More Blood, More Sweat and Another Cup of Tea

But there is no way that it could be considered a ‘Fast’ car.

I think the reason why we have them is because they are able to carry patients, and I imagine that soon FRU drivers will be asked to take the coughs and colds that we see so much of to hospital.

NYE Night

New Year’s night was a busy one for the London Ambulance Service. There were 38 stabbings over the course of the night. I spoke to my workmate who was on the FRU that night; he attended four stabbings one after another.

By 5 a.m. there had been in excess of 2000 calls (we normally do a shade under 4000 calls over 24 hours).

On the television one of our top-ranking management people described the night as ‘horrific’, which I would say is a pretty fair assessment.

I am extremely glad I wasn’t working that shift.

Ten Deep Breaths

The call details appeared on the computer terminal in the FRU:

‘Nineteen-year-old male—Patient has lump on ribs—difficulty in breathing.’

Halfway to the address, a private house, my screen was updated:

‘Patient has taken cocaine.’

I was met at the front door by a young male, stripped to the waist and obviously agitated.

‘Comein, myribsfeelfunny, andmyshoulderbladedon’tfeelright.’

‘Slow down,’ I said, taking his pulse—110, a bit on the high side, but he was bouncing off the walls.

‘My ribs man! They don’t feel right! Have a feel.’ He then started running his hands up and down his chest.

‘Have you fallen over? Been hit? Anything unusual happened?’ I asked.

‘No man—just feel them…FEEL THEM!’

‘Look, you need to calm down,’ I replied. ‘I can’t do anything while you are hopping all over the place.’

He started shouting, ‘FEEL THEM! JUST FUCKIN’ FEEL THEM!’

He turned his back to me, indicating that I should feel his normal-looking ribs.

A sudden wave of anger passed over me—it was all I could do to not punch him in the back. I examined his ribs; they felt perfectly normal to me.

‘There,’ I said, ‘your ribs are fine.’

‘What about my shoulder blades man?’

‘Look, you’ve taken cocaine right? You are feeling paranoid, it’s normal, just try to relax a little.’

‘WHAT…ABOUT…MY…FUCKIN’…SHOULDER BLADES!’

He turned his back on me again. I gritted my teeth and grabbed his shoulder blades. ‘They are fine. Now. Sit. Down.’

He sat down. Then he stood up, then he paced around the kitchen, then he did a few circuits of the sofa, then he sat down again, then he stood up and hopped around a bit. I was getting tired just watching him.

‘Look,’ I said trying to calm him, and me, down, ‘is this the first time you’ve taken cocaine?’

‘No man!’

‘OK, well if you want we can take you to the hospital, get you checked out if you’d like?’

‘NO!’ he shouted. ‘I’m not going to hospital.’

Fine, I thought, not that the hospital will thank me.

‘OK mate, then are you alone in the house?’

‘Nah, my dad’s asleep upstairs.’

‘Well, I’d like to have a chat with him, so he can keep an eye on you.’

‘NO! Get out of my house.’ He started advancing towards me. ‘No hospital, no waking my dad up, just get the fuck out of my house!’

I left the house. While a fight with the patient would have done absolute wonders for my stress levels, it certainly wasn’t worth the hassle, the risk of injury and, most importantly, the paperwork.

But what should I do now? If a patient isn’t transported then we should leave a copy of our patient report form with them. Should I post it through the letterbox? The problem with that was if his father saw the report I’d be breaching patient confidentiality. I guessed that the police wouldn’t be too interested in paying him a visit either. So I left the form sitting in my car—there was little else I could do for him, as he didn’t want help.

I sat in my car, filled out my forms and took a couple of deep breaths. It would be a long Christmas…

Taxi?

I’ve had a couple of people send me a story that appeared in the newspapers.

Nursing staff from a Telford hospital have been accused of using an ambulance as a taxi after a night out.

It was claimed some of the nursing staff got into an ambulance outside The Swan in Ironbridge on Sunday.

The ambulance service has found a crew did provide unauthorised transport to staff but said it was not in operation and returning to base at the time.

To be honest this tends to happen a bit with nurses asking if you can give them a lift to the train station and the like. You tell the nurse ‘Hop in the back, we’ll give you a lift—if we get a call you’ll have to hop out again.’ It helps keep relations good between the hospital staff and ourselves. It doesn’t hurt anyone and it definitely doesn’t remove an ambulance from service.

In fact, it can do good. A crew I know was giving a nurse a lift to the train station after her shift finished when they then got a call to a cardiac arrest and the nurse was able to help out. As long as the crew wasn’t refusing calls then I can’t see the harm in it. In London I’d imagine that our Control would love it as it would mean we are out roaming rather than sitting on station, something our management is eager for us to do.

And if I’m going to spend all shift taxiing drunks around, I don’t see why we can’t sometimes help out the poor buggers who work their fingers to the bone looking after those same drunks.

I wonder if the person who complained is the sort who expects an ambulance to turn up seconds after they’ve cut their finger?

Chickenpox

I went to two cases of adult chickenpox last night. The hospital says that there was another adult with chickenpox the day before that. It seems like we have a little outbreak here.

As both my patients were Nigerian, I have a sneaky feeling that the big (mainly Nigerian) church in Newham may be where the disease was spread and the timing of the symptoms would support this.

As one of the families had school-age children with the disease, I’m going to guess that a lot of children will be ill over the next few days.

Off the top of my head, I can’t remember if I have been vaccinated against chickenpox—but I do know that I had it twice when I was a child, both times at Christmas.

Rough

It was cold, it was dark and it was raining the sort of thin greasy rain that soaks straight through your clothes. I was making my way to one of the Docklands Light Railway stations for a ‘Male—collapsed, caller not willing to approach patient.’ I’d been to this station in the last week for a hoax call and I wasn’t sure if this was a repeat performance.

At the bottom of the stairs just sheltered from the rain was a young man in his twenties, dirty, dressed in filthy clothes and curled up next to a plastic bag. Standing over him was another man, this one dressed in a suit, looking a bit concerned.

(The London borough of Tower Hamlets has both the richest, and the poorest population in London.)

‘He’s just laying there, not talking,’ the smartly dressed man said. ‘I didn’t really know what to do…’

I let him know that I’d take care of the patient, and that he had done the right thing and could go home.

It was just me and the patient. Given the way he looked it was a reasonable assumption that he was homeless. If he was homeless then there was a reasonable assumption that he was drunk and given that he was in such a public place there was a chance that there was something physically wrong with him.

I attempted to wake him up—he was keeping his eyes closed when I tried to open them, so I knew that he wasn’t really unconscious.

‘Look mate,’ I said, ‘if you don’t open your eyes, I’ll have to check your blood sugar, which means poking a needle into your finger. If you open your eyes then I won’t have to do that.’

No response.

So I checked his blood sugar along with the rest of his vital signs; everything was fine.

I crouched down opposite him.

‘Look, you can open your eyes and talk to me you know—we’ll still take you to hospital. To be honest, I can’t blame you, an A&E waiting room has got to be a pretty good option on a crappy night like this.’

Some commuters walked between us; they didn’t look at us. I looked in his plastic bag; there was a sociology textbook.

‘Sociology? I could never enjoy reading that sort of thing.’

He opened his eyes. ‘’S’ all right.’

Excellent. He was talking to me, which meant that the paranoid voice in the back of my head telling me that he might be seriously ill could shut up. It is something that always worries me—that despite my experience I’d miss something serious on a drunk or homeless guy.

We had a little chat while I was waiting for the ambulance to arrive. He’d been a rough sleeper for two years; he admitted to drinking too much. He seemed a nice enough person.

‘Bloody freezing tonight,’ I said to him. ‘I reckon the hospital has got to be a fair bit warmer and drier tonight.’

‘I don’t want to go to hospital,’ he said back to me.

I was surprised. ‘Are you sure mate? It’s no skin off my nose if we take you in.’

‘Yeah, I’m sure. I’ve just had too much to drink.’ He mentioned a hostel nearby. ‘Which way is it from here?’

I pointed him in the direction of the hostel and he wandered off down the road.

I’ve got to admit that I felt sorry for him. I didn’t know why he was homeless, and I’m not a strong believer that all homeless people are victims, but because I’d sat and spoken to him, because he hadn’t tried to hit me and because he seemed like a reasonable person I felt some sympathy for him. He must have made some sort of impression on me as I can still remember the job six weeks after it happened.

Maybe I’m just getting soft in my old age.

The Black Dog Has Been Taken Outside and Shot

I left work this morning with a song in my heart and joy in my step; last night was my final shift on the FRU car.

No longer will I be standing around with my hands in my pockets for 45 minutes while a six-month-old child lies in front of me with possible meningitis. No more will I be told by Control to go and drive around and look busy when there is something good on telly, and no longer will my only conversation with people consist mainly of ‘Where does it hurt?’ for twelve hours straight.

The letter that I wrote my boss telling her that I wanted to come off the FRU takes effect from Friday. I’ll soon be back to working on a ‘truck’, a nice big person-carrying medical-taxi truck.

Lovely!

I was hoping that this last shift would fly by in an exciting cascade of trauma, life-saving and dramatic illness.

Ahem.

It was actually a fairly quiet night. I did seven jobs, four of them being people with coughs (one cough having lasted three weeks before the patient decided to call an ambulance at five in the morning). My last call was to an elderly gentleman with emphysema (and a cough) who actually needed hospital treatment.

However, my first two calls were to drunks.

My second job was a ‘classic’—‘Male collapsed in street, unknown life status—caller refusing to go near patient or answer any questions.’ So I rushed there and found two female police officers standing over a drunk male who was asleep in the street. I did all my normal checks to make sure that he was only drunk (as opposed to being drunk and in a diabetic coma, drunk and has had a stroke, or drunk and has been stabbed). Everything pointed to him being just drunk.

We woke him up and were prepared to send him on his way. He stood up—took one look at me, and smacked me in the mouth.

I ‘assisted’ him onto the floor. The police officers and I then stopped him from injuring himself by sitting on him in a professional manner.

The police have been trained in restraint—they are all careful because they don’t want people dying of positional asphyxia. I haven’t been trained in restraint (well, not in the ambulance service) but I’m guessing that someone isn’t going to die because I’m kneeling over their arm while holding their wrist.

So we carefully restrained him (for around 25 minutes), while he explained how he was either going to kick my head in or sue me. By then the police had tracked down a, now mortified, relative who came and took him away.

No damage done to me, although I would think that as he wakes up this morning he’ll have a number of bruises. I hopped in my car and told Control that I had been assaulted twice in two jobs, so I asked if I could head back to the station for a calming cup of tea, which they allowed. They also made sure that I was all right and didn’t need any other help.

When my mother found out about my being assaulted, did she ask how I was? Did she ask if I had been hurt or damaged?

No.

Her comment was, ‘At least you’ll have something interesting to blog about.’

Bloody lovely that is…

Complaint

It is a constant danger in this job that a patient, or more likely a patient’s relative, will make a complaint against you. While a member of the public can moan about a perceived insult (and half of the complaints against the ambulance service are due to ‘attitude’), there is little that we can do about a patient who is generally acting like a twit.

I have been pretty lucky in my career in that I’ve only had two complaints made against me: once while a nurse and once while working on the ambulances.

The nursing complaint was that I checked the correct dosage of a drug with another nurse before giving it to a child. For some reason this person had decided to complain about me for following the sensible rules laid down by my superiors. My boss at the time called me into the office, patted me on the head and told me I was a good boy and should keep up the excellent work.

The ambulance complaint went to a local investigation.

I was called into the office and asked if I remembered calling a patient a ‘bitch’. As I have a poor memory I didn’t remember until the ambulance officer gave me the paperwork for the job.

We had been called to a patient who had been arguing with his family, he’d drunk a bottle of wine and pretended to be unconscious. As he didn’t want to ‘wake up’, we decided to take him to hospital. While in the back of the ambulance he slapped my leg.

I told him that he ‘slapped like a bitch’ and that he really shouldn’t do it again or I might get upset.

I know, not the best insult in the world. He’d surprised me and I had to come up with something witty on the spur of the moment. If he’d hurt me then I would have thrown him off the ambulance, but as it was such an ineffectual strike I found it more amusing than anything else.

The officer had to investigate the allegation so he interviewed the other staff present and they supported my side of the story. He then had to travel to the patient’s home and interview him there. Luckily the officer saw the character of the patient and convinced him not to go any further with the complaint.

If I’d complained to the police it would no doubt have been considered ‘not worth prosecuting’ by the CPS, but if the patient had continued to complain I could have been seriously disciplined.

All of which only makes me think that I shouldn’t leave any witnesses alive…

Snapshots

…We get the call to the RTA, a car has crashed into a bus; normally these things are ‘nothing’ jobs. We put on the blue lights and head towards the crash…

…The radio bursts into life, there is an officer who ‘lucked’ onto the scene—he tells Control that he needs a lot of ambulances, the fire service and the police. The injuries are all serious. We wonder if he is talking about the same crash we are going to…

…We crest the hill, with one look at the car and the bus we know it’s going to be serious…

…I jump out of the ambulance and head to the car; I ask the officer what he wants us to do. He tells me that we can’t wait for the fire service to arrive to cut out the first patient as his breathing is so ragged. We agree that he needs to be out of the car immediately and that a possible neck injury is a low priority…

…We get him out and I watch as he takes his last breath…

…We work on him; he is so young we have to make the attempt. The DSO (duty station officer) and other FRUs work on the other people in the car…

…He is lying lifeless in my ambulance and the BASICS doctor declares him dead—then we rush off to the next casualty…

…This one gets sedation. I write the dose and time on his chest so that the information doesn’t get lost in the chaos. Another ambulance crew speeds him to hospital…

…The next one is declared dead as the firefighters cut him out…

…The other dead man is left in the car, there is nothing to do for him, it will be some time before the firefighters are able to free him…

…I check on the people in the bus, there are some injuries that will need hospital treatment. I’m trying to keep them calm and relaxed. My crewmate and I move from our ‘all-business’ personalities to our ‘reassurance’ ones in the time it takes us to walk to the bus. I deal with the multiple casualties one at a time, my crewmate helps me out…

…My ambulance becomes a mobile mortuary; the police are checking for identification. The blood is pooling on the floor…

…I’m sitting on the back step of the ambulance, two of the dead are in my ambulance; one, wrapped in a sheet, is at my feet. We are waiting for the undertaker…

…The police investigation team is chalking the outlines of vehicles and taking photographs of the scene…

…My paperwork is done. It seems like such a little bit of writing for such a serious call where three men have been killed…

…Medical equipment and wrappers mix with the debris of the accident. There is the familiar ‘tick-tick-tick’ of our blue lights revolving in their housings…

…Back at the station I have a face mask on as I clean the floor and trolley of the ambulance with the jet spray we normally use on the outside of the vehicles. My crewmate is doing the gentler job of cleaning the equipment. The blood comes off eventually…

…It’s time for our next job.

Repeat Offender

On Saturday one of the first jobs was to go to someone whose name my crewmate recognised.

‘He’s a nice old boy,’ he told me. ‘When his wife was alive she’d call us every time he coughed. He’s deaf and blind. He used to be a British champion boxer. He’s a big fella so I hope we don’t have to carry him downstairs. We don’t see him much now; he hasn’t called us out in ages.’

The patient was sitting alone in his flat, scattered around him were books that he could no longer read. In the corner was a television that probably hadn’t been turned on in years. He was just a frail man sitting quietly in his chair marking time. On the table next to his chair were the remains of some ‘meals on wheels’. I could see that he had once been a ‘solid’ man, like the old men still living in our area who used to work on the docks—tall and thick with muscle. He wasn’t that man any more. He was frail, shaking, and seemed nervous of everything, not something that you’d expect from an ex-boxer.

It was hard getting his history as I needed to lean close to his ear and shout. At one point he let out a hacking cough just as I was up close to him so we took him to hospital with a possible chest infection.

Our last job of the day was back to the same address—he’d been discharged from hospital and just wanted someone to ‘check his pulse’.

We didn’t mind.

Algesia

Seven-hour shifts are really easy to do, especially when you have spent the last year doing only twelve-hour shifts.

The jobs tonight were pretty easy—even easier for me as I was driving the ambulance rather than treating the patients. We had a 16-year-old girl with a sore throat, a pair of drunks, one of whom had a twisted ankle, a little old lady who’d fallen over indoors and had a nasty scrape to her arm, and a young woman, twelve weeks pregnant, who had been assaulted at work and struck in the stomach.

The real standout job for me shows just how daft some people are.

The patient was a twelve-year-old boy. We got the job as ‘child banging head on walls and floor’ and when we turned up the child was indeed clutching his head and hitting it against a wall. The parents and child spoke poor English, but we easily managed to learn that the child was suffering from an earache, and that this was the cause of the head-hitting.

‘How long has he had the pain?’ asked my crewmate for the night.

‘Five years then, three hours now,’ replied the father.

We understood what he meant—the child had an earache five years ago, but this current episode, and the reason why we were called out, had lasted three hours.

‘Have you given him any painkillers?’

‘No,’ the father looked confused.

‘Do you have any painkillers?’ my crewmate asked.

‘Yes, but we haven’t given him any,’ said the father.

So the family could see their child rolling around the floor, screaming in pain and banging his head against the walls, and didn’t consider that a painkiller might have—oh, I don’t know—helped with the pain.

I can imagine the scene in the hospital when the nurses give the child some pain relief—the parents looking at each other, slapping their foreheads and saying, ‘Doh! We could have done that!’

There are a lot of daft people out there—and I get to meet most of them.

Back on the Car…

There is a slight problem I have with returning to the ambulances, and that is my new partner is currently on sick leave, and has been for some time. No one knows when she will be fit to return—so I often find myself ‘single’ with nobody to work with.

When you are single you can be teamed up with another single pretty much anywhere in London.

At the moment our sector is having trouble reaching our government targets (which are calculated at the end of February). Of particular concern is Poplar ambulance station which, because of atrocious manning, is struggling to meet them. To counter this management have made it known that any shortfall in manning Poplar must be corrected as a priority.

So, when I’m single I’m often going to find myself making my way over to the Poplar area.

Last night, however, there was no one for me to work with at Poplar so they asked me to work on the FRU.

Fear of being asked to travel over to the other side of London if I refused meant that last night I was once more a solo responder.

This meant I had the right hump.

Thankfully it wasn’t too busy; the usual complaints of ‘my child hasn’t eaten properly for two days’, ‘I’m having an angina attack’ and ‘I’m drunk’ were quite enough. There was one interesting job though—a policeman hit a pedestrian with his car.

Thankfully he wasn’t travelling on blue lights, nor going too fast for the road. The woman apparently ran out into the road without looking, which given some of the pedestrian activities I normally see wasn’t out of the ordinary. Luckily for the woman involved there was an anaesthetist walking past, and he managed the immediate need to keep her neck still. After our examination our main concerns were that she was concussed and that she was cold from lying in the road—thankfully the ambulance was pretty quick, and she was soon in the warm, where our further examination showed no immediate injuries.