I didn’t sleep well last night – I think a total of an hour and a half – so if I’m a bit incoherent I’d like to register that as excuse number one. No real reason for the lack of sleep, it’s a disadvantage of rotating shifts that every so often your body clock just throws up its hands in despair and goes to sulk behind the sofa, leaving you suffering insomnia and/or intense fatigue.
Last night was actually quite pleasant. The first job of the shift (at around 4 p.m.) was given as an 80-year-old male collapsed in the street. Making our way there we were beaten by not only the police and fast response car, but also by a Duty Officer who had taken an interest in the job. It turned out to be a drunken Russian, actually in his early fifties, who had decided to lie down and sleep it off in an alley. I suspect he was very surprised when he woke up to find himself surrounded by three police officers and four ambulance bods of various ranks. He was a pleasant enough fellow, who didn’t speak a word of English, so to be on the safe side we loaded him onto the ambulance and took him to sunny Newham hospital. When we got there (and remember that this is around 5 p.m.) the crew before us, and the crew who followed us, both had people who were worse for wear for drink. Luckily for both our patient and the hospital a Russian nurse was working, so he could translate that the patient had indeed just drunk too much and would very much like to be left alone so he could go home. I’m always impressed by people who can speak another language, two people talking what sounds like utter gibberish, yet making complete sense to each other never fails to entertain.
When taking this gentleman to hospital I drove past six known drunks in the space of one street. Alcohol and alcoholism is a big blight on our society. On some shifts the only jobs we have are those influenced in some way by alcohol. Most assaults can be attributed to alcohol, frequent callers (sometimes 6 times in one day) are very often alcoholic, and the amount of ‘collapse ?cause’ jobs that turn out to be drunks is frankly astounding.
My personal view (and not the view of the LAS by any means) would be to prohibit alcohol, but legalise cannabis. Not only would it cut our workload by, at my estimate, 60–70%, but I’ve never had anyone high on cannabis try to hit me. Cannabis users are very rarely violent, tend to be generally easier to handle and seldom get loud and annoying. It’s true that there are long-term health consequences, and that heavy ‘stoners’ can waste their life away, but the same holds true of alcohol and alcoholics.
On the rare occasions that I get called to someone on cannabis, it’s normally because it is their first time and they feel ‘dizzy’. Often a pat on the head, and an explanation that this is what is supposed to happen is enough to calm them down, and they will rarely require a trip to hospital. Because the intoxicant effects are fairly self limiting, people tend not to overdose on cannabis, unlike alcohol (which is why you find drunk people collapsed in the street).
There is one problem with the use of cannabis – I’m never sure what to call it in order to sound ‘hip to the kids’, the slang just befuddles me. Is it ‘green’, ‘pot’, ‘hash’, ‘reefer’ or ‘draw’? At least alcohol is just ‘booze’.
And now the government has made it even easier to get hold of alcohol with extended ‘open hours’. Oh well …
(What I’m going to post about might come across as being heartless, or myself being lazy – I don’t think I’m either of them, but if you disagree with this post, as always, feel free to visit the blog and leave a comment.)
Tonight we got called to a residential home for an 87-year-old female with ‘difficulty in breathing’; once again it was way out of our area of coverage, but we made good time to get there. I’ve been to this home before, and it is one of the better ones I’ve visited; the residents are always clean, and appear well looked after. The care staff know their ‘charges’, and are always friendly, helpful and courteous towards ambulance crews.
I knew there was something wrong from the face of the member of staff who met us. She had a look of total concern, and I don’t like to see that look on someone’s face – it never bodes well. We went through the clean corridors and busy lounge of the home into one of the residents’ rooms. There were three nurses there, one of whom was crying (something I don’t think I’ve ever seen before); lying in the bed was a little old lady who was extremely close to death. Her pulse was weak, and thready, something I could have guessed by the patient’s colour. I very quickly told the staff that, yes, she was extremely ill and that she would have to go to hospital unless she had a ‘Do Not Resuscitate’ order. The staff said that it would be best to take her to hospital. We scooped her up, and her heart and breathing stopped in the lift to the ground floor.
I don’t believe in a ‘slow blue’ (where CPR is performed by ‘going through the motions’ knowing that the patient will not survive and that the CPR is for the benefit of the relatives), so I started active, aggressive treatment while my crewmate drove us the 5 minutes to hospital. The patient remained in asystole (no heart activity at all) and on reaching hospital the doctors there declared her dead.
I may have previously mentioned the study that showed that ‘out of 185 patients presenting with out of hospital asystole arrests, none survived to be discharged’. Both my crewmate and myself – and the hospital staff – knew that this patient had no chance of survival and that the reason we started CPR was because of our policy to commence resuscitation except in certain tightly defined circumstances.
If we had got there a minute later, the patient would already have died – in her bed surrounded by people that cared for her (although not her family) as opposed to being hoisted out onto a chair and then suffering the indignities of CPR in the back of an ambulance. While trying to resuscitate her during the transit to hospital I found myself looking into her dead blue eyes, apologising to her and hoping that she couldn’t feel anything that I was doing to her.
I don’t know if it is because I’ve had one and a half hours’ sleep in the past 38, but it made me feel bad to put her through the indignity of pointless CPR. I know the policies are there to protect us (and members of the public), but sometimes I wish we could use some discretion.
Now I’ll see if I can get some sleep.
I can still remember her sparkling blue eyes looking up at me.
So, two nights ago I was dealing with death, people collapsing on the DLR (Docklands Light Railway), young men vomiting blood and looking like death warmed up, and women having miscarriages. Basically everyone I attended to on Wednesday night needed an ambulance.
Last night we had …
One patient with indigestion (for 2 years – FRU on scene when we got there as it was given as a ‘chest pain’).
One ‘gone before arrival’ (a drunk who phoned 999 complaining of a broken arm, but had wandered off before we got there).
One overdose ‘acting violent’, who also had gone before we turned up (driven to hospital by her brother).
One ‘facial injury’ (a woman slapped by her husband: no injury and she didn’t want to go to hospital – her husband was taken away by the police).
One patient with ascites