Tag Archives: Police

Blood and bloody idiot

There are a couple of terms used to define bleeding in the medical field;

Capillary – this is when the surface of the skin is scratched, but not deeply, and small spots of blood ooze from the damaged capillaries.

Venous – when a vein is nicked and blood will slowly weep from the wound.

Arterial – Blood will spurt out with every beat of the heart, sometimes spraying large distances depending on the size of the artery.

 

That final one, the arterial bleed, is considered to be a catastrophic haemorrhage. That is, if the bleeding is not quickly stemmed, a person will die within minutes.

 

Today, while working from a different station to normal, we were sent to a 25 year old who had punched through a window in a fit of rage, cutting his forearm. We were told the call had come from Police and they would also be attending.

We arrived after the Police and followed the significant trial of blood to a male laying on the floor, with his girlfriend tightly holding a towel around his arm, blood pouring down through her fingers. Thankfully, we had brought our critical haemorrhage kit in with us, so prepared to uncover, assess and re-dress the wound.

My crew mate wrapped his hands tightly around the arm to slow any bleeding while I prepared some gauze, a trauma dressing (more on that later) and a tourniquet.

*This next section is not for the squeamish!*

I slowly removed the towels to find a large wound which was deep enough to nearly see bone through muscle and tendons. He had two large skin flaps where he had effectively de-gloved his arm, he had some blood clots within the wound from a venous bleed, and a quite noticeable spurting bleed from his Ulnar artery (one of two which run down the forearm). He had lost around 1500ml of blood. The quick actions of his partner prevented him losing any more than that, which would have lead to shock.

We quickly ‘eyeballed’ the wound for any pieces of glass – there was none – and wrapped our trauma dressing around it. The trauma dressing we used has been developed by the military. It is specially designed to apply pressure directly over a section of injury on a limb, without using a tourniquet, which is always the last line of defence in a catastrophic bleed, as the limb may not survive.

While all this was going on, we obtained a quick history of what had happened. An argument with his ‘missus’ caused a fit of rage and he’d punched a window. He was also intoxicated and had been taking cocaine. He was also a bit of a knob head.

He immediately took a dislike to my crew mate (the person applying pressure to his wound to stop him bleeding to death) because he had “one of them faces innit”, calling him a c*nt and saying he would smash his face in. Delightful. Thankfully, I’ve got a knack of getting on with people like that, a trick I learned from an old crew mate of mine. As such, I quickly built up a rapport with him and persuaded him to come to hospital with us. Yes, I had to actually¬†persuade him!

During this, he continued to be verbally aggressive to all of us and stood unaided to show us how strong he was. Now, he clearly worked out, but also clearly used steroids. We advised he shouldn’t eat or drink in case he needed surgery, so he drank a pint of water. We recommended a wheelchair due to the blood loss, so he walked upstairs to find his phone, all the while, using the C-bomb like it was punctuation and swearing at us all and being generally aggressive and intimidating. The Police said they would travel with us and called for backup from the PC they had dubbed the ‘man-mountain’. And with good reason. At 6’2″ and 18 stone of muscle, he would certainly be able to contain our almost equally sized patient – owing to the advantage of a working arm. And pepper spray. And a taser.

He eventually walked to the ambulance and sat in a chair because we’d suggested he lay on the stretcher (am I building up a picture of what this bloke is like?). I inserted a cannula into his vein to give some pain relief through a drip. All the while he told me how shit I was at my job. We swiftly left the scene on blue lights heading for A&E. After around 6 minutes of travelling, he decided he had become board of wearing a seatbelt and sitting in a chair while in an ambulance travelling at speed through a town centre, so he undid it – against mine and the PC’s insistence – just as my crew mate had to reduce his speed for traffic ahead. As such, the unrestrained man now hurtled towards the bulkhead, stopping himself on a work surface, pulling his IV line out as he did so. This angered him greatly, and clearly it was my fault so he began swearing at me and saying how I wasn’t fit to do the job etc etc. We had to stop the ambulance, causing traffic chaos, to re-restrain him on the stretcher.There was no way I was going back near him with a needle, so I offered him some gas and air for the pain, which he accepted….

 

…for 3 minutes before throwing the mouthpiece at me and calling me a smug c*nt. The Police officer all the while provided suitable dissuasion from him trying anything. I was glad of the PC’s presence!

This pattern of threatening violence, kicking equipment and behaving like a general tit continued for the long 20 minute drive to A&E. It was one of the most stressful journeys I’ve ever had while attending a patient in an ambulance, and I’ve dealt with some stuff in my time! During the whole trip, I had to keep an eye on the wound to make sure it didn’t start bleeding through the dressing, I had to check that it wasn’t so tight it was cutting circulation off to his hand and somehow get some vital signs. He declined any vital signs and wouldn’t let me near him. All I could do was document it and make sure the built-in CCTV was functioning.

We handed him over to the A&E nurse with an apology, as they’d have to deal with his very unpleasant manner. I feel I should add that he hadn’t lost enough blood to cause severe agitation like that, he was just drunk, high and angry.

Afterwards, I was washed out and a bit teary. It’s very hard to provide life saving treatment to someone, only for them to call you a c*nt 27 times and throw things at you. I can scarcely believe there are people like that out there. But there are, and I’m sure I’ll meet many more during my career.

 

So, I guess….don’t do drugs. Or punch windows. Or be a prick to people who save your life ūüôā

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Green cross code

The morning had been a busy one.

We’d attended a lady who’d fallen out of bed, was uninjured so we helped her up, checked her over and left her to her breakfast, we’d taken a 57 year old man with chest pain to hospital with a possible heart attack, and rushed a 60 year old man to hospital who was having a bleed on the brain – what we like to call ‘big sick’! 

We were almost back to our station for a much needed restock and cup of tea when we received another call. 

It came through as a road name in the next city. No house number, just a road name. Usually that means someone has fallen in the street, or there’s been a car crash. 

We received a message which said: “14 year old hit by car – unconscious, massive head injury”

Shit! Pedal to the floor and off we go. My colleague driving as I don my hi-vis jacket and think about how I might treat the patient depending on what we’re presented with. 

We receive another message:

“Ambulanc officer is on scene, he states the patient is GCS5 (which means barely conscious!) and has requested priority 1 backup and the air ambulance as a priority.”

Double shit!

We arrive shortly after to exactly the sort of thing you’d expect to see at an incident like this. An ambulance officer’s car straddling the road, a pickup truck parked awkwardly at the curb, a man sat beside it in tears while members of the public console him, a police car screeching to a halt to block traffic and a lifeless child led in the road with a stream of blood trickling down the Tarmac, our officer colleague at her side rapidly assessing her. 

The clinical handover was brief, it didn’t need to be complicated, we could all see what had happened and all knew what we needed to do. 

Her level of consciousness raised after some oxygen. She was in pain and distressed. 

“Quick ABC; airway clear. Breathing adequately and chest clear on auscultation, radial pulses present, she’s tachycardic (fast heart rate) and pale. Let’s get some IV access and get her off the floor.” 

Another paramedic arrives in a car to assist. I look up and see several more police cars now on scene interviewing witnesses. The patient’s mum arrives in a frenzy! Now we have 2 to look after, the paramedic who’d just arrived set to reassuring mum that we were working hard to save her daughter.

With some volunteers holding up a blanket to make a screen for some dignity, we cut her clothes off to assess her fully. She had a large head wound that we had pressure on, a presumed neck injury, large abrasions on her back and shoulders where she’d rolled down the road like a rag doll. She had wounds to her lower legs but as far as we could tell, no broken bones. We gave her some pain relief, a drip, some anti-sickness medicine as she’d vomited profusely (another concerning sign of head/brain injury). She was a little more ‘with it’ now. The helicopter had landed at a nearby school as the road was too narrow for them to safely land. A police car sped off to collect them. A HEMS paramedic and critical care paramedic arrived just as a critical care doctor arrived by road from another base. We told the story and it was agreed we would take her by road to the nearest children’s major trauma centre under blue lights with the doctor on board. 

We scooped her off the floor and onto our stretcher ready to load onto the ambulance. Another quick ABC check and we were ready to leave. The helicopter left having offered their opinions and assistance and we prepared to leave he scene. 

It was around 40 minutes to the trauma unit, with my crew mate driving and me in the back with the doctor and patient. She was fully immobilised and calmed by the pain killers we’d given via the IV. She vomited twice en-route meaning we had to roll her on the spinal stretcher she was on. Not easy with just two of you while doing 70mph through city streets, but this is the career I chose! 

We arrived to a resus room full of doctors, nurses, surgeons, orthopods, paediatric specialists and porters, around 18 people who would now take over her care. 

There was silence as the critical care doctor gave his handover. As soon as he’d finished, the trauma lead set everyone to work. 

Each was allocated a task from airway and breathing to assessing neurological function of her feet. Every inch rapidly assessed for defecit before whisking her away for a CT scan to see what was happening under the skin level.
Absolutely exhausting and emotionally draining, as dealing with children often can be. The police had driven mum to hospital, leaving us space to work in the back of our cramped ambulance. 

Hoping for a good outcome for her thanks to our interventions, we’ll probably never find out though. 

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Apologies

“Well, well, well”

I hear you say.

“It’s that bloody Ambulance bloke. I remember he used to write regular updates on his day-to-day life on a frontline Ambulance. I’d almost forgotten he existed.”

AHA! I have returned with an apology. It’s been a very long time since my last post but life has been very busy!

I went and got myself married, started my final section of studying for my degree in Paramedic Sciences and re-joined a band I was in many many years ago. I know it doesn’t sound that busy, but trust me, it is!

Anyway straight back into it, eh?!

On the subject of apologies, I did start a post I never finished which was along the lines of this:

On the ambulance, we carry a fairly limited range of pain relief, from Paracetamol tablets, to strong IV Morphine with basically only Entonox (gas & air) in between.

To enable us to give the strong pain relief, we need to get IV access with a cannula. This gives us access directly to a patient’s veins to give morphine or paracetamol in the form of a drip. But what if we can’t get access?

I was working in the city with a different crew mate. As soon as we booked onto the vehicles, the radio goes off:

“Morning chaps, sorry to be so prompt this morning. We have an outstanding call for a concern for welfare.”

“Roger, all received, on our way.”

On go the blue lights, no need for sirens at 0630, there’s no traffic about.

We quickly arrived to find a gathering of people, most in dressing gowns but all with bed hair!

It turns out the neighbour had got up for work and head shouting from the elderly lady next door. He went round but couldn’t get. He heard her shout that she was on the floor so called 999. They had also called the lady’s daughter who had a spare key.

We shouted through the letterbox to reassure her we were there and within a short time, her daughter arrived.

She unlocked the door and we walked in. It wasn’t pretty. The poor lady (who slept downstairs) had got up in the night and fallen forwards. She had scuffed her face down the wall as she fell. She’d landed face down and was unable to get up our to pain in her hip as well as general poor mobility and low strength. And there she stayed, for almost 4 hours until her neighbour heard her calling out for help.

We set to work. Quick ABC assessment revealed nothing immediately life threatening. Then we were concerned about a possible next injury as she’d hit her head. She had no central neck pain reducing the likelihood of a broken neck. We then assessed all the bones top-to-toe.

“Surely, just help the poor lady up” I hear you say. It’s certainly what we hear a lot, but if she’s broken a leg and can’t feel any pain due to nerve damage, then the bone pokes through the skin as we move her, that could prove fatal. So we methodically check top-to-toe.

Her injuries were some nasty facial skin tears, a laceration to her shoulder, a broken left wrist and a probable broken left hip. Unsurprisingly, she was in a lot of pain. We knew that before we moved her, we needed to try to get her pain under control. The best way to do so was with IV drugs.

This is where we got into trouble. My crew mate tried several times to get access, but her veins were so small that he couldn’t find one, when he did find one they just collapsed as soon as he touched them with the needle. While he attempted that, I made a plan to get us out of the house. It involved a second crew and moving most of the furniture into the garden. The plan would be to scoop her, carry her back into her bedroom, onto a vacuum mattress – which has hundreds of polystyrene balls in and we suck the air out of it to cocoon the person safely in – carry her through the house, up the front steps and to the stretcher on the pavement.

But, try and try as well did (the 4 of us) we couldn’t get any IV access. We decided to give her Oramorph (morphine drink) but it’s not as fast acting. We had to roll her onto her back before we could do anything.

We knew it would hurt, and so did she. When she was ready, and as quickly and smoothly as possible, we rolled her. She screamed and all we could to was apologise.

We were sorry that this had happened to her. We were sorry that nobody heard her shouting for 4 hours, we were sorry we couldn’t get into the house for a while and we were sorry we couldn’t get her pain under control before we moved her.

The rest of the plan worked like a dream. We dressed her wounds and drove her to A&E with the daughter.

My crew mate and I spoke about the job afterwards and both agreed that it is horrible when you can’t do what you think is best for a patient. It’s our job to ease pain, but when you can’t do that, you feel a little bit worthless. It may sound silly to you, but it’s true.

We returned to¬†A&E an hour later with another patient and asked how she was doing. An x-ray confirmed a broken wrist and broken hip, but she was comfortable. We popped our head round the curtain and she was led there smiling. “Thank you both so much for helping me” she said.

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Concern for Welfare

*Radio buzzes*

“Go ahead. Over”

“Thanks guys, received your clear status at Hospital. Further emergency call for you in the city; caller states he’s concerned for the welfare of his neighbour as there is no answer at his door. All other details unknown. Over.”

“Roger, all received, on our way. Over”

“Thank you, 21:15, red base out.”

This type of call is quite common. Either a ‘care line’ company will receive an alert as someone has pressed their care pendant but not answered the phone, or a concerned neighbour is unable to get an answer from the door so calls us or the Police to check on them.

There are usually 3 outcomes:

1) They are absolutely fine and probably¬†pressed their pendant accidentally and are quite surprised to see us, or simply didn’t hear the neighbour knocking.

2) They have fallen on the floor or are unwell in someway and very relieved to see us and so were unable to answer the phone or the door and are very relieved to see us.

3) They have died¬†and that’s why there was no answer and we are shocked and saddened to find them.

We didn’t know the details of this call until we pulled up to a small lane, down which we could not fit our ambulance. We were met by a man in his 80’s who was the person whom had called 999.

He explained that “Mr Smith (name changed for confidentiality) always puts his recycling out on a Tuesday afternoon, but this time he hasn’t done it. I tried phoning him and knocking on all of his doors and windows but there’s no answer, so I called you.”

Seems fair enough to me.

“Is it possible he’s gone on holiday?” I ask as we walk down the lane to his bungalow.

“He’s a similar age to me and hasn’t been away for over 40 years!” He replies.

As we approach the bungalow, which is all in darkness, I shoot my crew mate a look that she mirrors. We know that this will either be option 2 or 3 of the above.

We also knock firmly on the front door but there is no answer. There is a key safe outside the porch but our control doesn’t have the code, neither dose the Police control room and neither does the neighbour.

I walk around the perimeter to see if there is a back door or an open window I can squeeze through as my crew mate requests Police attendance to gain access to the property by force.

All the windows are closed and back door is locked shut with security bars.

We decide to send the neighbour home, promising that we will update him as to what the outcome is. We say it is because he can go and have a cup of tea and watch some TV in comfort, when in actual fact, if this man is dead and has been dead some time, we don’t want him to see it.

We wait a little while for the Police, it’s a lower priority call for them and we know it so we don’t mind. All the while we shine our torches around to find a way in.

The Police finally arrive and we fill them in to what’s happened. The too knock on the door and every window. I show one of them around the house to make sure that there is no other way in.

The Police need to justify breaking someone’s door in and also need to do it in a way that is cheap to repair.

Using what they call ‘the big red key’ (see picture):

Enforcer

One of the officers takes a few hard hits at the door. Then we are all pretty bloody startled by what happens next…

“WHAT THE HELL ARE YOU DOING?!” Comes a shout from INSIDE the house!!

We all look at each other, not sure what to say.

“Uuuh, it’s the Police” one officer tries to explain.

“Why are you banging down my door?” He retorts.

“Your neighbour called 999 as he was worried you didn’t answer your door. We’ve been knocking on your door for nearly an hour” I say to try to reassure him. It doesn’t work.

“How do I know you’re not burglars?” Fair point, we all think.

The WPC offers her Police Warrant card through the letter box. He agrees that she is indeed who she says she is and tries to unlock the door. The trouble is, giving an old lock a solid hit with a battering ram throws the lock out of joint, meaning that the poor bloke can’t unlock the door!

“I can’t get out, I shall die in here!” He shouts.

“This is turning into a bloody nightmare” I think to myself. We persuade him to pass his key through the letter box, promising to give it back, to unlock it from the outside.

We unlock and open the door and find the greyest most terrified man I’ve ever seen. He is most surprised to see 2 Ambulance Staff and 2 Police officers stood at his door. Truth be told, we’re most surprised to see him alive! Ever the optimists we are!

It takes us almost 20 minutes to convince him we definitely are who we say we are, and to calm him down. Then he pulls out a notebook and reads this.

“At 21:10 someone rang my doorbell, then knocked on the door and windows (the neighbour). Then 10 minutes later someone did it again, flashing a torch through all my windows (me). For 30 minutes someone knocked on the windows all around my house and shouted something through the letterbox. Then you stated bashing my door in!”

The Police officer says “With all due respect, why didn’t you just answer the door in the first place?”

“I thought it was a burglar.” He replies.

“Your neighbour was worried because you didn’t put your bins out this evening.”

“Bloody hell, he doesn’t know everything! I didn’t put them out because the foxes get to them!”

“That’s fair enough, why don’t you give us the code to your key safe to avoid something like this every happening again?”

“Well, errrm, no I’d rather not”

We tried to convince him that if Police and Ambulance control know what the code is, we can access his property if he’s unwell, but he didn’t want us to have it.

The Police made sure that he could secure his property, and we dutifully informed his neighbour that he was fine, explaining about the foxes.

We shared a laugh with the Police about how ludicrous the whole situation was.

My crew mates final words were : “You couldn’t write this stuff!”

‘I bloody well will’, I thought ūüôā

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Unwell kids….AARRGH!

Now, before I write this, let me just make something clear. I have a number of friends who work in the Police. They are as busy as we are (if not more) and equally, are under financial pressures with cuts to  Officer numbers and an ever increasing amount of paperwork. I will not have anything bad said about the Police as their job is, at times, unenviable!

Now, that probably gives some indication as to what I’m about to write about.

Many months ago, in the middle of the night, while working with a Paramedic from another station, we were called to a 2 year old girl having a seizure. As we’re a rural station, it was about a 14 minute drive. Our ambulances weigh almost 6 tonnes and are powered by 2.5 litre engines with upwards of 250,000 miles on the clock, so they’re not that fast, especially through the winding lanes around here.

We arrived to find a Rapid Response Paramedic who had been there around 5 minutes, administering Oxygen to a very grey, lifeless looking little girl lead on the floor twitching. I think we all simultaneously thought the same: “SHIT!”.

We set to work with our ABC’s. I first made sure we had an airway by inserting a Nasal Airway (google it, seriously) and taking care of the Oxygen, while my colleagues began trying to find the cause in order to correct it. We noted she had a high temperature and a new rash on her chest, her parents said she had been grizzly¬†all day.

She was still fitting so we gave a drug which works to stop the seizure. It didn’t work. This is what we call Status Epilepticus – a condition that quickly leads to death if left untreated – possibly caused by¬†?Meningitis! Thankfully, a critical care doctor from our HEMS unit had arrived by road. She carried a greater range of drugs and was able to give something to sedate the girl in order to stop the fit as well as an anti-biotic to try to stop the infection doing any more damage. We lifted her onto the stretcher and prepared for the blue light drive to a Children’s A&E in the nearest city, some 10 miles away.

Off we went, me driving, 2 Paramedics and a Doctor in the back of the Ambulance with a critically unwell, unconscious 2 year old on the stretcher. At this point, the Doctor was breathing for the patient with a Bag Valve Mask (BVM).

It was an uneventful journey, taking it steady through the lanes making sure not to turn corners too hard as it makes working in the back very difficult. Into the city on the wide empty roads meaning I could make good progress. In the near distance just off a large roundabout, on the exit I needed, was a ‘Police, Road Closed’ sign, with a response car blocking the road and a single Officer stood there. I drove up, blue lights flashing, wound down the window and asked what was happening.

“A man is threatening to jump from the roof so I can’t let you through.”

“Oh” I replied “but I’ve got a patient I desperately need to get to hospital.”

“I can’t let any traffic through at all.”

“You don’t understand, I’ve got a critically unwell child onboard that I need to get to the Children’s Hospital immediately.”

“Sorry” came the reply.

I shouted through to the Doctor in the back that we would have to take a diversion.

“Didn’t you say that this child is critically unwell?”

“Yes, I did” as I fumbled with the MDT to find a new route in this unfamiliar city.

Diversion planned, we pulled away and continued ‘blueing’ to Hospital.

We arrived safely and took the patient into resus’ where the Doctors and Nurses worked hard to save her.

Thankfully – as I found out about a week later – she survived and was doing well on a ward.

My gripe here isn’t really about the Police Officer who was following orders, but to the selfish man who decided he wanted to try to jump from a roof!

All ambulances received a message stating that Police had requested a ‘silent approach’ to all jobs (lights but no sirens) in order to stop this man jumping. So, because of the actions of ONE man (who never did jump, following 4 HOURS¬†of negotiations), multiple ambulances were hindered getting to emergencies, and the little girl who wasn’t breathing could have died due to the delay in getting to hospital!

I’ve been to suicides before. Those who actually want to do it, do so quietly without bothering anyone else. This idiot, it turns out, wanted attention from his ex-wife! Which I’m sure he got.

I’m glad nobody did die. and it is easy to get the ‘red mist’ when dealing with an unwell child, but this one really made me mad and still gets my back up a bit!

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