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Gold fish

Posted Nov 21 2008 4:27pm
Six emergency calls (all requiring an ambulance) and two running calls.

There is a goldfish in the fish tank at my base station whose sole objective in life is to hog one of the upper corners all day long. If another fish comes anywhere near, it attacks and runs them off its ‘territory’. One particular fish, another goldfish, approaches the guarded area over and over again. He is chased off every time he gets close and yet he persists in goading the aggressive fish by trespassing repeatedly. Some drunken people are like that; they just never learn.

The guard fish has fin rot.

Before I had gone as far as the bridge I was approached by a woman who told me that a man was collapsed in a heap at a nearby tube station. I couldn’t ignore her request to help in some way, although I might have been tempted – especially as her last words were “he looks drunk”, so I radioed it in as a running call and made my way to the location.

I pulled up to see a very drunken young man being propped up in a standing position by another man as he vomited all down his suit and onto the pavement. The stuff was splashing onto his brief case and over his shoes. He was a fine sight for public viewing in broad daylight – it was only 7pm.

I stood with him as he vomited over and over again (some people have endless stomachs) and then sat him down to complete the ordeal. I thanked the man who had propped him up (otherwise he would have fallen flat on his face) and took over from there. I asked the drunken man a few questions, such as his name and he responded well. He was still unfit to travel and so, very reluctantly, I asked Control to send an ambulance. He may as well be vomiting in hospital while he dries out. Meanwhile I cleaned up his case and clothing – I also wiped the vomit from his mouth, nose and eyes. To the rest of the world I was one of London Ambulance’s finest – a paramedic with a mission. Babysitter.

I apologised to the crew when they arrived. I had to really, the vomiting drunk probably never will.

Then off to a 36 year-old female who was having a fit at a large department store. There was a crew on scene already but I was asked to attend because paramedics are always sent to seizures now, even if that means a ten minute blue light journey during which the crew could have taken the patient to hospital. I got to the scene to find the patient in the ambulance and the somewhat bemused crew dealing with her. She showed absolutely no signs of having just had two fits, as was reported. She was more conscious than me in fact. Not only that but she carried a medical letter confirming that her fits were a mystery to the scientific world and that she was allergic to all medicines, including diazepam, so I wouldn’t have been able to help her much anyway.

Maybe it’s the sceptic in me but I’m extremely suspicious of people who have acute medical emergencies that require instant removal from shops, especially if they haven’t bought anything. I feel we have a complicity in something that’s not right.

After a quick (half consumed) cup of coffee, I was sent to the north for a 60 year-old man with DIB. When I got to the estate, I looked up at the grim flats to see a young boy hanging off the edge of the third floor balcony. He had a little group of people with him (all safely inside the balcony confines) and they were quite happy – amused even – to see him perform his act. I don’t know if he was doing it because I had just pulled up and he wanted to give me the extra work, or if he was normally stupid but I found myself considering what I would do if he fell. He wouldn’t die but he would break a few bones, including his head. Would I rescue him immediately, saying “ there, there, don’t worry I’ll help you ” or would I ignore him and deal with my genuinely ill patient upstairs, possibly ‘phoning in for another vehicle to scrape the young fool off the ground?

As a fun game, I’ll let you guess.

Anyway, my patient was quite ill. He came to the door and his problem was more SOB than DIB. Shortness of breath is more characteristically defined in specific acute conditions, such as cardiac problems. I would describe a patient with difficulty in breathing as one who is breathing in and out fully but is struggling to do it. I see shortness of breath as more of a ‘puffing’ type of breathing, where the patient is not completing breaths either in or out, or both. On that basis, I would say DIB for hyperventilation and SOB for asthma, DIB for gas or smoke inhalation and SOB for Pulmonary embolism. This man was experiencing SOB, especially when he lay flat.

The patient had a history of cardiac and blood pressure problems and had suffered two heart attacks, his first when he was only 30 years old. He had also had a recent chest infection and that may or may not have been relevant to his present struggle. His inhaler had run out and his condition was only relieved when we (the ambulance crew arrived shortly after I started my obs) nebulised him with salbutamol. I should point out that he was not a diagnosed asthmatic but his G.P. had given him an inhaler during his chest infection.

In the ambulance his ECG was abnormal, although not critically and he was taken to hospital where I’m sure he will recover fully.

I went back to my car, glanced up and noted that monkey-boy had reached a sensible decision – he was back behind the balcony barrier, grinning at me. I tried to look impressed with his stunt but I wasn’t, so I gave up and left the scene.

A 36 year-old female who screamed like a banshee every few minutes and grappled, clawed and kicked at anything around her was my next delightful assignment. She had been drinking heavily, although she doesn’t normally drink much (they all say that) and had suddenly become incoherent, nonsensical and aggressive, cycles that were punctuated by periods of hallucination and quiet staring. Now, I don’t know about you but the combination sounds more like the effects of drugs rather than alcohol. So I pursued my line of enquiry in that direction. Her colleagues barely knew her – she was quitting her job and this was her leaving party but none of the seven or eight people around her could help me with personal details.

I attempted to reason with this howling woman as she lay, pinned down by her friends, on the sofa of the bar (I’ve noticed that a lot of these clubs and bars have sofas). During my quiet, professional chat with her she lashed out at me, with the only arm that wasn’t being restrained, catching my eye with her fingernail, and it hurt. My eye watered immediately and I lost vision for a few seconds. I had to step away from her in case she launched a second wave of attacks, possibly on my other eye, while I recovered. My eyeball was burning and continued to hurt for a few hours afterwards.

I called Control to ask when I was going to see (however blurred) an ambulance crew and they told me that nothing had been assigned - great. I requested one and also asked if the police could drop by because I thought the crew may have problems controlling this lady.

I spoke to the woman’s boyfriend on the ‘phone a couple of times and he seemed neutral about the whole problem. At first there were denials about the possibility of drugs and then a few facts were made available to me to support my theory. Even a combination of prescription drugs and alcohol will send you off the edge like this but you are much more likely to be affected if you are depressed.

I had been on scene with this erratic patient, now held down by four of her colleagues, when the crew arrived to take her away. I noted the lack of police officers and was told that Control had cancelled them. This I didn’t understand, they had been requested for the safety of the crew. In the end, they were able to convince her to walk to the ambulance, although she had to be restrained and supported all the way. Inside, she calmed down and began to talk to us, even though her speech was slurred and rapid.

I have seen this before – wild, aggressive and abusive behaviour after the consumption of alcohol which suddenly switches off when colleagues or friends are no longer around. She was compliant and communicative when I left her with the crew.

My second running call was to Charing Cross Underground station where there had been a report of smoke in the tunnel. This prompts a heavy response from the fire service and they sent three vehicles, including a command unit to the scene. I waited until given the all clear and made my way back to my usual stand-by location. I didn’t go onto Leicester Square much tonight, it was just too busy.

My next call was to a 55 year-old Falklands veteran who had been down from Bedfordshire, celebrated with his old buddies from the war and then got so drunk he couldn’t get back home again. He missed his last train and fell on the pavement, splitting his lip and chin. He staggered into the station with his badges and medals, covered in blood. All the time I was with him, he cried and coughed (he coughed a lot and it prompted me to ask about his lung-health). His only clear communication with me was to tell me he was in the Falklands and that it had been 25 years. This I knew but I did feel sorry for him. I deal with a lot of drunks and some of them never learn their lesson – they go on being losers all their lives. This man had fought (whether you support the idea or not) for our country in the last true war we have ever had and here he was, unable to cope with his situation and obviously alone. His path had been carved out before he got back home from those islands.

A 19 year-old female, drunk in bed and surrounded by her worried family presented me with a challenge; do I leave her to sleep it off in her own room, or do I stretch the NHS resources even further tonight by introducing her into the hospital system? If her airway had been more stable (she was vomiting a lot and some of the larger chunks were not clearing very well) then I would have let her stay where she was and told her parents to keep an eye on her. She was, after all, only drunk. Her father was drunk too though and her mother spoke very little English. The girl’s brother was the most sensible of them all, sober and he communicated well but he was too young to take care of his sister, so my mind was made up by collusion of circumstance and risk.

When the crew arrived, she had been vomiting for almost two hours, including the time that I had been on scene, so I put her up on fluids before she left for hospital. This would help her replace water and salt whilst chucking it up and remind her of how foolish she had been when she comes round and sees the line hanging out of her arm.

Five o’clock in the morning and there’s a drunken man sleeping on a bus. Of all the calls I deal with, these are the ones that make me feel like I am just a public servant. My colleagues from my station were on the bus before me and they seemed to have solved the problem. He woke up and appeared to be going on his way. The crew left but I hung around with the bus driver (who never left his seat). Sure enough, the man went straight back to sleep. I shouted him awake and told him to get off the bus. He grinned (they all grin) and tried to go back to sleep. I shouted him awake again and thought this might go on all morning. Luckily the police arrived and helped him on his way, grinning obviously.

Be safe.
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