Nee Naw

I’m off observing! If you notice anyone strange hanging around your ambulance station today, it might just be me…

One of the superintendents came up to me yesterday and handed me a pair of blue epaulets.

“These are for your trainee,” she told me.

“But I don’t have a trainee!” I said, confused.

“Oh yes you do,” she said. “She starts tomorrow.”

So it looks like I have been given another chance to pass my bad call taking habits on to a new generation. Wish me luck!

Today, I nearly broke into a patient’s house and stole his dog.

Okay, that sounds bad. Maybe I’d better start from the beginning.

The call came from the police, and read: “NEIGHBOURS CONCERNED FOR ELDERLY GENTLEMAN. HE HAS NOT BEEN SEEN FOR A FEW DAYS AND HIS DOG IS WHINING AT THE WINDOW.”

Calls like this are called “suspected collapse behind locked doors”. Half the time we go to them, we find a dead body on the other side of the locked door, the rest of the time we find a very angry person returning from a shopping trip to find their front door hanging off its hinges as the police search their house fruitlessly. This call, however, was neither. The elderly man had fallen and had been on the floor for an unspecified length of time. His house was in a revolting state; the crew had to step over a dead rat to get to him. The dog, a small, skinny creature of unspecified breed did not look as if it had been receiving the best of care. The owner admitted that he just couldn’t look after it any more — in fact, he couldn’t even look after himself. He begged them to find someone to look after it.

The crew were posed with a problem, because they needed to get the patient into hospital straight away, but didn’t want to leave the dog. In the end, they felt they had no option but to leave it to us to arrange something for the dog whilst they rushed the patient in. The police secured the house, leaving the dog alone inside. And then we began to play musical phone calls. We tried calling back the neighbour who had originally called, but the mobile was switched off. We rang the RSPCA, but they told us they could enter a property without permission and take away someone’s dog just like that. The Cinnamon Trust gave us the same story: they could arrange rehoming for the dog, but someone else would have to obtain the patient’s written permission and remove it from the property. We rang the hospital’s social work department, who weren’t able to do anything, and the local town hall. Each suggested we ring the next organisation on the list, until we were back to the RSPCA again. I’ve summed that up in a few sentences, but in fact it was nearly a whole day’s worth of on-hold music, being passed from pillar to post, and people quoting bits of the law at me, not forgetting the occasional interlude of having ambulances to dispatch.

It was getting towards the day and the thought of that little dog whining at the window was beginning to haunt me in a way that even the most horrific human calls fail to. I couldn’t sleep knowing it was slowing starving and dying a horrible, painful death in that rat infested house. Perhaps you can tell that I like animals more than I like people. The patient’s house was not very far from where I live, and I made the executive decision that if no one was going to rescue that poor little dog before the end of my shift, I was going round there to get it myself, even if it meant breaking and entering! The crew who originally attended were now back on station, off the road with a flat tyre, so I decided to give them a call and see if they had any suggestions. Fortunately, it seemed that burglary was not going to be necessary after all, because they provided me with an alternative number for the patient’s neighbour. I rang her and asked her if she was aware of the situation with the dog. She told me yes, and that she had been on to various organisations all day, meeting much the same obstacles that I had. Eventually, she had managed to arrange something, and someone had just been to collect the dog.

I like to think that it went happily to a new home, but even if it did have to be put down, at least it will have had a quick and painless death, unlike the one I was imagining. Thank god for that neighbour’s persistence, and thank god she noticed that there was a problem with her neighbour in the first place. All too often, people turn a blind eye to this. It’s nice to know there are still some good, kind people in the road. It’s also a relief that I am not going to have to resort to hustling canines in the dead of the night after all.

Strangely enough, after my question about bystanders the other day, I found myself on the other side of the fence last night.

I am a member of St John Ambulance (yes I know, another blogging Johnner! Please no pages of abuse!) and regularly attend duties at my local football ground, Leyton Orient. Generally not a lot happens first aid wise at the matches, so I get to sit on a stretcher and watch the footy for free! I think the most exciting thing I have ever dealt with is a rather tipsy bloke who felt down the stairs and allegedly sprained his ankle. It looked fine to me, but he was making a bit fuss, and was delighted with the bandage I put on, hopping off without so much as a limp, so who am I to argue?

Anyway, there I was last night, waiting for a bus to take me to the evening match against Brighton and Hove Albion. It was a horrible, rainy, night and there were fifteen million billion people waiting at the bus stop. Several buses went past, full, and a couple more stopped and opened their doors to let a few people on, then, infuriatingly, drove off again. Soon it was 7pm, the time I was supposed to be at the ground, and I was still standing in the rain, at the front of the queue at last. A bus came, and I was on my way. The bus moved off, and then lurched to a stop, near some traffic lights. A few people complained about the driver’s driving, and then a bit of fracas started breaking out, and people started getting off the bus.

“What’s going on?” asked someone.

“There’s someone under the bus!” shouted someone else.

I suddenly realised that I was standing in a bright yellow coat with “ambulance” on it and therefore all eyes were on me, expecting me to take charge of the situation. Which was unfortunate, because I am not a “taking charge” sort of person, and my area of expertise lies with sprained ankles and not people under buses, but what choice did I have? I barged my way off to the bus and round to the front where a crowd was assembled around a woman in her thirties wielding a pair of crutches and a Tesco bag. She wasn’t under the bus after all, but she was doing her best to get herself there. I asked a passer by what was going on.

“She was in the queue for the bus and didn’t get on because it was full,” he explained. “So she tried to run along side it, banging it with her crutch, shouting ‘I’m disabled, how dare you leave me here?’ and then she tripped and dropped her shopping, which went under the bus. Then she pulled herself up and ran out in front of the bus and tried to lie in the road as some kind of protest.”

About twenty people were trying to persuade the woman to come away from the front of the bus, some more politely than others. A huge queue of traffic was building up behind it, horns were beeping, and people were getting out of their cars to see what is going on.

Everyone was still looking at me expectantly, so I put on my best Taking Charge of Things voice and (after making sure someone had called the police) ordered everyone to stand back, then approached the “patient” with what I hoped was a friendly smile on my face.

“Come on love,” I said. “You can’t stay here, it’s dangerous. I’m from St John Ambulance, I can help you to the side of the road.”

“I can’t move!” she wailed. “I’ve hurt my leg. And I’m disabled. I need an ambulance!”

“But you got up and deliberately stood in front of the bus!” pointed out a bystander. “Please, madam, we’ve all got to get on. I’ve got to pick my baby up from the childminders!”

“And I’ve got to get to work,” said another man.

“And I’ve done a twelve hour shift,” said a woman in what appeared to be a nurse’s uniform. “Come on, let this man help you. Do you want him to look at your leg?”

“NO!” she bellowed, “don’t touch me!”

“I don’t think she’s hurt at all,” muttered another man.

“WHY ARE YOU ALL TURNING ON ME?” bellowed the woman. “THIS IS DISCRIMINATION AGAINST THE DISABLED!!! WHY DID YOU ALL LEAVE A DISABLED WOMAN STANDING IN THE RAIN? WHY DID YOU GET ON BEFORE ME?”

“I got on before you because I was at the front of the queue and didn’t see you were there,” I pointed out. (I always let disabled/elderly/pregnant people get on before me and have the seats on buses, but I do think this is a matter of courtesy and not something they should expect as a right.) “If you had asked politely, I’m sure all of these people would have been happy to let you go first.”

“YOU DIDN’T SEE ME!” howled the woman. “THAT’S EXACTLY MY POINT! The disabled are INVISIBLE!”

Everyone was beginning to lose their patience at this point. A man in a bomber jacket started shouting about how he too was disabled (epilepsy) and how his mother was in a wheelchair and neither of them played the card like this. Another man (rather foolishly, I thought) dived under the bus to retrieve the lady’s shopping bag (which now contained an assortment of squashed chocolate bars and a flat four pack of beer), hoping this would encourage her to move on. A black girl with her hair in a big pineapple started telling the patient she needed to go to church and have faith in God as this would stop her being angry with strangers and trying to jump under buses. I stood and flapped my arms ineffectually tried to calm everyone down whilst simultaneously persuading the patient to remove herself from the road, with equal lack of success.

What seemed like an eternity later, but probably wasn’t, two police cars drew up and ordered the lady to get up and stop lying in the road. I’m not sure if it was because they were police or just because they were better at being authoritative than I was, but after a bit of whinging about her leg and how she needed to be moved on a stretcher, she got to her feet and scuffled to the side of the road. I noticed she wasn’t even limping. I was happy to leave her in the care of the nice policeman, and got the next bus to the football ground.

I got there five minutes after kick off. Our only casualty was a man who had, for no apparent reason (other than inebriation perhaps), come out without a coat or even a jumper on and was utterly freezing. His rationale for this was “It’s okay, I live in Bounds Green.” Leyton Orient lost, 1-4. I got utterly soaked.

When it gets busy, the dispatch desks spend a lot of time calling back our lower priority calls “apologising” for delays and hoping that the callers will get the message that they shouldn’t be calling us and should be calling a GP/taxi/etc instead. We are not allowed to refuse people an ambulance but we are allowed to warn them of long delays and generally coax them into deciding to cancel and deal with the problem more appropriately. We are on rather shaky ground doing this, but since the Telephone Advice people stopped using TAS and started using a new system called PSIAM we have no option. Gone are the days of the No Send Policy — using PSIAM, Telephone Advice are forced to make us send out ambulances for any person who insists on one. As you can tell, I am not a fan. I fear for us dispatchers, because one day, in an effort to weed out an inappropriate call, we are going end up coaxing someone who is seriously ill but mistriaged as low priority to make their own way to hospital, and the papers will get hold of it, and all hell will break lose. It shouldn’t fall on us to do this; Telephone Advice should be given their old system back, which worked perfectly well in getting rid of the time wasters and identifying the seriously ill people who had erroneously been triaged as low priority.

Anyway, despite these worries, I felt reasonably confident in calling back a thirty-year old man whose symptoms were given as “runny nose, cough, slight fever, headache, for two days”.

“Hello sir,” I began. “This is the London Ambulance Service here. I’m ringing to apologise for the delay. All our vehicles are busy dealing with other emergencies” (I emphasised the word “emergencies”.) “How are you feeling?”

“I have a cold!” grumbled the man, as if that much had not been obvious.

“I see,” I said. “And has anything changed since you called? Have you done anything for your… cold?”

“No!” said the man. “Nothing has changed, and I have had it for TWO DAYS! I went to the hospital yesterday, and they did NOTHING! They told me to take paracetamol and sent me home. They were not able to cure me!”

“Well, sir,” I said. “That’s the thing about the common cold — there is no cure. If you’re sure that’s what it is, then you just have to wait for it to go away.”

The man tsked and muttered something about the state of the NHS, and then cancelled the ambulance, which was good, because we needed five vehicles for an 80mph RTA on a 30mph road, and wouldn’t have had one for him for hours.

I think a lot of our inappropriate callers share the underlying beliefs of this caller, which is that if you are ill or injured and feeling lousy, you shouldn’t have to put up with it, and that someone from the medical profession will always be able to come along and wave a magic wand, which will make you feel better. It just doesn’t occur to people to go to bed and take some time out and wait for whatever is wrong with them to go away. Everything has to be fixed instantly, and if it can’t be, it is always someone’s fault.

Reader Aira is working on a development progress about bystander reactions and the various ways in which bystanders react in distress or emergency situations. If you have relevant experiences you’d like to share with her, you can email her at: aira [dot] planting [at] northonetv [dot] com.

Aira’s request has lead to some discussion about typical bystander reactions. From my experience, the typical bystander reaction is this:

1) Ring 999, even though you can see at least four people doing the same. If you happen to be passing on a bus or car, and have no idea where you are, do this anyway, and under no circumstances get off the bus to help, as this may make you late for an important engagement, such as a church service.
2) Swear repeatedly at call taker for asking you stupid questions like “what’s happened?” and “where are you?” Hang up phone. If call taker is impertinent enough to ring you back again, switch phone off.
3) Refuse to follow first aid instructions such as controlling bleeding and doing CPR - those are the ambulance service’s job! Put patient in recovery position, even though he is fully conscious and has broken arm.
4) Switch phone back on and ring ambulance service to berate them for not being there yet. You rang two whole minutes ago! Become stunned at incompetence of call taker when you tell him you’re ringing about “the accident outside Tesco’s” and he does not realise which of the 200 calls taken in the last hour you mean instantly. Hang up again.
5) Give patient cup of tea and cigarette. Stand back as patient starts to vomit.
6) Flag down police patrol car. Tell police you called for an ambulance half an hour ago but none has arrived. Police ring ambulance control who have no record of the call, but have been trying to contact a person who rang back “an accident outside Tesco’s” five minutes ago, but whose mobile phone seems to be malfunctioning and repeatedly dropping the call.
7) Ambulance arrives. Yell at ambulance crew for taking too long. Tell them how to do their job, as you read in Metro lately that all ambulances are staffed by technicians who have no training.
8) Go home and tell everyone how dreadful the ambulance service and how the patient would never survived without your intervention. Sell story to local newspaper. Be acclaimed as local hero.

So if last week was the Week of Horrors, this week seems to be the week of calls that are just very sad.

I was listening in to one of the suspended calls on our desk the other night. It was from a man who had found his elderly mother dead. It appeared to be too late for CPR. All he kept saying was “I told my sister not to visit mum today because she was too poorly. I told her to come tomorrow. What am I going to say to her?”

On Monday night, I took a call from an extremely upset lady who had been woken in the night by her elderly husband having a fit. He had never had one before, which I took as a rather bad sign — if a fitting patient isn’t epileptic, alcoholic, diabetic or a child with a fever, then it generally means something is badly wrong with them.

I stayed on the line with her and tried to calm her down as we waited for the fit to stop.

“It didn’t take this long last time I called!” she wailed. I looked at the clock; we’d been on the phone for two minutes and thirty seconds. I strongly suspected that, unless there happened to be an ambulance parked outside her house last time she’d called, it just hadn’t seemed that long. The longest minutes on earth are those spent waiting with a critically ill loved-one.

The fit stopped, and the lady laid her husband on his side. I crossed my fingers that he would start breathing. I heard a snoring sound, which at first sounded encouraging (people usually snore post-fit) but the snoring became increasingly irregular and the sounds stranger. I strongly suspected that I was listening to agonal (dying) breathing.

I think the lady knew what was happening. She totally lost it at that stage and put the phone to one side so I couldn’t talk to her. I could hear her in the background sobbing and saying “Oh Jim, oh sweetheart, please don’t go. Come on darling, please stay, please stay…” and I could hear her kissing his forehead. Meanwhile, I was shouting “PICK UP THE PHONE PLEEEASE!” at the top of my voice trying to get her attention. After a few seconds, this worked, and I began the instructions to put the patient on his back to check for breathing.

“I don’t think… yes… no… he’s gone blue… oh no, he’s… yes, he is breathing… no, I don’t know…”

I tried to use the breath timer gadget, but it was no use, she was sobbing too much. I asked her to put the phone to her husband’s mouth so I could listen to his breathing myself. She did so. There was nothing. I couldn’t hear anything.

At this point, the crew arrived. I heard one of them say to the patient “can you open your eyes?” which I thought was promising because it’s what ambulance crews say to unconscious people, and not “when did you last see him?” which is what they say to the relatives of dead people. Then one of the crew came to the phone.

“Hi, we’re here…” she said “… and I think we’re going to need a second crew.”

I didn’t need to ask the reason why a second crew was needed. We always send two to suspended patients if we can.

Half an hour later, the patient was blued into hospital, still suspended.

I suppose it is better that she got to say goodbye to her husband with a kiss on the head than by having to thump his chest and breathe into his mouth.