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

A Bridge Over Troubled Water

"29 year old male, cardiac arrest"

Even before we got this job I had a strange feeling. I can't describe it, something just didn't seem right! I was on edge like I was waiting for something to happen.  Well,  a 29 year old in cardiac arrest was enough to snap me out of my odd state! Generally the cardiac arrests we do are on the elderly. In fact, I'd say at least 95% are over 65, maybe even higher than that. I'm not saying it's any easier doing a resus on a 80 year old but on some one younger it seems a lot more of a waste. Initially we only had a road to go by, so headed off in the general direction.

"UPDATE: Patient on a boat"

A boat. Of course he's on a boat. It's a big city, where else is he going to be?! The actually location we had been given was to an incredibly narrow, slippery concrete staircase, leading down to an canal footpath. Only problem was there are two sides to a canal and boats lines both sides. There was also two staircases to chose from and we had a lot of kit to carry! Oh, and obviously it was dark.

With all the kit you can envisage for a resus we headed down the stairs that were nearest us and started looking / shouting speculatively for a response. After about 100ft we got on! On the other side of the canal.....

So, about turn, and back we went, up the stairs, across the bridge, down the other stairs and along the footpath to the boat. Now, the boat. The clue is in the name, a 'narrow boat'. There isn't going to be much room to work, nor will there be room to stand or  move around. Once I'd taken a step of faith over the gap to the water I felt a tad safer. My crew mate passed me the kit and then followed me over. Then it was a case of squeeze down a tiny, shallow stair case into the heart of the boat and there was our patient, lying lifeless on the floor.

I quick primary survey showed that luckily he wasn't in cardiac arrest. He was however on the verge of respiratory arrest so I got ventilating him while my crewmate started doing 'other stuff'. His pupils were pinpoint and there was plenty of evidence to suggest a drug overdose to we treated as such. We have a wonderful drug called Narcan that reverses the effect opioid drugs pretty rapidly so we loaded him up with that. After about 8 minutes he started to respond and began breathing effectively himself. 

By now, the FRU had arrived, unfortunately, owing to the fact that it was a narrow boat he was made pretty redundant by the lack of space. He decided to go and fetch our carry chair! Good call! Although the patient wasn't conscious enough to talk in sentences our walk he was opening his eyes and thrashing around slightly which was kind of what we expected. He had already been cannulated by the time the chair arrived back so we got him strapped in and started the the arduous process of extraction! 

Up the stairs we went and on the stern (?) of the boat. Now the plan of how to safety get him, us and our kit across the gap of water to the foot path! Scrap that.....he started fitting. Full blown seizure and pretty violent at that. BALLS! We got him out the chair and onto the deck. This job was really going from bad to worse. We waited a few minutes to see if the seizure would stop. It didn't. We gave Diazepam and waited some more. Still fitting and we are getting pretty desperate now. More Diazepam. Still fitting......aaaaaand stop. A quick ABC check and he was up, on the chair and across the back faster than you can imagine! Sure enough, the second we got him on board the truck the fitting started again and this time it didn't stop. 

You'd think after all of that, the hospital would be appreciative of what we'd been through, but no, the Dr was just plain rude! He interrupted my handover with:

"Well he's probably still fitting because you waited 5 minutes to give him Diazepam"

He then ignored the rest of the handover and talked over me. He looked at us like we'd dropped a baby and spoke to us as if we were naughty children. He criticised and questioned why we waited to give diazepam despite showing him our guidelines. He wasn't interested. Professional courtesy and respect works both ways and today both were distinctly lacking from the doctor. It was a sour end to what had been a challenging and difficult job.

In hospitals you have every level of experienced medical professional at your finger tips. You have every drug, lots of expertise and the patient is on a bed. Pre-hospital you have 3 of us, one of which is a paramedic, one is a student paramedic and the other a technician, a patient not breathing and then seizing uncontrollably, on a narrow boat, in the dark. We are not miracle workers. We are not giving a gold standard of care that the hospitals are capable of. We are simply making the best of a bad situation. And as far as situations go, this was pretty dam bad!