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Sick in the head 2

Posted Nov 21 2008 4:27pm
Giant inflatable man does somersault.

Ten emergency calls; one assisted only and nine taken by ambulance, including one gone before arrival and one running call.

An 18 month-old girl who woke up with DIB which lasted for 20 minutes was as right as rain by the time I arrived. She was happy, active and breathing perfectly well. That’s not to say that she didn’t have ‘an episode’, however but her mother was extremely apologetic for “ wasting our time ” nonetheless.

I didn’t see it that way. Her daughter may well be asthmatic or have had DIB due to an underlying illness or infection, so I stuck around and did a few checks, including temperature, to be on the safe side. Mum didn’t want to take her to hospital and the little girl looked absolutely fine, so I advised the parents (dad was there too) to take her to the G.P. at the first opportunity and to keep an eye on her until then.

The crew arrived within a few minutes of me but there was nothing for them to do; my form was completed and a copy was handed to mum, duly signed.

I noticed (as did the crew) how dusty the hallway up to the flat was, due to ongoing renovation works just outside their door. The dust caught in my throat a few times and I could see how it could irritate a small child’s delicate airways. This was mentioned to the parents and I left the scene with a “thank you” floating in the air. I don’t hear it much, so I may as well savour it.

After that I was sent to a 47 year-old female epileptic who ‘felt funny’ after taking her meds. This was my second call in the same area. There was a shortage of vehicles and staff today, so I found myself in unfamiliar territory for the first part of the day.

The woman was sitting in her front room and her husband, who seemed strangely distant and unconcerned, wandered about in other areas of the flat. She seemed fine; she had claimed DIB but I found nothing but a slight wheeze when I listened to her chest – even that seemed forced to me. She looked depressed and I think that was where the real problem lay. The crew took her to hospital and her husband remained where he was – there was no acknowledgement either way. I found that depressing in itself.

I greened up to be called back into the area I had just left for a 67 year-old female with ‘breathing problems’. The crew turned up at the same time as I did and I followed them to the patient. He was sitting on his sofa in a room full of medicines – the shelves were organised and neat but crammed full of drugs. It looked like a pharmacy.

He was a dialysis patient and he wasn’t very specific about why he needed an ambulance – he just felt ill. This is fair enough. When you are already being treated for serious illness and you have to take that many drugs to get through the day, we’re not going to argue with you if you feel ill. We’re going to believe you.

My next call took me back into W1 for a '40 year-old male, sick person – status unknown'. He had been found collapsed in a small garden area by the police but had been taken by an ambulance before I got on scene. Control had no idea that he was gone because the MDT on the ambulance was sending the wrong status back to them. As far as they were concerned, the crew were still on scene. I was on scene and, unless they were invisible, they had left. No police, no patient, no ambulance.

I let Control know about this and trundled up to the hospital to double check. Sure enough, the crew were there and so was the patient. I knew him; he was a regular caller and his ‘collapse’ was probably due to the fact that he was drunk.

I get lost when I am asked to travel into the City – too many dead ends and narrow street. This call was for a 25 year-old male who had collapsed and become unconscious on a tube train. He lay there motionless and, although his eyes were wide open and he blinked when I tested his response by brushing a finger across his eyelashes, he did nothing else. He was breathing, had a good pulse and I couldn’t smell alcohol. His pupils were dilated, so drugs use was unlikely (not impossible, just unlikely).

I spoke to him and tried various tactics to find out if he was faking but he didn’t react. Neither did he flinch when I did his BM, which was normal. He didn’t seem to have any reason to be lying there. I started another line of questioning, away from possible medical problems and got him to blink once for ‘yes’ and twice for ‘no’. The crew had arrived by this time and I had gained permission, via eye-blinking, to look in his bag for ID and any evidence of a medical problem.

I asked him if he had psychiatric problems and he blinked once, so I asked him if he took anti-depressants because this was ringing a bell in my head. I had been called to a woman who would not respond and just sat in a chair in her front room – she too had psychiatric problems and was currently on anti-depressants. It was impossible to do anything for her because she just could not communicate (or didn’t want to). She, just like my patient in the tube train, suffered from cataplexy.

After I had sorted that out and he confirmed by blinking (he must have sighed with relief inside after I had badgered him with a hundred irrelevant questions) we got him into the ambulance. His limbs were stiff but they eventually relaxed and before he was taken away he was beginning to talk again. It was an interesting little job.

A 48 year-old with ‘flu-like symptoms’ and DIB next. When I got on scene, the little street had been emptied because a fire alarm had been activated. Everyone was standing across the road waiting for the Fire Service to appear and switch the noise off; everyone except me and the crew, who had just landed and were making their way inside the building where the screaming sirens were sounding.

I went in a few seconds behind them and found the crew standing over a fair-sized man who was flat on the floor of his little bedroom (he lived in a hostel). The noise was loud and piercing and there was always the possibility of a real fire, so the paramedic suggested getting him out first. I helped the crew to get him to the ambulance – he was very hot to touch and probably had a fever but I left the ambulance crew to do the rest; it’s too busy today for me to hang around at jobs.

The fire service showed up a little while later (funny, they’re usually so prompt) and I watched as they went inside the building and deactivated the cacophonous signals. Hearing was restored…not by much in my case.

Back into W1 for a 25 year-old female who had fainted at her place of work. She lay on the floor, surrounded by her fashionable work colleagues but she was fully conscious and on her way to recovery. She was French but able to communicate with me and I found out she had a magnesium deficiency and this is why she sometimes passes out. She will be fine and I got out of the crew’s way after a few minutes, during which I tried my French out and decided the patient’s English was good enough, so no need for me to try to impress anyone only for it to backfire when I say something completely stupid.

Another confused communication on my next call. I was sent to Kings Cross station for a drunken male who had fallen and sustained a head injury but my navigation system insisted I went to Euston (not far up the road). Even though the address I had clearly stated Kings Cross, I drove into Euston anyway. A member of staff was waiting for me and had his radio to his mouth. I knew that this was the right place and I began to get my bits and pieces out of the car.

You have two patients who have fallen on the escalators”, said the man with the radio

“You mean one and he’s drunk, right?” I replied

“Nope.”

“??”

“Two elderly folk. They fell on the escalators. One has a broken arm I think”

I got on the radio to Control and told them I was at the wrong job. Apparently, this one was just being handled for despatch and the other was waiting for my arrival!

I was able to get them swapped and it was lucky that nobody was critically ill or injured during this delay. It was nobody’s fault – just one of those things.

I went in to the station and found my two patients. They were both in their 70’s and the woman had lost her balance on the way up the escalators. She had tumbled backwards, knocking her husband down and taking him with her. They both fell to the bottom. She had a grazed elbow and he had a possibly broken humerus. They were Australian, so hard as nails...hardly a moan between them.

When the crew arrived to take them to hospital, they were still in good spirits and I was considering emigration.

After that call the heaven’s opened up. The rain had been standing off all day but now every cloud with a silver lining was tipping its weight onto the streets. Driving became dangerous and as I waited at the station, I wondered how long it would be before the first RTC came in.

It took three minutes.

A taxi had hit a pedestrian as he crossed a busy road. The MDT comment read ‘bone sticking out of leg’ and I thought of the rain getting into the wound and how complicated this might be.

I arrived to find a young man on the ground with the taxi driver and a passer-by attending to him. He was fully conscious and the first thing he said was that it was his own fault – he had walked out in front of the cabbie without looking. He was hit at 30 mph and thrown onto the bonnet of the vehicle. Now he had pain in his left thigh. The taxi driver was fretting about this. I could see a lump at the top of his leg but no evidence of bleeding – even in the torrential rain.

I controlled his neck as other resources arrived; a motorcycle responder, followed by the ambulance and I asked for the leg to be checked. The man wanted to get up – he wanted to take his jeans off so that we could examine him but that’s not how it’s done unfortunately. His jeans were cut and his leg was examined. No injury was found. The bulge at the top of his leg was a wallet inside his pocket.

It looked like he had been lucky and had escaped injury but he was collared and immobilised as a precaution. In a short time he was on his way to hospital.

The police weren’t on scene and should have been, so I stayed where I was and got Control to remind them that an accident had taken place. The taxi driver was still worrying about the young man’s condition, even though I had reassured him many times. He told me later that when it had happened, he had looked on in horror as the passer-by had felt around the ‘broken leg’, saying that it felt like a bone was sticking out. He had turned his back and said “ I don’t want to see that ”. He had felt physically ill. In the same sentence he told me how much he wanted to join the ambulance service.

The police turned up (well, a motorcycle solo and two PCSO’s) and they had all been told that the RTC involved life-threatening injuries. They had obviously been given the old call details. We all stood around in the rain for a few minutes discussing communication problems until I got fed up being wet.

My last call of the shift was another one of those decision-making jobs. The call description stated that I was going to a 36 year-old male with DIB and difficulty speaking, elaborating that ‘the patient will not say why he wants an ambulance’. The truth is, he couldn’t say why.

I arrived at a decent hotel to find a crew on scene with the man. He was sitting in a chair, smartly dressed and with his business colleagues waiting anxiously outside. I was shown a note on which several lines of incomprehensible statements were written. At first, it looked like an attempt at a suicide note by someone who is very mentally unstable but I looked at the man and it didn’t make sense.

The attendant was going through his normal obs routine and the man was trying to answer his questions. He had great difficulty finishing them and I wondered why that was. He had complained of a headache and had no DIB, although his ability to speak was clearly impaired. Either that or his English wasn’t good. I discovered the man was Swedish but had lived in the UK for years. I asked that a colleague try to communicate with him in his own language but that made no difference to his struggle.

This man was having a CVA or had suffered a TIA; whatever it was there was a possibility of devastating deterioration if we didn’t get him to hospital now. I asked the crew to forget about the twelve lead ECG and anything that might delay his transport to resus, where he needed to be. We could have spent another ten minutes on scene gathering more clinical data but if he was bleeding inside his head that time would not have been pertinent, so off we all went, straight to A&E - four minutes away.

Yesterday sharpened my judgment about making the right choice for the patient. Today I had no doubt that what I did was correct. Tomorrow would challenge me yet again.

Be safe.
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