It Happens To The Best Of Us

"23 year old female, ? drink spiked, vomiting"

It was ridiculous-o-clock in the morning and most of the night's revellers were either a) tucked up in bed b) tucked up in a hospital bed or c) lying in a pile of vomit in a park waiting patiently for a good samaritan to call 999. As far as night shifts go, it had been particularly torrid. Alcohol and drugs had been the stars of the show, with the police and the ambulance service run ragged all night long! Some of my highlights of the proceedings included being spat at and threatened by a crack head, having someones dog 'set on me' (the dog couldn't be arsed) and watching a great episode of domino vomiting (one goes, they all go) outside a club. Oh, spending an hour trying to convince a man in only Thundercat boxer shorts, that lying in the road with his hands in his pants wasn't conducive to good public relations and future job prospects was also one for the out-takes reel. 

It was about 04:30, I was resembling a wild banshee and looking rather dishevelled! My hair really was a thing to marvel at! Being sent to a vomiting drunk person with delusions of drink spiking hardly filled me with warmth, I must say. I was wildly confident that the only thing her drink had been spiked with was alcohol. We headed on up to the 'top floor' flat as instructed. We were met half way up my a drunk, scantily clad girl who was walking like a new-born giraffe. Funny it was, graceful it wasn't. We followed her, and the noise of crying / wrenching into a bedroom. 

There, lying sprawled on the bed, wearing a t-shirt a thong was our patient. Her head was hanging over the edge of the bed and she was indeed vomiting. Her makeup had run somewhat and her hair was....well, matted in vomit. She looked a treat! She was also crying. Stood in the corner of the room as a sheepish looking boyfriend, who wasn't drunk and seemed rather annoyed by the whole situation. 

"Hello my dear, good night was it?!"

"Oh my god, I'm so sorry, I can't stop being sick!" she slurred at me.

Between her and her friend they went on to explain that she hadn't drunk any more than she normally would and drunk the same amount as her friends. They just didn't understand why she was so drunk! Must be a spiked drink eh?! Not the lack of food all day and tiredness combined with any number of other things. Oh, and all the Jaegerbombs. And wine. And other spirits. Definitely, without doubt, a spiked drink! Hmmmmm!

Her boyfriend just rolled his eyes! He looked particularly unimpressed by the whole situation. I made a few jokes about the situation and he chuckled. It was then I noticed his shirt. It was white, with flaps on the shoulders for epaulettes and a velcro patch on the chest. 

"Is that a police shirt?!"

"Yep! I'm a cop, I'm on early turn, start at 7am, then get a call from this muppet!"

"Sleep's overrated anyway buddy!"

The patient started wailing / crying again! She was apologising profusely and stating how ill and drunk she was!

"What do you do for a living?!"

A sorry pout and half grin appeared on her face.

"I'm also in the police! I'm so embarrassed!"

I just laughed, and laughed hard! She started laughing, and her boyfriend was now seeing the funny side of it! 

"And what do you do?!" I said to the friend.

"And what do you do OFFICER!" she said bursting out in laughter!

As far as I was concerned, all her sins were forgiven! Sure, it's favouritism and yes, I have bitched and moaned about drunk people calling ambulances because they are drunk and YES, they should have known better. But, the thin blue line is spread so thin and they do such a great job day in, day out that getting smashed on a Friday night was probably just what the doctor ordered. We spend half an hour talking work, sharing war stories and we left her to wallow in self pity for the entire day before she started night shifts! 

Getting drunk and paralytic happens to the best of us at times, even the police. When not in uniform we are all just normal people making the same stupid mistakes as everyone else! I won't hold it against her when our paths cross professionally. I will however, mock her unreservedly!

Don't forget, nominations are now open for the MAD Blog Awards 2014. Please go and nominate me by clicking HERE. Just add my URL www.tryingmypatients.co.uk to the categories I'm eligible for! (Best Writer & Most Entertaining) Thank you! 

New Years Day

It was New Years Day and the people of our fine city were not feeling well. I spent most of the day observing the pained expressions on people faces as they struggled with the simplest of tasks, like walking. The previous nights celebrations had clearly taken their toll and as per the norm, the ambulance service were left to pick up the pieces! Here is a rundown of what treats the day gave us! Bear in mind, I too was tired. Like everyone else, I had seen the new year in with friends, had a few drinks, mindful I was on an early it was limited to a few! When my alarm went off at 4am I wasn't amused in the slightest but I got on my bike and headed into the night for my 6am start! 

06:05 - '23 year old male, collapsed. He was drunk and asleep.'

Not collapsed. A good Samaritan had called us. They didn't stick around though. Shocker! Taken to A & E to join the heap of drunken delinquents.

07:00 - '21 year old male, collapsed, head injury.' 

He was drunk. In a skate park. He'd fallen over and cut his head. His friends found the whole affair extremely funny and used words like 'wack', 'nang' and 'rad' with worrying frequency. Bandage on head, a large cannula with fluids and trip to A & E.

08:15 - '23 year old female, vomiting blood.' 

She wasn't. She was vomiting red wine. And 'Purple Rain' which I was assured was an 'aggy' cocktail. Her main problem was a hangover. I gave her 2 x Paracetomol, a glass of water, sound medical advise and a few of my best hangover cures. Left in care of friends.

09:06 - '29 year old male, chest pain.'

He did indeed have chest pain. The cause was the copious amount of cocaine, MDMA and skunk that he had taken with alcohol the night before. Due to the fast heart rate and various other things he was given Diazepam to treat his cocaine toxicity. He was promptly taken to the New Years Eve recovery centre for monitoring and further treatment.

10:32 - '30 year old male collapsed.'

He was indeed collapsed. He'd taken an overdose, presumably of heroin.  He was ventilated, filled with Narcan and then once the effects of his high were reversed we were left with an angry, verbally and physically abusive patient who was arrested and conveyed to hospital. 

11:48 - '24 year old male, chest pain.' 

This one was in a police station. He was claiming to pain to avoid being at the police station. Much to his dissatisfaction, once I'd assessed him, done his ECG and spoken to the duty nurse I told him he could stay in the comfort of his room. He called me a cunt. I left.

12:55 - '14 year old female, intoxicated.' 

This one was in a park. She was smashed, well and truly. He blood pressure was in her boots so she got treated to cannula, fluids and a journey to hospital. Because of her age the police had to attend. She vomited all over the ambulance. And my leg.

*change uniform, clean vehicle*

14:10 - '25 year old male, cardiac arrest. '

Sadly, it was as given. He was dead, nothing we could do for him. His friend found him sat on the sofa. He'd been there 2-3 hours. The nights drink and drugs had stolen a young life. A very sobering affair for all involved. Happy New Year eh? 

15:35 - '26 year old male, severe headache, pains in chest.'

He had a hangover. I told him to take his own paracetomol and drink more water. I told him I had just attended a 25 year who had died. I asked him if he felt us being there was a good use of an ambulance. He apologised. We left.

16:20 - '46 year old male, unconscious on bench.' 

He was drunk, on a bench. He told us to fuck off. We did. The caller hadn't stuck around.

16:40 - '19 year old female, feels weak, chest pain, vomiting.' 

She seemed genuinely shocked that her symptoms were caused by lack of sleep, no food, consumption of weed and too much alcohol the night before. I gave her a dose of health promotion and left her with her proud parents. 

17:25 - '40 year old, collapsed in toilet.' 

Clearly the best had been saved until last. We arrived outside a heaving McDonalds and headed inside. A member of staff met us and took us downstairs to the toilets. Hundreds of pairs of eyes stared at us as if they had never seen an ambulance crew, as they chewed their Big Macs. Despite all watching us head into the toilet, within seconds people were trying to come in and seemed utterly shocked that they couldn't use the facilities! Inside was the wonderment that was our patient.

He was a big man, clearly an alcoholic and was locked in the cubicle. His head was slightly protruding from underneath was wall of the cubicle. He was well and truly unconscious. Oh, and his face was lying in a pool of other peoples urine. It appears McDonalds had fallen foul of their hourly toilet cleaning policy, much to the detriment of the patients big ginger beard and open mouth. We requested a chair to look over the top of the cubicle. 

I climbed on top and peered over. There he was in all his glory, trousers around his ankles, and lying in a pool of his own urine and faeces. He had literally keeled over from sitting on the toilet. It really was a wonderful advert for alcohol!

Unfortunately,  despite the treat waiting for us inside, there was the very real problem of how to get him out. I managed to reach down and unlock the door but we could only force the door open slightly, such was his position. My crew mate was slighter than I was so she begrudgingly agreed to be the one to squeeze through the gap and attempt to move him enough to get the door open. Despite her best efforts, the dead weight drunk man could not be moved and in fairness, such was his condition and covering in bodily fluids, she didn't bear hug him with gusto! Luckily for us he started to wake up of his own accord. His personality was every bit as endearing as his appearance. 

"What the fuck are you doing, get out of my cubicle!"

"You collapsed to the floor sir, we are trying to get you out."

"For fucks sake." he mumbled in a thick Scottish accent. 

"Sir, can you move your legs and sit up, we can't get the door open until you do!"

"Yeah.....I know......I'm not fucking stupid you know!"

It's at times like this I like to freeze frame the moment. Ideally I'd like to take a photo on a Polaroid camera and pass it to the patient for them to digest. I was curious as to which part wasn't stupid. Was it the amount he'd drunk? Or the falling off a toilet? Or the double incontinence? Or his face in puddle of strangers urine? All of the above smacked of stupidity, but who am I to judge?! 

Eventually he was up and out. With every passing moment he became more and more abusive and the smell got more and more offencive. After telling us both to, and I paraphrase, 'go away' he headed out back into the restaurant. After attempting to start a number of fights and verbally abusing everyone he passed he staggered up the stairs and out onto the street. During this short journey he only fell over 4 times so that should be looked at as some kind of achievement. He went off into the distance cursing at all he past. I never got his name. What a treat he was!

So, that was New Years Day! Entirely predictable, totally exhausting and all too familiar. Lives wrecked by alcohol and drugs again. When will people learn?! I could sit and reflect on the 25 year old that died but won't. He isn't the first and sadly won't be the last. Perhaps that's cold of me, perhaps it's just self preservation. I'm sure next weekend will bring similar. 

"It's like gambling somehow. You go out for a night of drinking and you don't know where your going to end up the next day. It could work out good or it could be disastrous. It's like the throw of the dice." Jim Morrison

Stuck

"53 year old female, passed out in car, drunk"

A big part of this job is thinking on your feet. Annoyingly, people don't tend to get ill or injured in ways and places that the textbooks say they will. You really would be amazed at some of the bizarre places we find people! Be it in the eves of a loft or upside down in a manhole, people manage to defy physics just when they need an ambulance. It's then our job to work out how to get them out! At our disposal we have the fire brigade, the HART team or just sheer numbers. Unfortunately, when you need 6 people, inevitably there is only room for 1! C'est la vie!

We were called by another crew, or part of crew even! They had been on a job and whilst dealing with their patient one of the crew had gone to get the chair. Whilst at the ambulance, he was called over by a member of the public who's wife was stuck in the car. He took one look at her and called for a second crew! When we arrived he greeted us with a wry smile....

"Hi guys, 53 year old female, been drinking heavily, has passed out slipped into the footwell of the back seats and is now stuck and asleep. Oh, and she's covered in vomit. I'd love to stay and help but I've got my own patient!"

With that, he patted me on the back in the most sarcastic of fashions and left faster than Road Runner.

I peered into the car and scratched my head. Let's just say she was a lady with a full figure. Very full indeed. She also wasn't just stuck, she was shoe horned. Oh, and did I mention the car was Nissan Micra...... 3 DOOR! She was properly out of it, massively intoxicated and totally unrouseable. As amusing as the whole situation was, we were aware that airway compromise was something to be aware of. She was stuck on her back and if she vomited we could be in a whole world of trouble! 

Right, the plan......erm......we had nothing! I used my tried and tested methods of waking up drunk people but she was having none of it! For those in the know, I had her at GCS 6 (1-15). It was quickly apparent we needed more hands, and ideally hands with better ideas than ours!

Twenty minutes later our second crew arrived, by which time I had a rough idea of what to do! 

The Plan: With both seats forward, one of us on the back seat and one wherever they could fit, using brute force,  would lift her to sitting, where a spinal board would be slid diagonally under her bum. A bed sheet would be wrapped under her arms and a lifting belt round her waist. Then, with two on the lifting belt and two on the sheet, she would be carefully be slid along the spinal board inch by inch until she was half out the car. At that point the two inside would exit from the other side, and come and assist to lift the board on to the bed. Simple.

'No battle plan survives contact with the enemy' Colin Powell

The Reality: We sat her up, she projectile vomited into my lap, we all grabbed a bit, and dragged her out of the car. I don't think there are enough words to describe just quite how unpleasant the felling of having someone's vomit on your crotch really is.

By the time we got to hospital her eyes were open and she was complaining of not feeling well. I won't be sending her a 'get well soon' card anytime soon! Her decision to drink too much cost £1000 in ambulance resources alone. It took two ambulances away from the public. She caused our ambulance to need a deep clean and me to shower and change my uniform. All in all, the job took 3 hours when all was said and done. Next time you read about ambulance services being criticised for response delays, bear this in mind!

24 - Season 2: Episode 1

What is an average day? There isn't one. It is as simple as that. Last year I blogged a 24 period, in real time, as it happened on my shift. I felt it would be therapeutic to visit the idea again and share a random day shift as a lone responder. Here goes. Eyes open, to eyes shut, to eyes open again. Sorry about the toilet stops!

The following takes place between the hours of 4:30am and 08:41am

04:30

No one should ever have to wake up at this time. Ever. No one should really have to know what 4:30am looks like! The light from my phone physically hurt my eyes as I turned off the dulcet sounds of Michael Buble's Mack the Knife! (Don't judge me!) Despite the desire and need to snooze, I couldn't. I got dressed, jumped on my bike and cycled the 5 miles to work. The cold air made my eyes stream the entire way and by the time I arrived, it looked like I'd just been to a funeral......in a hurricane! I had a shower at work, got everything ready, uniform on, drugs signed out, me signed in and all my kit on the car and I was ready with about 10 minutes spare to grab some breakfast! 

06:01

"94 year old female, abdo pain, dizzy"

With half of my cereal left behind on the mess room counter, I jumped into my car and shot out the garage. As it was so early, the roads were clear, so I got on scene within a couple of minutes. As it was still dark out, I left the flashing beacon on the roof so the ambulance could find me in the rabbit warren of the estate I was on. I grabbed my stuff and handed on up. I was met at the door by a very anxious, frail looking lady. I helped her back to her armchair and sat her down.

Her symptoms were quite vague and not that severe. So much so, that the illness code I gave her was 'generally unwell'! All her observations were OK, she had a bit of this, a bit of that and could probably have waited for the GP and been treated at home, but at 94 I certainly wasn't going to begrudge her my time or the resources. I made her a tea an some toast whilst we waited for ambulance. 94 is a lot of years and she had plenty of tales to tell me and seemed to enjoy telling them! Back in 1947 she tested racing cars and that was just one of the anecdotes I got from her fascinating life! After about 45 minutes of chatting, the ambulance arrived.

I gave a handover, helped them get her downstairs and on to the ambulance. I got back in my car, appreciative of my second caffeine hit and finished off my paperwork. Job done!

07:03

"2 year old male, fitting"

Yikes! Blue lights on again, yet this time the rush hour was upon me! Being on a car, I can fit through smaller gaps and go faster but that doesn't help being sat stationary in what is effectively a car park! Traffic really does mess with your emotions! On the one hand it makes you livid at the stupidity of some people and their inability to drive. On the other, you have a traffic jam, a potentially very sick patient and no way of moving. You are the person needed to help, yet you can't move faster than the traffic will allow and that can be extremely frustrating and worrying. Luckily, most 'fitters' have generally stopped fitting by the time we arrive and 'most' fitting 2 year olds are actually having a febrile convulsion. Obviously, today was never going to be 'most days'!

As I pulled up on scene a teenager came running outside waving frantically! One word popped into my mind.....'SHIT'! I grabbed everything and hurried into the house, knocking over the clothes horse and a photo off the wall as I bundled up the stairs. In the bedroom, my patient was lying on the bed, fitting. Foaming at the mouth, body shaking and contorted, the mum crying, the other children all crying, it was one of my worst nightmares. I put the oxygen on him and started trying to get a history. From what I could work out he had now been fitting for over 10 minutes. He wasn't a known epileptic but had had a seizure in the past and had been prescribed an emergency dose of buccal Midazolam in case it happened again. Well it was happening again, but in the panic, no one had given it, so I did. Whilst waiting for that to take effect I checked his temperature and blood sugars. All normal. 

There was no sign that the fit was stopping to I decided to give some of my Diazepam rectally. Just as I was administering it the ambulance crew arrived. We were pushing 20 minutes of fitting now, the boy had had the maximum amount of drugs he could, so we needed to run.

"Hello guys, 2 year old male, fitting now for almost 20 minutes, given Midaz and PR Diazepam, let's just go, yeah?!"

Generally speaking, if in an ambulance crew arrive, and the FRU says 'let's go' as they walk through the door, it's a case of no questions asked! Especially in sick kids. We are not equipped or experienced enough to deal with small children. 

No sooner as the boy and his mum were on board, we left for hospital. I put the blue call in on route. You've then got that terrifying 10 minute journey, where you can only watch. Watch a tiny, helpless 2 year old boy violently fit, and there is nothing you can do. You try and reassure the mum, but doing so, without the fear of god in your eyes is near impossible. As a parent I can't imagine the fear I'd be feeling. She held his tiny little hand whilst I held him in position on the bed. It was one of the longest 10 minutes of my life. 

On arrival at hospital, he had been fitting for over half and hour. His condition was critical. We handed over to the paediatric team and they took over his care. We left the mum standing in resus with tears pouring down her face. I did my paperwork with the crew and then got back in my car which had kindly been driven unto hospital by one of them. 

I never found out how the boy got on. I never will.

08:17

"42 year old male, collapsed, fitting, O/S supermarket"

The sex, age and location told me all I needed to know. I knew exactly who it was! It was one of our regular alcoholics and this was his morning fitting hotspot. He'd either have had a fit and now be recovering or will simply be asleep! He would most likely smell and once compos mentis would no doubt hurl abuse and then walk off down the road! I wasn't far away,  so I lit up the roof and off I went. 

As I pulled up outside the caring member of the public who found him waved me over. There, in all his glory was Steve! Lying, asleep, face down in some bushes. And yes, the smell made my nose sore! He was actually a really nice guy when sober, when intoxicated however, he was ghastly! 

"Hello Steve, wakey wakey!"

The onlookers seemed shocked that I wasn't doing CPR and sticking a biro through his neck like they do on casualty. My lack lustre approach was justified when a moment after I told him to wake up he promptly told me to 'f**k off'. 

"I'm afraid not Steve, I can't leave you face down in a bush!"

"F**k off, leave me alone."

"Up we get Steve, you know that I'm not going anywhere until you are standing up!"

"Just f**k off will ya."

The ambulance pulled up and gave me a knowing grin!

"Steve?!"

"Yep! He's not pleased to see me!"

Between the three of us, we pulled him out of the bush. He was looking worse than normal, clearly the 8am Whiskey run had taken its toll.

"How about we pop you up to the hospital Steve? Get you cleaned up and fed."

"Just f**k off will you!"

"At least let us check you over."

"F**k yourself" he said as he wondered off down the road. 

That was Steve! Anyway, just like a Hobbit, it was time for me to have my second breakfast! I think I'd earned it!

To be continued..... 

Trapped in Darkness - Part 2

continued.....

"Male, U/K age, One Under"

Until now, I had been totally patient focused and hadn't noticed the commotion around me! There were about 6 Fire fighters under the train too with various member of underground staff trying to work out how to lift up the train. I'm guessing by the discussions that it isn't something that is done too often! In most One Unders they are either a) dead, in which case the train is driven off them or b) alive but trapped by a limb, in which case if a quick extraction is needed an amputation and dragging out will happen. Unfortunately, they couldn't drive off as it was his pelvis on the track and you can't amputate a pelvis for obvious reasons!

As minutes ticked by we got drugs flowing! In went morphine and ketamine and fluids. We cut of as much of his clothing as possible to examine what we could get to. There were minor cuts and abrasions but nothing major. All the while, the patient was getting more and more frantic so more and more drugs were given to numb the pain and relax him. Problem was there was no real access to his head. He couldn't see anything but  darkness and could only hear and feel what was going on, and for someone who is claustrophobic I imagine it was torture. I was starting to get very uncomfortable my self, the heat, the smell, the noise, the taste of air, it all made it a very uncomfortable atmosphere. Add to that the fact that realistically the patient could simply die and we would be powerless to do CPR, ventilate and remove quickly. It was a scary thought! 

"Sorry we're all talking about you. How are you doing?"

"Get me out of here"

"We are, it will just take a little while, I'm staying here right by you, if you feel any new pains or anything changes, please tell me."

"Get me out of here"

"We will, we will."

"Please, help me, I don't want to die" he cried.

Talking to someone who can't see you is bizarre. I could only imagine his facial expressions and the fear painted across his soot covered face. I felt totally helpless in all honesty. I tried to keep him positive but as the pain continued and the time went on and on he became more anxious. To be fair, so did I. 

Eventually, after about an hour they were ready to lift. I don't credit the fire service that often but credit where credit is due. They had been fantastic. The were working their nuts off, bringing us more oxygen, providing light and lifting 120 tons of train up! It wasn't a case of 1-2-3 lift! So, in a co-ordinated effort and a very detailed plan, the scoop was lowered down to the tracks and slid along, rope on 1 end. The pelvic splint was positioned and as many hands as could fit were placed on various parts of the patient. We are all told to stay away from the wheels as if the train drops we don't want to get trapped! 'Drops?' 'DROPS?' Encouraging! 

"OK, we are lifting......"

"He's free. Lower him down"

"We got him"

He let out a gut wrenching scream. Once on the scoop he vanished. Pulled the along the suicide pit and out onto the platform where the HEMS paramedic and my crew mate would take over while we crawled out. I shuffled backwards slowly, eventually making it to the platform where the light and underground breeze could be felt. The platform was full. Police everywhere, about 30 fireman, a few ambulance officers, a second crew and of course......HART team huddled together watching! The patient was being strapped up and wrapped in bubble wrap. Blood infusions were being prepared and he was being put to sleep by HEMS. I bet he wished he'd been asleep a long time ago. 

Within only 2-3 minutes we were ready to go. I took over the breathing for the patient and 8 fireman lifted him up and off we went through the maze of tunnels and escalators. FRESH AIR! Oh how I missed it. Behind us was the band of merry men and woman carrying all the kit. Everything was chucked on board, blue call placed and off we went. I was trying to take stock of everything that was going on. Suddenly, the doors swung open, we were at hospital, I hadn't even noticed we'd stopped. Into resus we went, a 30 strong team waiting for us. Luckily for me HEMS did the handover. I'd have probably starred blankly and said 'Hit by a train...erm...'!

We went back to the vehicle which  looked like a bomb had exploded inside. We tidied up and I started on the paperwork. Where the hell did that job come from! It really is true, EMS Rule number 10:

EMS is extended periods of boredom, interrupted by occasional moments of sheer terror.

Nothing can prepare you for things like this. It isn't for everyone. It is one of the few jobs that tests every part of you. The problem is you never find out if you passed the test. As all crews will say, he was alive when we got him to hospital so that's a win for us. It's a cover though. In reality, we are all desperate to know if he survived. We will probably never know. That's the reality of pre-hospital care....once you're at the hospital, your care is supposed to end. 

 My crew mate pointed at my face...

"You got a bit of dirt on your cheek!"

Trapped in Darkness

As far as shifts go, it hadn't been a bad one. I hadn't been spat at, sworn at, I hadn't had to carry anyone and no one had wound me up enough to change my mood! That's not to say that anyone actually needed an ambulance. The mere fact everyone had walked on and walked off meant that in reality, no one actually needed an ambulance but that's by the by! It was late in the evening, we reckoned that we had about two jobs left to do to see us off, so made ourselves available. We were a fair way away from station so we started heading in the right direction as fast as possible (within the legal speed limit of course!). We didn't get very far at all! Within about 5 seconds.....

"Male, U/K age, One Under"

Action stations. We were only 2 miles away so there was a good chance we'd be first there. While my crew mate drove like a bat out of hell I dived into the back to get the hi-vis on and safety helmets out the top locker. Back in the front and...

"UPDATE: Patient is screaming, injuries, unknown"

....we started to get a plan. Once we had confirmation power was of and track protectors were in place, I would get under the train and assess, crew mate pass staff and liaise with fire brigade and train staff. I began stuffing my pockets with stuff I might need; gloves, tape, torch, cannulas, bandages and a tourniquet.

"UPDATE: HEMS on way. Eta 8 minutes"

Right, that should give us just enough time foe me to get under before HEMS take over and we are sidelines! (Trust me, totally happens!). We pulled up at the station to see we'd been beaten by the Fire service and Police.

"UPDATE: HART team on way"

They can bugger right off! HART or Hazardous Area Response Team is by far the biggest waste of money the service has ever had. Always late to any incident in their fancy suits and equipment and they just sit and watch the fire service. They have lots of fancy kit that they never use and it's a classic old boys network full of wannabe firefighters. I predicted they will be stood on the platform on mass.....watching at some point during this job! 

We were indeed the first medical staff to arrive so we needed to carry everything! Luckily some 'water fairies' were on hand to help. We took paramedic bag, response bag, oxygen bag, Life pack, dressings pack. suction, scoop, head blocks, entonox, straps and blankets! The problem with underground stations is some are very very very deep and going back for kit isn't really an option if you need something quickly. We made our way down, and down, and down to the platform. The fire service were on the tracks and doing a good job of talking to the patient. I jumped down to have a look and there he was. In one piece, very much alive and trapped. What was bizarre was that he wasn't trapped or tangled by a limb, which is common. He was trapped by his pelvis between the train and one of the tracks, on his side!

Now, there are no text books telling you what to do, no algorithm, no guidelines, nothing. It was going to be a case of improvise, adapt and overcome. Under I went. Blimey! I forgot how hot it is under trains! And dirty! By the time I got to him my hands were black. He was very much conscious and there was no obvious blood! Always a good sign! He was however in a lot pain from his pelvis and was obviously very panicked. He hadn't jumped. He was drunk and had tripped and was hit trying to clamber out and by all accounts the train had nearly stopped at impact. Via a gap between the platform and train, a hand appeared holding an oxygen mask. I popped it on the patient and then a blood pressure cuff followed. With a bit of a stretch I got it on his arm. All the numbers were relayed back to me. His blood pressure was a little low but if he had a fractured pelvis he could easily bleed out into that and it would only get lower. 

OK, a plan......erm......

"How are we getting him out?" I said hopefully.

"We are going to jack the train up off of him and slide him out." 

No idea who I was talking to!

"How long?"

"Half an hour. 45 minutes maybe."

"Is that the only timescale we have? If he has to come out quick to we have other options?"

"Afraid not"

That's was a long time as far as I was concerned but it wasn't as if he could just be dragged out! He was well and truly wedged! I stuck an orange cannula in the back of his hand as that was the only part of him I could get purchase on. Thank god for big veins! I wanted to give morphine but in the circumstances I felt a grown up should be consulted first. Luckily, as I fixed the cannula down a head torch appeared. It was the HEMS Doctor! 

"You look like a chimney sweep."

Oh goody.....a mascara joke! 

TO BE CONTINUED........

ICE ICE Baby

"14 year old female, unconscious"

Getting sent to an unconscious 14 year old in a park on a Saturday night means drunk! OK, I'm sure there will be an anonymous commenter who will list all the other possible causes of unconsciousness in a teenager and tell be it is negligent to suggest it's alcohol but let's face it. She's drunk. If I'm wrong, I'll eat my hat! 

We found the entrance to the park, chucked ALL the bags on the trolley bed to cover ALL possibilities and headed off into the darkness. We followed the noise and illumination of cigarettes to a group of 6 drunk teenagers. Lying on the floor, covered in vomit was our patient. Not only was she drunk, she was freezing cold. We briefly assessed her, got her on the bed and off into the warm. None of the friends were willing to come with her and none of them knew her parents phone number. That puts us in an awkward position of transporting a minor, to a hospital which is possibly further away from her home and unable to let her parents know she was safe.

Her blood pressure was extremely low so we raised her legs and gave her some fluids. We only had her first name and she was well and truly out of it. If I was her, I'd be on the hunt for some new friends when I came round! Useless! We opened her vomit covered bag and got out her mobile phone to hunt for 'Mum' or 'Dad' in the phone book. If we were really lucky we'd find an ICE (In Case of Emergency) contact. For those not aware, ICE contacts was something that started in 2005 and the idea is that everyone has a contact in their phone book called ICE so that in the case of an emergency an ambulance crew, police or hospital staff can contact your next of kin. A very easy, simple solution, especially as everyone has mobile phones these days! There is however, a problem! Screen Lock! 

Most people have their phone locked. Despite the issue being brought to the attention of phone companies no solution has yet been found and therefor we were left in a situation like tonight. An unconscious teenager, no idea where she is from, no way of contacting her parents and no access to her phone! Luckily, she was drunk and it was more than likely that within the hour she would be awake enough to talk to hospital staff. Suppose though, she had been hit by a car and was fighting for her life. How would her parents find out? 

We got her to hospital and left her in the safety of the staff. All we had for them was that she was possibly 14 and her first name. 1am is no time for a girl of that age to be out, let alone drinking. I wonder where her parents thought she was!

This job did make me think about the ICE system and how widely used it is. I have an ICE contact on my phone but I also have my phone locked, so it's useless! Only once have I ever been able to contact a relative via an ICE contact so does the campaign need some new attention?!

Do you have an ICE contact in your phone?

Do you have a phone lock on?

Perhaps now, you'll ensure your children have them on theirs or at least have the ICE contact on their screen saver. Let me know! I'd be interested to hear if the novelty has warn off or if it never got going.

Russell Athletic

NB: This blog contains very offensive language throughout.

“42 year old female,? Ethonolic, *LOCALITY MATCH* Police required, known violent”

Friday nights are always busy! Without fail! This is partly because of the higher call volume and partly because there are less ambulances. I know it seems strange to have less ambulance when there are more calls but that’s just how it is. Less staff work weekends because of an old fashioned rotaring system and the staff that do only about a 1/3 do nights! That means come the weekend, the service is stretched to bursting point and the people who pay the price are the crews that ARE working! 

There was a job waiting for us the second we officially came on duty. Obviously, we started earlier than that, not being paid, so we could ensure the vehicle had all the kit it needed for a 12 hour shift. Having to do this every shift is a bone of contention amongst staff but we don’t want to be in a situation where a patient needs something and we don’t have it! That argument will probably grumble on for eternity! Anyway, the first few jobs went without incident. Slowly but surely we had been dragged into a grim part of town which was pretty typical of a weekend!

Within 3 seconds of coming up available we were sent the next one. Aaah, nothing like a violent drunk to get the weekend going. When a ‘?’ proceeds ‘ethonolic’ 99/100 it means they ARE indeed drunk. Joy! We headed round to the estate and arrive the same time as the police van. Out climbed 6 of our finest police officers all looking rather miffed to be here. 

“Evening all!”

“You been here before?”

“Nope!”

“You probably won’t be needed, they’ll both be pissed and arguing about something. They usually are!”

“Joy!”

We all stood patiently by the door waiting to be buzzed in. Eventually the intercom was answered and the door opened. As we walked in we heard a muffled ‘Fuck you’ in the background! Here we go! We made out way up to the third floor and along the external corridor. The door was open, but we heard the argument as soon as we made it onto the landing.

“You fuckin’ cunt. Come back ‘ere”

“Pipe down woman”

“You what?”

“Pipe down, I’m gonna go ‘ome now”

“No, no your’e not, I fuckin’ paid for ‘em”

“Sit down and shut up”

“You’re gonna get arrested. Get him arrested”

I looked at her blankly.

“Shut up you old hag”

“Tell ‘im to take that top off, I paid for it”

“Shut up you slag, it’s mine”

“It’s mine and you know it. Gimme my fuckin’ jumper”

“Sod off”

“Officer, arrest him, it’s my fuckin’ jumper”

The officer looked blankly, shaking his head slightly

“I ain’t done anythin’ to be arrested for you nut job”

“You ‘av. You’re wasting the cops time and the paramedics”

“You fuckin’ called em’”

“You won’t gimme my fuckin’ jumper back”

“You owe me a tenner anyway”

“Oh fuck off, gimme my jumper you nonse”

“You what? I’ll clump ya, ya cunt”

“Nonse. Fuckin’ nonse. Dirty little cunt”

“Fuck you”

“No fuck you. Gimme my fuckin’ Russell Athletic jumper and fuck off”

“Officer. She’s unstable. Arrest her. I apologise for her behavior”

“Arrest him, that nonse has my fuckin’ jumper”

“It’s my fuckin’ ju....”

“RIGHT! Both of you, pack it in. We have much more important places to be and i’m sure the ambulance do to. You are both wasting everyones time, now you get out, I don’t care who’s jumper it is. You, stay here, don’t call the police, don’t call the ambulance. It’s the same story every night, how about, for once, you don’t see each other. If I hear a peep from either of you, you’ll both be arrested for a breach of peace, wasting police time and anything else I can think of at the time. Do we both understand?”

“But it’s my fuckin’ jumper.”

“I don’t care.”

“You’re all a bunch of cunts.” *spits at police officer*

*gets bundled to the floor* 

*gets arrested* 

“Told you she was a silly cunt”

“I thought I told you to leave”

*Sticks up middle finger and spits* “Fuck you ya cunt”

*gets bundled to the floor*

*gets arrested*

We never said a word. Just watched and enjoyed the show! Just another friday night in the city! Perhaps when people moan about having to wait for the police or an ambulance they could take a moment to think what we are actually up to?! Right, onto the next one!

The Three Stooges

“43  year old female, chest pains”

This job set the tone for what would turn at to be a very familiar night shift. I exhaled in frustration when I saw the address. It was one of the many regulars on our patch. She was a wine-drinking alcoholic; she always called for chest pains, always went to hospital and was always rude and obnoxious. Tonight would prove to be no different to the norm. We stomped up the concrete stairwell, navigating our way past the vomit on the stairs. Lush! Her door was wide open like it always is. We walked down the landing to her bedroom like we always do and found her lying on her bed smoking a fag like we always do. Then followed a very familiar conversation.

“Hello again”

“Alright luv”

“What’s the problem tonight?”

“I got chest pain”

“Same as before?”

“Yeah”

“Can we do an ECG?”

“Yeah, go on then”

We do the ECG and all her obs. They are all normal like always. 

“Shall we pop you up to hospital?”

“Yeah, I need to see a doctor.”

"Still got the pain?"

"Nah, but it should be checked out."

So, without any fuss he all walked (she staggered) arm in arm to the ambulance. We drove to the same hospital as we always do, where I gave the same handover as I always do. On to the next!

“37 year old female, suicidal, taken an overdose, police on scene”

We all say that the first job sets the tone and shifts have a theme but they really really do and I don’t know why! This address was also well known to us. It was the residence of the most abusive drunk in our area. I say abusive, she abuses the police and most ambulance crews but for some unknown reason she loves me! We pulled up next to the police car, which seems to be a permanent fixture outside her flat. In the hallway outside was one of the coppers.

“Good luck, she kicks off every time I go inside”

Sitting there in her underwear and dressing gown, she swigged vodka while smoking a roll-up. Her face lit up as soon as she saw me.

“Heya babe, tell the pigs they can go and you don’t need them”

As much as calling the police 'pigs' wasn’t acceptable, in all honesty, their presence was only going to make things worse and I knew they’d be only to happy to leave.

“I’m happy to deal with this, I know her well, she’ll be fine with me”

They were only too happy to leave and were gone near enough before I'd finished the sentence! It was the same story, drinking vodka to excess, self harmed her forearms, refused hospital and then there was a 45-minute battle to convince her to go. Sometimes she wins and sometimes I win. Tonight I won. Hospital was the plan and all we had to do first was go through the charade of collection her ‘valuables’ (vodka) and hiding them so they can’t be stolen. After completing this ritual we headed off and handed her over to the less than enthusiastic nurse. 

We left the hospital to go and get fuel and hopefully a Wild Bean coffee and a pre-packed sandwich. It really is 'gourmet on the go'! Well actually it wasn't because we never made it. We were flagged down by a member of the public for what appeared to be an unconscious man in the street.

“u/k male, unconscious, running call”

We called it in and were sent down a CAD number. It shouldn’t have surprised me that he was well known to us. I had picked him up yesterday about 200 yards down the road. In fact, he was being picked up 3-4 times a day, each time by an ambulance and each time taken to hospital. The problem is, each time, the hospital sober him up enough to be able to walk and then either sit him in the waiting room until he walks out or discharges him. He walks up the hill to the shops, buys more booze, drinks said booze and passes out again. The hospital are not willing or able to invest time in fixing the problem & we have no ability to anything else with an unconscious drunk person other than take them to hospital. The cycle will continue until he stops drinking or dies. The latter seemed most likely. 

Tonight, he was lying at the bus stop next to his empty bottle of scotch. He was face down and had wet himself. I often wonder what he was like before this. What kind of life did he lead? What family does he have? What friends did he have? Now there appears to be no one. The only people around him are the members of the public who call 999, the ambulance crews that take him to hospital and the nurses that kick him out. What can we do?! We scooped him up off the floor and onto our bed. We did the usual obs and then drove the half-mile to hospital. We got the usual looks of distain from the nurse and rolled him onto the bed. To be fair to the nurse, we had just brought in three abusive alcoholics in as many hours, but still……not our fault!

Alcohol is something that the NHS does not do well, a bit like obesity. We only treat in the short term when it is too late. Very little is done when warning signs are there. Accessing services is far to difficult and it is a lot easier to just give a bag of fluids and let them go than find out the cause and refer to the appropriate places. It’s a shame, if they invested in prevention rather than cure, the long term saving could be huge. Shame no manager or politician is ever that long sighted.

Off we went for fuel, this time we made it. The sandwich was rank and the coffee was a poor substitute to Costa but beggars can’t be choosers! After the start to the shift we had had it was a necessity! We went off and did a few more jobs to a different hospital and at about 2am came back to our area. We handed over our drunken teen to the staff and booked them in. I walked through the busy waiting room and what did I see?! All my regulars sat in a line on the bench together! The Three Stooges! That image summed up how the NHS treats alcohol and mental health. A sad sight but one that amused me! 

“Evening all!”