Nee Naw

Last night, I had the privilege of a night out on Steve’s FRU. A FRU is a First Response Unit, otherwise known as an ‘ambulance car’. They go to all the highest priority calls, the idea being that they will get there first and save vital seconds.

Call #1 - Phone Box Drunk
A nightshift in Nee Naw Control isn’t complete without an extremely drunk homeless person ringing up from a phonebox, slurring his words, not knowing where he is, not knowing what is wrong with him (usually they want a warm A+E bed for the night) answering “yes” to every question (hence this call being a category A) and then puking all over the ambulance, so I was delighted at the anticipation of seeing it from the other side (so long as I didn’t get puked on. I have a pathological hatred of vomit, which admittedly is a bit of a problem for someone who wants to be ambulance crew when he grows up). First of all, though, there was a two mile dash through the streets of South London at the speed of light with the nee naw siren blaring (it actually went “nee naw” and not “woo woo”, which made my day) and the blue lights richocheting off the houses. I don’t mind admitting my heart was in my mouth as we took hairpin bends at 60 mph on a 30 mph road. This is not any criticism of Steve’s driving, which was fine, but the knowledge that if I had been driving, I would have lost control within seconds and wrapped the poor FRU round a lamppost. I am possibly the world’s worst driver, btw, another potential stumbling block in my chosen career.

Anyway, we pulled up outside the location given, and found a few shoppers carrying their bags home, a few teenagers drinking alcopops, and absolutely no phone box drunks at all. Steve rang Control to inform them of the absent inebriate, and we searched the area for the offending phone box. Spotting that a box was ringing, Steve rang over and answered it. It was Control, trying to locate the drunk. After that, we conceded defeat and shuffled back to the car.

Call #2 - Bleeding Foot
No sooner had we finished the paperwork and press “available”, the MDT (mobile data terminal/in-ambulance computer that tells you what to do and where to go) started ringing and we were off to… a twenty-seven year old woman with a cut foot. At this point you may begin to realise that not all category A calls are the life threatening emergencies they are supposed to be. This one was a category A because of “abnormal breathing”. The call was just round the corner from the empty phone box, so it didn’t take long to get there. I think the relatives were surprised that a cut foot can warrant an ambulance within two minutes.

However, as we trooped up the stairs (I got to hold the oxygen bag), I noticed there was blood everywhere and was beginning to think that this was more exciting than it sounded. Perhaps the woman’s foot had been cut off! With an axe! There’s nothing like a good traumatic amputation, is there?

So we reached the top of the stairs, and there on the sofa, was an extremely plump woman in a pink tracksuit making faces like a dying swan. Three teenage boys were gathered round dabbing ineffectively at her blood stained toes with a roll of Kleenex. On her toes were three small cuts, none more than an inch long. She wasn’t breathing normally; she was in floods of tears.

So that was my first lesson of the day: cuts to the feet result in a lot of blood loss because feet contain a lot of capillaries.

I helped wipe the blood off her feet, and then the ambulance crew arrived and carted the snivelling woman off to hospital for a tetanus. Lots of worried faces appeared in the doorway as they took her away. “Is she going to be alright?” asked one man.

“I think she’ll live!” said the ambulance crew.

Call #3 - Pub Assault
We were greeted at the local chain pub by an Australian barman:

“We found him in the toilet! He’s flat out unconscious and has a lump on his head! We think he’s been beaten up!”

So we ran to the back of the pub and there he was, a man in his fifties, lying prostrate on the floor. Something about his position made me think that maybe he wasn’t “flat out unconscious” after all — it was the way his legs were crossed, as if he were reclining, enjoying the sun. This notion was confirmed when Steve shone a light into his eyes — suddenly, there was life, and our victim decided to talk to us. Well, slur at us. I’m not quite sure what he was trying to say. Steve started to do his observations (pulse, oxygen saturation, blood sugar, blood pressure and the like), which were all resoundingly normal, and at this point the police arrived. The patient suddenly became agigated and started thrashing his arms and legs around, knocking over chairs and nearly breaking his oxygen mask. We all got out the way, except the Australian barman, who decided to have a heart to heart with the patient to calm him down. A brave but foolish man!

One of the policeman asked Steve if he thought the injuries were lifethreatening. Steve replied “no, he seems to be suffering from a severe case of being very drunk.” Still, you can’t be too careful with head injuries, so the patient was dispatched in the direction of the hospital. We saw the ambulance crew again later in the night, and they reported that he had made a right nuisance of himself in A+E. Somehow, I wasn’t surprised.

Call #4 - Kebab Shop Assault
(Can you see a pattern here?) We were called to a kebab shop just round the corner where a thirty-something Russian girl was nursing a bloody nose. Apparently someone had been trying to hit her boyfriend and she had got in the way. The boyfriend was shouting at the police and his girlfriend alternatively, random people kept coming out of the kebab shop and shouting at the boyfriend, and the poor woman just stood there holding her nose saying “I want to go home”. She wouldn’t let us look at it or make a statement to the police, so there was not much more we could do. I felt dead sorry for her with everyone shouting their opinions and telling her what to do without letting her get a word in edgeways, and I kind of understood why someone had wanted to punch the boyfriend in the first place

And that was the first half of the shift… another entry about the rest of the calls will follow shortly. It was such a busy night that I’d give myself RSI writing about them all in one entry. Observer’s Curse, the phenomenon which causes any ambulance with an observer on board only to get dull calls, or no calls at all all night, was certainly not in operation. Unless Observer’s Curse was responsible for the pneumonia inducing weather conditions…

The other night, I took a call about an 84 year old woman with abdominal pain. Nothing unusual about that — I get several calls each night about old people with stomach ache. So routine it was, in fact, that I’m struggling to remember much about the call. I remember it was rung in by a young female relative, who was quite distressed, and who told me to “hurry up” whilst she was giving me the address (which is one of the most frustrating things on earth — how can you “hurry up” when you’re waiting for an action by the person telling you to hurry up?) but other than that, it seemed perfectly routine. I hung up, I took the next call.

Then, four hours later, an A+E nurse rang saying that one of the crews had forgotten to leave paperwork for a patient they’d brought in earlier. “No problem,” I said, “I’ll get them to drop it off with the next patient.” I took the name and address of the patient. It was the old lady with stomach ache.

“Thank you,” said the nurse. “Please make sure this message gets through — it’s quite important because the patient has died.”

Died? But she only had stomach ache! A rising sense of panic filled my chest and I quickly looked up the call I had taken. There it was, an amber (medium priority) call. “Collapsed with abdominal pain” was my description of the problem. The call had come in at a busy time, and after twenty minutes an ambulance hadn’t been sent. At that point, the relatives had called back saying the patient had stopped breathing. An ambulance had been sent but it was too late and the patient was pronounced dead at hospital.

I looked at the call closely — from what I could see and what I could remember, there was nothing to indicate that I should have stayed on the line or that the call should have been triaged in a different way. On the other hand, sometimes instinct tells me that I should manipulate the caller into giving me the answers that makes a call come out as category A; sometimes instinct tells me to stay on the line even though protocol does not demand it. And on this occasion, instinct let me down. Of course, I don’t know if anything I could have done would have saved the patient, and I will probably never know. And this is the worst thing about this job, worse than being sworn at, worse than listening to idiots demanding an ambulance for a stubbed toe, and worse than listening to 16 years olds taking their last breaths.

I gain some consolation from the fact that when the relations rang back to say she’d stopped breathing, they didn’t want to do CPR. Maybe they thought it was her time to go. And maybe that is what my instinct was trying to tell me. I hope.

“What’s the problem?”
“I’ve got appendicitis!”
“How do you know it’s appendicitis?”
“Because I had it before! And I had to go to hospital! And have my appendix out!”
“You had your appendix out?”
“Yes.”
“And you think you have appendicitis?”
“Yes!”
“In your appendix?”
“Yes!!!”
“Which you had taken out?”
“Oh…”

Thank you to all those who voted for me and helped me win Best New Medical Weblog in the Medgadget Awards! You can see a full list of winners in all the categories here. Random Acts of Reality also won both the categories it was nominated in. This proves that the London Ambulance Service has the best writers in the medical profession. (Although you would not think this was the case if you went down to Control today and discovered just how many of our call takers cannot spell “diarrhoea”, despite having to type it at least ten times a day).

Anyway, congratulations to us! Hooray! Woo! Etc!

Whenever a child dials 999, the operator comes on line as the call is connected, telling us that they’re connecting a call from a child. This is because about 90% of calls from children are the little devils playing with mobile phones. Mums and dads — please keep mobiles out of reach of little hands! On Christmas Day it seemed we spent half the day ringing back mobiles and trying to trace their owners, only to find some small person had got carried away with their new “toy”.

Anyway, yesterday the operator came on line telling me there was a child on line, and then there was silence. I was fully expecting this to be the usual child playing scenario, since when children do make genuine calls, they are actually a lot better at it and calmer than adult callers.

“What’s the problem? What’s happened?” I said, for the third time, and finally a little voice started to speak.

“Can you come? Mummy’s cut her wrists and there is blood everywhere!”

Oh hell, I thought, not a child playing after all. Unless it’s one with a really sick sense of humour.

“Yes, we can come,” I said “what’s your address?”

“Don’t know!” said the child. “I rang my uncle and he told me not to call you and that if I did I would get in trouble!”

This was just getting better and better. I sensed the child was scared to give me her address because of what her uncle had said, but after a bit of coaxing, she provided the name of a hotel, the fact that it was in London and a room number. Unfortunately, she had a bit of a lisp, so when she said “four thirteen” I thought she said “floor thirteen” and asked her for the room number again.

“I already told you, four thirteen! Aren’t you listening?” she said indignantly, which would have made me laugh if it hadn’t been such a dire situation. Children sound really amusing when they are trying to be authoritive.

“Okay, you’re doing really well,” I said, “now I just need to know the street name and which part of London it’s in — do you know that?”

(Damn our stupid mapping system that doesn’t have things like hotels on it…)

“No!” wailed the child breaking into noisy sobs “my uncle said you wouldn’t come! You’re not coming, are you?”

“Yes!” I said, trying not to panic — the sound of a small child in such obvious distress not helping much — “of course we’ll find you, we’ll look everywhere until we do, but if we knew a bit more of the address we’d find you faster.”

“Mu-MMMMEEEEE!” screeched the child. “MUUUUUMMEEEEEEEEEEE!!! Come here Mummy! Come here Mummy!”

Eventually a woman came to the phone and I asked her for the address.

“Salright,” she said in a slurred voice “m’okay, jussssht fine. Don’ send the umblunce, mmfine.”

“Just let us send someone round to see if you’re okay?” I asked, but the phone went down.

Now, according to Nee Naw Service policy, if the patient refuses an ambulance we are not supposed to send one, even if they are dying in a horrible way. This is because everyone has the right to refuse medical treatment, unless they are sectioned under the mental health act, which is not something that can be done on the spot. I decided that I was going to conveniently forget about this rule, and with the help of the operator, who found the phone’s approximate location, and Directory Enquiries, I found the address of the hotel and off went the nee naw and the police.

The ambulance crew got there first and someone, probably the child, let them in. They reported back to us that the patient had been self harming and was very drunk, and the child was only five years old. This shocked me; I had assumed she was older. I’m useless at telling kids’ ages from their voices, and even if they are stood in front of me I am not much better, but from the maturity displayed in her language and the way she took charge of the situation I would have put her at about ten. The patient was refusing hospital, but after the police arrived everything went quiet for a while and then the ambulance set off for the hospital, so she must have changed her mind.

I hope they both got the help that they needed.

I’m not particularly fond of children and the plight of a child in need doesn’t usually tug my heartstrings in the same way as a frail elderly person or a puppy with an injured paw, but I’ve been thinking about this poor little girl a lot. When I was five life was all Transformers, Scalectrix and pretending to be a superhero and I don’t think I knew that self harming even existed.

… which close in six hours, and not dropping hints or anything, but I’m only in the lead by a couple of votes.

You can vote for Nee Naw here.

You can also vote for Random Acts of Reality, which is in a similar position in different categories here and here.

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The average person will only have to call 999 for an ambulance once in their lifetime. There are some people, however, who feel compelled to dial us on an almost daily basis, so much so that we get to remember their names and addresses and instantly recognise them when their details flash up on our screens. Some are more benign than others. There’s one disabled man whose carer comes in to change his “nappy” at 7am sharp every day; if he soils himself before then, he calls 999. Every time, we patiently explain that his carer will be there soon and that it’s not an ambulance job; every time it happens, he calls again. There’s an elderly man who lives near me whose wife is always having falls and needs assistance to get up. He always starts the call with “It’s not a NATIONAL EMERGENCY but…” Our computer has a way of flagging these address so that when we receive a call, we can read a little paragraph about the patient which will alert us to what to expect. They usually say things like:

“Fred Portnall. 42 years old, wheelchair bound, psychiatric pat. Assaulted ambulance crew by hitting them with his crutch. Do not enter without police.”

“Laura Smith. 38 years old, white, 5′2″. Will claim to be unwell but will answer door naked and make crude suggestions to male crew members. Nothing wrong with her, she is just lonely since her husband left her. Consider all-female crews and/or duty officer.”

“Brenda Kramer. 42 years old. Alcoholic, timewaster, regular caller. Has been abusive towards crews in past. Send police.”

“Brenda” was one of the first regulars that I became acquianted with after starting at Nee Naw Control. There wasn’t a nightshift that would go by without a call from Brenda. The thing that set her apart from our other regular timewasters was that while the others would usually call for something non-specific and rambling, leaving you in no doubt that all they wanted was a visit from some nice people in green to cheer them up, Brenda always had the knack of convincing us that this time, she really was dying of something dreadful. I think she kept a dictionary by her bed, because she would ring up, describing all the symptoms of a stroke or heart attack, sounding weak, pathetic and at death’s door. Every time we’d go blazing off on blues and twos; every time the crew would report back that nothing was wrong and that Brenda was refusing hospital.

When she got bored of feigning heart attacks and strokes, Brenda got more inventive. Once, she rang claiming her house was on fire. She was coughing and spluttering, and I could imagine her dying in a room full of smoke like the boy who cried wolf. But of course, fire brigade and ambulance trumped up, and there was not a sniff of a fire.

A few weeks after that, another call taker took a call from Brenda’s house.
“Help!” said a high pitched voice “It’s Miss Kramer… I think she’s been stabbed! There’s blood everywhere!”

Once again, the call taker though that this was really the time when something serious had happened to Brenda. She took all the details and gave the neighbour instructions.

“Thank you so much, lovey!” said the neighbour, her voice dropping an octave.

“Wait a minute!” said the call taker. ‘Lovey’ is an endearment Brenda often uses. “Brenda, is that you?”

There was a sharp intake of breath, and the line dropped. Yes, Brenda was impersonating her neighbour and sure enough, the ambulance crew found her live and well.

For the last six months or so, however, I’ve not received a single call from Brenda and I must admit I was getting a bit worried, and starting to think that some hideous fate had befallen her. Until last Monday, when I was sitting on dispatch, and there before my eyes, flashed a familiar address. 62 Fortcross Estate, E8. Brenda! She was back, and claiming to have a heart attack. The crew were dispatched, and came on the radio fifteen minutes later to let us know that there was nothing wrong with her, that she didn’t want to go to hospital, and had been left in the care of the police.

I couldn’t help feeling relieved. It was like the return of an old friend.

Phil: Oh no! Ruby isn’t breathing! She’s choked on her vomit! I know, I’ll blow into her mouth once, slap her in the face, then drive all the way to Walford General with her still not breathing.

Mark, watching Eastenders: Aargh! You can’t do that! Call the ambulance! Clear the airway! Do compressions! Aargh!

I wish people on TV would do first aid properly. I know it’s an accurate reflection of the general public, who often don’t do it properly, but untrained people often copy what they’ve seen on TV, and if they copy this, they may well find a dead “Ruby” on their hands.

Still, he at least he didn’t come out with the “ambulance, Albert Squaaaah, naaaah! *click*” line so often heard on Eastenders.

After the Christmas rush, this week has been very quiet. Quiet, by the way, is a forbidden word in Nee Naw Control, because as soon as someone says it, something kicks off and all hell breaks loose. So there I was, feet on the desk, immersed in a leftover copy of Chat magazine (the no reading rule long forgotten), gently snoozing in my reclining chair, and someone must have said that word, because in an instant, the screen above our heads went from “10 call takers free; no calls waiting” to “No call takers free, 21 calls waiting”.

Uh oh. My first thought was: “BOMB!!” (even though on July 7th the increase in call rate wasn’t that sudden and I could count the number of calls about each bomb on my fingers). As the calls were answered, every single person had Angel Islington on their screens, and all the callers were reporting different aspects of the same incident:
“A man has been hit by a bus”
“The bus has hit Sainsbury’s!”
“There’s two taxis smashed up and pedestrians lying in the road everywhere”.

Piecing the bits together, we found what had happened was this — the bus had gone out of control ploughing into two taxis, two shops and umpteen pedestrians.

In the next two minutes, we received forty-three calls on the incident, which is the most I have ever seen. There must have been people standing next to each other with their mobile phones out ringing the ambulance.

Prior to this incident, the most calls I’ve ever noted about one thing was a horrible incident when an old lady was hit by a bus and dragged for a quarter of a mile under the wheels of a car — the car driver didn’t even notice because the lady was already on the ground when he hit her. Everyone down the route dialled 999, reporting the incident at its various stages. I got two calls out of the twenty; the first reported an elderly lady hit by a bus, the last a woman horribly injured under the wheels of a car. “I don’t know how old she is” said the caller “most of her face is missing”. Anyway…

Half the ambulance service was dispatched to Islington, so anyone who wanted an ambulance round those parts for the rest of the day had a bit of a wait, but fortunately no-one died in the incident. At least it woke us all up.

Nee Naw has been nominated for best new medical weblog in the MedGadget 2005 awards. You can vote here. The other categories are here — Random Acts of Reality features in a couple of them.

Some of the other nominees are well worth checking out too.