Binge drinking and the like is showing an increase in the news lately.  And unsurprisingly it seems to be showing a huge increase in the type of calls we get as well.

Most of the time, drunken people are ok.  They are reasonable to deal with, some are even pleasant and fun.  Its the ones who become rude, obnoxious, confrontational and aggressive that tend to be a drain on our resources, safety and sanity.

Then there’s the psychs.  As in psychiatric patients.  These can range from people with ongoing depression to people with full on violent episodes towards themselves and others.  Again, some psychs are nice to deal with and know full well the problems they have and equally know the help they need.  But on occasion, some psychs can be unpredictable.  And I do mean unpredictable.

There’s a standing joke amongst the Police and the LAS that says, “when the full moon is up and out, the psychs and drunks will run about”.

And coincidently enough, last week, around the full moon period, we had several patients befitting the above descriptions . . .

Patient 1 –
Call came down as “Male – unresponsive in street.  ?epileptic seizure” called by “Passer-by”.

On arrival, our patient was being propped up against a shop window by an FRU.  Smelling of cheap lager and stale urine the patient stammered and spat their disapproval of being interrupted from their morning’s drunken collapse.

After assisting onto the back of the ambulance we ventured some basic obs but were refused all attempts.  Each time we tried to help the poor man the more he became belligerent and offensive.  The final straw wasn’t when he accused my crew mate of being a “fat ugly bitch”, but when he tried to add to the insults by spitting profusely at all of us inside the ambulance.

We’d had enough.  He was promptly assisted “gently” from the ambulance and “politely” sent on his way – with good advice.

Patient 2 –
Next up, a regular psych patient.  He was calling this time because the “electro-magnetic waves that had been targeted at him by the MOD and fired from the local police station were causing him ongoing sleep deprivation and pains”.  He was growing tired of being used as a government experiment and wanted help.

He was in his fifties and was unkempt albeit a very gentle man.  And despite his apparent randomness he was very pleasant to talk to.

After all obs checked out we made him comfortable on the ambulance and started on our way to hospital.  During our journey we assured him he’d be safe with us as the ambulance was lined with “zirconium-lead sheeting” which was “positively charged”.  This, we said, would deflect all attempts at targeting him.  To prove our motives we ran our (iPhone app) Geiger Counter over him and showed that he was free from any electro-magnetic waves.  To add random weight to our efforts I mentioned that I was driving along natural Lay-Lines which would double the charge added to the zirconium-lead sheeting.

Although we were playing on his thought processes, ultimately it was in his best interests and after our continued assurances and electronic displays our patient arrived at hospital relaxed and admitting that his pains had gone – thanks to our help!

Patient 3 –
Patient lying unresponsive in street.  Upon arrival onlookers were worried as he wasn’t responding to anything they did.  The patient was lying on the pavement, coat tucked up over his head, arms folded.
Ok – primary survey – check for response . . .
We kicked the patient’s feet.
“Oi! Wake up!”
Patient opened his eyes, coughed and tried to roll over.
A miracle!

We escort him to the ambulance and find out he is Russian.  All he wants to do is sleep.  Getting info from him is difficult especially as his English is poor and to substitute he slips into fluent Russian thinking this will help.

On the way to hospital he becomes agitated and we ascertain he needs to go to the toilet.
“Not here fella.”
He starts undoing his trousers whilst on the bed.
“No! Not here!”
We grab his hands away.
“NO . . . !”
He keeps trying until eventually a pronounced darkening patch starts to appear around his crotch followed by the unmistakeable rancid smell of urine.
” . . . great!”

Patient 4 –
The next patient had the potential of being a serious case – a fifty year old female claiming to have been raped and wanting to go to “The Haven” (a place specifically set up to receive victims of rape).

When we finally found the patient (with the help of the Police) it turns out to be Molly**, another regular psych patient.  The only thing correct with the details was that she was fifty and female.  Molly was homeless and suffered schizophrenia and sadly wasn’t controlling it with medication.  She had not been raped.

With wild ragged hair and a sharp dashing glances of intense bitterness she spat her way onto the ambulance demanding that we take her somewhere to sleep.  As soon as we opened our mouths to speak she would scream at us in a thick Nigerian accent –
“I don’t need to listen to any of you bullshit!  Take me somewhere to sleep! I’m a Solicitor!  I know my rights!”
My crew mate attempted obs but was swiftly pushed away and spat at.
“Get you hands off me you . . . you are nothing!  You hear me!  NOTHING!  I’m more intelligent than you! I’m a Nurse you know! Now shut up and lets go!”
We kept our distance on two accounts – first and foremost, she was in a state of unpredictable agitation and second, the smell of urinary infection and stale faeces was so potent it made my eyes hurt.

Eventually, we were able to calm Molly and head off to hospital.  Speaking to Molly en route I found out she had a couple of daughters who were always concerned about her (she showed me letters they’d wrote).  And it appears she had contracted this illness several years back after her husband (at the time) had disappeared without trace, leaving her jobless and with two children to look after.

Thankfully, we were able to hand Molly over to the hospital in a calmer state than how we picked her up.

Patient 5 –
Another “male – collapsed in the street”.  Upon arrival we were told the man had collapsed in the road but had been coaxed onto the pavement where he was now.

We looked down at our patient.  He had a huge Santa Claus beard and the rugged look of a homeless person.  This was Gary* – another regular who was originally from Newcastle.  Gary was a genuine homeless person too – as in he prefers living on the streets as opposed to living in hostels and refuges.

We could just see two wide staring eyes through all his hair looking distantly across the floor.  I knelt down smiling.

“Evening Gary**”
No response.
“GARY . . . Oi! Geordie!!”
The patient’s eyes closed half way and I could see the crows feet on his face suggesting he was smiling.  I put on my best Geordie accent.
“Why aye mun – what ya doing doon there like”
I sounded more like a cross between Bengali and Welsh.

We got him up and onto the Ambulance where we made him warm.  Gary was a happy drunk.  He would never dream of calling us out but sadly he would get so plastered the Passer-by’s of the world would call us instead.

However, we liked Gary as he was always happy and always had a positive outlook on life.  Unfortunately, he was often found in a poor state after people would take joy in beating him up for fun.

This was our off job, and a nice one to end on.  So we made him warm on our bed, listened to his stories (again), stuck a load of thermo-blankets in his pocket (for later) and conveyed him to hospital.

There were lots more over the full moon period but it does get a little monotonous writing about every single one so hopefully this gives a little insight into it all.

Remember – when the full moon is up and out, the psychs and drunks will run about.

Binder

**Not their real names.

Proper jobs come round once in a blue moon.  But when they do, its a bit like the buses – they all come at once.

We only had four jobs the other day.  This was because we had to spend two seperate occasions at the dreaded Vehicle Fitters and eventually had to swap onto another truck.

First job, a hypoglycaemic patient with a [tippy title=”BM” ]“Blood Sugar”. A terminology used for measuring someone’s blood sugar count in their blood. Usually done for Diabetics but in the emergency services, done to . . . . um, anyone really. Very useful for diagnosing certain problems – like Hypoglycaemia (low blood sugar – indicative of an Insulin Dependant Diabetic) . . . or ruling out diabetic problems with someone who is suffering a CVA.  A normal reading will be between 4mmol/L to 8mmol/L.[/tippy] of 1.7.  He was hiding under his bed sheets and peering out at us with a look of terror and anguish.  Sweat was pouring from him and his sheets were drenched.

After the initial pleasantries it was clear to us that we’d have to hold him down to give treatment.  There’s nothing satisfying about doing this but sometimes it just has to be done.  And, after one Glucagon injection(IM), several sandwiches and a sweet cup of tea later we were able to leave the patient at home fully back to normal and with our closing words of “just doing my job man”.

After changing vehicles at the fitters it was onto our next job – a [tippy title=”hyperglycaemic” ]“Hyperglycaemia”. This is where your blood sugar levels are high.  Technically, anything above a reading of 8mmol/L is considered not normal.  However, hyperglycaemia is generally recognised at 13mmol/L onwards and signs and symptoms can start at as little as 15mmol/L onwards.  Some signs and symptoms can be; weight loss, excessive thirst, dehydration, excessive urination, excessive hunger, extreme tiredness and deep laboured breathing (Kussmauls Breathing).  If left unchecked the person will most likely slip into a coma and die.[/tippy] patient with a BM measuring “High” on the monitor (this means its through the roof and at a minimum of 30mmol/L).  The patient looked unwell, very obviously dehydrated, poor mobility and kept drifting off to sleep.  We gathered them onto the ambulance where I was told to get I/V access to give fluids!

Right.  Access.  I/V access.  Ok.  Um . . . right, I needed a cannula.  What else?  Erm . . . er . . .

Whilst I struggled remembering what basic bits and pieces I needed to gather together, I smiled at the patient and reassured them that we were going to look after them.  I made sure not a single one of my frayed nerves showed externally and took my time as best I could, under the circumstances.  I was about to insert the cannula when my Mentor touched my arm and whispered to me, “take a deep breath and let it out slowly”.  She must have noticed the tiniest beads of sweat starting to form on my brow – or probably that I was gibbering like a pathetic child and frothing at the mouth.  Either way, it helped and the cannula went into the tiny vein first time.

I secretly “high-fived” myself – but not before letting the patient bleed onto the ambulance floor as I failed to place pressure on the vein to put the cap on the end of the cannula . . . but these “little” faults can be excused.

After about 200ml of fluids the patient had perked up lots and even managed a smile.  And we felt that we’d managed to do something good and worthwhile when we handed them over to the hospital staff.

The next two jobs were “blued” into the hospitals.  The first was a poor woman with suspected haematemesis (vomiting blood) and melaena (gastrointestinal hemorrhage coming out as black tarry poo – not good).  Again, she looked very sick.  This was pretty much a “scoop and run”.  Because of excessive hyperventilation we found it hard to obtain an accurate blood pressure but later the hospital told us it was 63/33!

The last job was a suspected [tippy title=”CVA” ]“Cerebral Vascular Accident” Or, “stroke”.  This is when a clot of some sort enters the circulatory system of the brain and gets stuck – thus causing a blockage and subsequent possible necrosis of the brain that is being blocked.  This is where the FAST test is useful.  Having an extremely high blood pressure can be a cause of this. Once the diagnosis is made it is best for the patient to be transferred to a Stroke Unit – and this can sometimes mean bypassing several hospitals en route to do so.[/tippy].  Upon arrival it was clear the patient was reduced [tippy title=”GCS” ]“Glasgow Coma Scale”.  The GCS of a patient determines how “with it” they are.  Obviously a Doctor wouldn’t be saying “this patient has a reduced GCS as they’re not with it” but would justify their statement with a score.  It is scored out of 15 taking into account reaction of eyes, verbal and motor skills.  If the patient scores 1 in each they are GCS 3 – this is very bad and would suggest a coma of some sort . . . or at least very drunk! If they are GCS 15 then this is good.[/tippy] as they were confused and struggling with articulation.  The more the patient tried to speak the more incoherent they were and it appeared that this was distressing the patient as they knew something wasn’t right.  It was also clear from the history that only an hour before, this person had been up and moving and talking normally.

We attempted a FAST test but the patient was frightened and combative.  Therefore, it was a “load and go” situation again.  The carers on scene contacted the patient’s family as we started moving her to the ambulance and we got ready head off sharpish – as this was now time critical for the patient.  Cannulation and an ECG were also ruled out as the patient withdrew from all efforts to do so.

It took us twenty five minutes of aggressive (but safe!  Honest!) driving for us to travel the 7 miles to the Royal London Hospital.  And after rushing the patient into resuss we handed over to the Stroke Doctors.

As I sat in the ambulance afterwards, sipping a cup of tea, my Mentor approached and informed me that the doctors had decided they would not be [tippy title=”thrombolysing” ]“Thrombolysis” is the breakdown of blood clots.  Specific “clot busting” drugs will be introduced into the patient’s system as part of the therapy to treat disorders like CVA’s.[/tippy] the patient as she was over the cut off age of 80.  Apparently it is not considered to be in the government’s best interests to treat patients over this age.  Not viable I guess.

The patient was 81.

This means there will be no treatment for her other than palliative like care.  It did nothing less than boil our blood and break our hearts.  And as this was our off job it left a bitter taste in our mouths.

Weekend off now and back on Tuesday.  I will now attempt to keep these posts regular.

Binder