It's been an absolute age since I last went to someone in the process of being sectioned.

For those of you not well versed in English law as it pertains to mental illness a 'section' refers to a part of the Mental Health Act 1983. Most often it is used to describe admitting someone for mental health assessment against their will. The section that I most often come across is the police using Section 136 which enables them to remove to hospital the naked man running down the street screaming that he is off to kill the aliens who are putting thoughts in his head.

Don't laugh, it's happened.

But on this day we were sent to two 'Section Two' cases, people with a mental illness who are a danger to themselves or others. These are often a bit of a circus to be honest, you have a social worker (and probably their backup), two doctors (and sometimes their drivers) a stack of police (normally around six, it case it all 'kicks off') and an ambulance crew. There is a lot of hanging around on street corners waiting for these various people to arrive. You also have all the neighbourhood turning off their 'Jeremy Kyle Show' and instead putting chairs out in front of their houses to better watch the show.

Not good if the patient is distressed already. But then, that Bedlam spirit of gaining entertainment from the mentally ill has never really gone away.

I have no idea why you need an ambulance to take a physically well person to hospital. There are two ways that a Section two job goes - either the patient agrees to go to hospital (and can therefore travel in a car) or they refuse, in which case the safest place for them to be is in the back of a police van. I have no idea why it needs an ambulance to take this patient to hospital at the cost of £400+ in addition to removing an ambulance from frontline duties. While we are doing this we could have been dealing with the mental health patient who can't wait for an appointment. If the patient decides to get violent you find yourself struggling in the back of a van with loads of equipment that can be broken or used as weaponry.

But, at the end of the day, it's often an easy job - even if we are just being used as a very expensive taxi.

At both jobs the patients decided to come into hospital of their own accord, which is nicer for everyone. At the first job the Social Worker in control said, "Oh - I'm glad we didn't have to wait for you" to me and then wandered off - no-one thought that it would be helpful to tell the taxi driver anything about the patient.

At the second job we didn't even get that - the patient walked out, the Social Worker managed to string the words. "He he is - I'm driving back on my own" together and then vanished. Under a Section Two we aren't supposed to transport without an escort, so a police officer was pressed into service. Again the patient was fine the whole way, but it did seem that the receiving ward had forgotten that he was coming in that day.

I love to see that whole 'synergy between healthcare professionals in a multi-disciplinary, multi-pathway in an ethnically aware process' thing happening.

I'm not prejudiced, my dislike of social workers is based on experience - if I meet some who are good at their job and polite to me then I may amend my position.

I'm still waiting though...

Ah, the glory of taking three days off to do absolutely nothing that I don't want to do. I mean, everyone else has a bank holiday, why shouldn't I...

Now, of course, I have a huge list of things to do. But first an ambulance story...

I could have sworn that I've already told this one, but I couldn't find it anywhere. If this is a repeat then just blame my crappy memory.

I've mentioned it before that if I have the chance to climb something or to climb through a window then I will - so when we got a job described as 'Child fell off seven foot tall fence', I was hoping that he was on the other side.

It was a good job he fell on the other side - he had a softer landing. I say softer, instead of landing on concrete he'd landed in a bush of nettles.

Climbing over the fence was no problem, landing on the other side was a little trickier as my knees are getting old.

The story that we had from the large number of friends that were present was that our patient had been chased by a 'big dog', and in order to get out of the way the boy had scaled the fence and fell over the other side.

We didn't believe him for a second. He'd been with friends (who smirked somewhat as he told his story) and the garden that he landed in belonged to a derelict house, the windows and door sealed with metal plates. I'm sure that I'm not the only person reading this who used to play on disused land.

The dog, obviously, was nowhere to be found.

I suggested that I could call the police to let them know that an aggressive dog was on the loose - the friends let me know that it wouldn't be necessary.

The trouble of course was that our patient was on the other side of a seven foot tall fence. He'd also injured his ankle and I suspected a fracture.

Did I mention that it was dark and we were surrounded by a dozen teenagers? As well as the fence which we would have to lift the patient over.

Actually his friends were as good as gold, they would help me out by holding torches and mobile phone lights on the patient and by keeping him occupied while I got his leg into a splint.

After I'd assessed him I noticed that he was wearing female socks (pink and sparkly). I find that sometimes the best form of distraction therapy is to mildly mock the patient. I asked him if he usually wore womens socks. Bless his friends as they tried to cover for him by telling me that they were the latest fashion.

His mother arrived on the other side of the fence and let us all know that he was wearing her socks because he didn't have a clean pair of his own. She then shouted over to (jokingly) ask if he was wearing a pair of her knickers as well.

We explained to the mother what had happened and she was really sensible and unworrying. Reminded me a bit of my mum actually - you hurt yourself, you obviously aren't dead or missing any important bits of your anatomy and so are fair game for those magic words, "I told you so...".

To get our patient out we called out Trumpton The London Fire Service and they lashed some ladders together each side of the fence and one fireman came over to help me. I'd strapped our patient into our scoop and we would use that to get him out. Lets just say that lifting him to waist height was no problem. The 'jerk and lift' above our heads was a different matter (for me at least).

But after a bit of lifting and grunting (again, mainly on my part) we soon had our patient and his mother in the ambulance. Some further assessment and we were off to hospital where it turned out that the patient had only sprained his ankle rather than broken it.

A 'fun' job, no-one seriously injured but a bit of thinking needed on our part, a fun patient and a sensible mother. Could hardly ask for anything more.

I really want to moan about our Control dispatcher today – but, you know, if I said what I really wanted to say then I’d probably lose my job.  Suffice it to say that they [Deleted as I would like to keep my job...]

But enough of that…

 

A happier thing occured today – I was in work at 6:30am and out by 6:34am for a transfer from our local hospital to a hospital in sunny Essex.

I think I’ve mentioned before how it seems that when a hospital calls for us to transport a patient, the patient is never ready?  In this case we waited an hour at the hospital for the patient to get an x-ray and have his dressing changed.  Not a problem as it meant that I could finish my first (and only) cup of tea of the day.

The patient was a young man who walked onto my ambulance, didn’t cause a fuss and just fell asleep on my trolley for the duration of the trip.  It had been a long night for him and it meant that I didn’t need to try an make conversation for an hour with someone whose grasp of English was spotty at the best*.

We then turned around and headed back toward London – the beautiful weather and the simple job had put my crewmate and I in a very good mood and I was even able to have a little nap myself as we drove down the M11.

Not many jobs let you do that…

It set us up for one of those days that was completely stress-free (with the exception of the aforementioned Controller).  It’s sunny days like this when you are cruising around London with the window down and the radio on, going only to nice patients that you realise that you are incredibly lucky.

It does all go to pot when you start getting your regular drunks mind – but it’s good while it lasts.

 

*Not me – the patient.

I have a theory as to why the government refuses to properly fund ambulance, A&E and social care services.

 – Most of the people who use these services are old, as in retired old.

 – Retired old people don’t pay taxes, but they do cost benefits.

 – The above services prolong the lives of old people.

 – Therefore, if we don’t fund them then more old people will die and save the government money.

 

Simple really.

Is anyone going to this on Saturday – if you are then you may spot me roaming around with a camcorder talking to people.

I had an email from a neighbour of the house that caught fire (for it is indeed a small world); I asked them to make sure that the owners knew where their cat was, I'd left a note but I know how such things can got missing when your house has been wrecked.

They emailed me back yesterday to let me know that the owners had been reunited with their pet, and that he was apparently doing very well.

Now I just need to try and find out how our cardiac arrest is doing...

"Funny place to be drunk...", I said.

We were being sent to a 'Not breathing' at one of the bridges around my patch. Most 'not breathing' calls to public places are drunks, but this one didn't 'smell' right. Sure, there is a pub underneath the bridge, but there was something about it that made me think that it might be genuine.

It doesn't make a difference to my driving what I'm thinking - I'll get there as quickly and safely as I can, even if I know it's one of our local drunks.

The bridge is a dual carriageway with a divider down the middle and as we approached we could see them on the other side of the road - there were a few cars parked there and a person standing there waved at us as we drove past. He didn't look too bothered.

We spun around the roundabout at the end (narrowly missing some idiot who not only doesn't know how to give way at a roundabout, but jumps out on ambulances that are all lit up) and approached the two parked cars.

It immediately struck me that there was a man laying his back, with another man doing very effective CPR on him. Looks like the call was a genuine one!

I stopped the ambulance and told my mate to grab the 'shock box' and look after the patient; I would get the trolley off the back of the ambulance and we would 'scoop and run'.

The patient had been a passenger in his son's car, then he had suddenly collapsed. The son had pulled over to find that his father didn't have a pulse. A man driving behind them had stopped to offer some assistance. He'd recognised what was wrong and had started the heart massage.

By the time I'd managed to get the trolley and maneuver it through the traffic (which was whizzing dangerously close to us) my crewmate, who has been out of training school for less than a year, had diagnosed the patient's heart rhythm and had given him a 'shock'.

It was about then that another ambulance and an Emergency Care Practitioner arrived. We loaded the patient onto the ambulance and started some advanced techniques. I kept bouncing up and down on the patient's chest.

Then the patient got their pulse back!

And he started breathing!

Time to drive to hospital...

When we got to the hospital the patient was given a good chance of surviving his 'death' - he has the best chance an outdoor cardiac arrest ever has. While what we did was important it was the man who was driving behind the patient, stopped his car, pulled the patient out and performed very effective heart massage for the eight minutes it took us to get there.

...and... while I may often gently mock the St. John ambulance service - the man who was doing all this was one of their members.

So if the patient survives, and he has a pretty good chance, it'll all be because of the help that bystander gave. Unfortunately I was too busy to tell our good samaritan this - so with a bit of luck someone who reads this might know him and pass on my thanks. He deserves to know what an effect he had on this patient.

Of course now I'll get a reputation for being soft on the 'Johnnies'...

The Universe has a strange sense of humour - I can say this because no sooner than I ask for something a little different from the tales of doom and gloom I have been 'entertaining' you with than one drops in my lap. This post will also make my mum really happy and proud of me...

In fact it's so perfect I took some pictures so that you would know that I wasn't lying.

The call was given as 'House fire - persons reported inside', an interesting job. So at 1am in the morning we fly through the streets to find firefighters having just dowsed the fire that has wrecked a house. I spoke to their top man and he told me that they had checked the entire house and that there wasn't any people inside.

It's then that I looked down to see a firefighter on his knees giving oxygen to what I thought was a baby.

With a longer look I was extremely happy to see that it wasn't a baby.

It was a cat.

The poor little soul was covered in soot and was having real trouble breathing - it was panting like a dog, and the rate of it's breathing was incredibly fast. The firefighters were giving him oxygen and trying to keep him warm (as he'd been soaked by the firefighter's hoses).

One of the firefighters seemed a bit upset, "Don't lose him, we had a cat die on us last week".

I let them know that we would take the cat.

So we picked him up and took him into the back of the ambulance, the neighbours who'd all gathered to watch the show seemed bemused. Unfortunately the owners of the house couldn't be found, so the cat had suddenly become my responsibility. We dried it off and gave it oxygen - in the picture you can see a McIlroy funnel which is used to give oxygen to neonates.

This is the first (and hopefully only) time I've ever needed to use it.

The cat really didn't look well, I'm no vet and I've never kept a cat, but I could see that this was serious.

I listened to it's chest and it sounded...well...kind of normal. But I have no real idea what it should sound like.

I radioed our Control.

"Hello Control, erm... This is going to sound weird", how best to phrase this? "We have no human casualties at this call, but I do have a very sick cat with smoke inhalation, I'd like to take it to the 24hr vet hospital at Wanstead. Mainly so that I can sleep tonight. Can you ring them and let them know that we are on our way please?"

There was a long pause, the controller was probably talking to her senior.

"Roger that ambulance - we'll show you headed to the hospital, do you know their phone number?"

I let them know that I didn't.

Then another crew who had been listening in on the conversation broke in and gave Control the number to the hospital.

We whizzed down there and was met by a vet and veterinary nurse who did lots of clever things to it, including giving aminophylline and doing the worlds smallest venous cut-down. It's breathing became a lot better and the staff seemed hopeful for it's chances. We gave them the address of the house so that they could reunite the animal with it's owners.

Now some folk will moan that we used an ambulance to look after an animal - but this 'patient' was the only one who actually needed an ambulance that night, we'd been dealing with drunks for much of the shift. So if you want to moan, then moan away - but it was good for the mental health of my crewmate and myself.

I'd like to just say a big 'Thank You' to the Control staff who let us run to the vet hospital and also to the vet hospital staff who helped us out. Also thanks to the crew that gave Control the phone number to the hospital. Because of them I can hit send on this posting and can sleep soundly knowing that we did the best we could. Even if it did make the ambulance smell of wet smoky cat poo for the next hour.

We had been on a rest-break, but Control had interrupted our break in the last fifteen minutes (which is fine by me as we get financial compensation, and I'd rather not be named as 'Medic on tea-break while my child died' in The Sun)

The call was given as a 'elderly woman collapsed behind locked doors, possibly deceased'.

We got round there as quickly as possible (after taking a detour due to a council rubbish truck sitting in the middle of the road, obviously picking up some cardboard boxes was much more important than whatever we were going to). Our FRU was already there, as was the patient's nephew.

The front door was shut and our FRU pilot was nowhere to be seen. WE knocked on the door and it opened a crack. The familiar face of our FRU appeared in the gap.

"She's laying in front of the door - I climbed in from the neighbour's back garden".

We made our way through the neighbour's house and stepped over the two foot fence that separated their gardens.

The first thing that I noticed was that the house was spotless, our patient was originally in good health.

Then I saw her laying in the corridor.

She had been there for probably twenty-four hours, there was no carpet so she had been collapsed onto tiles overnight. The entire right side of her body was a huge bruise.

As you get older your skin becomes less resistant to damage, so you bruise easily, tear the skin easily and can get pressure wounds. The weight of a body can cause the flow of blood to become interrupted and unless you move (which is what people normally do) then the skin and underlying tissue can die.

You end up with wounds like this (Warning, you may not want to see this).

The right side of her body was likely going to become like the above picture.

It became obvious that she had suffered a stroke - she wasn't moving the right side of her body. Her left hand kept snaking out and grabbing at us and you could see the fear in her eyes.

She was also as cold as a block of ice. Being unable to eat or move, stuck in the draft from her front door in an unheated house meant that she was suffering from one of the worse cases of hypothermia I'd ever seen.

Her core body temperature was 28 C. (82.4 F)

We carefully removed her to hospital - any sort of physical shock at this temperature can cause the heart to stop. All we could do was to make her as comfortable as possible, wrap her in blankets, hold her hand and talk to her.

With a hypothermia this severe the hospital can rinse warm fluid around your internal organs after making a surgical hole in the abdomen - in this case though the risks to a patient this frail meant that they stuck to the safer warming blankets and warmed fluid into the veins.

It's unlikely that she will survive this episode. I hope that the stroke affected her mind, and that she wasn't aware of what was happening to her. I can't imagine what it must have been like, to lay there for so long, unable to move, gradually getting colder, not knowing if help was ever going to come.

I hope that it affected her mind, but with the look in her eyes I think that she knew exactly what was happening.

It's not a good way to end 80+ years on this planet.

---

It seems that all I'm writing about at the moment is sad things - hopefully I'll have some happier stories to tell in the near future. At least I have my Mac laptop back and can work on answering some emails.

Any doctors in the house?

If so could you answer me this. Why would a large brain bleed (probably an AVM) cause ischaemic ST changes in the 12 lead ECG?

Just curious.

(For everyone else, a proper post after I wake up sometime this afternoon...)