More Blood, More Sweat and Another Cup of Tea

Have you had a huge spillage of some noxious fluid? Are you worried that as you return to your station to mop out the back of the ambulance the fluid will run through the door into the driver’s cab and thus contaminate your packed lunch? Simply mop it up with a blanket.

If someone tries to attack you, throw it at them like a net—it may distract them long enough for you to run away.

There are probably a hundred more uses for the ambulance blanket—and no doubt as soon as I publish this I’ll think of another 20. Still, I think that you will see that the humble blanket has many more uses than our defibrillators and ECG machines.

Friday Night’s All Right for Fighting

The first job of our Friday night was to a little old lady (actually, she wasn’t that little). She had been standing on her bed with her daughter to fix the curtains when she’d felt dizzy and fell down. She then bounced off the bed and landed on the floor. Unfortunately for her, she had landed on her neck and head.

One of the first things that I do in a case like this is to make sure that there isn’t an injury to the neck. I’ll do this by gently feeling the neck while the patient tells me if it is sore. If there is soreness to one side of the neck then this will normally be a muscular injury while if the pain is in the middle of the neck then there is a chance that the injury is more serious. Like a broken neck.

This woman nearly leapt from her bed when I gently touched her neck—she had a potentially serious neck injury.

So we needed to be extremely careful in order to make sure that if the patient had broken her neck, we wouldn’t make her injury worse by bouncing her down the stairs from her flat to the ambulance. Unfortunately, everything we had to tell the patient had to be translated by the daughter. I need to learn Bengali; it’s a real shame I have no head for languages.

The patient had to be moved down the bed so that our scoop stretcher could go under her then she needed to be securely strapped onto it ready to be carried downstairs. In this case I used a blanket roll to secure her head rather than the more expensive and less effective head blocks. We called for another crew to give us a hand because in a case like this it is better to be safe than sorry, and you need to be careful carrying a potentially unstable neck fracture down two flights of stairs.

We were all really impressed with the neatness and effectiveness of the strapping. I wanted to take a photo of it because it doesn’t often look as good as it did with that job.

As mentioned, she wasn’t too light, and it’s really tricky to manoeuvre a six-foot-long orthopaedic stretcher out onto a balcony, around half the building and down two flights of stairs. At one point we had to suspend the poor woman’s head over the balcony in order to get her around the awkward architecture of her building—pretty lucky that she wasn’t looking down at that point.

The job itself went like clockwork.

My back, however, was starting to hurt from the less-than-safe lifting that we needed to do to get the woman out her flat and into the ambulance.

We then had a couple of ‘nothing’ jobs—coughs, colds and bellyaches.

We got to around midnight when we were sent on a call for a ‘17-year-old male, has a knife, cutting wrist, suicidal’. As it was in the street I thought that we’d go and have a look—if he was violent then we could soon drive off and await the arrival of the police.

The young man was lying on the floor, his left hand was covered in blood and there were already two policemen there. They looked happy to see us.

A quick assessment later and it turned out that the patient had nearly severed his left little finger. He was covered in blood and refusing to say anything except that he wanted to die. I managed to get a ‘quick and nasty’ bandage on his hand while the police and I wrestled with him. He wasn’t very happy with being put into the ambulance and once inside fought with us like a man possessed. Blood was everywhere, he was trying to bite us and the police had to handcuff him (which for some reason, probably paperwork, they really didn’t like doing). It took the three of us struggling with him to get him to hospital and when he reached the department there needed to be six police guarding him in the psychiatric room.

He was, to use an ambulance service technical medical phrase, ‘proper mad’.

I felt sorry for the fellow—he didn’t ask to go out of his gourd.

I also felt pain.

Pain in my back.

While fighting with the patient in the back of the ambulance I had somehow wrenched my back and the whole right side of my body was in pain.

So we went back to station, I filled out the required paperwork and went home. I stayed home for the next two nights, partly due to the pain and partly due to a desire on my part to avoid exacerbating the injury.

Gassed and Splinted

I often bemoan the fact that I tend not to get sent to many jobs involving ‘trauma’. If you’ve been stabbed, I’ll be down the road picking up a matern-a-taxi. If you’ve fallen out of a second-floor window, I’ll be one street over dealing with the sleeping drunk. And if you’ve thrown yourself under a tube train, I’ll be one stop down dealing with the twisted ankle.

It’s not that I like people to be badly hurt, it’s just that I occasionally like to have a job that I have to think about. So the smallest little traumatic injury makes me happy.

We were sent to a 50-year-old man who had fallen. We made our way up the stairs to the gentleman’s bedroom and saw him lying on his bed; with him was a woman in a nursing uniform crying her eyes out. The patient had indeed fallen; his foot was the main injury.

The patient normally wore a caliper on his foot because of nerve damage from having polio as a child. He had fallen and the caliper had caused the toes of his right foot to bend upwards. He had split the skin on the underside of his foot where the toes meet the body of it, and he had probably broken something.

The woman in the nursing uniform (who turned out to be the patient’s wife) told us that at least one toe had been dislocated and that the patient had twisted it back into shape himself.

He was, unsurprisingly, in a lot of pain.

First, we gave the patient pain relief, some Entonox. The paramedic I was with was going to give him something stronger, but the patient’s pain completely disappeared with the ‘gas and air’.

We then bandaged his foot and placed it in a vacuum splint. This is pretty much a sand-filled bag that becomes rigid when you suck the air out of it. They are very handy when dealing with injuries in awkward areas. I don’t get to use them often, but when I’ve needed one, they are perfect.

We then had to very carefully carry the patient down the stairs.

All the time the patient was thanking us for looking after his pain and for helping him get to hospital. He was a genuinely nice man, and his wife was nice as well. It was a good job. We were able to aid someone who needed help and while we needed to put on our thinking caps as to how best to get the patient out of the house the job went smoothly.

I spoke to him later in hospital—he’d managed to break three toes and one of the bones in his foot; his wife was still with him and once again they thanked us (and let us know that the Entonox was a better painkiller than anything the hospital gave them).

It put me in a good frame of mind for the rest of the day.

More Crap GP Work

I was working on the FRU again for a shift; I’d turned up to work on an ambulance, but there was no one else to crew up with me.

One of my first calls was to a possible heart attack in a GP surgery.

Once again I found the patient (a very pleasant lady) sitting out in the waiting room. There are a number of treatments that should happen with someone who is having a heart attack. First they should have a full set of vitals, then oxygen should be given along with an aspirin and, if the blood pressure is good enough, a squirt of glyceryl trinitrate (GTN). It’s pretty standard stuff and does a world of good for the patient (aspirin alone increases your chance of surviving a heart attack by around 25 per cent).

So, how many of these things had the GP done?

Well, he’d taken some vitals but they were very different to what we got in the back of the ambulance. However, vitals can change and I wouldn’t want to call the GP a liar.

At no point had the GP given aspirin, GTN or even waved some oxygen under the patient’s nose. The receptionist was helpful, and she led the patient from the waiting room into her office so that I could better assess her without everyone in the waiting room listening in.

I checked the patient’s blood pressure, gave her some GTN, an aspirin and put her on oxygen; all things that should have already been done by the GP.

Thankfully, the ambulance was pretty quick in turning up, and the patient went off to hospital.

I had a chat with the GP—it’s one that I’ve had a couple of times now. It’s a chat about how possible heart attacks shouldn’t be sat out in the waiting room, about how ISIS-2 and NICE say that an aspirin should be given. How GTN is a good thing to give such a patient, and that oxygen can really help with the pain and anxiety.

‘I don’t care about that,’ said the GP, ‘I just want her to get TROP-I.’

(TROP-I is a special blood test to determine a heart attack.)

He then didn’t want to hear that sitting a woman out in the waiting room with a potentially life-threatening condition was, on reflection, a bad idea. I know GPs are busy, but is a two-year-old with an ear infection really more important?

I’m left in awe of GPs who don’t seem to want to treat anyone. Like nursing homes I’m sure I only meet/remember the rubbish ones. But if my mum was having a heart attack and went to the GP I’d be fuming if they sat her in the waiting room for an ambulance to arrive. It’s not hard to give someone an aspirin, it’s not hard to give them oxygen and it’s definitely not hard to keep an eye on them in your examining room while you wait the (less than) eight minutes it takes for an ambulance to arrive.

I’ve mentioned before how the LAS will visit and help train rubbish care homes—I’m beginning to wonder if we should also go to GPs and let them know what the ambulance service (and by extension the local A&E departments) expect.

Wasting the Time of a GP

I’m not aiming to annoy GPs, but the day after the ‘heart attack in the waiting room’ I went to another case where the GP was less than helpful.

It sounded like one of our ‘crap’ calls: ‘six-year-old female, losing weight, tired’, not what you’d mark down as needing an emergency service.

The ill child was very thin, and her concerned parents told us that she had been losing weight for the past couple of weeks. She was lethargic, wasn’t eating well (she was mainly drinking a lot of fizzy drinks) and had been having spells of dizziness. To my eye the child did look rather unwell.

The father had taken her to the GP earlier in the week, and the GP had told him that he was ‘wasting his time’ and that the child would soon put the weight back on. The father asked for the child to be sent to the hospital, and the GP refused this.

We got the child into the ambulance and starting running our tests.

Her pulse was normal, as were her blood pressure and oxygen levels.

Her blood sugar was not normal. It was above 33 mmols (which is, I think, around 660 dg/l). The normal value is around 5 mmols.

The child was (almost certainly) an undiagnosed diabetic.

In my ‘big book of how to tell what might be wrong with someone’ there are six probable causes for severe long-term weight loss. They are Malignancy, Depression, Thyrotoxicosis, Uncontrolled Diabetes, Infection and Addison’s Disease. Within minutes of meeting this child for the first time, we had a provisional diagnosis.

It’s not hard to do a blood sugar test in a GP surgery; it takes less than 30 seconds.

So why did the GP tell the parent to go away? Was it because the GP was so busy trying to fill the government’s targets? Or was it the case that the GP considers severe weight loss in six-year-old girls a ‘phase’ that they will grow out of?

However, now I realise why the ambulance service is doing diabetes screening.

Small Observation

When the weather is nice, a polite 90-year-old woman who has drunk a bit too much wine and has fallen over can be a very endearing patient.

(Another) Nan Down

Since I am feeling (and to be more honest looking) fat I’ve decided to take up cycling again. I’m sure that I gave a great amount of joy to anyone who saw this particular tubby man puffing and panting against the wind while cycling along at 1 mph. Still, if I want to stop from looking six months pregnant I need to start some exercise. Another reason is a job I did yesterday.

We were sent to a strange call. It was given as ‘Elderly woman lying on the green as you enter Kellett Road. Woman may have got up.’

Rushing to the green we found it empty. So we decamped from the ambulance, grabbed our bags and went for a little wander to see if the patient was hiding in a dip in the ground. Across the green, near some houses, some people started waving at us so we trotted over.

The patient was a very elderly woman. She was wearing a nightdress, a threadbare cardigan and nothing on her legs. She was also barefoot—I was surprised that the thin skin on her feet hadn’t been torn apart by the pavement.

The temperature, not taking into account the strong windchill factor, was around 1° Celsius.

She was—unsurprisingly—a bit blue and she felt like a block of ice.

We only had our medical equipment with us; we didn’t have a blanket so I took off my fleece and wrapped it around her before running back to the ambulance to bring it closer to the patient.

I was shocked by how out of breath I was after jogging about 150 yards. Twenty-four hours later and my ankles were still in pain.

I brought the ambulance closer and we bundled the patient into the back, turned the heating on full and wrapped her in our blankets. The patient was one of those little old ladies that you would want to give a good cuddle to if she were your gran. We had a short and uneventful trip to the hospital where she was soon receiving the attention of the nursing staff.

My crewmate filled in a ‘vulnerable adult’ form, which means that the social services will get involved so that the patient will (hopefully) get any long-term care that she needs.

I managed to get my fleece back.

It now smells of granny wee.

It’s in the washing machine as I type this.

More Madness in East London

We were called to a fourth-floor flat in one of the many housing blocks in the east of London where we found an unkempt man in his forties pacing back and forth along the access balcony to his flat.

He wasn’t wearing any shoes, socks or a shirt, and his trousers and pants were falling off him.

While he paced he was muttering about God and the Devil.

The patient obviously had mental health issues, but we also suspected something else was causing this behaviour. At one point he made to throw himself over the balcony. We stood in his way to prevent him doing this, and more importantly to stop him making us go through the, frankly hard, work of trying to save his life in the face of major trauma.

As we led him back into his flat to get some shoes/clothes we realised that the reason why he was behaving so strangely might have been exacerbated by drug use. We nearly tripped over an empty bottle of methadone.

The flat was—as I’ve mentioned before—exactly how you would expect a drug den to look. There was drug paraphernalia strewn around the place, mattresses on the floor and the heavy curtains looked like they had never been drawn.

The patient continued to pace around while occasionally becoming quite agitated. While we didn’t think that he would become violent we were still rather wary of getting too close to him or letting our guard down.

After half an hour we had managed to get him dressed and were able to lead him downstairs where we ‘ahem’ ‘gently’ got him into the ambulance.

While I drove us to the hospital my crewmate did his best to keep the patient calm. We pre-warned the hospital that they would need security and the secure room ready for us. Unfortunately, the hospital switchboard wasn’t picking up the phone so there was no one there to meet us when we rolled up outside the A&E doors.

At one point he exposed his genitals to my crewmate.

A bit of a struggle began where the patient wanted to jump off the ambulance and run away, so my crewmate and I ended up restraining him until security arrived to help drag him into the department’s ‘padded room’.

I had a similar job the day before, another job where I ended up wrestling with a mentally disturbed patient.

What struck me as amusing was that on consecutive days the first job of the shift was to someone with an altered mental state who was blaming their God and the Devil, and who would later go on to show us their genitals.

I wonder if it’s something in the water?

I also sometimes wonder what the mentally disturbed would rant and rave about if we hadn’t thought up the idea of religion.

Ethnic Relations

After two days of struggling with people, it was nice to go back to the simple jobs that are a joy to do. It’s also good to see a sense of community.

In this case it was a little old lady who had tripped over a wobbly pavement in one of our local markets. She was surrounded by people of all backgrounds. There was a black market warden who had put cones over the offending paving stones. A Bangladeshi man was chatting to her and two Greek-looking men met me at the ambulance and led me to the patient. A Sikh stall keeper also pointed me in her direction.

The patient herself was one of the dying breed of ‘traditional’ English east Londoner. Normally an extremely healthy 80-year-old, she had a graze to her nose that refused to stop oozing blood. A real pleasure to talk to, we chatted about how the east of London has changed in her lifetime and how she still enjoyed living here.

‘I’m an ethnic minority now,’ she told me, ‘but there are still a lot of people around who’ll help you out.’

And she was right—as an ambulance person I tend only to see the worst of people. I go to the assaults and the arguments. I hear about the murders and the abuse, the neglect and the trouble. Just as this woman was, for me, an unusual patient in that she was a healthy 80-year-old, so it was that I saw the unusual event of people helping someone in distress.

It was one of those jobs that leaves you with a smile on your face for the rest of the day.

Lying to Patients

Here is the thing—I’m a pretty poor liar. I don’t get much practice, I don’t like doing it and as part of my personality flaws I love sharing things that I know with anyone who’ll listen. Unfortunately, in this business you need to try to keep some things to yourself.

I was called to a place of work where a 55-year-old woman was complaining of constant headaches. When I arrived on the scene a work colleague was comforting her as she had obviously just been crying.

I got a verbal history from the patient—the headache had been coming and going for two weeks and normal painkillers weren’t touching the pain. There was no other history of ill health, she hadn’t been to the doctor for years and she had no allergies. She told me that on that morning she had woken up with the headache and also a feeling of ‘not being connected to the world’. Once more, her painkillers hadn’t even touched the pain.

A quick ‘n’ dirty neurological examination didn’t reveal anything particularly scary and her observations were all normal apart from a moderately raised blood pressure. I discounted the blood pressure as her being scared and sitting in the back of an ambulance looking at my ugly face.

So we had a drive over to the hospital.

All through the trip I could see that her main fear was that she had grown a brain tumour. The words were never mentioned but her fear was of such intensity and direction that I knew that this is what she was thinking. I would have loved to lie to her. I would have given a lot to be able to put my arm around her and tell her that there was no chance of the headaches being caused by a brain tumour.

But I couldn’t.

I had to sit there and explain about all my ‘negative findings’. I could tell her that her pulse was fine, that she hadn’t had a stroke, that her blood sugar was better than mine and that her short neurological exam didn’t show anything unusual.

But I couldn’t tell her what she wanted to hear.

We reached the hospital, and while I handed over to the nurse one side of her face started to become numb…

A little later, while returning to the hospital with another patient, I saw our woman in the resuscitation room. She was sitting up and talking to her work colleague who had accompanied her in the ambulance. I wondered why she was in there but was too busy to ask the resuscitation nurse.

Towards the end of my shift I saw our patient walking back from the toilet (with colleague still in tow). I asked her what the doctors had found.

‘They are keeping me in,’ she told me and my heart sank, ‘apparently I have a really high blood pressure, and that’s what’s been causing it.’

‘Oh superb!’ I said. ‘They can cure that!’

You could see that she was a lot more relaxed, and that her main concern was that she was now going to be in hospital while the doctors treated her blood pressure.

Hardly a concern at all.

The thing that I didn’t tell her was that her blood pressure had been so high, our machine for recording it hadn’t been able to measure it correctly. Which is a little troubling.

Patientside

Let’s imagine that you are old and need a bit of care in your home—simple stuff, nothing too taxing, just a bit of a hand to help you wash when you wake up. Maybe you need help with some of the fiddly little tablets you have to take. Perhaps you just need someone who’ll help you keep your flat tidy.

Then, for the sake of argument, let’s say you’ve had a bit of a fall—nothing too serious, it’s just that your legs are starting to get a bit weak, and you don’t want to use the walking frame the hospital has given you. You are lying by your front door. You press the community alarm button you are wearing and when your carer arrives she lets herself in and then the ambulance people.

The ambulance people quickly check you over while you are on the floor—they let you know that they don’t want to pick you up if you’ve broken your leg. So you let them examine you, and when they find nothing, you ask them if they can just put you in your normal chair by the television. You wonder why the ambulance crew are tutting at your carer for not at least putting a pillow behind your head while you were stuck on the floor.

The ambulance crew help you up and put you into your favourite chair. As you aren’t hurt by the fall you don’t want to go to the hospital—you’ll only sit in the department for several hours before some young doctor tells you that you should be using your walking frame. It’s easier to sit in your own flat. The ambulance people seem pretty nice, though, and they want to give you a full physical check-up to make sure that there is nothing obvious that would cause you to fall.