The second night-shift of a batch is always the hardest, your body clock doesn't know whether it is coming or going and you really aren't emotionally equipped to deal with people who want to give you a hard time.

This might explain why the desire to run over the patient who decided to run out in front of the ambulance and 'collapse' was really rather strong.

It might explain why, after a twelve hour shift, when you call up with 15 minutes to go because 'I've had a cold all week', you may get a less than friendly EMT.

And it might explain why, given our recent diabetic death, we 'Blue' in a 47 year old with a blood sugar of 24mmols, one kidney and a respiration rate of 42.

One bizarrely enjoyable job was an alcoholic Indian who had fell, while drunk, between two cars - his wife was on-scene telling him off, while he lay in the pouring rain, splashing around in a puddle. In March he had broken his hip, and now it looked like he had possibly dislocated it. But he was so intoxicated he was waving it around like it was just troubling him a bit, rather than writihing in the excruciating pain that you would expect. When we managed to scoop him up and get him in the back of the ambulance his hip looked 'wrong' - unsure whether it was due to his operation, and given the amount of alcohol he had on-board, we treated like a fracture and took him into hospital.
All throughout transport the patient, his wife and myself had an enjoyable chat - mainly about his drinking and how he is 'daft'. An enjoyable job despite scrabbling around in the cold, wet, cramped conditions that he found himself in.
The hospital x-rayed it and said 'something is wrong - but we don't know what' - an admirably vague diagnosis.

SPAMPOT: 2 Spams (Filtered), 0 Unfiltered Spams.

The night started with a feeling of impending doom, as I had forgotten that England was playing a fairly important football match against Croatia - I live in a block of flats with a load of Croatians so I wonder if they are still standing, and will the night-shift be full of people injuring each other over a game?

As it turned out the night was remarkably free from people beating each other up - one call to a family who'd had a fight between husbands/boyfriends and sisters with a 18 month baby getting in the way of a punch as well. Luckily the baby was fine, and the man who hit the baby was rather battered, in a minor injury sort of fashion. We'd also gone to an nurse who'd taken an overdose and was very drowsy - she initially refused to travel, but after half an hour of persuasion (including me asking her that if she really wanted to kill herself, why did she phone her work up and tell them what she had done? And where was the suicide note?) she travelled to hospital where she spent the night on a cardiac monitor.
We had one 'matern-a-taxi' to the Homerton hospital where the mother was booked in - even though Newham hospital was half a mile away. It was one of those jobs where the patient tells you she is having five minute contractions, but as soon as they get in the ambulance time dilates and you don't see one contraction during a 15 minute transport...
And finally we got a 23 year old female who had vomited once, and had a touch of diarrhoea - she decided not to transport to hospital so we left her in the care of her boyfriend - an easy job all round.

We did a total of five jobs during the night, which counts as a very quiet night for us. Three of the jobs were off one street - we just kept getting sent to the same area. It sometimes happens like that, you send ages without visiting a place and then get called there three times in a night.

Other crews reported that there were not as many violent incidents following this game - I even found my flats still standing when I returned home this morning.

SPAMPOT COUNT: Still Zero...but I have plans...

Our second call of the day was to an address where the elderly woman who lived there was believed deceased - the neighbours had called the police, and the police had called us. What this often turns into is us struggling to gain entry to the house, normally resulting in an injury to me, only to find someone who has been dead for sometime.
We rolled up to the house and met with the neighbours who led us around to the back garden where, peering through the rear window, we could see the old woman sitting in her chair looking pale, still and very dead.

Simultaneously my crewmate and I jumped back in shock as we saw her take a breath!

She was breathing about 6 times a minute, and surely didn't have much longer left to live - I rushed around the front and kicked in the front door (in one hit, something I've never managed before) and we got her out to the ambulance in double-time. We quickly decided that it would be wrong to 'stay and play' instead opting to ventilate her via 'ambu-bag' and to monitor her cardiac rhythm and her pulse (which was strong and regular).
The hospital had a team standing by, as we had notified them of the patient on leaving the scene. The transport time to hospital was about two minutes, and on arriving the A&E team leaped into action, intubating and ventilating her, gaining venous access and running the various blood tests - family members were contacted and plans for her treatment were drawn up. At no time did I feel that this 88 year old woman was receiving anything other than the best treatment possible.

We cleaned the ambulance and restocked before going onto our next job; each time we returned to the hospital we popped our head into the Resus room to check how she was doing - there were plans to CT Scan her head, and to move her to ITU. The family arrived and after some discussion it was decided that the best care for her was going to be palliative - that is to make her comfortable, but not to do any invasive procedures and to allow her to die. This was, I feel, the right course of action - lack of oxygen would make any survival both short and would probably result in serious brain damage.

It has been a very long time since I've felt a great deal of sympathy towards someone - but this was one patient that I did actually care about, and not just because I'm soft on 'little old ladies'. She had little chance of recovery, but we hoped for it anyway. She fought for her life, and had probably been doing that for the whole of the night. Because of our actions, and the actions of the hospital team, she wasn't going to die alone, and she wasn't going to die without her family saying a final goodbye to her.

It's a small victory, but sometimes those victories are the only ones you get.

There is something that I've learnt over many years of health-care work. When you are lifting little old ladies with senile dementia, they will sometimes grab you by the testicles.

And squeeze

This hurts.

I swear, the higher the degree of dementia, the higher the accuracy and the stronger the grip.

And for the love of all that is holy...

Don't drop them.

That hurts even more...

Back to work tomorrow, two twelve hour shifts, a day off then Nights, deep joy - more stabbings/slashings/bottlings/death and destruction. And that's before England are knocked out of Euro 2004.

A lovely quiet night,
1 x matern-a-taxi - baby not due for at least the next 10 hours
1 x crying 1 year old - asleep quite happily when we arrived
1 x headache - who was more concerned about his depression than anything else (I actually had some sympathy for this patient).
1 x 23 year old chickenpox - One of those people who wraps themselves up in a blanket when they get a temperature and wonder why they feel so ill.
1 x panic attack That saw us off shift on time

There were no stabbings, no glassings and no assaults.
Tomorrow is a bit busy, I need to wait for the 'City of Heroes' computer game to arrive from America; visit my mum to convince her that the mark on her face isn't cancer, and attend a small London blogger meetup.

After working twelve shifts on the trot (a mix of 12 and 10 hours) it'll still be relaxing.

For the first night in ages it has been reasonably quiet on the streets of East London - only one stabbing and that was to the patients arse...
However, while adults are no doubt nursing hangovers the children are out causing mischief. The first two calls we got yesterday were to kids (8 and 10 years old) who had been hit by cars. The first was a 'classic' - child running out towards an ice-cream van. He was alright apart from a broken right ankle. No sooner than he is safely ensconced in hospital than we find ourselves dealing with a child who has run out in front of a car (in the absence of an ice-cream van) and has broken his LEFT ankle.
Tie in a hyperventilating adult, a 14 year old with hay-fever and a drunken 'Colles" fracture and you have a pretty good night.

We had one serious job, a CVA on a train. The CVA wasn't so much the problem as the extrication of the patient, who couldn't move, and yet was combative with his unaffected side. To start off the space between the seats on the train weren't large enough to allow our carry chair to pass. The man was large and heavy so we had to basically manhandle him (in a very undignified manner) him through some connecting doors and out onto the platform. The train station has a big flight of stairs towards street-level and only one lift - and the lift wasn't on the platform we were on. It would have been unsafe to carry this man up the stairs due to his weight and combativeness. In a rare spark of genius I realised that if we waited for a district line train we could carry him through the train onto the other platform. We Blued him into hospital as hid pulse-rate was 40 (should be 60-100).
When I went to see the patient later in hospital he had started to regain his speech and wasn't confused - he was about to go for a CT scan so I'll find out what it showed tonight.

On the drive home I saw a water main had broken, and like the loon I am, I thought 'that might make a nice picture'

Well it looks like I was right, the nice weather with people in the pubs from an early hour, coupled with England losing 2-1 in the football has led to what can, in best tabloid fashion, be described as "an orgy of violence".
It started out with a couple of "glassings", which we have been getting over our MDTs as "stabbing to the head" for some reason.
A couple of more assaults including one who was set upon by a number of drunks who were intent on stealing his car - luckily not too badly injured, he was more shook up. Other crews were "blueing" in a number of assaults, including at least one stab victim.
The police were running from call to call, and once more there are not enough ambulances to deal with the large number of calls we have been receiving. Our Duty Officer has been telling crews that we should be wearing our stab-vests constantly - but he isn't the one who has to lug a 20 stone arrest down four flights of stairs in this heat...

Good job I'm not searching for a quiet life.

I am, however, off to bed now.