Go and read yesterdays article in order to make sense of this post's title.

It seems I forgot one thing in the list of nasty coincidences that I mentioned yesterday - that it was also the last day of the Notting Hill Carnival. The Police are calling this years carnival a success, with little reported crime, but I would tend to disagree - just that the crimes all happened to people as they travelled home.

Our second call of the night started worryingly when control told us that a male had been stabbed in Stratford shopping centre, and that he could still hear shouting in the background of the call. As I predicted yesterady, the stab vest went on and we made our way down there, meeting up with a lot of police officers trying to control a rather large crowd of post-carnival spectators.

We found a 15 year old male laying on the floor, with a policeman holding some paper tissues over an upper abdominal stab wound, there was no external bleeding, and the patient was alert, calm and talking. He also had a small wound to his right leg, which again wasn't bleeding significantly. I ran through a primary survey (a very quick examination of the patient to rule out anything that is going to kill him in the next five minutes) and then concentrated on making sure his chest and lungs weren't damaged, and on clearing them turned my concentration to the belly wound.

We don't like stab wounds, they can do a lot of damage leaving only a tiny entry wound. One stab wound can easily kill you, whether it is in the leg, the arm the chest of the belly. After my examination I decided that, although he needed exploratory surgery, he wasn't critically ill. There was a bit of 'something' poking out of the wound, I had no idea what it was (I initially thought it was part of the policeman's dressing) so I soaked one of our dressings in saline and applied it to the wound. We then got a phone call from what I took to be the HEMS road team (a doctor and paramedic) letting us know that they would be on scene in twelve minutes and that the patient should go to the Royal London Hospital. The problem with this is that the Royal London is some way further away than Newham, and that I knew that if the HEMS crew got on scene they would want to 'stay and play' securing IV lines, considering intubation and running a full examination on the roadside. In my opinion, having assessed the patient, his best option would be to go immediately to the nearest hospital and let the surgeons there deal with him.

So we loaded the patient onto the ambulance and made a run to Newham Hospital which took us less than five minutes.

The result of which was the patient got to theatre, was 'packed' as he had a lacerated liver and gall bladder and is now in ITU for recovery.

I wonder if the HEMS crew will moan, I suspect they won't because around the corner was another young lad who had been stabbed in what later turned out to be a connected series of battles between two schools. The HEMS crew played around on scene with that patient before taking him to the Royal London Hospital (who do love their trauma jobs). There were then reports throughout the night of other crews picking up more teenagers injured during the fight. The patients were spread fairly evenly between the two hospitals, so no one department became overloaded.

A couple of things struck me as amusing, the first was that when we were about to leave for hospital the patient's girlfriend and cousin were fighting among themselves, essentially over who loved him more and should go to hospital with him. The patient's brother was also there and was fighting with police to get to the patient. He then vanished, and my prior experience would suggest that he was planning revenge and a counterattack.
While going to hospital, the patients girlfriend was talking about the other lad who had been stabbed (apparently his name is 'Biggy G') and how it seemed that the fight had been planned at the Carnival.
As always when I got to the hospital it seemed that the doctors weren't interested in my handover - on which I will post/moan more later.
As we were going to hospital another crew, this time in North London, were putting in a priority call to their local hospital - they had two young men (19 and 20) who had been stabbed, luckily in a non-serious manner.

I'm sorry if this posting is a bit more disjointed than normal, but I am completely knackered and a twelve hour night-shift can have you hallucinating by the end of it if you have been busy enough. I'm off to bed now - goodnight.

Later today (for it is 1am here in Reynolds-land) I shall be starting the first of four night shifts (19:00-07:00), I'm sure I've told you before how much I love night-shifts.
It is also a full moon - traditionally the time for strange things to happen, and for the 'wilder' sort of behaviour from my patients.
And lastly, it is a Bank Holiday Monday, and will therefore be full of people who have been drinking for three days straight anxious to get those final few pints drunk.

I think I'll keep the stab vest on throughout tonight.

Another FRU (Fast Response Unit) has crashed, luckily no-one was injured, at least in part due to the FRU driver not being a 'boy racer'. The FRU was on it's way to (yet another) category 'A' call, when it crossed a 'T' junction against the lights. The flashing lights and sirens obviously meant nothing to the driver who pulled out in front of the FRU. A reasonable amount of damage was done to both vehicles, but there were no serious injuries.
Interestingly, when the police started up the other car, "Drum 'n' Bass" pounded out of the stereo entertaining the whole street. Maybe this is why the driver didn't hear the sirens of the FRU?

The main problem with the FRU is that because it is small, sleek and very fast, people tend not to see it coming. Also unlike an ambulance (where you sit fairly high up), you don't have brilliant vision of the road ahead.

Ambulaances tend to have little 'bangs' when reversing, FRU cars tend to make a bit of a mess. It helps that it takes a real effort to get over 40mph in an ambulance.

One day they'll let me loose on an FRU car - Then I'll see if I can cure more people than I run over...

The other night I had my favourite type of job, the type of job that meant I wasn't upset to be late leaving work.

People who are diabetic sometimes have very low blood sugar - this makes them confused, agitated and sleepy, this can lead to unconsciousness and even death. Their blood sugar can become low for any number of reasons, most often they have done more exercise than normal, and not eaten enough to raise their blood sugar.

The treatment for this condition is to either give them sugar, or an injection that 'frees up' some sugar that is stored as fat in their body.

Our patient last night normally controls her diabetes very well; so much so that her family had never seen her with a dangerously low blood sugar (the medical term for this is hypoglycemia). They called us because she was acting confused, and was unable to speak properly or stand upright. We arrived, and found out she was a diabetic, checking her blood sugar we got a reading of 1.6mmols (the normal range for a diabetic is around 4.5-12.0mmols), this is very low and explained why she was slipping out of consciousness.
The family were understandably upset, as they had never seen this before, they saw her slipping into a coma in front of our eyes - so we explained what was going on as I prepared the injection that would raise her blood sugar. I gave the injection (this injection is called Glucagon) and waited for it to take effect, all the time reassuring the relatives.

Within 10 minutes she was up and talking, we then gave her some sugar jelly which raises the blood sugar some more. Soon she had made a full recovery, with her blood sugar reading 5.6mmols. We gave her some carbohydrates (for 'slow-burn' energy) and left her in the care of her exceptionally happy family.

The reason why this is such an enjoyable type of job is that we are actually saving a life (for a change) with the treatment that we can give, and that the recovery is normally rapid, and always impressive. From unconsciousness to 100% fitness in the space of about 15 minutes really impresses onlookers, and it does our ego good to be praised every so often.

We got called to a pub (which is always promising), to a 24 year old female who was having 'difficulty breathing'. When we turned up at the pub, we were met by a man who, after letting us know he was a 'first aider', told us that she was fitting, and that she had stopped breathing - but that mouth to mouth resuscitation had 'brought her back'.
Entering the pub we found the woman thrashing around on the floor. She wasn't having a fit, it was more like a temper tantrum. Throwing himself on top of her was her husband, who was reluctant to let us approach her. People in the pub told us that they had both been drinking heavily.

We near enough had to force the man off of his wife so we could examine her properly - and it soon became apparent that she was just very, very drunk. Out of the corner of my eye I saw sudden movement and ducked quickly as the husband threw his wife's shoe at a man standing behind me. We decided that loading her onto the ambulance would be the best thing to do. The husband demanded to be let in, but we told him that we needed room to properly examine his wife. He banged on our windows twice, but then left, apparently running up the road - possibly due to him throwing a pint glass at another of the pubs customers. (This was very unwise of him, because half of Newham police force were 200 yards up the road dealing with an armed incident).

By this time a second crew had turned up, as someone had called 999 and told our control that the woman had stopped breathing. We stood them down, although on reflection they could have been of help keeping the woman on the trolley because the woman was still throwing herself around, refusing to lay still, and generally making life difficult - we managed to get a blood sugar, pulse and blood pressure (all of which were normal) but she refused to stay on the trolley, wouldn't sit on a chair and so we let her lay on the floor.

At times like these, I think I'd give my eye-teeth to be able to put people like her in a four point restraint - but it's something we are not allowed do.

Then while I was driving to hospital, she made an attempt to leap out the back of the ambulance, and it was only the rugby skills of my crewmate that prevented her escaping under he wheels of a following car. The rugby tackle was all the more impressive given that my crewmate is five foot nothing tall.

We finally managed to get the patient to hospital, where she threw her vomit bowl (with vomit) over the floor and tried to hit a nurse - luckily I was standing behind her, and grabbed her before she could damage any of the staff, or even a patient.

To cut a long story short, the nurses let her phone her sister to come and pick her up, and then kicked her out the department.

Two things about this job that bring a smile to my face; one - one of her shoes is still laying in the gutter, where we picked her up from, and two - Her husband got out of prison today, and given his attitude and behaviour, he'll soon be back inside.

So, it's not just weekend nights we get the violent drunks, it's every damn night...

The London ambulance service is normally pretty good for supporting their staff through some tough times, but at the end of the day it comes down to the management on the ground, tonight was a case in point.

A crew had to deal with one of the worst jobs you can get - I won't give any details, but I suspect it will be on the news tomorrow. Just imagine the most heart-wrenching thing you can.

One half of the crew is fairly new staff, he's a good bloke who knows his stuff, but this job was so outside the normal, it had obviously shaken him up (and I would suggest that anyone not at least a little shaken up by this job is someone who has lost all sense of humanity). The hospital involved offered a chance for a 'debrief', which is when they sit around a pot of tea and discuss the job, dealing with the feelings that everyone has. Not many hospitals do this, and I'm very happy that they included the ambulance crew in this session.

A Station Manager was working, and his advice was to 'return to base for two hours and have a cup of tea', which isn't helpful at all.

Every other crew rallied around and made sure that the crew involved was alright, and a Duty Officer was called - he spoke to the crew and stood them down for the rest of the night - doing something that the Station Officer should have done hours earlier.

The reason why we are stood down is because after dealing with such a ghastly job if your next call is to someone with bellyache for seven days, there is a strong likelihood that you will say something to the patient that you will regret. I know I've done it when I worked in hospital, and luckily gotten away with it.

So, there is support, it just depends on who is on duty that shift.

The thing I like least about doing seven 18:00-01:00 shifts is that I start losing touch with friends, at least in part due to no-one being on IRC when I'm at home.

Then there is the cycling home at 01:30, where I would be really tired and ready for bed before leaving work, the cycle home wakes me up. Not good when you want to go straight to bed so you can get up early in the morning.

Still, what other job lets you deal with calls similar to those I had tonight - An RTA at less than 10 mph, with very minor cosmetic damage to the car; and yet the driver is clutching his neck as if it is about to fall off...

At least the lazy git I was working with wasn't any trouble, he didn't decide to run off and hide so I couldn't call up ready. So I suppose you could call it a good night. I might be working with him tomorrow...

So 'Good Night' to you all