The Complete Blood, Sweat and Tea

All went as normal until we rounded the corner to the hospital, where he got off of the chair and laid on the trolley-bed. One hundred yards later and we pulled up to the hospital and I told him to get up, then I told him louder, then I did a sternal rub to wake him up – and there was no response! I then slipped an oropharyngeal airway into his mouth, this would wake anyone up, but not a flicker … he was deeply unconscious. This meant he was due for the Resus’ room.

We rolled him (rather quickly) into the Resus’ room and were met by a rather angry nurse – she wanted to know why we hadn’t pre-alerted the hospital. I explained that he had just lost consciousness outside the department. She then asked me why he didn’t have oxygen on him. Again, I repeated that he had collapsed when we were outside the hospital. We got him onto one of their Resus’ trolleys while the doctors in the department ran into the room.

For the third time I explained what had happened, and that I had no vital sign observations; this time they paid attention, and accepted what had happened.

To be honest I don’t blame them, the A&E department rarely has any surprises – the hospital is normally forewarned about any ‘nasty job’ we are bringing them, and to suddenly have a seriously sick patient turn up without any warning is always a bit of a jolt.

Now the patient was unconscious the nurses were able to do those vital observations that I was unable to do – and they were all normal. His pulse, blood pressure and blood oxygen levels were all better than mine, his blood sugar was also well within normal limits. There was no obvious reason why he was in such a deep state of unconsciousness.

He was quickly intubated, and we left the department. I’ve spent some time wondering if I missed anything – if there was anything I would have done differently – but to be honest I don’t think there was. Even if I had managed to get a full set of vital sign observations, they would have all been normal and there was nothing that indicated his condition changing so quickly. I can’t ‘assault’ a patient who has refused a procedure (such as observation taking), and all I could do was exactly what I did do – watch him while we took him to hospital.

The current idea is that he had taken an overdose of some sort along with the alcohol, and that it had started to work. Because the patient hadn’t spoken to me, I had no way of knowing if he had taken an overdose.

I never did find out what had happened with the patient – it’s one of the poor things about this job, that you can’t always follow them up.

Protecting Little Old Men from the Police?

We were asked go to the local police station to help with arresting someone. The arrestee (is that a real word?) was an 80 (or more)-year-old male who was accused of recently committing a crime that I would suggest required some amount of physical strength. We were to follow along because the person had heart and breathing problems – so much so that he had bottled oxygen in his house.

We met with the police officers (nine in total, and all rather scary looking plain-clothes types) at the police station, before following them to the address in question.

Once the police had made their entrance we were called forward to give the patient a clean bill of health. We watched as this frail man slowly dressed, needing help from his son to tie his shoelaces; we watched as he struggled around the house and wondered how he could possibly be guilty of any crime that needed any form of physical exertion.

The patient’s son was also a bit put out by the allegations, and promised to have a good laugh at the police’s expense when the truth came out.

Throughout the arrest the police were polite, helpful and behaved in a thoroughly professional manner at all times.

The patient/arrestee was also calm throughout and the whole thing went, as far as I could see, very smoothly, and our ambulance followed the car in which he was taken, until it entered the police station and the FME (Forensic Medical Examiner – a doctor that the police use) took over.

The next job we went to was to outside the same address: a woman had been mugged and the police who were searching the address had called us as she had a rather large bump on her head. Unfortunately, the mugger managed to get away. It surprises me that you can get mugged outside a house full of police and the mugger can still escape.

Victims

Imagine, if you will, getting sent to a job where a 15-year-old boy is threatening suicide. You turn up at the address and discover that it is a care home. Meeting with one of his carers she hands you a list of the boy’s medications and it reads like a ‘Who’s who’ of psychiatric drugs. You talk to the boy, and he seems calm, collected and very polite. He explains that he wants to jump out of a window and kill himself, and agrees that he would like to go to hospital. You take him into the paediatric department of a local hospital. As this does not feel like the normal ‘Teenager wants to kill themselves’ you have a chat with the children’s nurse and you ask them to let you know what happens to the patient. You leave, and continue with your shift. The next day you ask the children’s nurse about the patient and she tells you ‘The boy wanted to die because he wants to have sex with, and kill, small children – and that he knows that it is wrong’.

I hate paedophiles as much as any other member of society, but in front of me that day, I saw a victim.

Behind Locked Doors

One of the jobs that I both enjoy and hate is for a ‘Collapse behind locked doors’. This is when a (normally elderly) patient has not answered the front door or the telephone, and is presumed to be in some trouble. What we often get is someone who has died during the night. Although I hate having people die, the one good thing about this type of job is that I get to use my size 12 boots to kick down a door.

There is a skill to kicking down a door, and I was taught by the best – a policeman. The police also have a huge ram that they can use when their boots aren’t enough. These are very heavy, but also lots of fun to use.

We got called to a house where the daughter could see her elderly mother lying on the floor; shouting through the door and banging on windows didn’t get any response, so we assumed the worst. The daughter was (understandably) crying, so I had an attempt at kicking the door down.

Unfortunately for me, the woman had been burgled earlier in the year, and so had two locks, and a bolt holding the door shut, so it took a couple of minutes of prolonged (and eventually painful) kicking to get the door open. I also managed to wake up all the neighbours, and it’s always fun to be the centre of attention …

Finally, the door gave and we gained access, we were greeted by the elderly woman sitting on the floor smiling at us – earlier in the morning she had fallen and couldn’t get up. When we had tried banging on her windows she had been asleep, and it was only the repeated bashing of my foot against her door that had caused her to wake up.

This was a good job in a number of ways: the lady was happy and healthy, and just needed a hand to get up off of the floor; I got to kick in a door and get away with not causing any serious damage; and finally we looked like heroes to the two daughters of our patient. There were smiles all round and we left the job feeling that we had really been of some use today.

Substitute

I know that the ambulance service is being used as a substitute GP service these days, but it really takes the biscuit sometimes. Take, for example, the job I was sent on last night. It came down to our ambulance as ‘Patient wants to kill his doctor’.

I immediately called up Control on the radio and asked if we were being sent because they couldn’t find the patient’s GP? Although I was half joking, I wondered what good we could do for the patient. Control got back to us, and let us know that they were sending the police, and that we should wait until they turn up. However, when we arrived at the address we knew who the patient was – so we cancelled the police and sorted out the patient’s problem.

I mention this if only because, when I got back on station and read the local newspaper, I found a story about a coroner’s investigation into the death of a 55-year-old female who had taken a fatal overdose of bloodpressure medication. When Control asked if she was violent, they were told that yes, the patient was violent. The police were called and the crew waited at a rendezvous point for half an hour until the police turned up. By then it was too late, and the patient died. Once more, the paper blames the ambulance crew. It doesn’t blame the psychiatric services who discharged her a few weeks earlier after a failed suicide attempt, neither does it blame the person who made the phone call that said that the patient was violent. It blames the crew who, quite rightly, waited for the police. If one of the crew had been stabbed to death, it might be a more sympathetic headline. We are expected to go into people’s houses, where we have been told that the patient is violent, where we could get assaulted or even killed – but as soon as we start thinking about our own safety, we are the ones to blame for anything that goes wrong with that patient.

Violence from the drunks, druggies and criminals doesn’t worry me – the job that worries me is the little old lady who has become confused and is sitting in her living room with her husband’s service revolver, or her favourite kitchen knife, desperate to stop the strange men in green from stealing her away in the night.

As normal the ambulance service has investigated, but in a show of support for its road staff, has stated that the policy of waiting for the police at a rendezvous point is the correct thing to do.

We are not cowards, but neither are we stupid/paid enough to wander into dangerous situations.

Nicked

I’ve just gotten on station for the start of my shift, only to find out that some scrote had broken into the station last night and nicked the video recorder and DVD player.

I mean, it’s not like we are ever on station long enough to use them, but it’s the principle …

These are the sort of people that we serve, these are the sort of people we are polite, professional and caring towards – and this is how we are repaid …

More Nicked

It’s getting so you have to tie things down now …

Yesterday a ‘Decontamination POD’ truck was stolen; this is an unmarked truck that we use to carry around chemical incident equipment. The current word is that this truck was carrying a load of atropine, which is the treatment for nerve agents.

If people were to start injecting this into themselves, they could get serious (as in fatal) effects.

I leave it as an exercise for the reader to decide if this is a good or a bad thing …

You Decide

Still no drunks, but the weekend starts today and my shift ends at 2 a.m. …

I’m going to describe a job I went to last night.

The patient is female and 30 years old. She is married and is attempting to get pregnant. The only medicine she is taking is fertility treatment, and she is (obviously) having unprotected sex; she is normally fit and healthy and has no allergies. Her normal menstrual period is regular, but her period is over 2 weeks late this time around. She has been having nausea and vomiting for the past 3 days. She has no abdominal pain, and is not tender or guarding. She has no pain or increased frequency of passing urine. All vital signs are within normal limits.

So … given this information …

(a) What do you think is ‘wrong’ with her?

(b) Does she need a trip to hospital in an ambulance?

(c) Why do you think she hasn’t done a pregnancy test?