Nights

Tonight's the last in a set of night shifts and it has to be said, I've only done two jobs that could be classed as interesting. I have, however, beaten my previous ridiculous call.

I was sent to a 35 year old male with chest pains. Normally these calls turn out to be muscle strain from a lot of coughing or heavy lifting, or pain caused by hyperventilating.

This one surprised me - he was complaining of crushing chest pain, which rang alarm bells that he could be having a heart attack (MI). While I waited for the crew, I did the usual tests, but couldn't find anything wrong - all the readings were normal, and he didn't look ill. It appeared to be nothing much on the face of it, but something still niggled at the back of my mind that there was something more going on, so I gave Aspirin and GTN for the pain. If it wasn't an MI, it wouldn't do any harm.

The crew arrived, and took him to the ambulance on the carry chair. They did a 12-lead ECG while I did my paperwork in the car. The driver came up to the car when they'd finished and told me they'd found signs of a heart attack on the ECG, and took him off to hospital on blue lights.

The other interesting call was a man who appeared to have fallen off the bed and hit his head. He'd been found unconscious by his wife when she'd come in from work. He had a small wound on his forehead which had bled profusely (they usually do), and although he had asthma, there was no sign that the collapse was due to an asthma attack. His wife thought he'd been drinking - they'd had a tough time lately - their son and grand-daughter had recently died. I felt sorry for him, and wouldn't have blamed him at all for having a drink or two after that. It still didn't quite add up - I couldn't smell any alcohol, and there was no sign of a head injury other than the obvious cut.

I had to go to the hospital later, and I saw his wife. I asked her how he was and she said they'd not found any sign of alcohol, but they'd put a tube down his throat (intubated) and had sent him for a scan of his head. I don't know what happened, but I rather suspect he had a bleed into his brain. As if the family didn't have enough on their plate.

The most ridiculous call I've been to though, was a 40 year old man with 'flu, who'd been coughing relentlessly and had chest pain because he'd pulled a muscle in his chest wall. The thing that made it so ridiculous, was he lived opposite the entrance to A&E. The crew walked him across the road to the hospital.

Oh for God's sake

I arrived at the scene of the RTC to see the motorcyclist laying on the ground smoking a cigarette.  He was surrounded by a pool of petrol.  Clever.

I got out the car, and a bystander greeted me with “You’re no fucking good, he needs an ambulance!”  Charming.  It was going to be one of those jobs.  “There’s an ambulance on the way,” I told him. I squatted next to the rider and asked him to give me his cigarette so I could put it out for him.

Bystander piped up again.  “He’s just had an accident – can’t you even let him finish his fucking cigarette?  Anyway, I told you he needs an ambulance you ignorant twat, you’re not going to get him in your fucking car are you?”  The phrase “Pot calling kettle” sprang to mind. He was beginning to seriously give me the arse.
“And I told you sir, that an ambulance is on the way.  In the meantime, I’m here to begin any emergency treatment that’s required, and smoking a cigarette when he’s surrounded by petrol is a fantastic idea don’t you think?”
“That’s a funny attitude to take….”

I was pleased the ambulance arrived shortly afterwards.

Drunk Driver

This post will contain some graphic descriptions of injuries which I make no apology for.  Maybe it will make people think before drink driving.

“We’ve got an Amber call which we think you should be sent on,” said the dispatcher.  “Do you know where Boundary Road is?” (Not the real location)
“Yes,” I said.
“Well there’s a car on fire with people still inside.  We’re arranging the fire brigade now, can you go please?”
“No problem, show me mobile”

I turned into the road behind the fire engine.  I could see the car had crashed head-on into a tree and an ambulance had just pulled up.  I told control by radio that I was on scene, and that the fire brigade were there too.
A policeman briefed me as I got out of the car.  “We’ve got one with no pulse, and another sitting up talking with head and leg injuries.”

I grabbed my kit and followed the policeman to the “suspended” patient, who had been the driver and had been ejected about 20 feet from the car.  The ambulance crew had split up.  The paramedic was just starting CPR, and his crewmate had gone over to the other chap who was sitting up.  I helped the paramedic.  The defib showed us the patient was in Asystole.

The patient had multiple injuries.  Open fracture right femur (thigh bone), closed fracture of his left lower leg, fractured pelvis, chest injuries, and facial injuries.  The paramedic intubated as a priority because the patient had been drinking and his airway was full of beer.  We resuscitated the patient while immobilising his neck with a collar and putting him on a hard stretcher to support his back, putting a dressing on the open fracture to prevent someone catching the jagged edge of the bone, the paramedic “decompressed” the chest to release trapped air around the lungs threatening to cause them to collapse.  

Another FRU had been sent to help.  He was also a paramedic, and he helped to cannulate.  Three bags of fluid were put up to replace lost blood volume, a total of 1.5 litres of fluid.  All three had run through by the time we got to hospital and had made no difference.  We weren’t really surprised – the prognosis for any traumatic cardiac arrest is very poor.

We wheeled the patient into the Resuscitation room, and handed over to the hospital staff. They took over CPR, and a doctor made an incision in the patient’s chest to properly release the air trapped in the lining of the lung.  What happened next is a sight I will never forget.

It was like turning on a hosepipe.  Blood gushed from the hole in the chest.  It took a full ten seconds before it stopped.  His entire blood volume ended up on the floor.  CPR was abandoned.  It was pointless – there was no blood left to circulate.  He was dead.  The doctor said the crash must have caused a tear in the Aorta – the main artery that leaves the heart.
We didn’t know who he was, but he looked to be in his late twenties or early thirties.

This hadn’t been a nice job, but at the same time, it had been a good job in that everything had gone well from our point of view.  Everything had been done properly, in the right order, as well as it could have been.

The saving grace of this job, is that the drunk driver had only killed himself.  That was a waste of life in itself, but obviously it would have been worse if he’d killed his passenger or, heaven forbid, if he’d taken out a pedestrian too.

We helped the crew clean the back of the ambulance which was trashed.  There was kit all over – there wasn’t much on the ambulance that we hadn’t used.  Then the crew took both me and the other FRU driver back to our cars.

Control rang me as I started driving back to station.  “We’ve taken you off the road mate, go back, have a cup of tea and green up when you’re ready.”  

It was what I needed.  I imagined a family waiting for their son/boyfriend/husband/dad to come home.  And no-one knew who he was so they could tell the family that he was dead because he’d been drink-driving and driven his car into a tree.

Tired

It's 3am and I'm tired, and it's only the 2nd out of a series of 4 night shifts.

Tonight I've been sworn at by a man for trying to help his pissed wife who'd fallen over, I've had a pissed 17 year old try to puke on me, and I've been to one of the specialist hospitals in the area for a respiratory arrest that wasn't. In fact, he was breathing very well thank you very much.
I've been to a 15 year old fitting, and an old man who'd bumped his head and had been put into his bed by the care home before they called us.

I have at least managed to get something to eat.

Saved One!

I had just “greened up” – that is, become available for calls after completing the paperwork for an old lady fitting in a nursing home.  I’d pulled out of the driveway and turned onto the main road when the MDT (computer in the car) rang with another job.  

The call was given as a diabetic collapse.  Diabetics usually collapse for one of two reasons – either the sugar levels in the blood are too low (hypoglycaemia) which is the most common reason, or they’re too high (hyperglycaemia).  It was literally just round the corner, so I was on scene about 30 seconds after the call had finished in control.

I walked into a rather cluttered kitchen to find a 70-something year old lady laying on the floor with her head being cradled by a neighbour.  I paused in the doorway to look for chest rise to indicate breathing.  I couldn’t see any.  Bollocks.  I asked the neighbour to lay her down, and take her elderly sister into the other room so I would have space to work.  I had to stack a couple of chairs and push a table out of the way, then I was able to get to the patient.

I felt for a pulse and couldn’t feel one, then attached the defibrillator pads and looked at the screen to see if there was any electrical activity in the heart while I got the Bag and Mask resuscitator out and connected it to the oxygen cylinder.  Flat line, with the occasional blip which indicates what’s known as “dying heart syndrome”.  I didn’t have anything to lose, so I started CPR.  

The ambulance crew arrived shortly afterwards, and a couple of minutes later, the AED announced it wanted to analyse the heart again.  I paused and looked at the screen, expecting to still see a flat line.  Instead, there appeared to be a normal heart rhythm, but very slow.  A check confirmed there was still no pulse.  This is known as PEA – Pulseless Electrical Activity.

The paramedic on the crew put a line in, and gave adrenaline.  After about 10 minutes of continuous resuscitation, pausing only to re-analyse every three minutes, we finally felt a pulse.  She still wasn’t breathing, so we continued ventilating her.  We loaded her onto the ambulance, and I went with the crew to hospital in case we needed to re-start CPR – I could do the chest compressions while the paramedic gave drugs.

The patient still had a good pulse when we arrived at the hospital, and after cleaning my equipment, and helping the crew to clean the ambulance, we checked in the resuscitation room to see how the patient was doing.  She was still going – in fact she was making respiratory effort to the point of almost gagging on the tube that the paramedic had placed down her throat to make sure her airway remained clear, and the doctors were preparing to send her up to Intensive Care.  The patient’s sister was in the relatives room, and she thanked us for saving her sister.

It was a great end to a satisfying job.  It’s not very often we can save someone’s life after a cardiac arrest – but it’s one Hell of a feeling when you do!

I hope she’s still alive, but if not, at least we gave her sister time to say goodbye.