Wednesday, 30 March 2011

The mire

Small minds
Hoax calls, made by children are usually benign and can be dealt with on the phone but a few of them are well-planned and executed little scenarios that require a lot of nerve to sustain under interrogation.

The caller sounds like she’s 12 years-old but she’s claiming to have murdered her husband. She says she’s 28 years-old and her husband is in his thirties. She is calm and repeatedly states that there is a lot of blood and that he has been stabbed through the heart and is dead. She even goes through the motions of giving CPR under instruction but it’s obvious that no effort is being applied and when she counts to 30 for the compressions, she misses the numbers 10 to 12 for some reason.

Resources are deployed, including the police because no risk can be taken with calls like these; it can be very hard to be sure of a person’s age or whether they are telling you the truth or not. When the crew arrive, they can be heard banging on the door in the background shouting 'Hello?' - to them this is a genuine call and they have good reason to be concerned when there is no response. But the child is in the room; she's still on the phone but now she's silent.

What was particularly disturbing about the call was the cold, callous voice of the child on the line. At any age in childhood the words ‘murder’, ‘killed’ and ‘dead’ should never enter the vocabulary for imaginative use - certainly not in this context, where an emergency service is being summoned on the pretext. Where were the parents of this kid? What kind of mind does the child have and how far would she go to get excitement like this?

When she was told that the call would be traced and the police would be sent to her, she said ‘don’t do that’ in an almost panicked way but it was all part of the game and she was soon back to her original story that her husband lay dead on the floor after having been brutally stabbed through the heart by her. We have some very, very sick children on the way to adulthood.

Thank God for the Press (at times); the news footage of the Libyan woman being hand-gagged and obstructed from speaking out against the Regime in her country was truly shocking but if the Press hadn’t been there, filming every detail and reporting the incident, who knows what would have happened to her. She was taken away by security men in a car and reporters were told she was safe; the Security men knew that harming her would result in consequences for them individually when this thing blows over. If the press hadn’t been there I’m pretty sure she would have simply disappeared forever.
In contrast, in a country where you can speak your mind without recrimination, we have a hardcore of mainly young men rioting and polluting every peaceful protest, not because they have an argument or a point to make but because they simply hate everything. They hate the Government (it doesn’t matter which party is in power), they hate the police and they hate anything that doesn’t pander to their unrealistic belief that a society can run safely without authority. They think jobs can be wished into existence without bankers and rich employers. Although I will concede any point made about greed in these professions. It's not really the argument, it's the way it is being 'protested'.

The vast majority of us do not behave like this. More than a quarter of a million people turned up to protest spending cuts that would affect their lives – they were trying to make a point but it was washed away in the tide of hooliganism that followed. I watched it all unfold at work, as did many of my colleagues and it was unbelievable that we had to use phrases like ‘be careful’ and ‘avoid’ on a night that is usually full of routine. Anything with a blue light bar on it was going to be a target for these idiots.

But let's get all paranoid and out of perspective; Trafalgar Square has been the site of more than a few riots instigated by those who wish to break the law. In 1848, protestors with no alignment whatsoever to the planned income tax demo (which was officially cancelled), gathered to use the meeting as an excuse to do what they would probably normally do if they lived in a society without police – they set about damaging property and stealing whatever they could lay their hands on, after a good deal of violence. Protests with a small group of hooligans, intent on chaos has been a repeated event over the past couple of centuries. What magnifies it to this generation is the fact that it is being perpetrated by 'intelligent' young people who honestly think, while they are naive enough to bathe in the bubbly bathtub of ideology, that everything can be solved by making everyone equal. When they grow up and get into middle-age, with a job, debts of their own and a family to raise, they will be different people - if they can get a job with a criminal record. It’s all so familiar.

So, while my colleagues once again put themselves in harm’s way to help others – and I include the police in that statement – a couple of hundred individuals, whose opinions are of no promotional consequence to the well-being of anyone but themselves, destroyed whatever they could because there were a lot of them and they knew the police would not lay into them heavy-handedly. There was, in effect, no immediate consequence for their actions (the result of bleating hearts complaining about former police actions to quell disorder – a job we pay them to do).

I have an eighteen-month old child. If there are no consequences for his bad behaviour, he will continue with it. I don’t need to physically hurt him to make my point but he will understand, very clearly, that his wrong-doing will be punished. Everyone has the right to protest and everyone has an opinion but if we smashed up private property and lit fires in the street because we had something to prove, where would society be and what kind of job would we, as paramedics, have? We'd be riot medics.

We don’t need a police state but we can’t have a stupidly tolerant one either. We need a middle-ground of understanding and a realistic approach to how we act and react to situations that threaten us or our society.
The Press may have saved the life of a Libyan woman who spoke out but they are also part of our current problem in this country – strategic photography and reporting has demonised the police to the point where we now no longer have the right to walk freely when a protest may go wrong. Not because the police are stopping us, but because they are wary of stepping too hard on top of those who are.

Be safe.

Saturday, 19 March 2011


I had an observer with me on my clinical mission today – a driving instructor who wanted to see what the difference was between the tidy lesson-method and the only way to get around on blue lights in London town. She had a thoroughly good day by her own account.

A 15 year-old insulin-dependant female was the recipient of my first visit of the morning; she’d left hospital in the early hours without taking a new batch of insulin with her and I was to taxi her back to get it. When I got into the little flat, Gran was moaning about her and she was cooking food while her teenage mate slumped on the sofa looking very uninterested.

‘I don’t need to go back to hospital’, she told me. She spoke with that new-south-London accent that teens, especially white girls, use; it’s a kind of pseudo-black popular twang that I find very annoying to listen to – it smacks of I don’t care.

I checked her BM and she showed me that her insulin was in the fridge. Gran looked powerless and a little nervous to be honest. This was not a cosy little family and I’m convinced the girl and her mate had been out all night. She probably ended up in A&E drunk and the insulin was a side-issue. Gran’s place was very likely the reasonable excuse for not being at home all Friday night.

That was followed later on by a drug addict who wandered into a tourist shop and promptly fell, hitting is head and causing mild panic. A police officer was on scene when we got there and she explained that she was asked to help him when he tumbled.

The man looked stoned to me – tiny little pupils and hardly awake – he had to be prodded back into life regularly; a sure sign that he was on something. He denied this of course. A police officer was there, so of course he denied it.

As I collected information from him and checked his obs, the store Manager (he looked like a manager) tried to get him to stand up and leave the shop because he was (a) in the way on the steps and (b) untidy looking and therefore bad for business. I asked him to be patient and walked the addict out of the shop and onto the back seat of my car, where he tried, again and again, to become unconscious.

The crew arrived as other cops landed to help out and I handed the man over for Narcan and a quick trip to A&E. I was told that he was a Misper (missing person) – he’d been reported missing by his friend, who was elsewhere worrying about him.

I managed to find out that the patient had met someone and wandered off with him, probably to get the drugs he now had in his blood. This is typical behaviour and so his mate shouldn’t really have been worried about it.

While the crew was dealing with him in the ambulance, the police officers were asked to assist with something across the road and out of my vision. A few minutes later, I was asked to help someone who was fitting in the street. This is where the cops had been taken and I crossed the road to find them trying to hold down the man as he seized on the pavement. A small crowd had gathered around him but the place was heaving anyway, so people were going to be an obstruction, no matter what.

A few more cops arrived and another FRU pulled up to assist. My driving instructor observer helped out too; she became an expert at getting certain bits and pieces for me by the end of the shift.

It took a couple of minutes to change the status of the young man on the pavement – a bit of oxygen was required. He stopped fitting and became agitated and confused, which is pretty much par for the course. Another ten minutes went by as we asked him questions and tried to ascertain his medical history – he wasn’t epileptic and I suspect that he’d probably taken something. He’d been out all night.

An awkward job next; a woman fell down a set of steep steps in a shop. She didn’t see the first step and simply tumbled, head-over-heels until she hit the bottom with her head. She had two nasty bumps on her cranium. She hadn’t been knocked out and there was very little blood around but she’d come down at a high angle and must have hit hard when she landed, so I asked for a crew to bring a spinal board down.

Unfortunately, taking her out on the board wasn’t going to be safe, for her or the crew, so we collared her and made use of the chair while she was still in a sitting position. At the top of the steps, she was transferred onto a board and strapped in securely. She had no neurological deficit and no neck pain or tenderness. Her status didn’t change during the lift up the stairs. It was all precautionary.

Another 15 year-old girl, this time with less attitude, and a normal accent, albeit American, was waiting for me at a tube station. She’d collapsed after being sick into a bag – she felt generally unwell and it may have been down to something she’d eaten. I put the blame on ice cream.

Her mum, dad and older sister were with her and everyone seemed happy enough. I spoke to her while we waited for the ambulance and I chatted to her parents and her sister (who is very nice and apparently doesn’t bully her sibling) while still waiting for an ambulance.

Eventually, after being told that it was ‘on scene’ but not seeing a crew appear, I walked the girl and her family to the car. There was no ambulance outside. They were at a completely different station. It made more sense to take her in the car now.

Big sister and dad walked across the bridge to the hospital and I drove the patient and her mum but, as the direct result of paperwork, I was beaten to the hospital by the walking party. So now the people of Colorado think the London Ambulance Service is slower than a snail in a headwind. Not true though… ask the driving instructor!

The young lady was left in the gentle care of the paediatric nurses and her family waited with her. I said goodbye and left for the next mission. Before I finished this call however, I made enquiries on behalf of the young lady. So, just for you and because you didn’t know – your name means ‘Towers’.

The shift ended with another fitting. This time we had to run and descend deep into the underground to get to the patient. It was busy with people of course and not many of them cared to move out of the way so that we could reach the platform quickly. A tannoy announcement had been made just as we arrived, informing passengers of a medical incident but it made no difference to the people who were obstructing us by standing in the middle of the escalator.

The lady was with her family and friends; she had been fitting on the train and was taken off to recover on the platform. She was very confused and very strong, as she thrashed and lashed out when I tried to give her oxygen. This was to be expected and I won’t fight with someone in that condition, so the mask was left off until she was a little less combative.

The crew was on scene soon after I’d started my obs and the woman was less agitated by the time she was placed into the chair for the long trip up to street level.

I have a few more shifts on the road coming up, so I’ll report as and when. In the meantime I’ll continue to comment on the issues that make a difference to us here.

Be safe.

Sunday, 13 March 2011

Slow to act

It has been suggested that the emergency services (some of them) showed a little too much caution on 7/7; some, apparently, were slow to take ‘calculated risks’ in order to save lives.

I personally do not believe that any of us on that day stopped to think too long about whether our involvement was too risky and that the lives of others were not of paramount importance during the terrorist attacks but I would like to tender this reasonable presumption on behalf of those who are being seen as ‘slow to respond’ – maybe there were too many unknowns. We don’t get bombed every day (thankfully), so we don’t have the experience necessary to activate a train of thought that superintends our sense of caution for our own sakes. We are, however, reluctant to rush in without thinking because that too will cost lives.

Believe me, this is not an excuse for alleged delayed response but, from a human point of view and knowing how it all unfolded for real, I can see why people may think that too much caution was exercised. I’m sure that in the first few days of the Blitz, emergency services and ordinary folk were unexercised and slower about their decisions to commit themselves to immediate danger – I’m confident, without knowing for sure of course, that they began to get braver and more involved with the thick of it as they grew accustomed to the effects and aftermath of the German Luftwaffe actions. They’d be taking risks based on their experience and knowledge, gained over the period in which they managed to survive previous risk-taking activities, which would have been slower and more cautious. It would have been a learning process borne out of self-preservation.

Would we be criticising the response to 7/7 if it was carried out without caution and many emergency services personnel died as a result? How many of the brave Fire fighters in New York would have been ordered to stay in the Towers if their bosses (and the public) had known of their imminent collapse? I’ve actually received an email from someone stating that ‘paramedics should expect to risk death for their patients’.

I remember carrying out a mock exercise at university, the year before I graduated and qualified, where we were to respond to an explosion (a bomb) at an underground station – one of those that had, in fact, been targeted in 2005. I recall how unlikely it seemed that it would ever happen in reality but it did, only a year later. Everything in that mock exercise had to be planned precisely so that errors would not be made, or at least they could be reduced in number. Such calculating takes time.

If terrorists strike again and they put into place secondary devices and other traps, would we be foolish to exercise caution? Or would it be okay to lose ten or twenty members of the emergency services instead of the risk that we’d lose two or three victims who had to endure until they arrived? It’s a horrible balance to achieve but it is a regrettable function of mass casualty emergency medicine; saving the greatest number possible, without needlessly risking the lives of others.

I hope I made sense there.

I don’t tend to focus too much on what we did or did not do on that day because, although there needs to be a thorough inquiry for the sake of the victims’ families and I do appreciate that, I tend to look at the bigger picture. As long as we tolerate self-segregation by those who come to our shores, have families, create generations of new ‘Brits’ but, throughout the entire process, refuse to integrate and whilst loathing our systems and beliefs, teach their children the same poisonous stuff, we will be at risk from attack from within. We will see more photographs of smug, smiling men who believe they will get to heaven by murdering others on the say-so of their religion (a religion they tarnish by doing so) - men who hold small children and who will ultimately leave them with the shame of what they have done.

The 7/7 inquiry is important. I would want to know how and why my loved one died on that day, of course I would. Everything needs to be analysed because it’s how a civilised society behaves after disaster but let’s not overlook the fact that none of it would have happened if the young men being bred to do it were not here in the first place; if our civilised way of life did not extend to allowing them to attend hate classes and berate our soldiers on the streets as they bring home their dead.

The Inquiry has to hear the views of everyone with a voice and I guess the caution perceived on the day is a matter that has to be addressed. However, at the risk of sounding unreasonable, is the primary thinking here that emergency services personnel are, by merit of uniform, salary or rank, expected to take risks without thinking?

If I get to a call and there is a problem – there is smoke billowing from the entrance of a tube station – I will have a look and see how far I can get. If I see flames and know that entering further will get me burned and possible killed, I will back off and re-think my strategy; I’ll wait for the Fire Service to arrive. Members of the public will then recount my actions and say that I acted too cautiously or that I refused to act at all when people were dying below ground, although none of them would have ventured inside either – the one wearing the uniform is the expendable one.

I will gladly risk whatever I can to save someone else – we all would - but I challenge you to find many who would thoughtlessly give up their own lives, their families and loved ones, for a stranger.

Be safe.