The radio squawked into life, "Can anyone assist with an emergency call in Alice street?"

We were around five miles away and there were three ambulance stations between us and the call, obviously everyone else was further West than us or already busy on their own calls.

"Sod it", I said to my crewmate, "It'll be fun for you to have a decent run on blue lights..."

So we made our way there as quickly as we could in the traffic that seems to come from nowhere at 11pm in East London.

As we approached the scene we saw our FRU already on scene along with a van full of police. My heart sank, I knew that this wasn't going to be a simple job as I could see the police stringing the 'Do Not Cross' tape around where our patient was lying. The locals, as usual, were ignoring the tape, the police were getting exasperated.

Jumping from the ambulance I headed over to the patient. Our FRU paramedic was leaning over the patient's head and as he straightened to greet me I saw that the patient's head was... well... mushed.

He had huge swellings around his eyes and head, he was semi-conscious and covered with blood and vomit.

"Apparently". our FRU told me, "he's been hit once with a lump of wood".

Looking at his head I wondered why, if he'd only been hit once, it was such a strange shape.

"OK", I said, "We aren't going to hang about, lets run him to hospital".

There was some commotion as his drunk friend gave his story, in fractured English, to a police officer while more locals ignored the police tape which was cordoning off the crime scene. I needed to know how many times the patient had been hit, as it would change my treatment of him. His friend was adamant, he was only hit the once and his face normally looked misshapen. It wasn't outside the realms of possibility that our patient was just... ugly.

As we lifted the patient onto the trolley he let forth a long stream of vomit, my boots were merely splashed.

In the light of the rear of the ambulance I could take a closer look at our patient - he did have a very lumpy head along with plenty of 'soft tissue injuries' to the face. One eye was swelling up and he was still leaking blood from a large cut on his scalp. He was still semi-conscious and I made the decision to 'blue' him into hospital.

But which hospital? If I was sure he had a brain injury then I could take him a couple of extra miles to a unit with a neurology unit, but, if his drowsiness was as a result of alcohol (and we had been told that he had been drinking a lot) then the much closer local unit was a better bet. In the end I decided on the closer unit, they would be better able to assess him and if needed could easily transfer him to the hospital with the neurology unit.

So, after making sure that he hadn't been stabbed or shot (not..ahem...unknown in East London), we started towards the hospital.

The police officer who travelled with us asked if our patient's injuries were life threatening, I could only reply that it was a possibility but he'd have to wait until the hospital ran some more tests.

It was only as we were pulling into the hospital that I noticed one of his pupils was getting larger where previously they had been equal - this is not a good sign as it is an indicator of a serious head injury, it's normally quite a late sign though and he didn't look that neurologically impaired. Still it was too late to change our destination. During the transport he had turned his head to vomit on the floor (and this is the picture at the top of this post), and on arriving at the hospital did the same on the lift of the ambulance.

Straight into resus and I gave my handover to the doctor in charge - the team descended on him and, after booking the patient in, we left to begin the long, smelly and mucky task of cleaning out the back of the ambulance (and changing my now spattered uniform).

We went back to the hospital later to find out what had happened to our patient - after exhaustive tests it was found that his facial bones had been broken in
several places and he had a fractured skull - his friend had obviously been lying when he told us that he had been hit only the once. The reason why the patient's pupil had started to change was because the optic nerve had been damaged, there was a strong chance that he would lose the sight in the affected eye.

Thankfully I'd made the right decision, after CT scans it was determined that there had been no brain injury and that the reason he was so 'out of it' was because of the alcohol he had drunk over the night.

It later transpired that the beating was in part due to the 'inter-tribal' warfare that often takes to the street of London. Country 'A' hates Country 'B', and so they decide to beat each other up. The ambulance service and A&E departments along with the police are the lucky souls who get to pick up those pieces.

OK, I have now run out of stories to write about, so I hope I get something 'interesting' in the next four days... Also I now have an empty Inbox, so if you have sent me an email and expected an answer then it's been lost somewhere.