Feigned Illnesses

One of the tricks that people use when they've been chased and caught by the police is to feign some sort of medical illness in the hope that the police will take pity on them and not arrest them.

This invariably results in the police calling us. The most common conditions that are tried on are chest pain, fitting, and the old favourite - unconscious.

I received a call from the police, and the only information that was given was that it was to a male unconscious. I arrived to find half the met there, and was led to the patient by one of the officers, who told me they'd found him behind some bushes after a short foot chase, and as soon as they'd apprehended him, he'd collapsed to the floor and was apparently unresponsive.

It was dark, so I got one of the officers to shine his torch onto the patient's face - and his eyes screwed up a little from the light. That was the first giveaway. The second was when I touched his eyelashes and his eyes flickered. He still refused to believe the game was up and wouldn't talk to me, so I applied my pen to his finger nail, pressed down on it and rolled it. This is to assess whether the patient responds to pain. Ear pinching is a bit feeble, and most people can stand that.

That did the trick, and I was rewarded with the usual response of "Ow! Get off my finger - that fucking hurts!" I told him to open his eyes and start talking to me and I'd stop doing it. He did.

I did all the usual checks, and I couldn't find anything wrong with him other than having pupils the size of dinner plates which suggests he's taken something - possibly drugs or alcohol, but he denied drinking or taking anything. He was arrested by the police and taken to hospital in handcuffs.

I've had people doing pseudo fits, to which a sharp bang on the floor with my hand usually makes them jump - which it wouldn't if it was a real fit, so that gives that one away.

The only ones we really have to be careful with are chest pains, because we can't disprove they're having them, but a 12-lead ECG involving having to shave some of their chest hair off, nasty tasting aspirin, even worse tasting GTN spray, a cannula in their arm and various blood tests and arterial blood pressure assessment at the hospital (involving a needle being pushed into an artery usually in the wrist or groin which bloody hurts) usually discourages them from trying that again.

Regular Caller

The other day, Neenaw commented on regular callers.

Well today I went to a regular caller who I thought had dropped off the face of the earth.  The job was at a railway station, and was given as a 36 year old male with chest pain, intoxicated, passive.

I arrived to see the patient standing next to the payphone he’d called from, and I recognised him instantly.  Last time I’d gone to him, he was complaining of having painful feet for four years.

Today, he told me he’d called because he wanted the suitcase at his feet carrying upstairs, across the footbridge, and down the other side so he could catch a train.  He said his “chest pain” had gone.

When I refused to carry his case, but suggested he go to hospital to have his chest pain investigated, his complaint progressed to having post-traumatic stress disorder.  It was getting a little wearing, and I was giving him a lecture on inappropriate use of the ambulance service when the crew turned up.  The paramedic on it got out and was fuming.

“Don’t fucking talk to him!” she shouted.  “This is the third time I’ve been to him today – the first time was to actually find his bloody case!”

Each call had been a Cat A, so not only had he had three ambulances today, but he’d also had three FRUs.  Apparently he’d called four times yesterday.

To cut a long story short, we ended up calling the police because he was refusing hospital, and we just knew if we left him he’d only call again.  In the end, before the police arrived he was last seen leaving the station on a train after tricking some poor unsuspecting member of the public to carry his case for him (which was filled with old newspaper and used Tesco carrier bags).

I’m back in next on Tuesday night.  It wouldn’t surprise me one jot if I end up going to him again.

Drivers & TV

Why is it that drivers block you in while you’re on the way to a call then shrug their shoulders as if to say “What am I supposed to do?” when you give them a blast of the siren?

“Drive forward love, I can’t drive through you!”

On a totally different note, I got an e-mail from my sister today telling me that she’d seen me on Trauma Uncut on BBC3 on Wednesday evening with a “speaking part” as she described it.  My speaking part consisted of “Ready, Brace, Slide!” as we were getting a woman out of her smashed Mercedes and onto a spinal board.  Hardly major league TV exposure.

I remember the job – what they didn’t show was me drawing up a flush to put in a cannula to stop blood clotting in the tube and turning round to find the camera so close it was nearly poked up my nose, but then I can understand the need to censor a view up my snout.  A cannula is the “needle” that is put into a vein for IV access.  Really, the needle is only there to pierce the skin and the wall of the vein.  Once in the vein, the needle is withdrawn leaving a tube in the vein.

My dad missed it – he’s now making sure he sees every episode of Trauma Uncut until I’m shown again.

Car Park

I was sitting in the car filling out the necessary forms at the start of my shift before going to make a cup of coffee when the mobile phone rang.

“Are you the night turn?” asked the dispatcher.
“Yeah, have you got a job for me?”
“Yeah it’s a Sector request for an Amber call so I can’t send it to your MDT.”

This is quite common.  If the sector are holding a call that isn’t a category A call but sounds dodgy or they think has possibly been miscategorised, they’ll ask the FRU desk to send a car.  The only problem is that the FRU desk can only send category A calls to the MDT, so all other categories of call have to be given “the old fashioned way” – pen and paper.  I got a piece of paper ready to take the details.

“It’s to a car park,” they gave the location, including a map reference so I could look it up quickly.  “It’s to a male who’s fallen 30 feet from the second floor of the car park.  Sector are sending an ambulance but have asked us to send you as well to give them a hand.  Can you report for HEMS please?”  This one had been miscategorised.  A fall from 30 feet meant there was a high probability he was dead.

I arrived to find the crew already on scene.  The car park attendant wouldn’t lift the barrier for me to drive in so I took a ticket.  The other option would have been to drive straight through the barrier but I didn’t think that would go down too well.

The patient was laying on his back on the ground floor of inside of the car park.  I got a rundown from the crew as to what had happened.  The chap and his girlfriend had been out doing some shopping, on returning to the car had been messing around and fallen over the parapet.  His girlfriend had caught his arm and tried to pull him back up but he was too heavy for her and she had to let him go, and he’d fallen through some steel bars on the way down.  

Amazingly he was alert and complaining of pain in his back, chest, stomach and legs.  Another ambulance crew arrived so I left them to deal with the patient while I rang the HEMS desk and told them what had happened and what was wrong with the patient.
Because it was dark, they were responding in the car, and I was told they were about 10 minutes away.

Then I got the patient’s details – name, address, date of birth, medical history, allergies etc – from his girlfriend,  and I made two more copies to give to the crews for their paperwork.  I still didn’t know how he’d got from the floor outside over the ground floor parapet and back into the car park.  I asked the girlfriend, and one of the car park staff said “Oh, we lifted him over.  We thought it would make it easier for you guys.”

I gave him a polite lecture on the importance of not moving people who have fallen a long way, then asked him to arrange for me to be allowed out of the car park when I was ready to leave because I wasn’t going to pay the ticket.

The crews had got the patient in a neck collar and on a board ready to put onto the ambulance.  HEMS still hadn’t arrived, so they wheeled him out of the car park to the ambulance outside (it was too tall to get into the car park), and the HEMS team arrived as they were loading him on.  I took the patient’s girlfriend to the hospital in the car as there was no room for her in the ambulance with the doctor and the crew in there as well.

The guy was very lucky – he managed to get away with a broken rib and a ruptured spleen.  He could so easily have been dead.  Someone was watching over him that day.

Comments

I've just deleted a couple of comments from my last post as they could have been seen as offensive.

If I continue to get such comments, I will have to turn off anonymous commenting or even moderate comments before they are posted to the list.

Thanks

Crunch

I don't believe it! Some bugger's run into the back of the FRU while I was on station. I'd left it parked just outside the gates, and when I went out to do a job, I found the lens from the left hand back light in pieces on the floor, but no other damage to the car.

Whether someone's come round the corner too wide and hit it, or whether some vandal has broken it I don't know. With the wonders of surgical tape, it's now artistically taped up into place as best as possible to see me through the rest of the night until it can be seen by the fitters in the morning.

That's something that's always puzzled me - we run a 24 hour service, but the fitters only work during the day, so if something breaks at night, then you've had it.

There's no spare cars either, so I'll just have to hope my handywork holds. It was a bit of a jigsaw.

Mind the bumps!

Dull Weekend

There’s not been much to write about from this weekend’s shifts. The only calls that I could possibly defend as being “genuine” jobs were a 2 year old boy with croup and a lady I went to that was categorised as an Amber 2, which is not classed as being life-threatening, which was a crew request for me to attend to assist them in getting the patient out of her 3rd floor flat into the ambulance using a carrying sheet because her blood pressure was so low that they thought she would go into cardiac arrest if they sat her up on the carry chair.

The funniest so far was a lady in her seventies who fell over and banged her head in the street. When I asked her why she’d fallen – had she tripped, or become dizzy, she said she fell over simply because she was drunk. At least she admitted it I suppose.

The biggest waste of time award so far has to go to the 62 year old lady who called us because she had a cold, a dry cough, a headache and felt sick. So she had ‘flu then.

There's always one with the "Oh God" factor, and that was to a drunken male who'd fallen over and banged his head. One of his mates has just finished his first year studying to be a dentist so declared himself "medically trained". These are the worst, because they insist they know more than you, when infact they know sod all about pre-hospital emergency care. Apparently he also annoyed the doctors in A&E because he took to questioning their assessment too, despite it matching mine and the crew's assessments.

Still, never mind. I’m sure there’s more to come tonight…

You Might Be In The Health Care Field Too Long If…………

Discussing dismemberment (or rectal exams) over gourmet meals seems perfectly normal to you.

You find humour in other people's stupidity.

You believe in serial spraying of Prozac.

Your idea of comforting a child is placing him in a papoose restraint.

You believe that "Shallow Gene Pool" should be a diagnosis.

You believe that the government should require a permit to reproduce.

You think unspeakable evil will befall you if anyone says "Boy it sure is quiet around here".

When you are out in public you compliment complete strangers on their veins.

You have ever wanted to hold seminar "Suicide…….getting it right the first time".

You have ever had to leave a patient's room before laughing hysterically. (Have had to do this several times)

You think caffeine should be available IV form.

You have restrained someone and it was not a sexual experience.

You commonly utter the phrase "What changed tonight at 2 am that made it an emergency AFTER SIX MONTHS??"

You believe that "Too stupid to live" should be a diagnosis.

You think putting a Valium salt lick in the A/E waiting room is a novel idea.

When you mention vegetables, you are not thinking of a food group.

You have been exposed to so much x-rays, you don't bother with birth control.

You have used the words "Healthcare Reforms" to strike fear in the hearts of co-workers.

You have heard "Why, I don't know how that got stuck in there" too many times.

Purple

“Good morning, thank you for coming so quickly,” said the lady at the door.  “It’s my husband, I think he’s dead.”  She was being extremely calm about it all.

She led me through the flat and into the bedroom where her husband lay with his legs over the edge of the bed as though he’d been about to get up.  He wasn’t breathing and he had no pulse.  I quickly checked him. His hands were cold, and his chest was vaguely warm.

“When did you last speak to him?” I asked.
“About an hour ago.  I just found him like this when I came to bring him a cup of tea.”

I attached the defibrillator and switched it on.  I knew what I would see on the screen, but I had to do it as there wasn’t yet any sign of post-mortem staining, where the blood pools at the lower part of the body after death leaving a purple mark on the skin, nor was there any rigor mortis – stiffening of the body after death.  There it was, asystole (flat line) for more than 10 seconds.  He was dead.  At this point, the crew arrived.

“I’m very sorry,” I said, “but there is nothing we can do for your husband.  I’m afraid he’s died.”  We have to say it like that.  Any other way just becomes embarrassing when the relative says “What do you mean?”  There can be no mistake using words like died and dead.

“Oh I thought so,” his wife said, still with the same calmness that she’d greeted me with.  Inside, I guessed she was an emotional mess, but was determined to hold it together at least until we’d gone.

She told us her husband had a brain tumour, and it was terminal.  She was glad he’d died peacefully at home.

One of the crew took her through to the lounge and made her a cup of tea while with the help of the other crew member, I got her husband back onto the bed properly and covered him up to just below the chin.  He looked peaceful.

He was, as the LAS term it, Purple.  We have a code that we enter on our sheets for “Deceased, not removed”, and I entered that into the patient report form (PRF).
I was working with a paramedic colleague once and we went to a patient that was Purple.  He accidentally entered the code for “Gone before arrival” onto the PRF.  It’s really intended for calls where we turn up and the patient has already left the scene, but I suppose it fitted the situation quite well really.

Rude awakening

I was woken at quarter past seven in the morning by the phone ringing.  “who the bloody hell’s that?” I wondered.  Then the answerphone kicked in:

“Steve, just ringing to check you’re ok.  We’ve got you down to do overtime on the car today 0630 – 1830.”

Shit.  I’d completely forgotten.  I rang them back and told them I’d be in ASAP.  “No problem, we’ll just change the start of your overtime shift” said the friendly voice at the Resource Centre.  This was lucky – it meant I wouldn’t get a late report and have to explain myself to a station officer.  I’ve helped the resource centre out quite a bit lately, so I suppose it was their way of saying thanks.

I started my shift at 8.30 instead.  I got in the car and started the engine to go out on standby.  The MDT promptly went blank and restarted itself.  It would take it over a minute to restart itself.  I hadn’t yet pressed Green Mobile, so if control got a job for me, they would ring the mobile to tell me anyway, so I wasn’t too worried, but made a mental note to keep an eye on it.

My first job was to a young woman who was 17 weeks pregnant and had gone to her GP for a check-up.  Whilst there, she had a mild epileptic fit.  The GP wanted her taking to hospital to check all was ok with baby.  The crew came and we got her into the back of the ambulance.  I left the crew to it, got in the car and did the necessary paperwork for the job.  I pressed Green Mobile then started the engine.  The MDT did it again.  This was going to drive me bloody mad by the end of the day, so I called control and told them my MDT was playing up so 1) could they tell me if they send me a job and I don’t show Amber to Scene within 10 seconds and 2) could I go to the engineers in central London to get it fixed?

I got to the engineers without a problem.  The engineer did the usual sucking between his teeth and oooing and ahhing, then said it was the backup battery on the circuit board.  It would take a while to fix, so I left him to it and went across to the café, where I had a fantastic Full English Breakfast, consisting of sausage, bacon, egg, beans, tomatos, chips, two slices of bread and a cup of tea.  I finished it hoping I wouldn’t get a job to a suspended any time soon, and made my way back to the car.

It was fixed, and the rest of the day was relatively uneventful with a steady stream of calls, but nothing too taxing, so all in all I ended up having a pretty good day really.  The easiest money I’ve earned for ages.

I’m on nights this weekend, and with extremely bad timing, I’m having a new washing machine delivered on Monday morning.  It should have been delivered last Monday, but the idiot delivery blokes managed to break it before I even clapped eyes on it.  So I’m hoping for a relatively quiet night on Sunday night so I can have a bit of a nap as I won’t be getting any sleep on Monday.  I just know I’ll end up being busy…    

Awards

Nominations are being invited for the 2006 Bloggies awards.

Please feel free to have a look and nominate your favourite blogs.  Of course I wouldn’t mind if – ahem – I received a nomination or two.

Aspirin

It’s quite a nasty drug really.  It’s great for things like helping to prevent blood clotting, which is why small doses – usually 75mg – are given to patients who have a circulatory problem, e.g. previous heart attack, stroke etc.  It doesn’t thin the blood, as a lot of people think.  What it actually does is affects the clotting process, so making the blood less sticky.  A side effect of it is that it thins the lining of the intestines, and can cause gastric bleeding.

So I’m given a call to a young male in his 20s who’s fitting.  When I walked through the door, he was being propped up on the bed.  He was so pale, his mucus membranes were actually white.  The last time I saw someone look that pale they were dead.

After some probing to try and discover the cause, he told us he was under the local psychiatric hospital for schizophrenia, and went there monthly to have an injection to help control it.  He then told us that he had been taking 2x 300mg aspirin (we give 1 x 300 mg of aspirin to people with cardiac chest pain) religiously every four hours for the last three months.  That’s one Hell of a lot of aspirin.

We suspected he looked so pale because he had damaged the lining of his intestines and he was slowly bleeding to death.  His oxygen levels were in his boots – possibly the cause of his fit, and only came up to a reasonable – but not good – level on high flow oxygen.

The crew blued him in to hospital.  He’d unknowingly made himself very ill.

My personal opinion is if you have pain, try taking paracetamol or something similar.  Only take aspirin if it is prescribed to you by your doctor, and if the pain won’t go away, go and see your doctor who can investigate the cause and give you an appropriate pain killer.

His was the most interesting job of the shift.

Back To Normal After New Year

New Year’s Eve was a busy one for the LAS – there were 38 stabbings in the first three hours of 2006.  What on earth is that all about?  At the busiest point, our call-takers were taking calls at a rate of 400 an hour.  Hats off to them – they worked bloody hard, as did the crews on the road.

By Midnight of New Years Day, the number of calls received for the 24hour period had topped 6,100.  On a normal day, we’ll take around 3,500 calls on average.

But it was back to normal today – my first patient called because she’s had “difficulty in breathing” for the last two months, my second called because she was hungry.  The one that really annoyed me though was a call to a 13 year old girl with a broken arm.  I’m not annoyed because she broke her arm, but I’m annoyed it became a Category A call.  
The reason?  That old stupid question in the system “Is the patient breathing normally?”  The girl was crying (as you’d expect from a 13 year old girl who’s broken her arm) so of course she wasn’t breathing normally.  
My personal opinion is if the question was changed to “Is the patient having difficulty in breathing” we would probably halve the number of calls that are mis-categorised as immediately life-threatening, i.e. category A.

Still, it should be entertaining later in the month – I’ve persuaded Mark Myers to come out on a rideout on the car.  In return, I have to go and listen to him take some calls.  I don’t mind this in the slightest.  I’ve always maintained that road-staff should spend one shift per year in control to see what it’s like for them, and that control staff should come and see how their decisions and those of their superiors affect us on the road.

Being someone who’s prepared to practice what he preaches, I’ve decided to put my money where my mouth is.  Actually, it will be for the second time, cos I’ve already spent a day in control last year, but a bargain is a bargain, and I also believe in carrying out what I think should happen.

It’s just a shame I can’t get a paid observation shift in control.