Friday, 28 February 2014

MORE Opinions Required

Ok people, I require your help AGAIN! Thanks for all the comments in Opinions Required. Same question, except this time I have changed 1 number and added one word.

I did a job a few weeks back that I want to write about. First though, I want some different opinions from you lot! 

"94 year old male, chest pain, suicidal, verbally aggressive, police requested"

That was the information that I had. I chose not to wait for police because he was 94! I was feeling particularly bolshy on this particular day!

The patients brother met us outside the flat and gave us a run down on his past medical history. The highlights included, paranoid schizophrenia, delusions, hallucinations, psychotic outbursts and OCD. Today he is extremely agitated. We entered the property and cancelled the police. 

I swung open the bedroom door. The patient was standing in the middle of the room holding a zimmer-frame. He stared at me. He slowly starts walking  towards me.

"Get out of my fucking flat or I'll throw you out of the fucking window, I mean it. Fuck off."

He says this whilst raising his fists.

*          *          *          *          *

So! What I want to know is, what would you do? What should I have done? What are your thoughts on the situation I find myself in? I welcome the views of everyone! Ambulance staff, police, mental health working, nurses or anyone who wants to share what they'd do! Please comment!! 

Thanks, Ella x

Opinions Required

Ok people, I require your help! I did a job a few weeks back that I want to write about. First though, I want some options from you lot! 

"44 year old male, chest pain, suicidal, verbally aggressive, police requested"

That was the information that I had. I chose not to wait for police because I was feeling particularly bolshy on this particular day!

The patients brother met us outside the flat and gave us a run down on his past medical history. The highlights included paranoid schizophrenia, delusions, hallucinations, psychotic outbursts and OCD. Today he is extremely agitated. Despite all of the above, we enter the property without the police. 

I swung open the bedroom door. The patient was standing in the middle of the room. He stares at me. He slowly starts walking towards me.

"Get out of my fucking flat or I'll throw you out of the fucking window, I mean it. Fuck off."

He says this whilst raising his fists.

*          *          *          *          *

So! What I want to know is, what would you do? What should I have done? What are your thoughts on the situation I find myself in? I welcome the views of everyone! Ambulance staff, police, mental health working, nurses or anyone who wants to share what they'd do! Please comment!! 

Thanks, Ella x

Tea And Toast

"89 year old male, collapse, irregular breathing, not responding"

I remember my first ever shift on an ambulance. I remember everything about it, every job, every patient, the two people I was with, where I was working, how I was feeling etc etc. There was a job that day which was given as 'COPD patient, difficulty breathing, not responding'. My mentor turned to me and said 'this guy could be very unwell, he may die on us'. I didn't understand how he could possibly know that! He told me it was just a feeling he sometimes got. Sure enough the patient was unwell. Very unwell indeed! On route to hospital he went into cardiac arrest and despite our best efforts he died. I remember feeling quite amazed that my mentor had predicted it from the minimal information we had. Well, years later, and I get those feelings, and today I had one! 

I told the student with me to grab everything we would to take to a cardiac arrest. She looked at me like I was drunk, but I was insistent! We headed into the care home and were told the patient was on the second floor. My student pressed the button for the lift, I didn't wait and with surprising vigour, I bounded up the stairs. My student didn't follow, and waited for the lift with one of the carers. I was quickly located to the room and sure enough, lying on the floor was our patient, well and truly in cardiac arrest. I started CPR, got the oxygen on him and attached the defibrillator. The student was no where to be seen. It turns out they had to wait ages for the lift, then went to the wrong floor and then couldn't find the room. I later explained that no matter what floor the patient is on, as a first responder, if you suspect the patient could be very unwell, never take the lift! 

As resus attempts go, this was quite long and drawn out. Once everyone had arrived, there were 5 of us in total sharing the workload. By sharing, I mean the two students were doing the lions share of the CPR, I was doing nothing but running the resus (perk of arriving first) and the other two were administering the drugs etc. We got his heart started at least 10 times but it was never sustained for longer than a minute or so. Each time it started beating it was slow and weak. We tried external pacing to no effect and it quickly became clear he was just reacting to the adrenaline we were pushing into him via the vein in his neck. After 90 minutes we stopped. We'd exhausted all of our options for the guy and after seeking advise from some grown ups we ended CPR, removed the oxygen and called a time of death. 

It was quite sad. He hadn't been unwell, and only just moved into the home so wasn't known well by the staff. It was just his time. As is protocol, we requested police for the unexpected death and started our reams and reams of paperwork whilst the students started clearing up! A carer appeared in the doorway.

"Would anyone like some tea?" she said.

We all unanimously nodded away! How very British! There is nothing a good brew can't fix!

"How about toast? Would anyone like toast?"

Again, we all kind of looked at each other and started nodding away! 

"Yes please, thank you!"

She disappeared off and we continued with the writing. Five minutes later she and another carer appeared with two large trays and set them down on the dressing table. There was pots of tea and coffee, sugars, milk, a selection of biscuits and about slices of toast with a pot of butter! Amazing! One of the students took up the role of 'chief butterer' and the other begun taking orders and pouring drinks. It was much needed and very appreciated. We sat around talking about the job, looking at the patients photos of himself and his family and talking about the life he had had whilst drinking tea and eating warm buttered toast. 

The door then opened and two police officers entered the room. Take a freeze frame of what they saw:
5 members of the ambulance service, one sitting in an arm chair, one sitting on a bed, two sitting cross legged on the floor and one leaning against a chest of drawers, all with a cup and saucer of tea in one hand, toast in the other and a dead 89 year old man lying in the middle of them.

This sums up our job and a picture paints 1000 words. Some may think it's not appropriate, some may think it's extremely weird. To me, the last 5 people this man had contact with, who tried for 90 minutes to save his life, were sitting around toasting (excuse the pun) his life with tea. I like to think that he would have looked down and enjoyed his very British send off. 


Don't forget, nominations are now open for the MAD Blog Awards 2014. Please go and nominate me by clicking HERE. Thank you! 

Thursday, 27 February 2014

Reservoir Dogs

Having hosted a great guest blog by Binder Smiff from a few weeks ago, he kindly gave me the opportunity to share my ramblings over on his blog! He wanted humour and buffoonery as a vague theme, and seeing as being a buffoon is a speciality of mine, it wasn't to hard to find something relevant! Anyway, this was my guest post! Enjoy!

"84 year old male, chest pain"

It was student season. For 4-5 weeks the university students were chucked out from the comfort of their lecture rooms to the unforgiving shift patterns of their respective mentors. It is during this time they home their skills and learn how to take a patient history, diagnose conditions and talk to people. Of course, always under the watchful eyes of one of us! I remember being chucked into the deep end all those years ago. staring blankly at an expectant patient and not having a clue what to say, there were so many awkward silences! It's just part of the learning process. 

We headed off to this particular non-descript chest pain and one route discussed what relevant questions should be asked. Chest pains are a very common call to go to and as such, it is one of the first things that students get well accomplished at doing. However, as today proved, it is often far too easy to get overly focused on one thing, and not looking at the big picture! 

The door to the care home was eventually opened and we headed in! It always amazes just how long it takes them, despite having called 999 and presumably expecting an ambulance to arrive! We followed the carer upstairs and were presented with our patient, who was lying on the floor! To me, it was painfully obvious why we were called. To me, the injury was obvious, as was the fact they had said chest pain just to ensure a quick ambulance. To the student, it was a chest pain lying on the floor and so the history taking began! 

To their credit it was an excellent example of history taking for a patient with chest pain. Unfortunately, they were concentrating so hard on trying to establish the history via the dementia patient's carer and his confused responses that they neglected to focus on what I felt was glaringly obvious. Not wanting to rain on the parade I allowed it to continue for a few moments. I turned to the carer and quietly asked her to get me a few things that I would be needing! (All will be revealed)

"So, from the top, tell me what we have?"

"Frank had an unwitnessed fall, unknown loss of consciousness and now has some discomfort in his chest, not radiating anywhere, says it feels heavy."

"Anything else?"

"Should I do an ECG?"

"Yes, that's probably a good idea. However, perhaps address the fact that his EAR isn't attached to his head first."

The student glanced with horror towards the patients head, and clearly for the first time, realised that lying next to his head in a small pool of blood was his ear. Completely severed. The look I was given was of distraught fear. On cue the carer arrived with 2 sandwich bags, 1 empty and 1 full of ice that I'd asked for.

"Can you pass me the ear please?" I said with a smile on my face. 

I thought it was about to be an ear covered in vomit! Apprehensively the ear was picked up and handed to me. 

So, there I was, standing in a care home, a student kneeling in front of me almost in tears, a patient lying on the floor grinning like the cheshire cat having a whale of a time and I was holding his ear in my hand. I couldn't help but think I was just a cut-throat razor away from Reservoir Dogs! It was most surreal. I popped the ear onto a sterile non stick dressing and put it in a sandwich bag. I then put that in the bag of ice.

"OK, from the top, what's the plan now?!"

"A dressing?"


Our patient, who was in no discomfort, was promptly wrapped in a bandage and thoroughly checked for more injuries. I couldn't help but ask the student to check for any more missing body parts to which they just glared at me. The ambulance arrived, an excellent handover was given and we left for a debrief in the car! 

The student felt awful. Part of me felt cruel for allowing it to go on as it did. The other part thoroughly enjoyed it! We have all been there when we were new and naive. It's easy to miss the blindingly obvious when our minds are telling us to look for something else. The first thing that went through my head as I entered the room was "WHY THE F**K IS HIS EAR ON THE FLOOR AND WHY DIDN'T THEY MENTION IT?!". Clearly, the first thing on the students mind as we walked through the door was "Chest pain, chest pain. chest pain!"

It served as a valuable reminder that looking AT the patient is always a good place to start. Things are rarely as we expect to find them and despite being taught to expect the unexpected, the student fully expected to find a man with chest pain, not a modern day Vincent Van Gogh. I have no doubt, missing body parts will never be overlooked again! 

Wednesday, 26 February 2014

It's a MAD time of year!

Well well well! It appears that the MAD Blog Awards have returned! How is that possible?! I'm sure I was only at the award ceremony last week?! Last year was amazing! I was humbled to be nominated in the Best Writer category and completely blown away to be one of the 5 finalists. Unsurprisingly, and rightly, the award went to the fantastic @Mammywoo. It was a great evening where I met loads of fantastic people and I'd love to try again this year!

Nominations are now open for the MAD Blog Awards 2014 and obviously I need nominations! So please please please take a few moments to fill in the form! You can only nominate once but you can vote for each category! This year I've been told I've been nominated again for 'Best Writer' and also 'Most Entertaining' so I'd very much appreciate if you could nominate me for both of them! Obviously, 'Blog of the Year' would be nice! 

Follow the link below, give your email address, nominate a 'Blog of the Year' and then nominate me in the categories you think I deserve by simply adding my URL ! Nominations are open until 14th March and then voting begins!

Thanks again for all your support! 

Ella x

Maternity Woes

"32 year old female, heavy bleed, contractions every 1-2 minutes"

What a way to start the shift! A materni-taxi! *grumble grumble* Being in labour is not a medical emergency. All other species successfully go through the process without the need for an ambulance and in general, us humans should be no different. Sometimes an expectant mother is caught completely unaware and is suddenly having an urge to push on her living room floor. Others have genuine high risk pregnancies and may need rapid transportation to a maternity unit. These are a rarity though. In my time in the ambulance service I have seen roughly 10,000 patients. Of those, I have delivered 13 babies. The number of women I have driven to a maternity unit because they had a contraction or their waters broke runs into the 100s. There is no need for it. Get a lift, get a taxi, don't call 999 as your first port of call! 25p a week during a pregnancy will leave you enough for a cab, FYI! Most don't even bother phoning their maternity unit first which is just infuriating! On route to the address I had a similar rant to my poor crew mate but managed to enter the house all smiles and laughter! 

The patient was 40/40 weeks pregnant and remarkably, today was her due date. Her waters hadn't broken and despite what she had told the call taker, her contractions appeared to be every 8-9 minutes, if that. She hadn't phoned the maternity unit and hadn't considered getting her husband or any of the other 12 adults in the house to drive her to the hospital, in one of 5 cars parked on the over-sized driveway. Yet still I smiled!

"Have you got your maternity notes?"

"Yes, why?"

"So I can phone the labour ward and see if they want you to go in."

"I'm going in. I'm bleeding."

My crew mate took the lady to the bathroom whilst I flicked through the notes. When they returned it was confirmed that she had had a 'show'. Perfectly normal in the early stages of labour. (Actually, what my crew mate said to me privately was that she would probably be able to yield more blood from a medium sized spot!) Perfectly normal in the early stages ofabour. We did her blood pressure and all the other observations that we do. All were absolutely fine so I phoned the labour ward.

"Hello there, my name's Ella, I'm a paramedic from the ambulance service, I'm with one of your patients at the moment."

"Hello dear, what's the problem."

"Normal labour, full term, water intact, had a show, contractions every 8-9 minutes lasting about 15-20 seconds, all her OBs are normal."

"So why has she phoned an ambulance?! Tell her to stay at home and make her own way here when contractions are every 2 minutes. We are full at the moment so there is no room at the inn!"

"Okey dokey, will pass that on, thank you!"

I relayed the message to the patient and her expectant relatives. 

"No, I want to go in."

"Well the midwife doesn't want you in yet so we won't be taking you there."

"Yes you will, I phoned an ambulance and I want you to take me in, you can't refuse me."

"I'm afraid we can. I have referred you to the midwife who has told us not to bring you in and you're to make your own way when contractions are every two minutes."

The argument continued for a number of minutes whilst I wrote up my paperwork. They became extremely rude and were livid with us. Don't shoot the messenger! Eventually, through polite smiles we left. Unsurprisingly she refused to sign our paperwork. Another happy customer! Another life saved! 

We headed off into the night and my indignant rant continued! We were sent to a drunk on a bus a few miles away so I could turn my mood to bus drivers! A few moments later we received a call from control.

"We've got a call from the patient you just left, she's now in a car around the corner from where you were saying that you refused to take her to hospital despite bleeding. Any other info, over."

"She's in normal labour, the bleeding was a show, contractions are 8-9 minutes apart and the maternity unit is full. The midwife told us not to take her in and told her to make her own way when contractions are every 2 minutes. Over"

"Rog, unfortunately because of the symptoms she is describing and the fact she is now in a public place we are having to send another ambulance. I'll let the crew know what you've told me."

What is wrong with people?! She's now in a car. The hospital is less than two miles away and she's phoning another ambulance because she's in labour! And she's getting another ambulance! I was seething. How can people play the system like this and win?! It is total madness. Being in labour isn't an emergency, it's a part of life! Why do some woman think that an ambulance is the only answer?! And why can't we charge if we are simply being used as a taxi?! Crazy! 

Sunday, 16 February 2014

Fakin' It

"42 year old female, ?CVA, facial weakness and slurred speech, NHS111"

This type of call is a high priority and as such gets a response to match the level of urgency. For those not in the know, a CVA is medical jargon for a stroke. Admittedly, I felt she was a little on the young side for a stroke, but it's not unheard of so I would treat it as such until I arrived. I had a pretty long journey to get there and because of that a vehicle containing community volunteers was also dispatched. Despite this, I arrived on scene first. I don't know what that says about my driving, or even theirs! 

I was let into the house by her some, who looked pretty annoyed to be honest. 

"She's upstairs in the loft room."

Of course she's in the loft room! They are always in the loft room! Not the living room, or sat by the front door. Oh no! The loft room, every time! 
The EMS Law of stairs: The severity of a patients illness or injury is directly proportional to the number of stairs said patient has climbed to get away from the front door. The worse the patient is the more stairs they will have climbed. 
Corollary 1: If a patient can't walk, has chest pain or is fitting they will have gone upstairs to call 999
Corollary 2: If a patient is heavy they will have gone upstairs to call 999
After staggering up the stairs with all my bags, watched by the many people in the house (clearly chivalry is indeed dead) I made it to the loft room. Laying on the bed, in the dark was our patient. My first move was to turn the light on.

"Turn the fucking light off will you."

Note to self: A) I don't like this patient B) The light stays on.

"Hello there, I'm afraid whilst I am examining you, the light will need to stay on. Also, if you swear at me again, I will be leaving and cancelling the ambulance. Now, what's the problem today?"

"I'm having a stroke."

"What makes you think you're having a stroke?"

"I've got a really bad headache, slurred speech, facial weakness and weakness on my left side."

"You speech doesn't sound slurred."

"Wellll iit issss."

It was the worst attempt at faking slurred speech I had ever heard and only appeared after suggesting it wasn't slurred. There was certainly no slur in 'turn the fucking light off'! Anyway, I decided to go through the motions and see where we got. At this point the community vehicle walked in, we exchanged hellos, and I continued with my assessment. 

"Can you sit up for me please?"

"No, I can't."

"Well I need to assess you and I can't do that with you lying down and facing away from me."

With all the moans and groans she could muster, she eventually righted herself to sitting, refusing to open her eyes because of the apparent photophobia. I knelt down in front of her. 

"Can you look at me please. Right, now give me a big toothy smile."

Her face contorted into some kind of weird position. I asked a number of times for her to smile properly but she persisted with trying to fake facial weakness. The facial droop in someone having a stroke is quite unmistakable. This wasn't that! This was trying to bend a face into what she thinks a facial droop should look like. It was most bizarre.

I took hold of her hands and held her arms out in front of her. I asked her to keep them where they were. With an air of predictability her left arm shot down with precision and accuracy onto her lap. I repeated it 3 times. At no point did it resemble paralysis in any way shape or form. 

"So tell me about this headache, where is it, how bad is it, when did it start etc?"

"It's an 8/10 on the left side of my head and came on suddenly 20 minutes ago."

Wow, I didn't even ask for a pain score, she must have done this before! 

"And what pain killers have you taken?"


Obviously not. Why take pain killers for a headache?! Not as if they are designed to kill pain or anything. 

At this point the ambulance crew arrived, meaning that with my student and myself and the two community responders there were now 6 ambulance staff in her bedroom. 

"This lady has a 20 minute history of a headache. She hasn't taken any pain killers. She is FAST negative, no facial weakness and good strength on both sides. There is also no slurred speech. All her OBs are normal. She says the pain is 8/10"

"I do have face and weakness."

"You used both arms to push yourself up to sitting and whilst I was just talking to my colleague you reached over and picked up your mobile phone. And look, you facial droop isn't there and the slurring isn't there."

*cue the slurring again and holding one eye shut*

I had seen enough. I packed up my stuff and left the crew to deal with her. Due to her refusal to walk it took them 25 minutes to get her down the stairs with various episodes of throwing herself on the floor. I'm assumed there was also a fake feint and a fake seizure which I must admit, I'm disappointed I missed! 

WHY WOULD ANYONE TRY AND FAKE A STROKE?! Seriously! Do these people really think they can trick us?! Do they think they can trick the neurologists and CT scanners?! What is their end game?! I just don't understand the mentality or rationale behind it?! The cost of the resources that were sent to her was phenomenal, not to mention, that was three resources that couldn't be attending other genuine emergency calls. NHS111 had their hands tied. A patient describing stroke symptoms over the phone, is, for all intents and purposes having a stroke. A patient having a stroke gets all the resources it could need. I can understand why her some looked so annoyed when we arrived. He knew she was playing up and knew his friday night would most likely be ruined by a trip to hospital. 

Why hospital though?! I know I will get the questions! Basically, despite the obvious fake symptoms, she persisted in describing a sudden onset of severe headache causing photophobia. Medically, these are red flags and could signal a number of serious, but unlikely medical conditions. As she insisted on hospital, it would take a very brave medical professional to refuse! 

What annoys me most, is there is no way to stop the madness! 

Thursday, 13 February 2014

Hot Potato

"31 year old female, 37/40 pregnant, loose stool, NHS111"

WHAT?! A loose stool. Why in God's name is a bum-wee worthy on an ambulance?! On top of that, how, in a huge busy city, am I the nearest ambulance to this?! It was 9 miles away, which if my maths is correct (∏ x r2? Right?!) then I was the only available ambulance in an area of almost 255 square miles. That means, based on the cities population, I was the only ambulance covering the needs of 3,449,880 people, at that particular snapshot in time, isn! Thinking twice about calling an ambulance now?! Good! Anyway, the powers that be over at NHS111 deemed it appropriate to use the only resource available covering the equivalent of the entire population of Berlin, for a woman with the runs! I can't for the life of me understand while people have to wait for ambulances from time to time......

So, after an indignant statistic filled rant, similar to the one above we pulled up at the house. Within two seconds of knocking, the door swung opened and out came our patient, wrapped up warm, all ready for a night at the hospital. Clearly, hospital was where she wanted to be! Formalities and introductions out of the way we headed into the warmth of the ambulance where she appeared most put out by my request for her to remove her layers so we could do her blood pressure. 

"Can't it wait until we get to hospital?"

"You might not be going to hospital, I haven't assessed you yet."

"What do you mean?"

"I'll assess you, if you need to go to hospital, we'll take you, if you don't, we won't."

*shocked face*

I decided to follow the 'lets start where it all begun approach'. After various questions I established that she had had an 8 hour history of the shits and her abdomen felt warmer than normal. Once I was happy that that was all that was wrong with her, I had to ask the question that was burning on my mind.

"Why do you think you need to go to hospital?"

"111 told me I had to go."

What transpired ran deeper than that, and goes a long way to explain why the ambulance service is under such strain. It also explained why we were the only available ambulance in such a large area! 

At lunch time the patient's symptoms begun. Personally, a loose stool wouldn't give me any cause for concern or invoke a need to seek medically attention or advice but she did the right thing, she called her maternity unit. They didn't answer so she left a message. Two hours later, she rung again. Like before there was no answer so another message was left. Maternity units are notoriously hard to get in contact with. Obviously they are busy departments but the amount of expectant mothers who then call an ambulance because there was no answer is quite astonishing. 

Anyway, after two failed attempts she called her GP. The GP had no appointments that day. She was told to go to hospital if it was an emergency or call back in an hour to speak to a GP. It wasn't an emergency so she phoned back an hour later to talk to one of the doctors. She got the answer machine as the surgery was now closed! 

Annoyed at the lack of help and advise available to her, she phoned the number she had for the out-of-hours GP service. This service no longer existed and the message she got told her to hang up and dial 111. So she did. The friendly voice at 111 asked her lots of questions and after the thorough 'clinical assessment' it was determined that she needed an ambulance. She told them she didn't want an ambulance. She didn't want to go to hospital. She was told she had to go to hospital and an ambulance was on its way. So she got ready and waited by the door. 

So, after being ignored and passed around like a hot potato all afternoon and evening, here we were! I phoned the maternity unit and got through to the delivery suite. A rather angry sounding midwife started lecturing me about how the patient didn't need an ambulance and didn't need to go to hospital. She then gave the patient the same ticking off, told her call her GP and ended the conversation. Midwives fill me with such joy.....perhaps she should have answered the phone hours ago and saved all this nonsense now!

I told the patient to go back indoors, relax and try to sleep. I said I would phone the GP and get them to phone her within an hour. Off she went, appearing slightly confused that the ambulance wasn't driving her to hospital like she had been told! I phoned NHS111 and referred the patient back to them to get the duty OOH GP to phone her. Annoyingly the GP decided to phone me instead so I decided to take my phone to the patient to get a conclusion to this ridiculous episode of passing the buck! The GP told the patient to take some over-the-counter remedies and to call back the next day if she had any further concerns. Wouldn't it have saved a lot of time and money if they had all just told her that 8 hours ago?! Why does everyone need an ambulance to facilitate common sense?! 

No wonder the NHS is in a bloody mess. Not only can people not cope with minor ailments and treat themselves at home, but every part of the NHS is determined to pass the buck and hope the ambulance service will pick up the pieces!

Tuesday, 4 February 2014

New Years Day

It was New Years Day and the people of our fine city were not feeling well. I spent most of the day observing the pained expressions on people faces as they struggled with the simplest of tasks, like walking. The previous nights celebrations had clearly taken their toll and as per the norm, the ambulance service were left to pick up the pieces! Here is a rundown of what treats the day gave us! Bear in mind, I too was tired. Like everyone else, I had seen the new year in with friends, had a few drinks, mindful I was on an early it was limited to a few! When my alarm went off at 4am I wasn't amused in the slightest but I got on my bike and headed into the night for my 6am start! 

06:05 - '23 year old male, collapsed. He was drunk and asleep.'
Not collapsed. A good Samaritan had called us. They didn't stick around though. Shocker! Taken to A & E to join the heap of drunken delinquents.

07:00 - '21 year old male, collapsed, head injury.' 
He was drunk. In a skate park. He'd fallen over and cut his head. His friends found the whole affair extremely funny and used words like 'wack', 'nang' and 'rad' with worrying frequency. Bandage on head, a large cannula with fluids and trip to A & E.

08:15 - '23 year old female, vomiting blood.' 
She wasn't. She was vomiting red wine. And 'Purple Rain' which I was assured was an 'aggy' cocktail. Her main problem was a hangover. I gave her 2 x Paracetomol, a glass of water, sound medical advise and a few of my best hangover cures. Left in care of friends.

09:06 - '29 year old male, chest pain.'
He did indeed have chest pain. The cause was the copious amount of cocaine, MDMA and skunk that he had taken with alcohol the night before. Due to the fast heart rate and various other things he was given Diazepam to treat his cocaine toxicity. He was promptly taken to the New Years Eve recovery centre for monitoring and further treatment.

10:32 - '30 year old male collapsed.'
He was indeed collapsed. He'd taken an overdose, presumably of heroin.  He was ventilated, filled with Narcan and then once the effects of his high were reversed we were left with an angry, verbally and physically abusive patient who was arrested and conveyed to hospital. 

11:48 - '24 year old male, chest pain.' 
This one was in a police station. He was claiming to pain to avoid being at the police station. Much to his dissatisfaction, once I'd assessed him, done his ECG and spoken to the duty nurse I told him he could stay in the comfort of his room. He called me a cunt. I left.

12:55 - '14 year old female, intoxicated.' 
This one was in a park. She was smashed, well and truly. He blood pressure was in her boots so she got treated to cannula, fluids and a journey to hospital. Because of her age the police had to attend. She vomited all over the ambulance. And my leg.

*change uniform, clean vehicle*

14:10 - '25 year old male, cardiac arrest. '

Sadly, it was as given. He was dead, nothing we could do for him. His friend found him sat on the sofa. He'd been there 2-3 hours. The nights drink and drugs had stolen a young life. A very sobering affair for all involved. Happy New Year eh? 

15:35 - '26 year old male, severe headache, pains in chest.'
He had a hangover. I told him to take his own paracetomol and drink more water. I told him I had just attended a 25 year who had died. I asked him if he felt us being there was a good use of an ambulance. He apologised. We left.

16:20 - '46 year old male, unconscious on bench.' 
He was drunk, on a bench. He told us to fuck off. We did. The caller hadn't stuck around.

16:40 - '19 year old female, feels weak, chest pain, vomiting.' 
She seemed genuinely shocked that her symptoms were caused by lack of sleep, no food, consumption of weed and too much alcohol the night before. I gave her a dose of health promotion and left her with her proud parents. 

17:25 - '40 year old, collapsed in toilet.' 
Clearly the best had been saved until last. We arrived outside a heaving McDonalds and headed inside. A member of staff met us and took us downstairs to the toilets. Hundreds of pairs of eyes stared at us as if they had never seen an ambulance crew, as they chewed their Big Macs. Despite all watching us head into the toilet, within seconds people were trying to come in and seemed utterly shocked that they couldn't use the facilities! Inside was the wonderment that was our patient.

He was a big man, clearly an alcoholic and was locked in the cubicle. His head was slightly protruding from underneath was wall of the cubicle. He was well and truly unconscious. Oh, and his face was lying in a pool of other peoples urine. It appears McDonalds had fallen foul of their hourly toilet cleaning policy, much to the detriment of the patients big ginger beard and open mouth. We requested a chair to look over the top of the cubicle. 

I climbed on top and peered over. There he was in all his glory, trousers around his ankles, and lying in a pool of his own urine and faeces. He had literally keeled over from sitting on the toilet. It really was a wonderful advert for alcohol!

Unfortunately,  despite the treat waiting for us inside, there was the very real problem of how to get him out. I managed to reach down and unlock the door but we could only force the door open slightly, such was his position. My crew mate was slighter than I was so she begrudgingly agreed to be the one to squeeze through the gap and attempt to move him enough to get the door open. Despite her best efforts, the dead weight drunk man could not be moved and in fairness, such was his condition and covering in bodily fluids, she didn't bear hug him with gusto! Luckily for us he started to wake up of his own accord. His personality was every bit as endearing as his appearance. 

"What the fuck are you doing, get out of my cubicle!"

"You collapsed to the floor sir, we are trying to get you out."

"For fucks sake." he mumbled in a thick Scottish accent. 

"Sir, can you move your legs and sit up, we can't get the door open until you do!"

"Yeah.....I know......I'm not fucking stupid you know!"

It's at times like this I like to freeze frame the moment. Ideally I'd like to take a photo on a Polaroid camera and pass it to the patient for them to digest. I was curious as to which part wasn't stupid. Was it the amount he'd drunk? Or the falling off a toilet? Or the double incontinence? Or his face in puddle of strangers urine? All of the above smacked of stupidity, but who am I to judge?! 

Eventually he was up and out. With every passing moment he became more and more abusive and the smell got more and more offencive. After telling us both to, and I paraphrase, 'go away' he headed out back into the restaurant. After attempting to start a number of fights and verbally abusing everyone he passed he staggered up the stairs and out onto the street. During this short journey he only fell over 4 times so that should be looked at as some kind of achievement. He went off into the distance cursing at all he past. I never got his name. What a treat he was!

So, that was New Years Day! Entirely predictable, totally exhausting and all too familiar. Lives wrecked by alcohol and drugs again. When will people learn?! I could sit and reflect on the 25 year old that died but won't. He isn't the first and sadly won't be the last. Perhaps that's cold of me, perhaps it's just self preservation. I'm sure next weekend will bring similar. 
"It's like gambling somehow. You go out for a night of drinking and you don't know where your going to end up the next day. It could work out good or it could be disastrous. It's like the throw of the dice." Jim Morrison