came to help and then I had to drive around for another quarter of a mile to get in. An inner security barrier was down when we got as far as throwing distance of the fair’s main entrance, so we waited for that to be raised but then I was told to park up and walk.

The SP went on ahead of me and I parked the car. Then I walked along a pedestrian avenue with funfair stands and attractions either side, including a giant singing moose-head that was chucking out-of-tune Christmas songs into the air at high volume while a woman stood directly underneath it attempting to use her mobile phone. The moose was the cleverer of the two I think.

Inside the rink, the SP was happily dealing with a very stable, quiet little girl with a bumped head. The girl’s mother was there and I decided they could go in the car rather than an ambulance. But a member of staff asked me to look at an employee who had abdo pain; the 23 year-old had left-sided pain which had started earlier in the morning although, typically, she hadn’t bothered to take anything for it, so now she was doubled up. I asked for another car to be sent for this patient because I had no room for the SP, the child, her mother, this abdo pain lady and her husband, so a colleague arrived a short time later to convey patient number two.

I managed to get the car all the way into the park and just outside the rink but only after I made it clear that I wasn’t happy with their access arrangements for the emergency services. These were minor first aid problems but if they had a real emergency they’d need to sort out their comms and gates.

Be safe.

Saturday, 21 November 2009

Tricky situations

Day shift: Six calls; three by car; three by ambulance.

Stats: 1 Broken nose; 1 eTOH fit; 1 Gas inhalation; 1 Back pain; 1 Flu; 1 Fractured wrist and ? Neck.

On this mild November morning, a 25 year-old woman tripped over an uneven kerb and fell flat on her face, breaking her nose and bleeding all over the pavement. She sat alone, crying and leaking from her nostrils until an off-duty police officer saw her and stopped to help. I think she was on her own for ten or twenty minutes.

I have my Student Paramedic (SP) on duty with me all weekend, so she attended as I watched. There was nothing we could do for the young woman except take her to hospital in the car as she sobbed into her phone, explaining to her friend what had happened. Her bleeding was under control but her nerves weren’t settled yet.

Alcoholics are prone to seizures and sometimes it’s obvious what’s happened to someone when you see their pallid, profusely sweating faces. Add a history of falling over suddenly and evidence of possible alcoholism in the form of a half bottle of vodka in their pocket and it’s a no-brainer.
This 30 year-old alcoholic had fallen over in seizure, smashing the back of his head on the glass part of the front door of a coffee shop. There was a large crack where his head had made contact. His fit had lasted a few seconds and he’d bitten his lip but he was over the worst and recovering in the company of two police officers when we arrived.

I wasn’t sure of the man’s honesty when he assured us that he’d behave in the car if we took him to hospital that way, instead of by ambulance because he was reluctant to go to either of the two hospitals that I serve. He must be getting thrown out of them and there’d be a good reason for that, so I asked the cops to do a background check on him and, sure enough he had a history of violence and other problematic things (like suicidal tendencies). He was calm and reasonable though, so the cops agreed to follow me down to the hospital if I took him in the car. I’m still not happy to make an ambulance crew convey a patient who could quite easily be taken in the back of the FRU, so that was that and the trip was uneventful.

After coffee and one of those messy but delicious chocolate swirl thingies, we were off to an 82 year-old man with a history of black outs who’d collapsed at home and triggered his Careline alarm. Another FRU was on scene and we all travelled the lift to the floor on which the elderly gentleman lived. The SP and the other FRU paramedic went into the flat and I followed a few seconds behind them. They were assisting the patient as he lay on the floor of his room but I immediately smelled gas and asked if the others did too. He had left his cooker ring on and for at least 20 minutes, gas had been escaping into the little flat. He also had heaters on and this meant the hazard was higher for all of us.

We evacuated him and I took the keys from the door and allowed it to close. A window had been left open to air the flat out but we asked for the LFB anyway, just in case because I suspected that an electrical heater was running in one of the rooms.

The FRU paramedic’s equipment was inside the flat when I closed the door and I was distracted by the fact that the patient collapsed and became unconscious on the landing just as the crew arrived to help. He recovered quickly on oxygen but I found that when the door had closed it locked on the Yale. The keys I had taken were the wrong ones and didn’t fit, so now all the equipment was locked inside. I’d taken quite a lungful of the gas and, although it shouldn’t do me any harm, it still made me feel dizzy for a while. So we were on the landing with a collapsing patient (his ECG showed a heart block), a paramedic’s gear locked behind a door and the prospect of something igniting the gas inside the flat.

The police showed up just before the Fire Brigade arrived and I went downstairs with the patient and crew to the ambulance. He was stable now but his breathing wasn’t great and there was an obvious retraction of his intercostals and diaphragm, so he was blued in.

The LFB made the flat safe before we left for hospital and the fuss died down around the building (residents were beginning to worry). My head cleared and we got on with it.

An unnecessary ambulance trip next for a 40 year-old man with a childish estimation of his age: ‘How old are you?’ ‘I’m 40 and a half’. He was lying face down on the floor of a police station where he’d presented himself after travelling from deepest south London. His only business with the police was to inform them that he had a sore back.

He had been drinking (a half bottle of vodka by his own admission) and his hands bore the tell-tale swollen knuckles that indicated a puncher (of things or of people), so I was wary of him. He moved into a sitting position after much persuasion and the crew took him, reluctantly on his feet and slowly, to the ambulance, where he became cured by distraction, as often happens with people who are drunk and have nothing else wrong with them. He would now tie up a hospital bed or waiting room chair until he is sober.

Oxford Street was pedestrian-busy as we weaved around the buses to get to our next port of call. Inside the large store, a 30 year-old member of staff lay on the floor of the Manager’s office, refusing to open her teary eyes and playing limp as if dying. I’ve seen this many, many times before and you know I just hate it when adults behave like that; with some certainty I can tell immediately that there is little wrong with them – not enough to warrant an emergency ambulance, that’s for sure.

The SP managed to get the patient to speak but of course, in time-honoured fashion for this behaviour, all verbal responses were whispered. Little voice patients believe that making inaudible sounds with their vocal chords is tantamount to establishing serious illness for the benefit of colleagues and anyone else near enough to actually hear them.

She had aches and pains (pain all over), a cough, dizziness and vomiting – she probably had ‘Flu and since all influenza these days is H1N1 Piggy-type, she was given a mask and we donned our own. The drama was too much for the staff and we found ourselves with some clearance as we made our way out of the place, with the patient in a wheelchair, via the back entrance.

We took her in the car and she ended up waiting, like everyone else with minor problems, suitably masked up, for a doctor to tell her what we already knew – she could go home and get over it naturally.

Finally, as darkness invaded the day and the rain spoiled everyone’s fun, we were sent to the 5th floor of a large store where a 30 year-old staff member had slipped on water and landed awkwardly on the hard toilet floor near the urinals he’d just visited. He was complaining of pain in his right wrist, which was probably broken at the Ulna, lower back pain and, more significantly, high spinal pain, at around C2, so he was going to be collared and boarded. Trouble was, there was no ambulance around and I had to call for one.

During the wait for the ambulance I gave the man morphine for his wrist pain (he couldn’t tolerate entonox) but his respirations suddenly dropped and he tried to go to sleep. I’d only given him a smallish amount but I was forced to reverse it all by giving him Narcan in small doses until he came back to normal (or as normal as possible).

Now that he was stable and feeling the same pain as he had originally, thanks to the lack of analgesia (next time I will give Oromorph), the crew arrived and together we got him onto a stretcher and took him down in the freight elevator (the only one big enough for the stretcher and all of us) to the ambulance.

This was blued in once I was sure his breathing was better and his trip to hospital lasted five minutes. The entire job, from start to finish, took almost 2 hours. And I got home late. Never mind.

Be safe.

Monday, 16 November 2009

Head cases

Night shift: Three calls; one treated on scene; two by ambulance.

Stats: 1 CVA; 2 Head injuries.

The last night shift and I’m glad of it. This is a quiet one, which makes up for the three nights before.

A call to an elderly man with a previous history of CVA first; he’s losing power in one arm but otherwise he’s stable, so I left the crew with it and made my way back across the river to a West End that had settled down somewhat compared to the previous nights. The revellers had clearly had enough.

It wasn’t until the early hours of the morning that I received my next call for a 28 year-old female who’d been assaulted during a fight at a club. She was being helped by the security people but it was clear from a distance that she wasn’t a happy person.

She had minor cuts to her mouth and scalp, some of which needed to be cleaned and dressed and I made a valiant effort to do just that when she went a bit mad, screaming at everyone and generally being abusive. ‘Where the f**k is that bitch!’ she yelled. I assumed she meant the person who’d done this damage to her. And try as the security did to calm her down, she wasn’t interested and stood up, pushing her way through him and me, almost knocking me off balance. She didn’t care and made that clear as she tore the perfectly bound dressing from her head, throwing it to the floor.

I accepted her refusal because that's what it amounted to and I wasn’t in the mood to baby-sit a drunken outraged woman, so I told her I was leaving and made my way back out into the street, passing the two police officers who’d been brought in to interview her. She followed with a male friend and stormed past us all. Neither the cops or anyone else who’d been sent to help her were given any courtesy, so it all ended there. Sad and stupid.

A little more stupid was the passenger who allegedly threw a man from a bus because he didn’t have the patience to wait for him to produce his travel pass. The call was for a 25 year-old man who’d dialled 999 as he lay on the ground at the bus stop with blood pouring from his head after making hard contact with concrete as a result of this assault. The well-spoken patient was being attended to by police when I pulled up and he lay where he’d landed until I’d deemed it safe enough to move him into an upright position so that I could apply my second head dressing of the night. This time it wasn’t torn off but the man was very reluctant to go to hospital and the reason for this became clear as I progressed through my clinical interview with him.

More and more young Muslims are drinking alcohol these days and, with the strict upbringing they receive, when they get into trouble and the police and ambulance services are involved, the last thing they want advertised is the fact that they were drunk; if their parents find out, they risk more than a ticking off I understand. So, he didn’t want to be treated at hospital unless we promised him that it would all be confidential. And for the benefit of my readers I should let you know that treatment is entirely confidential unless you are unconscious or seriously injured and a next of kin has to be notified.

With this assurance, he went with the crew to A&E, where his wound could be cleaned and properly assessed.

As for the bus driver, I think he will find himself in trouble for driving off after one of his passengers carried out such an unprovoked and violent attack. The poor man was only having trouble getting to his pass but the delay was obviously too much for one person on board. The driver should have stopped the bus and contacted the police, unless there is a rule I know nothing about which states that they can leave the scene of a crime. The cops have the bus number and they know where it was headed; it will be stopped and if the assailant isn’t on board, the CCTV footage will be examined. The driver will have questions to answer I should think.

Be safe.

Sunday, 15 November 2009

Ghost hospital

Night shift: Eight calls; two false alarms; one by car; the rest by ambulance.

Stats: 2 Head injuries; 1 ?PE; 1 ?Allergic reaction; 1 Sleeping non-fitter; 1 Homeless sleeper; 1 eTOH with fracture; 1 Abdo pain.

Radio communication is still leaving me in awkward and dangerous situations and being solo without a voice at the end of a call is beginning to look like a rotten option. My first call highlighted, once again, that our new all-bells-and-whistles radio system may not be as good as we are told because I found myself crouched down next to a semi-conscious man who’d sustained a head injury after hitting the ground hard, surrounded by drinkers from the pub outside which he’d come to grief, all denying that he’d been punched in the face when the evidence was clear that he had, and absolutely no reply to my repeated requests for assistance over the air. One of my MRU colleagues heard my open-channel request for the police and an ambulance and liaised on my behalf to get things organised as I attempted to keep control of an increasingly restless patient and a crowd of witnesses who ‘didn’t see anything’ in very close proximity to me as I worked to get obs.

The police arrived within few minutes as I put oxygen on and completed the minimal obs I could gain under the circumstances, then the MRU paramedic pulled up to add another pair of hands to the task.

I’d palpated the man’s neck and it felt like he had a step deformation (where the bone feels like it has sunken in) of his upper spine at the neck; this is not good and suggests a seriously hard landing on the ground when he fell, probably hitting the kerb with his neck. His mouth was bloodied and burst around the side (the first indication that I’d got of an assault and not a fall, as had been vehemently suggested) and he was slipping in and out of consciousness, although the alcohol he’d imbibed possibly had a lot to do with that.

HEMS was requested because the man needed to be calmed for the trip to hospital and his head injury would soon make him very difficult to manage safely, so the police threw a taped cordon around the scene and once the doctor arrived, the patient was RSI’d and rushed to Resus, with me ‘bagging’ him all the way there.

I'd find out later on that this man's condition was very serious indeed. He had multiple skull fractures with internal haemorrhaging to his brain and a broken neck.

A 23 year-old French girl fell down at work, complaining of leg pain, chest pain and feeling faint. She told me she had a history of ‘bad circulation’ in her legs and I thought that working as a waitress at a restaurant was possibly not a good move if this was the case. She may have been describing blood cots in her leg because the actual problem she suffered with was not clear. Certainly, and even in the absence of dyspnoea, there was reasonable cause to believe that she may have a PE and so I asked for an ambulance, rather than risk taking her in the car.

If we come to help your young child after you’ve called 999 and requested an emergency ambulance, please do not do the following; (1) expect us to assess him/her while he/she is still asleep in bed; (2) tell the paramedic who has just had to wake your potentially dying child up in order to do said assessment to ‘speak quietly’ so that he doesn’t wake your other child up (the one in the cot nearby) and (3) inform your child that the paramedic will be sticking a needle in you when he is about to do a BM test.

The parents had called us because mum thought her child was having an anaphylactic reaction in his sleep. The crew was arriving as I pulled up and we were led into a dark room in which two children slept peacefully. The boy in question had been breathing a little noisily so mum was concerned. He had a history of potential allergic reaction, so she was being careful and wanted us to check that he was okay but she didn’t want to wake him up and took issue with the volume at which I spoke to him when he was awake. She’d dialled 999 but was more concerned that I’d wake up the other sleeping child; it was a confusing paradox, so I suggested we take the boy into another room, where I could speak like a normal person and not a librarian.

‘What’s he allergic to’ I asked. ‘Horses’, mum replied. Bearing in mind we were in Central London and the nearest horse was probably rotating on a spit in the local kebab shop, I found it unlikely that her little cherub was reacting to one.

He was fine, except for a cough; there was no wheeze or swelling or rash or any other problem that I could determine – not that he was very good at co-operating; he wriggled and cried and was obviously too tired to be prodded about like this, so I decided a BM would be the last of my obs while I had the opportunity. Unfortunately mum decided it would be prudent to inform her little 4 year-old that I was about to stick a pin in him and, predictably he went a bit mad; writhing, screaming and generally making more fuss than it was worth. On this basis, I confirmed that he was well enough to stay home and abandoned the idea of taking a drop of blood from him. Mum seemed pleased. ‘It’s okay, she’d said to him, it’s just a little prick’. Yeah I thought... it is.

And then the local drunks had a laugh at our expense when a bus driver called in a ‘collapsed person’ that he’d seen fall down at a bus stop before driving off. What he had seen (and had generated a Red1 call) was a very drunk fool falling over. The guy was on his feet and swaying when I arrived. His grin and sheepish look made him the ideal culprit for someone who frightens citizens into doing the right thing. He stood with a black bin bag in his hand – it either contained his worldly goods or cans of extra strength lager (which amounts to the same thing). So, without actual proof and his denials ringing in my ear, this was a no-trace nonsense call.

A ‘fitting’ call in Oxford Street was nothing of the sort. The poor guy was trying to get his head down for the night in the doorway of a shop and had been rubbing his hands together to keep warm when two MOPs, one of which identified himself as a nurse ‘with a year’s training’ decided he was epileptic and having a seizure! So, when I arrived, the homeless man was understandably peeved and the ‘nurse’ continued to be concerned despite the fact that the man was very clearly not having a fit. ‘If I was having a fit, I would have told them’, he shouted illogically. The MOPs should have taken the hint but they didn’t and were keen to see me haul the man off for tests and such no doubt. ‘I’m being harassed now’, said the trying-to-sleep man.

After I’d politely sent the MOPs away, the homeless man told me that the ‘nurse’ had been feeling his leg and saying ‘come home with me’. Apparently one go wasn’t enough and the nurse-MOP had returned again and again after several objections from the man, allegedly to cop a feel and ask him back to his place. London just gets weirder and weirder.

On the second attempt at trying to put me on a rest break, I was called to attend a 75 year-old man who fell down a few steps at his apartment building and cracked his head on the floor. He’d been carrying a plastic bag containing two half bottles of whisky and these were now rattling about inside it, so his money and ambitions to get even more drunk than he already was, had evaporated.

Two of the tenants, returning from holiday, had come across him and his bleeding head as he lay around waiting for rescue. Luckily they had been returning from holiday at a rubbish hour of the morning and just happened to be entering the building at the right time to call for help. Otherwise he may well have been there til much later on in the day before being discovered.
His injury was minor – a cut or two to the top of his head and a slight bruise on his face but his age and the circumstances of his inebriated fall were worthy of a hospital trip.

As I sat on Trafalgar Square watching as workmen placed a bunch of strange trees onto platforms I got a call to a bus on the other side of the Square. There was an unconscious man on it apparently, shock horror. He was a tall, filthy, homeless chap with dreadlocked hair and huge laceless shoes. He was asleep and easily woken. Within 3 minutes he was off the bus. Then he crossed the road at a pace (he’d been limping as he left the bus) and boarded another bus going north. I watched him go upstairs, sit at the back (where he’d be invisible), pull his hood over his head and settle down for a sleep (part II). Somewhere in London later on an ambulance will be called just so that he can be ejected from the vehicle; he will bus-hop at the expense of the tax payer and genuinely ill people all night and probably every night.

Now, I wonder how he and his fellow bus-hopping homeless sleepers get aboard. Do they have bus passes? Doesn’t the driver recognise a potential problem when he or she sees it climb on? I’d really like to hear from bus drivers on this subject.

Of course, I complain about them but it’s the drunks on buses that annoy me, not so much the sleepers with nowhere else to go. I think I’d rather be called to wake them up than have them go to hospital to steal a warm bed and a free meal from a more deserving person (like someone who is unwell). In some respects they are playing the system where London Buses is concerned. If they are allowed on and can hide at the back without being bothered then they might get an hour to sleep at a time. Unfortunately, the bus people can’t manage this problem so we are called to deal with it and that is an abuse of the service. Street dwellers looking for a dry, warm place to sleep is nothing new and they will go anywhere that gives them an undisturbed kip – the buses are included, so why don’t the bus people fix their own problem? Maybe it’s best just to leave this status quo for the sake of the ‘they have to go somewhere’ argument or purely on humanitarian grounds but what if this costs someone their life?

This debate continues with a trip to a bus terminus to attend to an alcoholic whose been removed from a bus by the police. They think he needs to go to hospital and they are right because not only is he very cold (temp read ‘LO’) but he has a cast on his arm and from the appearance of his upper arm, just above the cast and sling, it looks to me as if he has broken his Humerus and dislocated his shoulder. This drunken man has fallen onto his already injured limb. So, I take him to hospital in the car and I walk into a ghost town – beds are empty and there is nothing going on. For the first time in a long time (as far as I can remember in fact) there are no ill or injured people around. Except of course for the one I’m bringing in. Judging by the reception I got you’d think I ruined someone’s birthday party. Even in the waiting area there was nobody waiting. This must mean that Londoners have drunk themselves to sleep or that alcohol has simply run out.

A local call to end the shift and a crew arrived behind me for the lady with abdominal pain who needed more advice than treatment. I left as the crew settled in to listening to her entire medical history. They had another 30 minutes to go, so I’m sure they didn’t mind.

Be safe.

Saturday, 14 November 2009

Cats and dogs

Night shift: Nine calls; one treated on scene; two assisted-only; two by car and four by ambulance.

Stats: 1 Palpitations; 1 Lacerated ear; 1 Drug o/d; 1 Head injury; 3 eTOH; 1 Hypoglycaemic; 1 Assault.

I wish the rain would stop for a minute. It's relentless and could fill a fireman’s helmet in seconds (I know L and S will appreciate that one) :-)

The first call was given as ‘chest pain’ but the 59 year-old man in the hostel for whom I’d been called denied this when I arrived. A crew was on scene and one of them knew the man well enough to tell me that he is a regular caller. Tonight he said he had palpitations and that he was diagnosed as having AF. In fact his ECG disputed this and all I could see was an irregular heart beat with deep Q waves, generally where they’d be expected to appear. I’d see this man later on in the shift, at hospital after having been thrown out several times by the staff because he is wasting their time. At the end of my shift I saw him sitting at a bus shelter, in the pouring rain, alone and miles away from the hostel.

The lacerated ear belonged to a 6 year-old boy who was ‘play wrestling’ with an older neighbour (a 12 year old). Things got rough and the little one ended up with a snip removed from the top of his ear, like someone had taken a pair of scissors to it. It would heal and he’d be fine but he needed to go to hospital and get it cleaned and closed. His not-too-impressed dad travelled with him in the car.

A 22 year-old woman who claimed that she had been drugged and robbed wasn’t keen to have anyone of the male gender near her, so I asked a female member of the crew and a WPC to help. Turns out she was drugged but hadn’t been robbed, unless she thought the price she’d paid for her fix was too high.

Another woman who seemed shy of men was the 35 year-old Latvian woman who stumbled in the street and smacked her head. The cut was deep enough to warrant a trip in the car to hospital but it wasn’t, as the doorman who’d picked he up had described when I arrived; a ‘serious head injury’. The lady was adamant that she didn’t want treatment – her English was poor and she spoke only Russian so I used our interpreting service to help me get to the bottom of her problem because I was convinced there was more going on with her than just a fall.

Eventually she opened up a bit and told me that she had problems settling into London life, describing the city as too big and noisy for her and her family. Her child had been having trouble at school too, so her pressures were considerable. A single mum in a foreign land, trying to earn a living to make a decent life for herself and her kids has a mountain to climb in this modern day. Nobody cares enough, so she was struggling. She’d had a drink and got caught out, so I got her to sign the paperwork and let her get the bus home.

Off to Soho next to test the blood glucose of a 30 year-old Glaswegian man who had been out on the tiles with his mates and whose behaviour had caused them concern. He’s a diabetic but his reluctance to have his BM done was nothing to do with him being hypo; he was just annoyed that nobody would leave him alone in his drunken stupor. I tested him on the pavement and declared him fit and drunk, nothing more.

A less than fit drunk lay on the pavement by a bus stop, vomiting pools of rancid red wine around him like he was promoting an art exhibition. He was over 6 feet tall and I called Control several times to get an ambulance crew to take him away but I got nothing; comms were, once again, down and out... like my new friend. So he and I agreed that he could be taken in the car if he behaved. He didn’t behave. He wailed, moaned, flopped around and generally made a nuisance of himself as I sped to hospital. He vomited in the back and it took more than a good scrub to clean the vehicle afterwards – particles were on the inside roof.

In A&E he threw himself from his wheelchair and onto the floor for a dramatic exercise that fooled nobody. He got a bed and zero tolerance. Puddling about in his vomit and being exposed to it so closely in the car was not the time to find out that he was HIV positive.

Far away in the south in a small flat I listened to a young woman tell me about her recent faint and how unconcerned she was about it, as her parents stood by with worried looks on their faces. They’d called an ambulance because she could have fallen down the stairs when she blanked out. Luckily, they had a stair gate at the top. She had a gastric band fitted and her appetite had decreased dramatically. Her BM was low but she wasn’t diabetic and there, I think, was the problem. I advised her to go to hospital and a crew was on scene to take her but, as far as I know, she refused and the crew spent more time with her after I’d gone, trying to convince her.

The rain began to fall with real enthusiasm again and twice I had to run up north for an assault involving a few people. When I got on scene the first time, the police were there and they’d found no-one. The next time, after the 999 call had been made again, I went thinking it was a hoax but two men presented themselves (well I had to find them) and told me they’d been set upon by a gang of other men earlier. They had minor cuts and bruises and I treated what I could on the spot and left them to worry over whether to bother reposting the incident to the police.

At the end of the shift I was sent to an address with no easy access and spent ten minutes trying to get close enough to the location to do any good before an ambulance arrived and we all piled into the street together. An elderly man had got himself drunk and fallen down stairs. I didn’t see him because the crew dealt with it. I went home instead. It was still raining.

Be safe.

Friday, 13 November 2009

Damage control

One lucky driver...

Night shift: Eight calls; one gone before arrival; one assisted-only; one by car and the rest by ambulance.

Stats: 1 RTC with invisible patient; 1 Cut wrist; 1 Faint; 1 ? # ankle; 1 eTOH; 1 DIB; 1 DOAB; 1 RTC.

None of us appreciate being dragged four miles on blue lights to a RTC where the patient has decided he would rather just go home and not bother to inform us of his change of heart. Luckily, I was the only one assigned and I was able to cancel the ambulance (not that one had even been sent yet) and thus avoid even more waste of resources. The driver who’d hit the cyclist told me the 27 year-old man had a head injury and was knocked out for a few seconds after colliding with his car as he cycled the wrong way round a roundabout. The police arrived and I thought it best if the driver continued his story while they were writing it down.

The patient, meanwhile, had left the scene and that meant paperwork for no reason and a long trip back to my own area.

Another call on which nothing but a solo (me) could be tasked because there was nobody else available, took me to a hotel in which a 28 year-old Lithuanian member of staff with perfect English had cut her wrist on a broken wine glass that she’d been stacking in the kitchen. The quick-thinking chef followed her as she made her own way to the back room, where the first aid kit was stored and he put pressure on the wound as soon as he saw it. The incision was very deep and close to her Ulnar artery – she was very lucky not have severed it and the actions of the chef, who had applied the pressure and elevated the arm immediately whilst waiting for the first aider to get to them from the 9th floor, had saved her a lot of blood.

By the time I arrived, the bleeding was almost under control and I was able to fix another dressing and place a sling on her for the trip to A&E, where she’d need stitches. The poor woman was terrified of her own blood and looked away as I examined and then covered the wound. I took her and a colleague in the car because there were no ambulances around and, to be fair, she didn’t need anything more than first aid and definitive care in hospital.

A 71 year-old woman fainted after having a meal at a swanky club in one of the better parts of town. She was on the floor when I arrived and her husband and a few friends were in attendance. She was conscious but still very pale and unwell. She had a history of high blood pressure and was taking Atenalol for that; this drug slows the heart rate down and sometimes the blood pressure falls a little too low and a faint results.

I sat her up to gauge her condition and sure enough she began to feel unwell and faint once more. She vomited a few times on the plush carpet as the diners around her looked on. The staff moved everyone out of the room, leaving a few lovely and delicious looking deserts behind. Tempting as they were, I still managed to look after my patient until the ambulance arrived. The crew were momentarily distracted by the food too though.

An unusual twist to the next call, which is for a 26 year-old female (who happens to be nearer 40) who has fitted. When I arrive, there is a police officer or two around because she has collapsed outside the local cop-shop and her husband, who is also there, is an off-duty policeman. She has recently had a miscarriage and for some reason her husband thinks she may have fitted for a few seconds before falling to the ground but she is only complaining of ankle pain, so I have a look and her leg is swollen at the ankle; it feels like jelly down there too, so I assume she has broken it on the way to the floor as her husband struggled to keep her upright.

She must have fainted – although a fit isn’t out of the question, she has no history of seizures and is more likely to have fallen down in faint if she is still under the strain of her latest miscarriage (she’s had three to date).

I give her entonox and it helps but she’s losing the feeling in her toes and this means her circulation is suffering. The ankle is at a strange angle, so it will have to be straightened out. I wait until the ambulance crew arrives and they can help me support the limb for splinting. This straightens it out and, with a little more pain she can once again feel her toes.

After a useless long run to the City for a drunk person with a bleeding face, for whom another FRU was already on scene and dealing, I returned for my break and found myself at the station for much longer than normal on a Friday night. This pleasant hiatus ended though and I got a call that took me into the West End for what amounts to the most typical call type for the weekend; a drunken, vomiting female.

She was in a doorway with her friends and two PCSO’s were guarding them. The patient was an 18 year-old who was throwing up and flopping like a heavy-headed baby in the stinking, rain-soaked entrance of a commercial building. Three of her mates were there; two of them fairly sober and sensible and the other just as drunk, although able to wail and whine about how bad it all was for her. She’d probably spent £40 tonight just so she could feel hard done by.

Initially the reception I got was frosty and disrespectful but I think I charmed then onto my side when I explained how ridiculous it was for them to be in this condition when they were vulnerable and depriving a really ill person of an ambulance. The two sober girls seemed to get it and, to my surprise, the head of my patient even nodded in silent, shameful agreement.

I asked for the Booze Bus and it arrived very swiftly. One of the PCSO’s had very kindly donated his hi-vis jacket to cover up the vomiting girl’s dignity. He must have been new to the job because you just don’t do things like that with stuff you need to wear. I managed to save his uniform from disgrace when the girl attempted to vomit all over it. She got a blanket instead.

As usual, the Booze Bus crew were magnificent and efficient, sweeping away the human debris from that doorway in quick time. I took the girl’s friends to hospital in the car, so that they could join their mate while she recovered.

On the way back up Charing Cross Road I saw what looked like a small woman being chased by a larger man. In fact, she was a plain clothed police officer and she was running after the man in an attempt to arrest him. The handcuffs she was brandishing helped me to come to that conclusion and as she raced across the road after him I thought she might need a hand, especially when she caught up with him but he overpowered her, throwing her to the pavement. My business or not, I am not the type to sit and watch something like that when the street is full of people who could have given the officer a hand, so I got out of the car, ran after him and grabbed his arm, while the cop held onto the other one and tried to cuff him.

Three or four other men appeared around us and began to have a go at the police woman – telling her that she had no right to arrest him because she was on her own and that it wasn’t legal. I think this is nonsense but maybe one of my police readers can confirm this. As far as I’m concerned, a police officer can arrest someone, whether they are alone or not.

The cop’s very large colleague showed up and took over from me. She had no radio and no chance of getting help if things had turned nasty (my radio, as usual, wasn't working) and, as I said, whether you judge me to have done the right thing or simply interfered, it’s in my nature to help and I’d do it again, despite the obvious risk. That female cop had a lot of guts doing what she did in any case.

Soon after that excitement, a call to a 4 year-old boy with DIB took me into the Oxford Street area in support of a crew that had just arrived as I pulled up. The boy had bronchitis and now an infection was making it worse. His guardians spoke very little English so what information we could glean was very limited but the sound of him coughing was enough and so he went to hospital.

A DOAB next and for once it was a female. The Russian woman was fast asleep, smelled heavily of alcohol and had her bag, phone and long leather boots around her as she slumbered. She’d actually settled in for the night. No wonder she scratched me when I continually harassed her to wake up and get off the bus. It took a few more minutes than usual and I think I was treated to a lot of Russian expletives but eventually, like all the others, she had to comply and get off.
As I prepared to leave the scene, she walked straight back onto the bus and the driver happily drove off with her and a few other passengers. Another complete waste of time and tax.

As I crept towards the light on a promise that I would make it home on time, the heavens opened up and I was sent a job that was almost certainly going to make me late. It was a RTC involving one car that had careered at speed into traffic lights, flattening the post and sending the red, amber and green mounts flying across the road. When I arrived the car was empty but a woman called to me and said that the driver had got out and been taken into a little shop, where he now sat with his head in his hands.

The rain had been persistent all night but now it was torrential; the worst kind of weather to be the only blue light on a crash of this type. Traffic was beginning to build on the road and my car was blocking the scene for safety, so buses and large vehicles were having trouble negotiating around me and it was only going to get worse.

I was soaked through by the time I got the man to my car and sat him inside. He’d already been up and around so he was very lucky to be walking. His windscreen was bulls-eyed twice; once by his head I suspect and again by a smaller thing that had impacted when the car stopped suddenly. This lesser crack was probably caused by his mobile phone, which I found on the floor of the driver’s side. It’s very likely, but not definite, that he was on his phone when he crashed. There seemed to be no other explanation for his abrupt loss of control on what was (at the time of the crash) a quiet stretch of road. He was probably texting.

Within twenty minutes the fire service and police were on scene in some numbers. Exposed electrical cables from the traffic light that had been wiped out and the crushed engine of the car necessitated the LFB’s presence but, typically given the time of the day, there was still no ambulance.

A crew arrived almost half an hour later and the patient, who’d spent the duration drying off in the back of my car, was finally collared and boarded for removal to hospital. It all seems a bit open-stable-door but the same precautions applied, even though his neck was more than likely in good shape, which is more than can be said for his car.

Be safe.

Thursday, 12 November 2009

Street Medic - second print

The reprinted version of 'The Street Medic's Survival Guide' is now available through SP Services and my usual stockists. There were a few minor quality faults that I felt the need to redress, so I have worked on them and replaced every single stock copy of the book with a new, improved version!

The text was printed too close to the margins of the pages, making it difficult to read without breaking the spine, so I have increased the margin slightly. Unfortunately, increasing the margin increases the page number and I am reluctant to send more trees to their deaths for the sake of a minor flaw, so I have only increased it enough to make the book perfectly readable on opening. There are now 84 pages instead of 80.

There were also a couple of very minor typo's. On page 21 the CRB note has been inadvertently cut, so it is incomplete. It should read 'CRB - soon to change; from October 2009 the Independent Safeguarding Authority (ISA) will hold information on individuals which will be available free to employers and organisations wishing to check if their prospective employee can work with children and vulnerable people. Other ‘regulated activities’ will be covered and if you aren’t registered - or are barred from certain activities, then your Service may not be able to employ you.'

I have simplified the page heading and page number footers so they look cleaner and the widows and orphans (lonely single lines at the beginning and end of the pages) have been repaired.

On page 79 'Zulu zulu' should read 'Zebra zebra'!

About three spelling/grammatical errors were also identified and repaired.

And that's it. First print editions do tend to carry the teething problems associated with deadlines, so I hope I have now sorted things out. If you have a copy of the book, it is a rarity now because only a few thousand were printed with the errors. You can now go off and Ebay it!

If you are starting Paramedic Science or are thinking of going into frontline Paramedicine, click on the link (the post title), go to SP and buy the book!!


Tuesday, 10 November 2009

Fits and faints

Day shift: Four calls; one taken by car; one assisted-only and two by ambulance.

Stats: 1 EP fit; 1 Abdo pain; 1 Faint; 1 eTOH fit.

The whole of the morning disappeared in a flash as I ran around getting my comms sorted out and waiting for a patient. Then as lunch time crept in, I was sent to a 40 year-old man who was fitting in a cafe. He was post ictal and recovering slowly when I arrived; he made no sense yet but I managed to confirm with him that he was epileptic.

The lady running the cafe said he’d fitted for 15 minutes but I found that unlikely – two of the customers said that he’d only been down for 5 minutes. So, I spent another twenty minutes with him as he attempted, time and time again, to push me out of his way so that he could wander around. He was a good few inches taller than me so he became a handful at times and I was glad to see the ambulance pull up.

By the time he’d been checked out again by the crew, he was almost fully back to normal and he was given a lift round the corner to his workplace – he refused to go to hospital.

Immediately after this call, I made my way to an abdo pain in a restaurant, where my CRU colleague was attending a 33 year-old woman with a history of endometriosis, normally controlled by monthly injections of GnRH analogue. Her pain was so severe that entonox did nothing for it, so she was given a few mls of morphine and that did the trick. She was needle-phobic, so after persuading her to have the analgesic, I inserted the slowest cannula I’ve ever done into her arm – I had to talk her through every millimetre of what I was doing. She felt nothing and I may have convinced her that injections aren’t so bad after all, who knows?

A 45 year-old fainted at work and lay in the reception area with colleagues around her as she recovered. The woman is taking antibiotics and this may be a factor; not the drugs themselves but any stressors that affect her if she is currently suffering from depression. It’s a common enough problem. A crew arrived and took her away after my initial obs revealed no physical problems.

The last job of the shift took me to the Leicester Square area for a 33 year-old Polish alcoholic who had ‘fitted’ in a doorway. Several MOPs had called it in because they were concerned but I reassured them and spent twenty minutes with the man trying to translate his Polish into English, or as near as dammit, as his friend looked on. He didn’t want to go to hospital and his hands were very cold, so I wrote down the name and location of the nearest hostel and gave it to him. He won’t go there; he’ll hunt for alcohol instead because that’s what he does. I felt sorry for him but then dismissed it because there are many, many unfortunate people around me who don’t drink themselves into a stupor every day. I should feel sorry for them instead.

Be safe.

Monday, 9 November 2009

Glass children

Day shift: Six calls: one treated on scene; one false alarm; one by car; two assisted-only and one by ambulance.

Stats: 1 Fracture; 1 Cold turkey druggie; 1 Not choking child; 1 Faint; 1 eTOH; 1 Minor cut.

A few things have caught my eye recently and I thought I’d share them with you to brighten your day (if it’s dull). I was watching a news item on the war in Afghanistan when the Chief of the Defence Staff appeared for an interview. He was named as Sir Jock Stirrup and this had me smiling. There’s no way on Earth he got through the Academy without a few million jibes at his name (and for my American friends, if translation is needed, the man can be called ‘Jock strap’)

I drive through Camden on my way to work every morning and there is a building with a sign on the outside that states ‘Jews for Jesus’. I find this confusing and paradoxical – can anyone tell me what that is all about?

And finally, a little courier van runs around Central London with the statement ‘my little sister is a bike’ liveried upon its side. Funny and close I think... reminds me of a broken optician's sign I once saw in which the only two letters that were missing were the ‘i’s. These little things make me smile.

I had to scrape the first of this winter’s frost off my car windows this morning before I left for work and by 7.30am it still hadn’t warmed up enough to remove the slip risk from the roads, so my first call, for a fall with fracture wasn’t a great surprise.

The 69 year-old woman had slipped on spilled milk that had been left in the road outside a tube station. The liquid had frozen and she had skidded onto her wrist, landing hard enough to give her a Colles’ fracture. Her wrist was badly deformed and the pain quite severe, although entonox helped somewhat. I put her injured arm in a sling and took her to hospital in the car. Her taxi-driver husband followed in his cab and they both went into Resus.

The patient told me she recognised me from a job I did much earlier in the year at a bank where she works; luckily she had a positive memory of me – it’s a small world.

A few hours later and after several cancelled calls, including one in which a woman was described as ‘incontinent’ and nothing else, I was asked to check out a man who was lying in the street vomiting. A police officer was on scene and all he wanted to do was move the man along but he was a little concerned about the fact that he was throwing up. He described the man as ‘anti-police’ and felt that I would be able to communicate with him and persuade him to move.

The drug addict was cold turkey and vomiting comes with that territory, so he didn’t want to go to hospital. It was an impractical notion anyway because his large black dog was with him, lying under the ragged, filthy sleeping bag with his owner. He barked a warning to me several times but I wasn’t worried because these animals tend to be well cared for and less territorial than house-bound pets. They have a natural inclination to protect their masters, of course but most of them recognise the uniform and understand that we mean no harm.

I persuaded the young man to move on and tried to interest him in the local hostel, which may have been able to support him through a very tough time but he wasn’t interested. Meanwhile the dog came out from underneath its cover and began to lick up the stream of watery, bile-coloured vomit that the man had left trailing out into the gutter. That wasn’t pleasant to watch and my attempts to discourage the animal from lapping it up came to nothing as he blatantly ignored me. He was wagging his tail, so he must have been enjoying it.

On to a non-event with a ‘choking’ call for a 2-year-old who stuck a passport photo in her mouth and retched a few times. The call was made by her mother and by the time I arrived there was nothing more to see. The little girl was understandably quiet and shy about having me around and at first declined, by means of a reluctant attitude, my request to inspect her throat. I was happy to leave her with mum but I needed to know she was out of danger. The first clue I got that all was okay was when she indicated that she wanted a drink of juice from her little plastic cup and then mum offered her breast milk, which she took there and then. I figured if she could suckle, she had no trouble breathing and I wasn’t going to consider her age for too long because every mother and child will continue that feeding bond until they both feel it’s no longer required. I reckon after the age of sixteen it should be outlawed though.

I managed to get lunch in before my next call of the shift. This one took me south of the river for what, I imagine, my Control desk thought to be a straight-forward pick up and convey job after a 22 year-old female fainted in a university lecture theatre. Unusually, it wasn’t that simple. The young girl had a recent history of bilateral pulmonary embolism and was on Warfarin as a result. She was due to have a catheter inserted in her heart and today she appeared to faint and fit just before taking an exam. Now, this kind of stress can and does produce the household type faints that we are all used to running on but don’t worry too much about and so it was prudent just to send me along but this lady had a complicated history and that changed the colour of things, so I requested an ambulance. She had chest pain and was emotionally wired, so travelling to hospital in the car was not an option.

A false alarm in Soho later on as I chatted to a colleague in Frith Street. Someone dialled 999 then left the ‘phone off the hook and ‘shouting’ could be heard in the background. I went around the corner to where the call had originated, followed by my CRU colleague and saw nothing initially, although I could certainly hear the shouting. It was one of those distinctive random cries that tend to emanate from the drunk or insane (or both) and it wasn’t long before we identified the source of it. A drunken (and probably drugged up) man was wandering down the street yelling, dancing and trying to sing. He looked harmless and even approached us to shake our hands. No emergency there then.

And once again, just as the time approached to end my shift, I was sent miles north and out of area to attend a 2 year-old boy who had bumped his head on a wooden bed post and cut himself above the eye. It was a very superficial wound and needed no more than a few strips of tape to close it. The young mother, who already had another two older children, seemed to have no idea whatsoever about the difference between a simple first aid issue and a true emergency. She dialled 999 because her little boy cut his head – he wasn’t unconscious and displayed no complications whatsoever. This lack of a basic understanding of childhood injuries leaves me stunned. You don’t need lessons for this because you experience it yourself in life (well, most of us do). Obviously an ambulance had never been despatched to this; they’d sent me simply because they knew it was a nonsense call but somebody had to deal with it. It’s frustrating to have to advise grown up people, especially parents, over and over again, to do a first aid course and get some confidence. Please, we are running out of ambulances.

Be safe.

Wednesday, 4 November 2009

The common sense leak

Day shift: Four calls; one treated on scene - the rest by ambulance.

Stats: 1 CVA; 1 Antibiotic reaction; Scalded hand; 1 Hyerglycaemic.

Now they need to carry out studies to tell us something we already knew!

On the first of my two ambulance duty dates I was tasked to a vehicle running out in the East, outside of my sector, because we are providing much needed cover in that area. So, I found myself crewed up with a friend and running around all day in the Woolwich area.

Our first call came in after a fairly lazy morning and it was for an 88 year-old man who had suffered a stroke and was under hospital care (or so it seemed) until he decided to discharge himself and walk out. He plodded three miles home in his pyjamas and straw hat, plonked his frail body into his little warden-controlled flat and began to make a right nuisance of himself – so much so that when we received the call it stated that police may be required as he was violent.

He was indeed aggressive but not really violent; he shouted, swore and insulted the woman who had called us to have him returned to hospital. She was trying her best to help him but all she got in return was abuse. The man had a brain injury, so it was predictable behaviour, unless he was always a cantankerous old bean.

He wandered around his flat collecting bits and pieces for his trip back to hospital – he knew he was going back and he thought we were there to force him to go. ‘Are you the police?’ he asked matter-of-factly. ‘No, we are here to help you and take you to hospital again’ I replied.

He was in shorts and his legs were smeared with faecal matter, some of it was dried into blobs on his calves. I thought this was a mercy because if it had been fresh and wet, I’d be smelling it all the way to hospital and would have to clean it up – the fact that it was dried meant all I had to do was clear off the larger particles and leave the smears. Sorry, I know it’s a bit in-depth and detailed but now you know what we get up to all day. All that training and it comes down to working out how much poo you are going to scrape off an old man’s legs. There’s no chapter in the text books to cover it. Maybe I'll write one.

After a few tirades and insults, we managed to get the man back to his ward, where the medical staff had been waiting for him. During the journey, he told me he was an ex-WWII pilot and we chatted about the kind of planes he flew (bombers) and regardless of his acidic character and his filthy demeanour, this was a man, among many, that had put his life on the line so that we could all live the way we do today. So, when we got him to his ward and a doctor and two of the nurses began giggling and pointing at him (he was dressed in his shorts, t-shirt, a straw hat and flip-flops) I thought it prudent to discuss the possibility of them watching him more closely next time rather than making fun of him. He’d had a stroke and clearly wasn’t well; what he needed was a safe place to get better, not the ridicule of a few young medical professionals.

Later on we attended a 62 year-old woman who’d just started antibiotics for an infection. She was complaining of feeling dizzy and sick and it was fairly obvious that the tablets didn’t agree with her. She needed to see her GP but s/he had refused to come out to her, so we were called. Sometimes the worst abusers of the ambulance service are the very people who should know better. So, a car and an ambulance were despatched and all we had to do was drive her to hospital. She had no emergency symptoms and her trip resulted in a long stay in the hospital waiting area with her relatives.

Even more stupid was the call made by a University security man who was also one of the first aiders. A staff member had been carrying a cup of coffee and got bumped by a student walking past (with no apology of course), resulting in a small spillage of hot liquid onto the back of her hand. She stuck it under cold water for 20 minutes and was still rinsing it when we arrived (on blue lights).

She had a superficial scald; nothing could be done – no blisters in sight and no prospect of permanent damage. It was a common-or-garden variety liquid burn and all she needed was cold water (done) and pain relief until the hand got better (in approximately 24 to 48 hours). The pain would go within a few hours.

All she got from me was advice. She didn’t want or need to go to hospital – the first aider had panicked and called us or quite possibly (and this is a real problem) the University had a ‘policy’ of calling ambulances for every little thing. Sometimes ‘policy’ really means ‘scared of litigation safety net’.

This was a 49 year-old woman who had burned herself a few times like this in her life and knew exactly what to expect. She knew her hand wouldn’t fall off and she was well aware of the throbbing pain she would have to endure until it settled. We all know this but for some reason we have lost our sense of knowledge-through-experience and have replaced it with policy-minded fear that there are hidden consequences. And there will always be someone, somewhere who will gladly cite a strange and unusual story; a rare thing that happened to somebody else, somebody they have never met in their lives, who got burned just like this and had to have an amputation ‘cos it got all infected and the hand went green. So we live by the principle that if we don’t cover our backsides this could happen again – for God’s sake let's grow up!

To end the shift we were treated to a 65 year-old man who sat in a sticky-floored front room, in a filthy little drug-den flat, drinking a can of lager as his druggie friends insisted he needed to go to hospital because ‘he wasn’t right in the head’. The man had a history of walking out of hospital before being seen and he adamantly refused to go this time when I asked him. I can’t force him to go but I have to reason it out before I just say ‘ok’ and leave, so I asked about a medical history and they told me he was a diabetic but that he hadn’t been taking his tablets. I checked his BM and it was high (33.3), so I used that as an excuse to coax him into going to be checked out.

When we arrived at hospital, the staff recognised him and before I could even finish my hand-over the triage nurse said ‘waiting room’. I explained that his BM was very high and this changed her mind. He was given a cubicle and I booked him in. I watched from the receptionist’s booth as my patient wandered past on his way outside – he was escaping again. I managed to stop him and turn him back to his cubicle but I found, to my astonishment (because it had only been ten minutes) that another patient was being put into it!

‘This patient is in here’ I said as the nurse settled another old man into the chair.

‘Not any more’ she replied.

I had to argue with the medical staff that if my patient wasn’t treated he’d likely become seriously ill and that he needed to be watched because he would walk out. I had a suspicion that this is why he was being slung around. He’d come in with a crew, be sat in reception, walk out and then be returned again later on or on another day. Meanwhile, his blood glucose level was rising and rising through neglect.

None of us are perfect and we all (in the medical profession) have to bear the strain of the sheer number of patients, real or imagined who require care every day. We also have a limit to our internal professional patience because we are human but if writing this blog and receiving criticism from some of my readers has taught me anything, it’s that making assumptions about individuals just because I am fed up at times, will cause clinical misjudgement. So, much as I rant about timewasters and the stupidity of some people, I will always look at the bigger picture in case I miss something. Today I saw various levels of lethargy in my fellow professionals and in all levels of care, from first aid to medical practise; I was confronted with an impassive attitude to those who really needed help and I am reminded of what someone said to me very recently about a visit to their GP in which the doctor had to look up an illness in her book while the patient sat waiting for an answer. ‘I could have done that myself on Google’, she told me with disbelief.

Be safe.