Monday, 20 September 2010

Robots in London

More and more cases of SLE are appearing; it’s like some kind of convention for the disease has visited town. I’ve dealt with half a dozen cases in the past few months and today I went to the aid of a woman suffering chest pain in a bank. She was a member of staff and the first aider laid her down and put her into the recovery position – people who know me will be rolling their eyes to heaven because it’s a pet hate of mine. What first aid training company is telling people to roll perfectly conscious patients into the recovery position? And why are they being laid down with chest pain? Nuts I tell you.

This lady had been diagnosed with SLE thirteen years before but her doctor had neglected to tell her of its affects, which she'd feel...sooner or later. She was having a ‘flare’ with associated headache and muscular pain in her chest. It was painful for her but there’s not a lot we can do for it except provide analgesia and take her to hospital.

There’s a robotic centrepiece in Traffy Square at the moment (I don’t know how long for, nor what it’s called) but eight autonomous robot arms move at random on top of a video display stage. Each arm has a light on the end of it and I’m sure it looks pretty cool at night, although kind of creepy at the same time. Names, and I’m assuming it the names of the robots, appear on the matrix screen. One of them is called Jesus. Or maybe the thing is designed to teach religion.

During my standby period on the Square, two men passed by and one of them pointed at the car. He then referred to his friend and said ‘just in case’ – most people think I am there to help anyone who falls off the lions (but I’m not). His friend looked at him, shrugged and replied ‘why bother?’ There was more than one robot on the Square.

Running calls occur commonly and my peace and quiet was disrupted by a panicking , sweating man who ran up to the car, said ‘You must help my friend – she’s bleeding somewhere’, then he ran off without another word. He was holding a mobile ‘phone, so I assumed he was in contact with the bleeding friend. I watched him run away and frantically wave at someone at the bottom of the Square. A private medic was there and so he got help for his girlfriend. But I still had to go and check it out, so I called it in and was told an ambulance had been despatched to a PV bleed.

The Spanish girl had bled as the result of an operation she'd recently had (from her broken-English description it sounded like a biopsy) and her jeans were soaked and red around her groin. She sat in the first aider's car whilst I gave her pads to stem the flow. In such a public place, there wasn't much else to be done - her BP and other vitals were normal, so nobody was panicking about it.

The ambulance arrived soon enough and I gave my handover. The girl was taken to the vehicle in a chair and appropriately covered up to save her dignity.

This was my last shift for a while; I'm going to have a holiday and try to finish writing the novel - it's almost there but needs a bit of attention. Mr Tonsilpus is about to go away on his tour of the UK before he leaves to tour the rest of the world, so I am also occupied with that for the moment. Once he's gone, Lottie will take over with most of the admin and communications. I'll come back after a few weeks to another couple of shifts and then things may change for me; I will let you know what that means if it happens - but don't panic!

In the meantime, keep reading and donate to the Tonsilpus cause!

Be safe.

Wednesday, 15 September 2010

More bumble trouble

This was one of my pool shifts and a shorter day for me. I was assigned the ‘spare’ car but only in theory because an actual spare FRU doesn’t exist – not one that runs anyway. So I spent a few hours wandering around trying to find a suitably fit-for-purpose vehicle until I negotiated ‘borrowing’ one from management.

The shift was routine and I only needed an ambulance for one call – the first one – when a woman had a near-faint at a tube station. I left her crying with the crew after I’d chatted to her and managed to root out the stress she was suffering, thus her panicky-fainty condition. I have that effect and it was good for her to get it out of her system with people she trusted.

Next was a fit in the street. The 35 year-old man was a diabetic and had probably had a hypoglycaemic seizure but I couldn’t be sure because the cops with him had given him orange juice when he recovered and his BM was normal when I checked it. He got a carbohydrate anyway and I drove him to hospital in the car. We crawled for ages in heavy traffic and passed the lovely Spitfire that currently sits on Whitehall – it’s only little. Small but deadly. Like me :-)

A bee sting to the ear after that. The 40 year-old bus driver thought it was a wasp but I looked inside his lug-hole and a nasty looking stinger (see pic) was lodged in the cartilage. I removed it carefully and he got the fright of his life when he saw it. I sometimes wish the bees that leave these things could see the faces of their victims when they are taken out – they might reform. Again, small but deadly – literally.

Luckily for him he has no allergies but I cautioned him and advised him to get some antihistamine and go to see his GP if his throbbing ear and face got worse. He was happy to do that and I left him with his colleagues. Then I drove back to station so that I could deliver the car to someone who needed it more than me. This and yet another warning light on the dashboard, ended my shift.

Be(e) safe.

Wednesday, 8 September 2010

Cold heartbeat

This is one of the BTP's explosive search dogs. They each have a card giving their names and details. Apparently these cards are collectable, so I'm going to try and get them all! I have three, the other two dogs are named Pete (#42) and Cookie (who was sacked because he was no use at sniffing for explosives!). Don't you just love the look old Bouncer is giving the photographer?

Have I told you that the worst kind of drunkard is a well-to-do drunkard? Yes? Probably ad nauseum but these people never fail to depress me about the state of society when, compared to a good-old honest alcoholic, they get themselves so wasted that they turn into animals and their attitude and behaviour becomes arrogant and abusive. Historically, as you know, I’ve been sworn at, spat at, punched, kicked and generally insulted by doctors, lawyers, bankers and stockbrokers – people with money, affluence and no good reason to overdo it with the sauce.

This man, a 50 year-old City type, was found at the bottom of escalators at an underground station. He’d fallen. I was asked to attend but by the time I arrived he’d gone – last seen hugging a lamp-post I was told by the staff member who met me.

We managed to locate him harassing a complete stranger in the street. His stance was unbalanced and he looked like he would fall any second if I didn’t get a hold of him. So, I impressed upon him the importance of going to hospital to sober up a little before continuing his long journey home to an entirely different county. He was unimpressed but walked with me to the car.

Our conversation consisted of me trying to advise him that he had no capacity to make a decision about going or not going to hospital and that he was a danger to himself. I explained that he might fall into the busy road and get killed. None of this stuck in his brain and he launched into a verbal nursery rhyme of rubbish information about ‘70’s rock bands. He wasn’t listening at all.

He became a little abusive in his language and claimed he’d had a bag with him. At that point I couldn’t leave the scene with him; I had to ask for police to come and record his claim, otherwise I might get lumbered with the blame for its loss. Witnesses confirmed that he had no bag with him but I needed this written down and so the BTP were called in.

If you are going to get drunk and you are a clever person with degrees and a good career, don’t blow it by becoming an idiot when you drink and more importantly, don’t start giving the police abuse when they try to reason with you about going to hospital for your own safety.

This well-off, well-turned out, intelligent drunkard got himself arrested. He was hand-cuffed in full public view (he tried to fight the cops off) and was taken unceremoniously to the waiting van. He’ll spend a few hours in a cell and dry out. He will certainly regret what he’s done and he will have a record for being drunk and disorderly. I don’t expect his wife will be impressed.

A sudden collapse during a dinner at an hotel (same one as last night!) had a wife, who was a nurse by profession, panicking as she watched her husband falling in and out of consciousness for reasons unknown. The scene was very noisy, with hundreds of people wining and dining themselves and having a good old look at the excitement on the floor. But it was all too dramatic and, although the 30 year-old was diaphoretic and weak, he recovered well on oxygen.

The man had a known fish allergy but he hadn’t eaten fish, so I think he probably reacted to something else. A sudden release of Histamine would do that; increased capillary permeability, drop in blood pressure, possibly leading to collapse and unconsciousness. There was nothing on his ECG to suggest a sinister reason for his drop and his vitals returned to normal within ten minutes of the crew’s arrival. He went to hospital for further checks but I’m sure his wife has nothing to worry about.

Time-wasting individuals with selfish ulterior motives are fairly common in pre-hospital care unfortunately and the next patient, a 35 year-old claiming DIB and ‘can’t move’ was sitting outside a tube station directly across from the hospital when I arrived. He thumped his leg a few times to demonstrate that it was ‘completely dead’ and that he’d need assistance, so I enquired about him at A&E and was told that he had been thrown out twice for drinking their alcohol gel and that he had no clinical need.

I told him what I’d found out and warned him that if he called for an ambulance again it was very likely the police would come and deal with him. He seemed to get my point and I left him sitting where I found him – he will have to hatch another plan if he was going to get what he wanted from the NHS.

Smelly jobs come along every now and again and I’ve had my fair share of them. Tonight the Gods decided I’d get a rancid, putrefying leg in a police station cell. The drug addict had been arrested and was seen by the doctor for an ulcerated leg. He’d been ignoring it and taken none of the antibiotics prescribed for him, so the thing had reddened, become inflamed and a vigorous infection had taken root and was working its way through his flesh to the bone. As soon as I got to the cell door I could smell it; a very strong odour of fish. If he didn’t go to hospital and get it seen to, he would lose his leg.

Of course, he was awkward about it and adamantly refused to go. However, being in custody meant he really didn’t have a choice, so, with the help of a crew, two police officers to guard him and a mask and gloves for everyone concerned, off he went. I can still smell his leg as I write this. I have gone off fish too.

Ending the shift with a bit of drama is guaranteed to wake you up; this is not good if you are kept very late as a result and have another night shift to do later on. Fifteen minutes from going home and a Red1, cardiac arrest is given to me. There is no-one nearer (no paramedic in the area) and the journey will take me north, miles from the station. I know that unless I am cancelled down I am going to be at least an hour late off, possibly more but the call is not for a drunk or an abdo pain, it’s for someone whose life could be saved – it’s a 30 year-old female ‘not breathing at all’, so I raced up to the address and got there just ahead of an ambulance and another FRU; I’m the only paramedic on scene so the onus is on me to run the show, as it were.

The door to the flat was opened by a young child who pointed to the front room and said ‘in there’ as if, at 6.20am, there was no crisis in the place. I would usually be sceptical by this time, thinking that this was a nonsense call but at no point in this run did that cross my mind – it felt genuine from the start.

We bundled into the front room and a woman was straddled over another, carrying out chest compressions using the loud timing ‘beep’ that could be heard over the ‘phone. On the other end of the line was a 999 call-taker who’d calmly and professionally guided the resuscitating woman to this point, and thus began the life-saving process. I went over to the woman and asked her if she was alright, which always seems strange and inappropriate. She nodded and continued but I asked one of my colleagues to take her place and so the well-rehearsed ALS routine began in earnest.

The woman on the floor had last been seen alive the night before and her friend said she’d been making snorting or snoring noises when she breathed. This struck me as strange – if it was true, why didn’t she call an ambulance? A number of other statements seemed out of place but I can’t record them here for pertinent reasons.

There were at least two children wandering in and out of the room as we worked on this young woman and I had to ask a number of times for them to be removed; this is not the kind of thing you want your kids to witness. Resuscitation is a messy, noisy and emotionally traumatic event for anyone to see, let alone a small child.

We had been there for twenty minutes and I was deciding on the exit strategy (we were four floors up and there was no suitable lift). The woman had been asystolic throughout, despite drugs and good CPR, so I really thought we were going to end this with a run to hospital and that it would be called there. But then one of my colleagues said that we had output – a pulse was palpable at the neck. I’d tried Narcan on her, just in case, after asking about drug use. It’s possible this helped to ‘bring her back’. We had no idea how long she’d been in arrest –it could have been all night and her body core temperature (32c) suggested this but the change threw all of us; we really weren’t expecting to get a result.

We continued ventilations and fluids as we struggled with her body all the way down the concrete stairs of the flats and into the ambulance. We connected her to piped oxygen, IV fluids and more drugs as they were needed, then rushed her to hospital, which was less than five minutes away.

At hospital there was genuine disbelief that she had a heartbeat; she was cold and her blood gases were all over the place – she was very acidotic. She was put on a ventilator and I left to do my paperwork and get back to my station. I was two hours late and it took me another hour or so to get home but I didn't really mind because I felt I had done something worthwhile for a change.

When I went back to work later on I was told that the young woman had died. The doctor told me they had struggled to keep her stable and that a drama had unfolded at the hospital when I left and the woman’s family arrived. There is a lot more to this story but I can’t divulge any of the details. It certainly wasn’t a straight-forward job and I expect I will be called upon to relive it.

Be safe.

Tuesday, 7 September 2010

Midweek violence

Rachel and Callum Bunn play host to Mr Tonsilpus on the dark streets of London town during a break in the proceedings.

I don’t like being late. I also don’t like being ill. But most of all I don’t like being late for work. So the latest Tube strike meant loads of extra traffic and an hour and a half to get from Euston Road to Waterloo... and late!

An assault on a young woman by her boyfriend left her lying in the road with facial injuries and a crowd of people around her, including two private ambulance men and a doctor. Two witnesses to the incident stuck around for the police and the assailant chatted on his phone across the road. He showed little interest in the state of his girlfriend.

She’d allegedly been pushed to ground and hit her head hard on the concrete. She may have been knocked out because she had no memory of the event.

A crew arrived to take her away and I chatted to the man and wife who’d seen it all happen. It was one of the most interesting conversations I’ve had with MOPs in a while.

A man was knocked down, sustaining a head injury but he decided, in his drunken state, to get up and stand around with the gathered crowd as police arrived with me. He was dressed to party and didn’t want to leave for hospital until he was persuaded by myself and the cops that it was in his best interests. He was too drunk to make a lucid decision anyway.

When the ambulance arrived he got aboard and, after a long discussion about his refusal to have a collar placed, he produced some white tablets from his pocket – class A I think. I asked him to put them back into his pocket and let the crew know what he had just in case he decided to take them out again for show or distribution. It was going to be one of those nights.

Not long after that I went to the aid of a Geisha who’d fainted at a posh party in Park Lane. It was strange to be treating a lady of her calibre and she was recovering well enough but her history of such collapses was suspicious, so she too had to be persuaded to go with the crew for an ECG and further checks, although this made her nervy and she was adamant that all was okay - her translator had to emphasise the importance of the checks. Luckily the crew was all female and I think that helped.

At a train station in the small hours, a 20 year-old female asked for an ambulance and claimed chest pain. When I arrived I recognised her from a previous call a few months ago. She had a certain M.O. and it involved reeling off her illnesses, which included SLE and asking for pain relief. She may have been having a ‘flare’ and she’d already taken her own Oramorph, so I got her and her suitcases into the car and took her to the nearest hospital which is on the doorstep of the station.

She had crutches with her and I wondered how she'd been managing to get about at this hour (or any hour) of the morning with three cases and two bags. She'd told the station manager that she was waiting for a train because she was going to her brother's place but when he asked her where her brother lived, we had to look at each other - she was in the wrong end of town completely. Her story made no sense.

The nurse immediuately recognised her. She is very, very regular.

Getting punched in the face and batted around the head by a belt buckle is bad enough on a weekend but when you are attacked like that on a boring Tuesday night / Wednesday morning, things are dire. The 19 year-old who ended up in the back of an ambulance tried to break up a fight involving three thugs and a homeless man. This is always a mistake unless you have adequate body armour or a good insurance policy that will benefit your wife and kids.

Luckily for him the extent of his injuries could be described using the word ‘minor’. Cuts to his head and bruising to his face as well as a developing fat lip were all he earned for his good deed. The smoking blonde girl who hugged him as he went into the ambulance was more of a danger to his health I think.

To end the night, another man – a 39 year-old – was pushed to the ground, pinned down and robbed after he invited a man he’d only just met in a club to join him around the corner for sex. He had a bloody mouth sporting a cigarette when I arrived and the atmosphere was generally unsettling because the assailant and his alleged accomplice were still on scene. In fact one of them was brazenly challenging him as club door staff tried to keep him back. I thought I was going to end my shift with a black eye myself. London is not a nice neighbourhood at this time of the day.

Be safe.