There is a reason that I came off the FRU, I don't like sitting on scene with patients that (for whatever reason) I can't transport. Sick patients need to be in hospital, not in their houses being stared at by my ugly mug.

I was working on the FRU and was sent to a child who was suffering an allergic reaction. These are normally pretty minor things, mum has changed the washing powder and the little 'un has a bit of a reaction to it.

Not so in this case, the child looked like something from a horror movie. The two year old's skin was covered in itchy and painful looking blisters, his lips were swollen and he was generally a funny shade of red.

The first thing that I checked was is mouth, allergic reactions can cause the tongue to swell up and if this blocks the airway then they can easily choke to death. Luckily this wasn't happening to this child, while his lips were swollen his tongue looked fine. The next thing that you do is to get the stethoscope out and listen to the child's chest, an allergic reaction can have the same sort of effect on the lungs as an asthma attack. Once more the child's lungs sounded fine, maybe a bit of an infection though.

I asked the parents what had happened.

They had realised that the child had developed a runny nose, so they took his temperature and discovered it to be a bit high. Then, unlike a *vast* majority of the parents in the area, they had given him Calpol and Nurofen in order to keep his temperature down. This is something to be applauded as there are large numbers of families who would call out an ambulance for such a thing.

As soon as he swallowed it - pop, pop, pop, the child developed the blisters and his lips started swelling. So it looks like the child was allergic to one of the ingredients in the medicine.

Now it was time to wait for an ambulance, I knew we were short of trucks that night, I'd been bouncing from call to call including a couple that I shouldn't have been sent on but was asked to go because there was nothing else to send (yesterday's post for instance). So we waited, and waited and waited.

Then we waited some more.

And a bit longer.

And even more.

By now the parents were, quite understandably, beginning to get upset. Their child was a bit distressed, although not as much as most kids would have been. There was little I could do as, while I have an injection to reverse life-threatening reactions, it's not very nice to give it to a patient whose tongue isn't swelling up. I've sat around with patients like this before and it isn't much fun as all you can really do is monitor them and if it gets worse give then a shot of Adrenaline/Epinephrine (whatever it's called today).

I phoned Control to see if there was any chance of an ambulance. They told me that they had already put a 'general broadcast' out for this call, but there was only one crew at the hospital and they were the ones I'd just done a job with, so they would still be unloading the last patient.

I even tried phoning my station to see if there was anyone there who was waiting for an ambulance to dry after mopping out after a mucky job. There was a crew there, but they were tied up talking to an officer because they had been assaulted and were also filling in one of our emergency referrals for a child being at risk. I know the crew well and if they could have come to my rescue then they would have.

I can't take small children to hospital as the FRU doesn't have a child seat and it's unsafe to transport a small child in it's mothers arms. I asked the father if he had a car/child seat - but they use public transport. If the child was in danger of not breathing then I might have taken the risk, but while the reaction looked severe the child was more uncomfortable rather than likely to stop breathing - actually the child was having a great time playing with my car keys...

So all I could do was to monitor the child and keep both him, and the parents, calm. I like to think that I'm pretty good at this as, perhaps due to writing this blog, I can explain exactly what is happening in quite simple language. I'm also not quick to panic and my general attitude tends to lend itself to keeping people relaxed.

Listening to the child's lungs he had started to develop a little wheeze, exactly what happens to asthmatics, so I gave him a salbutamol nebuliser (our treatment for this) and it settled down almost as quickly as it had started. His tongue was still the normal size although his lips had become more swollen.

Then the ambulance crew who had been to my last job walked in through the door. They had 'turned around' their last job in just over 40 minutes, which is very fast and had then ridden to my rescue. I love the look on parents faces when they realise that the ambulance has arrived and I love the relaxed feeling in my gut when I have a sick patient and they walk in through the door.

It all worked out fine in the end - the child didn't need the injection and perked right up after some oral medicine, he spent the night and next day in the hospital under observation and made a full recovery. While it might sound daft it probably worked in his favour - at least they'll have a good idea what started this reaction and can plan on avoiding it.

While we go to a lot of rubbish on the car, this was a 'genuine job', it was just a shame that the ambulances in the area were probably going to drunks who have fallen over in the street or other minor illnesses. While the FRU is mainly used to get the government mandated targets it can sometimes be clinically worthwhile. This was such an occasion. I'd also like to applaud the parents for keeping calm while their child looked so ill, they were worried but polite and understanding. A rare combination...

I was working on the Fast Response Unit so I was on my own and pretty much left to my own devices. I'd spent part of the night driving around looking for a job to do, but there wasn't much going on for us solo responders. I had a bit of a hunger on me that I thought a quick trip to Tescos would cure. The one advantage of working on the car is that you can sometimes get decent food.
So I had a drive down there, parked up and went shopping. Plenty of chocolate and other unhealthy foods (I said you *can* sometimes get decent food, but there is little point for me breaking the habit of a lifetime). I just managed to put my shopping bags of goodies in the car when the computer terminal rang.

"17 year old male, assaulted outside Tesco".

Brilliant. The call wasn't the high priority calls that FRUs are supposed to be 'saved' for, but as I was already on the scene it would have been churlish to complain. It turned out that Control had seen me sitting there, realised that they were out of ambulances and so decided to keep me 'on scene'.

The patient was sitting inside. He had a brand new hole in his forehead made by some form of weaponry and the Tesco staff had been taking care of him. A motherly manager was fussing over him, which I thought was nice of her as he wasn't a happy bunny. He was otherwise unhurt and while the cut was pretty big it wasn't anything too serious and it had already stopped bleeding.

"So", I asked him, "Who did this?"

"Don't want to talk about it", he replied.

"OK then, did you see what weapon they had?"

"Said I don't want to talk about it".

Great, another young man who wasn't interested in throwing out any information. My psychic powers were tingling - it was pretty obvious that he knew the people who had hit him, and he probably knew the reason *why* he had been attacked. I've mentioned it before but truly random attacks are pretty rare and while it is wrong, you can generally understand why most of the people we see get thumped. I looked at my watch, there was no way I'd be able to put up with this fool playing the 'silent gangster' role while waiting for an ambulance.

"OK, come one, I'm not supposed to but I'll take you to hospital in my car".

"Thanks", so while he was untalkative he was at least polite.

I let Control know what I was doing and, due to the lack of ambulances, they were quite happy I was bending the rules.

He sat quietly in my car while I ran him down to the hospital, my attempts at conversation were met with silence. While on one hand this is an easy patient to deal with, on the other it's nice to know what happened so as to better assess the injuries he received. He wasn't impressed that I was trying to talk to him. He wanted to go to hospital and get fixed and he wasn't interested in making my life any easier.

I asked him if he wanted the police involved and he refused, which is fine by me as it reduces the amount of paperwork that the police have to do. Unfortunately for him the police were there to meet him at the hospital, the Tesco staff had called the police on his behalf and had directed them to the hospital. I don't think that they got any additional information out of him.

Before I left him sulking in the waiting room I asked him one last thing, "When you find the people who hit you, don't go and beat them up. It only makes more work for me".

His reply was a sullen grunt.

I love teenagers.

I Like Curry, tells us about his most pointless job. Thought you might like it. People are still amazed at some of the calls we had to go to...

I think my most worthless job was the 999 emergency call to a patient with a verruca, something I may have mentioned before.

I've got the hump for reasons that I don't want to go into here - still, there is the light at the end of the tunnel that I have to look forward to. The previous sentence will only make sense to a couple of people.

Some injuries are like buses, you don't see any for ages and then two come along at once.

We were called to a young man with a cut foot. The trail of blood led up the garden path up to a small pool of the same blood underneath a rather annoyed young man. While walking in the street he had stepped on a broken bottle, the glass had sliced through the sole of his trainer and managed a fairly nasty cut to the sole of the foot. It was a simple job to wrap his foot in a bandage and then stare in awe at the lump of glass poking through the trainer. He was a nice enough lad who hopped to the ambulance, and who's friend's mum had already put on a pretty good dressing. He just needed an x-ray to exclude any glass being left in the wound and a couple of stitches.

Our last job was also a foot cut on some glass, this time it was a fifteen year old girl who lives in a pub, she'd been barefoot, and as is typical with the pubs around our way, there had been a nice sliver of glass on the floor. Cue much screaming and a rather huge amount of blood. Feet tend to bleed a lot, partly because there are plenty of blood vessels in them and partly because gravity tends to make the stuff leak out of you. I'd give the people in the pub a medal though, not only had they tried using a towel to stop the bleeding, but they'd also laid her on the floor and lifted her foot above her head. If only all out patients had such sense.
She still had the sliver of glass in her foot and while we aren't supposed to touch such 'foreign objects', I believe that have enough minor injuries experience to pull it out and better control the bleeding with pressure. It's a bit nasty to put pressure on a wound when there is a two inch lump of glass in it. Needless to say the patient managed to leak the red stuff all over the floor of the ambulance and my crewmate looked as if she had performed surgery on the patient. The bleeding was controlled, the patient was taken to hospital and everyone was happy.

A question now : In 'my day' working in A&E, we'd try to find an example of the glass that the patient had been injured with, then x-ray the wound *and* the glass. The reasoning behind this is that glass shows up on x-rays in different ways depending on the type of glass. If the example glass was invisible on the x-ray then we'd take more care to examine and wash out the wound, while if the example glass was easily visible then we could be more sure that there was none left in the wound. Do hospitals still do this, as the nurse in the local A&E looked a bit befuddled when I told her about this trick? (Although to be fair she was under some strain as the department was very busy).

My final glass story happened the night before last. We were called to a 'collapse behind locked doors', the relatives of a woman in her sixties had called us because they could see the woman laying on the sofa in her house but she wasn't answering the door or telephone. We arrived and the door was well locked - there was a deadbolt as well as the normal Yale, so neither I, not my martial arts master/built like a brick outhouse of a crewmate could kick the door down. At the relatives request I smashed the bedroom window and, after some backbreaking limbo work, climbed in.
Unfortunately the patient was deceased, it's never a nice thing to try an explain to relatives that their loved one is dead and that there is nothing we can do to help. I tried to explain that the patient looked very peaceful and that she had probably passed away in her sleep. We waited for the police and left them to look after the family - I had to have a quick run back to the hospital so I could wash the blood off the brand new cut I'd given myself on my hand. A minor injury that needs no treatment, and if it meant that the relatives thought we did all we could, then perhaps worth it.

Although I have spent the last two shifts picking glass dust out of my hair/clothes/boots.

I am now listening to 'Out Of The Blue' by E.L.O in order to cheer myself up. No posting on Tuesday as I'm out at 7:45am to do about seven regional radio programmes before sadly heading off to work.

I was sent an email from one of my readers, and it's so good I thought I'd share it with you. This is from Churba who lives in Australia,

I was hanging about after work with a workmate while he had his usual after-work ciggie, and we hang around talking while he does so, because I'm waiting for a lift. We can hear the street racers having a few runs nearby, no cause for concern, and they've been going at it for about ten minutes.
Still just standing around chilling, We hear a run going, and suddenly a long screech and a weird thump. We figure one bloke has just hit a pole, nothing to worry about, saunter over and have a look once Big L finishes his smoke. Then, about two seconds after we come to this conclusion, we hear a bloke start screaming, followed by a few people following suit, but nothing like this bloke, he was really giving it some stick.

Big L and I have taken one look at each other and started running, and I'm already pulling my Small First aid kit from my bag(I'm a Rover, be prepared, all that Scouts b*****ks - Plus, its a handy thing to have) we arrive at the scene, and we see a boy-racer with some heavy frontal damage, and a buggered windscreen parked sideways about 40 metres up the road, and a crowd of people clustered around a bloke on the ground, and we couldn't see much else.

We start shoving our way through the crowd, I'm waving my first aid kid about as we shove people out of the way, and they are slowly getting the idea we're here to help - until one scared looking pollock - I'm assuming the driver of the car, as he is dead white, scared and obviously juiced on adrenaline - tried to block our way, as the bloke on the floor lets out another scream as this dickhead accidentally bumps his leg trying to bar us from helping - by now, we can see the bloke is in an obviously bad way - The bloke is just shoving me back going "Not a chance mate, He's screaming in pain, you can't help with that" - and Big L has finally caught up to me and shoves him out of the way just as I shout at him - Quoting yourself - "Good! Screaming means You're still ALIVE!" And going to ground next to the poor b*****d, I check him over quickly as Big L starts moving people back to give me some room, and to stop people freaking out, starting at the legs, going up - obvious Two Broken

Legs, and From the small amount of blood on his jeans, Probably open fractures, a bunch of Fractured Ribs

(At this point, I'm hoping he doesn't go into respiratory or cardiac Arrest, because I really, really don't want to do CPR onto fractured ribs)

I also discover he has a broken arm, and as I check his neck for wounding, I find a small, deep wound just under his jaw - Which is spurting blood, which you and I both know means artery.
Immediately, very quickly check the wound to see if there is anything in there that might get worse if I apply pressure, and then I whip off my work shirt and start applying some pressure - I for a moment take one hand and grab my mobile phone and hand it to Big L, telling him to dial 000 (Our version of 999), get an ambulance on speakerphone and hold it over to me.

He does so, and when we get onto the dispatcher, I give her as many details as possible after I have given the address, but when I get to the cut neck, she asks for more detail, sounding rather less than worried about it, While this bloke is coughing some, managing to spray blood on my chest and face, but thankfully, He completely misses my eyes and mouth. Now, I'm getting REALLY worried, because this poor bugger is losing juice fast, and something from one of your blog posts reminded me of the name of the Artery that runs just under the Jaw - So I tell her it is severed artery, most likely the Left Mylo-hyoid artery. She pays serious attention to that, and shoots an ambo out to us, and offering verbal assistance, I just ask if I should keep the pressure on it, which she replies with a positive, which I do until the EMTs get there, and they take over - Just as they are about to load the Bloke in he half gurgles, half says that he's scared - So looking to the EMT who was now applying his pressure, who nodded at me, I hopped in and grabbed his hand, and just kept telling him how he was going to be right, and how we were really close to the hospital, just reassuring him as much as I could.

When I was washing the blood off of myself, one of the EMT's comes up behind me and pats me on the shoulder, saying "Mate - You saved that bloke's life" and I tried to tell him that I'm a Rover, we are meant to help the public in situations like that, I'm trained in advanced First aid, blah blah blah, and he's stopped me and gone "Nah, mate, Not just that - how you gave the detail about his Mylo-hyoid being cut - If you hadn't of mentioned that it was an artery, It would have been dropped in priority to an broken bone call, and he would have bled out."

A top bloke, I think you'll agree, and I'm glad that the EMT took time out to tell him.

Sometimes, even when it's cold and dark and raining on your head, you have to go a bit slow.

I was working on the FRU last night, my crewmate is still off sick and will be for at least the next four weeks so finding myself without a partner and being asked to go 'on the car' is fairly common.

I'm sent to a job marked as 'Male fell onto train track, head injury, ***track current off***'. It's that last bit that I like to see...

I get there and park up at the normal parking place for the police and the ambulance, just as my handbrake goes on a British Transport Police (BTP) van screeches up behind me. A policeman jumps out, shouts, "He's on platform three", and runs into the station. I gather my equipment bags and waddle after him. (All the equipment we carry tends to slow us down).

I'm led to the patient by one of the staff. Even though we are both walking quickly and with purpose a passenger still tries to stop the station worker to ask if there is a replacement bus service. I'm guessing that obviously leading a heavily laden ambulance worker to a patient is less important than her trip home...

The patient is indeed laying on the tracks of the Docklands Light Railway, around him are several BTP officers and station workers. Some of them are down on the tracks with him, so I know that the area is safe. They have already covered him with two blankets and put a dressing on his head wound. Wisely they haven't moved him, so he remains pretty much facedown. They have been talking to him although they say that he isn't making much sense.

I jump down onto the tracks (it's about a five foot drop) and start to get a feel for what has happened and how badly injured the patient is. He's not behaving normally, in fact he's acting 'post ictal', which is a side effect of having had a seizure. There is what I would call a 'reasonable' amount of blood swilling around the puddles on the track. I know I'm going to get 'bloodied' in this situation, so I dive on in.

I'm not happy with the distance that he fell. One of the station workers was talking to the patient as he fell onto the tracks and his head bounced off one of the rails, which explains the blood that is covering everything. The worker then tells me that, after falling and hitting his head, the patient had a fit for about a minute. It's all starting to come together.

"When you talked to him, before he fell, did he sort of go all stiff?", I ask the station worker.

"Yes, his eyes kinda went funny".

So now it looks like the patient started to have his fit while standing on the platform, fell back onto the tracks and has landed on his head. I'm not happy about moving him. His head has travelled about eleven foot, and I can't rule out a serious injury to his neck. So now there is little I can do beside give the patient oxygen, try and reassure him and get rained on.

Thankfully the ambulance crew are quick to arrive. I explain what has happened and they agree with me that the best course of action is to 'collar and board' the patient before moving him off the track. We do this to protect the patient's neck and back - if he has damaged his neck then the hard collar and head blocks that we fit around him will reduce the chance that moving him will damage his spinal cord. A damaged spinal cord can result in paralysis or death - so we don't want to make any injury worse.

Unfortunately this takes time, especially when you are dealing with a wet, semi-conscious patient in the dark. As we are preparing to secure the patient he has another fit. Then he has another fit as we are trying to strap him to the scoop so we can lift him off the tracks. Thankfully he has a clear airway throughout and the fits don't last too long. It's one of those situations where you need to go slowly in order for the patient to receive the best treatment.

Throughout this we can hear the station tannoy announcing delays due to 'a person on the tracks'. So now, dear tube traveller, you have an idea what is going o when your train is similarly delayed.

The Transport police have been very helpful throughout and now they and the station staff help us lift the patient onto the platform and then onto the trolley. The police want to know how the patient is going to do, if the injuries are life-threatening then a much more in-depth investigation needs to be carried out.

I tell the police that, to be honest, I don't know how seriously the patient is hurt. While the fall may have been caused by an epileptic fit, the head injury is nothing too serious and the further fitting is his normal pattern of epilepsy. Or alternatively it may be that the patient may not be epileptic at all and may have just fainted onto the tracks and the that the fitting is being caused by bleeding onto the brain.

We load the patient onto the ambulance, now he is in the warm, dry and well lit ambulance we can cut off his clothes and make a proper inspection of him. Physically he seems unhurt apart from the seizures and the head injury. We need to decide which hospital to take the patient. We could take him to Newham hospital, which is about three minutes down the road. While this has a good A&E and is very close it doesn't have the resources of our second choice, the Royal London. We choose the Royal London mostly because if the patient does have bleeding on the brain, then that hospital has neurosurgeons that can operate on the patient. If we took the patient to Newham hospital and he needed neurosurgery then he'd have to be transferred, all of which takes time.

So we go (under blue lights and sirens) the further distance to the Royal London. I travel with the crew in case something nasty happens during the transport. The patient has a further two fits while on our way to the hospital.

However, we safely reach the hospital. Wheeling the patient into the resuscitation room he chooses that moment to start to lose control of his airway. It's annoying, we look after him all this time, then as soon as some doctors see us the patient gives them the impression that we have been letting him choke to death.

Nevertheless, he is safely in the hands of the doctors. We have done our job by not letting him get any worse. By bypassing the nearest hospital we have got him to a center than specialises in his potentially serious injury. A job well done and the crew and myself feel happy that we have helped someone who really needed it (unlike my mate who went to a young woman with period pains...).

The only problem is that the back of the ambulance looks like a bomb has hit it, I'm covered in blood up my arms where my gloves stop and my hi-visibility jacket is likewise covered in blood and train oil and possibly other substances. I have only one such jacket and as I'm working for the next six days, I wonder when I'll be able to give it a wash.

Oh well - a dirty jacket is the sign of a hard worker. Right?

And I appear to have lost my wristwatch...Bang goes £20.

It’s normally pretty easy to get a patient out of a house.  They either walk, or we put them on our collapsible carrying chair and carry/wheel them out.  Occasionally you come across a job where that simple approach isn’t going to work.  This is often a ‘satisfying’ job as you have to problem solve for a change.

We were sent to a teenager that had hurt her leg playing football in the garden.  We arrived to find the girl laying on the living room floor.  Also present was her mother, older brother and baby sister.  The girl had indeed been playing football and, due to circumstances that I shall obscure for reasons of privacy, had broken her leg right up where it joins with the hip.

This is often an injury related to age, old people fall over and ‘break their hip’, and this was the exact same injury.  The problem with this is that we can’t really carry them out on our chair because of the pain and further injury that can be caused by the two ends of the bone grinding together chewing up muscle, nerves and potentially damaging the main artery that supplies blood to your leg.  If you damage that it’s very easy to bleed to death.

“No problem”, we thought.  The girl herself is light and the mother and older brother are sensible people.  So we warned everyone involved that it would take a bit of time to remove the patient from the house in a safe and as pain-free as possible manner.

Now, with a patient like this we would normally put our scoop underneath, strap them in a bit and then lift them onto our proper trolley-bed.  Unfortunately, in this case, the angle to the front door was such that we wouldn’t be able to get our large trolley-bed into the house, and giving the scoop a dry run, we wouldn’t be able to fit that out the front door either.

Didn’t those people who designed houses eighty years ago consider modern ambulance stretchers?  Typical really.

So we sat an thought for a moment, the patient was calm (and by now the pain relief we had given her was working), the mother was calm, the older brother was calm, baby sister filled her nappy (that or my crewmate farted but managed to keep a straight face).  Could we go out through the garden?  Nope, no access to the street through that route.  Could we open the living room window and pass her out that way?  Nope, the design of the window precluded us doing that.

Brain-wave!

If we strapped the patient to the scoop really well then we could tilt the scoop up by 50 degrees and fit the scoop (and patient) through the door.

However this involves a lot more strapping in a way that we don’t really get much practice in.  Then you follow it up by a bit of faith that when you lift the scoop up the patient isn’t just going to slip out the end of the scoop and end up in a painful heap on the floor.

So we explained what we were going to do (Rule#1 in keeping patients calm, explain what you are going to do) and spent the next ten minutes tying her to the scoop, hoping that we were doing it right…

Then came the moment of truth – we lifted her up, carried her towards the door and tilting her up held our breath.

It worked perfectly, she didn’t move an inch, she didn’t cry out in pain and most importantly – we didn’t drop her.

From there it was a simple job to carry her to the ambulance where we travelled as carefully to hospital as possible in speed-hump infested East London. 

She was seen pretty much immediately by an A&E consultant.

 

Job’s a good’un

I think I've mentioned it before that the Helicopter Emergency Medical is a charity, it receives no funding from the health service or the government. That big whirly thing in the sky that swoops down on Londoners who have been mashed up by large chunks of machinery? Charity all the way.

A stupid way to fund a service that, when it is needed, provides some serious assistance to some of our trickiest jobs.

There are two men who are undertaking a painful operation in order to raise money to continue providing this service... Well, I'll let them tell you.

After a night out on the town and a few beers, myself and a colleague from White Star Medical Ltd have agreed to have our chest, belly and legs waxed in aid of London Air Ambulance (White Star Medical's charity of the year).

This event is planned for Monday 2nd October at The Blind Beggar public house in Whitechapel by The Royal London Hospital where the London Air Ambulance is based.

It costs £1,000 just for the London Air Ambulance to take off and save lives! They take off 3 - 4 times a day and this financial year will need £750,000 to cover rising costs of fuel, insurance and so on.

It's going to hurt, so help the pain with a donation!

*** If I make the target of £2,000 I will put a movie of the event on the Internet for everyone to see ***

So go here to sponsor them.

Brave souls, I'd have to raise more than £2,000 to wave goodbye to my manly chest hair (and back hair/belly hair/leg hair/foot hair/nasal hair/shoulder hair...)

(Don't worry about the charge the site makes - it works out cheaper than processing cheques and the like).