by Stuart Gray
She was lying on the ground and getting colder, despite my blankets and warm reassurances. An audience of queuing fast-foodies were watching with docile, cow-like interest. One or two shouted out sexual innuendos, and others yelled snide remarks at the police. Imaginative stuff, like ‘Don’t you have anything better to do?’ Catching sight of my grim face, one of them said, ‘Cheer up, mate, it’s New Year’s Eve.’ Thing is, I look grim because I’m not happy, and I’m not happy because I’ve got better and, frankly, more important things to be doing.
In the end, I bundled her and an attending WPC into the back of my car and drove them to the nearest hospital, hoping she would behave and not throw up all over the back seat because I was going to have more ‘patients’ to convey before the night was done.
* * * * *
Let’s not forget the other activity that is rife during the Christmas and New Year celebrations - violence.
It may be the season to be jolly and all that, but for many it’s the ideal time to dust off the knives, guns and baseball bats and get to work. There were almost 40 stabbings in London during the festivities last year, and across the country a large number of violent crimes were recorded. One woman, a young bar owner and a mother of two, died after trying to break up a scuffle in her pub just before closing time. She was knocked to the floor and rendered unconscious and she never woke up. See, that’s the reality of pub fights. They’re dirty and nasty and mean and they sometimes claim lives. Whoever knocked that woman over didn’t know about her two kids and didn’t mean to kill her. They were just fighting drunk and out of control; but the result was a massive human tragedy that put terrible holes in other people’s lives.
Drugs also play a big part in the festivities. For some reason, and probably the same one that the drunks use, drug addicts and abusers tend to increase their consumption of whatever they can get hold of on the last day of the old year.
My final call came in five minutes before I ended my shift. Usually you’re left alone until you finish for the last 20 minutes or so, but not this time. The call was for a 23 year old man having an ‘art attack’. I had to get on the phone to the FRU desk about this one.
‘Hello,’ I said. ‘Have you actually read the description for this call?’
‘Erm, no,’ the controller said. ‘Let me have a look.’
Short pause.
‘Oh, yeah. I see what you mean. Sorry. Still, he needs to be checked out. Do you mind?’
‘Not at all. Pleasure,’ I replied. It was almost 7am, I was knackered and in a sarcastic mood, to be honest.
I drove to the location and landed up in a sleazy alleyway near London Bridge. I kept my eyes peeled but I didn’t get out of the vehicle because I was uneasy about this. I couldn’t see anyone; it looked like a hoax or as though the caller had simply left after waiting a fairly long time. But as I turned the car around to go, I spotted a hooded youth sitting on the wall across from me. He was staring at me and I guessed he might be the caller. I didn’t like the look of him and decided to stay in the car and roll down the window.
‘Hello?’ I called. ‘Did you call an ambulance?’
‘Yeah,’ he mumbled. ‘I’m out of it and I think my heart is going to stop. I think I might be ’avin an ’art attack.’
A little light went on in my head.
I sized him up, decided I could cope with him if it turned nasty, and got out of the car. I tried to look as big as possible, breathing deeply and squaring my shoulders.
‘What have you been taking tonight?’
‘Ecstasy and other sh*t. My heart’s goin’ really fast. I’m dyin’.’
I assumed he was exaggerating, but I checked his pulse and other obs, anyway. He had a fast heart beat, sure enough, but nothing critical was going on with him, he was just clucking a bit.
TACHYCARDIA: A fast heart rate. A heart rate above 100 beats per minute in adults is considered tachycardic. Sometimes the word is shortened to 'tachy', as in ‘he patient was tachy at 130’. As distinct from ‘Bradycardia’, a slow heart rate. In adults this term is applied when the HR is less than 60 bpm. In athletes and other individuals it may be perfectly normal to have such a low heart rate, however, and the term is only applied clinically where the rate is seen as abnormal for the patient.
I weighed up the options. He looked evil: he just had one of those faces, dangerous and mean, and he was also out of his skull. Very hyper, very edgy and very unpredictable. We aren’t allowed to search people - the best I can do is say to them, ‘Do you have anything on you that will harm you or me?’ If the police are there you can ask them to perform a search, but otherwise you have to take people at their word. I was uncomfortable with the thought of having to take him to hospital myself. As he sat in the back of the car, my head and neck would be very exposed to him. But I wouldn’t get an ambulance at this time on this day - and I’d have considered it a waste of resources, anyway. The police were too busy to help. I wanted to go home. But I couldn’t leave him here. It was a conundrum with only one solution.
Much as I didn’t want to, I was going to have to take him.
‘OK,’ I said. ‘In you get.’
He climbed in and when he finally strapped himself in - I had to tell him twice - I started up and drove off. Instantly, he wanted to be my mate. That always makes me suspicious, straight away. When people are leaning over a lot, and getting really close to you to talk to you, behaving like they’ve known you for years, I don’t like it. It sets alarm bells ringing.
‘Those bastards,’ he said. ‘They stitched me up.’
I said nothing, but just nodded, not wanting to get involved in conversation.
He sat back and started ranting. From what I could make out, he’d gone out for the night with a mate and his mate had dumped him. To make matters worse, they had gone out for drugs and he’d only got half of what he had paid for. He alternated between shouting and mumbling, and gradually he started directing the shouting at me. He sounded like he was ready to pop at any moment, as though I was his enemy rather than someone who was trying to help him.
He turned from his traitorous friend to the medical staff awaiting him at hospital. ‘What are they going to do to me?’ he yelled. ‘They’re just going to kick me out, aren’t they?’
I glanced into that rear-view mirror more times than I ought to have done, considering I was driving, and I had my foot as close to the floor as I could safely get it. But the streets were now clear and we eventually got to our destination without him making any moves on me.
I left him sitting in the reception area of the hospital. They wouldn’t take him in any of the wards because they were full and he wasn’t an emergency. Neither were many of the residents of the cubicles, to be honest, but once you have a bed, you’re home and dry. As far as New Year’s Eve goes... them’s the rules.
HORRIBLE HOUSING
THERE ARE SOME parts of London which you would never venture into at night unless you had to.
Unfortunately, we do have to. We’re wary when the calls come in. Often, it’s not only that these places are dangerous, but that some of them are so badly-designed that getting into them, whether safely or not, is a navigational nightmare (this is true at any time of the day, it’s just harder to find your way around at night).
The old London County Council estates are some of the largest in Europe and contain some of the worst construction designs I have ever seen. Lloyd George’s Housing Act of 1919, where the pledge of ‘homes for heroes’ seemed to promise a new dawn in architectural excellence, instead produced examples of poorly-planned construction that still exist today. The people now housed in these estates are the immigrants, the elderly and the poorest of society. In some ways, they are heroes just for putting up with it.
One word that always makes me cringe when I see it on the screen is ‘Peabody’. The Peabody Donation Fund was set up in 1852 by an American banker called George Peabody. He’d done well out of life and yet he was troubled by the poverty and mise
ry he saw all around him. Rather nobly, he decided to do something about it and set up a fund to provide housing for the city’s poor. The Trust that bears his name now owns or manages over 19,000 properties and houses almost 50,000 people across London.
So far, so good. Unfortunately, what was an improvement over the conditions which had previously characterised Victorian England is not - in my opinion - suitable for a crowded, modern city of eight or nine million. It’s not the ugliness of these places, and they are ugly: I’m not a commentator on architectural design, but I know an eyesore when I see one and I know a badly-designed pile of bricks when I go into one. No, the ugliness of some of these estates is not an issue for me, because I don’t have to live in them, thank goodness. What annoys me is the difficulty in getting access to them when you are responding to an emergency call.
You try finding a gasping, dying man in a top floor flat on one of the Peabody estates - or any of the capital’s tower blocks and rabbit runs - at 4am on a dark, rainy November morning, when half the lights aren’t working and the lift is bust (or non-existent). It’s not easy, and we’re in a profession where lost minutes - lost seconds, even - can mean the difference between life and death.
Sometimes, it’s almost as though whoever built these places deliberately put obstacles in the way of the emergency services: numbering that makes no sense, stairwells that are too narrow or in odd places, bollards placed across roads… it all feels like a conspiracy to stop you getting to the address in question with enough time to do much good for the caller. Many buildings have large gates at the entrance to the car park. Yes, people need to feel secure, and a good, solid gate with a strong lock will help, but if an ambulance crew has to stand at it for 10 minutes until somebody finds the key or remembers the access code, then from time to time this will cost a life. We do get given keys ourselves, but there are so many of them, and it only takes someone to lose a bunch, or have them stolen, and you’re in serious trouble. (A better system, and one used by many old people’s homes, is coded entry: these numbers are held centrally and sent to us via our screens as and when needed.)
On most estates, the blocks all look absolutely identical with only a small identifying name plate to help you distinguish one from another. These are rarely well-lit and finding and reading them is a task and a half. It’s bad enough when you’re in an ambulance, with a crewmate to look whilst you drive, but on the FRU you are driving and looking at the same time and it’s next to impossible.
This all compounds the stress you feel when you head to a call you already know is serious, one where you need to be with the patient very quickly. Standing outside in the rain looking up at an illegible map on a graffiti-covered map-board is not helpful. Even a routine call can quickly turn tragic.
I was sent to a 72-year-old man who was suffering difficulty in breathing (DIB). I sped to the estate and found myself, once again, trying to see the map and locate the relevant building. I saw that it was on the opposite side to where I had stopped and realised it would take a few minutes to walk round. Then I saw the ambulance appear on that side and decided to drive round and join the crew; they obviously knew the place better than me, I thought.
I got to the other side of the estate and found that my optimism had been misplaced. The ambulance was now reversing out of the car park - it was full, and the driver’s only other option would have been a very tight three-point turn. She and her crewmate looked as lost and bewildered as me. There was no visible access to any of the buildings from where we were, and no signs or boards designating each block. They didn’t know where to go either.
I was just about to call Control and ask them for a better location, when two young boys appeared, running and waving at me. They pointed to the block of flats just behind them and I hurried over to the ambulance to let the crew know we were at the right spot after all.
I asked one of the boys to take me to the address whilst the other stayed behind to guide the crew in after they had unloaded their bags. I followed him as he unlocked a gate and ran up the path to the block. He then took me up a flight of stairs.
‘It’s just up here,’ he told me as he glanced back.
‘Great,’ I said. I was carrying all my bags, which must weigh at least 15 kilos. You can add to that the crash bag that I carry, which is another couple of kilos, and then the oxygen, which will be a further couple of kilos. So the fact that we were nearly there was music to my ears. One flight of stairs was enough. (If you’re in the business, you already know how this turns out so feel free to skip the next paragraph.)
The first flight led on to the next flight, then another, and then another. I was gasping for air by the time we reached the fourth floor, and I consider myself to be fit. It seemed like an eternity getting up those stairs, laden as I was with the equipment I needed. Where the hell was the lift?
Eventually, we got to the door. A huge pile of shoes lay outside. We went into a flat that was heaving with people. They were immigrants, and there tend to be many more of them crammed into one place, usually all from the same family. The shoes are the first hint you get.
The old man was lying in bed, surrounded by seriously-worried family members. He didn’t look right - in fact, he was virtually unconscious - and I could see him labouring to breathe. I quickly cleared the room of most of the people, until just the older members of the family and the paramedic from the ambulance were with me.
There was no response from the man, and I carried out my obs as usual. A worried-looking lady in a pretty headscarf - perhaps his daughter - mentioned in good English that he was a diabetic (type II, non-insulin dependent), so I checked his blood glucose; the meter simply flashed ‘LO’, which meant his body’s sugar level was too low to measure. This was significant and would explain his current state. He had also had a fall earlier in the day, so there was the possibility of a head injury.
The other paramedic’s crewmate had arrived, carrying the chair and panting, and we wasted no more time with the patient. He was given oxygen and taken down to the ambulance as quickly as possible. Luckily (and thankfully), we were shown to the lift - it was on the other side of the building. The man was too floppy to carry down stairs safely, so the lift, regardless of the distance we had to run with him to get to it, was a blessing.
Once in the ambulance, I gave him an injection of Glucagon and the other paramedic started running glucose fluids IV. The combination would release stored sugar and boost the blood glucose level immediately. If we had this wrong, there would be no improvement. If we had it right, he would revive quite quickly.
Meanwhile, lots of members of his family had started gathering outside the ambulance. A young man pushed his way to the front and, very politely, said, ‘How is my grandfather, please?’
I left the other paramedic working on him and stepped down from the vehicle. Speaking to the young man and the woman in the headscarf, I said, ‘His blood sugar was very low, so we’re trying to get that up. And we’re giving him oxygen. He’s in good hands.’
Some of them spoke no English, so the message was quickly relayed around the group and I saw them begin to relax slightly. People want confidence in a crisis; they place their trust in you and you do your best by them. It’s a humbling feeling.
Inside, the man was beginning to show signs of improvement. His breathing was still being supported but he was definitely fighting for himself. I re-tested his blood glucose and this time the meter read ‘1.3’, which is very low but an increase on my last result. ‘He’s getting better,’ I shouted to the young man, and a smile of relief passed across his face. Mentally, I began to relax slightly, too.
I travelled with the patient in the ambulance and his glucose level had risen to above 7 by the time he reached hospital. We still didn’t know if this was the only cause of his sudden deterioration, but it looked very likely. Somewhere along the line, the man had neglected himself; it’s important for type II diabetics to watch what they eat and when they eat it, and any lapse can be se
rious.
After we handed him over - confident that he was going to be OK now - I couldn’t help reflecting on how time-critical this call had been. If the layout of that estate hadn’t been so difficult to understand, we would probably have got to the man before he lost consciousness. Conversely, the stupidity of the place’s design could have contributed to a delay which cost him his life. Badly put-together housing is another way, less obvious than others, in which the poor and weak have the odds stacked against them.
Unfortunately, the poor are always calling ambulances, sometimes when they don’t really need them. The only thing more frustrating than spending precious time trying to find a seriously-ill person on an estate which might have been put together by Salvador Dali is spending precious time trying to find someone who isn’t ill at all.
I was working on an ambulance in east London when an emergency call came in for a 22-year-old female with severe DIB. We rushed to the scene and found ourselves staring up at a block of flats which may or may not have been the caller’s location. We struggled through a locked gate on every flight of steps (and there were lots of them) until we reached the top floor of the building.
There we found a young woman. She came towards us, shuffling her feet and coughing. She got right up to us before either of us spoke; we were too busy staring at her in disbelief. We knew what was coming.
‘Did you call us?’ my colleague asked.
