Heroin Overdose.

One autumn afternoon, Tony and I had just cleared at a local hospital and were hoping to be RTB’d (Returned to Base) for meal.  Instead, with its usual irritating bleep, the data terminal announced another job for us.  It was a few streets away and was a reported heroin overdose, possibly more than one patient; the caller was too agitated and panicking for our call taker to clearly get all the details, but possibly the patient was not breathing.  This is the thing with heroin, as with all opiates such as morphine, as well as being excellent pain relievers they act on the cardiac and respiratory systems to reduce the respiratory effort, ultimately causing respiratory arrest which if left untreated rapidly leads to cardiac arrest – death.

We were on the street within minutes. Unfortunately we weren’t 100% sure which house number we were going to.  The caller had been hysterical and shouting making it hard for our call taker to understand clearly what he was saying.  Our call taker said to try number 51, that’s what it sounded like.  The caller had ended the call and wasn’t answering when our call taker tried to ring back.  We knocked at number 51 – no reply. By now we were joined by Stuart, a paramedic on the response car.  We waited for control to listen to the tape recording of the call to have another attempt at interpreting the address (all calls to the service are recorded and it has often been proved useful to get vital information on a second or third listen).

As we waited, a man further down the street popped out of the door and started waving and shouting frantically.  It was number 31.  We quickly moved the vehicles and Tony and I grabbed the equipment we needed for resuscitation.  Stuart followed us in.

As always seems to be the case when you need to act quickly, the house was cramped and the room we needed was hidden by the open front door so we had to enter one at a time and close the front door behind us to get in the bedroom before the next one could open the front door get in.

I was in now. Instantly I had a flash back to training school where as part of the training for resuscitation we set up scenarios for each other and as we got the hang of the resuscitation procedure we would make the scenarios more ‘interesting’ with multiple casualties and confined spaces.

One patient, a lad in his mid twenties was asleep on a single bed near a window.  He was breathing but only occasionally and his lips were blue.  A male aged approximately 50 was on the floor next to the bed and was in cardiac arrest.  The man who had called us down the street was doing chest compressions on him.  A third patient was in the doorway, also in cardiac arrest.  There were needles and syringes scattered over the floor.

Stuart updated control and requested two more ambulances as I managed to shake the patient who was breathing occasionally and wake him up enough to breathe normally.  Then I took over the resuscitation of the 50 year old, with assistance from the man doing chest compressions.  Tony and Stuart started to work on the third patient.  I also had to keep an eye on the sleepy lad, make sure he didn’t fall back asleep unnoticed and stop breathing.  I could reach him with my outstretched leg as I was resuscitating my patient so every so often I had to kick him to wake him up. All the while we were working we had to be very careful not to injure ourselves on any of the discarded needles scattered around the room. Luckily the service wasn’t too busy that afternoon and the backup crews arrived quickly.

The first crew took over the resuscitation of the patient in the doorway and moved him out of the door.  The next crew took the sleepy patient so then Tony and I could concentrate on my 50 year old patient.

Despite the initial chaos, the job flowed smoothly.  We had all three patients out of the house and in hospital within about 20 minutes from first arriving on scene.  The sleepy patient survived and was discharged from hospital that afternoon.  Sadly the two cardiac arrest patients died.  What made the job more poignant was that the 50 year old patient was not a regular heroin user – today on a whim he’d decided to try it for the first time because his friend was a user – first and last time.  The man who had tried to help with the resuscitation had supplied the sample for the three of them.  Because our patient had never used before, his ‘friend’ the supplier had actually injected it for him.  The last I heard he was arrested and being tried for manslaughter.

After this we did eventually get RTB’d for meal break – a somber and reflective meal break.

Girl on a bridge

One ordinary spring afternoon I was on with my regular mate, Tony.  The next job arrived with the beeping of the data terminal on the ambulance dashboard.

We were passed details of a girl threatening to jump from a pedestrian bridge crossing the motorway.  The girl had been spotted climbing over the railing on the bridge by an off duty ambulance man, Tom, as he was driving along the motorway.  He left the motorway and rang the details in.  He then drove to the car park near to the bridge to see if he could talk to the girl.

We arrived shortly after Tom; luckily we were available and fairly local when Tom rang control.  We were advised to use a ‘silent approach’ which as the name hints means turn off blue lights and sirens when near the incident so as not to startle a volatile person.  The police had arrived shortly before us, also using the silent approach.

The girl was on the bridge, on the wrong side of the railings, above the third lane of the carriageway.  Tom was half way to her and the police were on the car park.  As the police arrived the girl had become angry and threatened to jump if they didn’t go away so they withdrew out of her sight.  I stepped on the bridge and asked if I could come and talk to her.  At first she said she would jump if Tom, I or Tony came any closer.  I said that it was hard to hear what she was saying from a distance and I couldn’t keep shouting, she reluctantly agreed to allow just Tom and I to come nearer –  she repeated her threat to jump if any police officers or anyone else stepped onto the bridge.  The police officers stayed hidden in the car park, meanwhile requesting a trained negotiator to join us to help.  Tony stayed at the end of the bridge so he could relay information to our control centre as the incident evolved and equally importantly help Tom and I should we need help suddenly.

When I got near enough to talk I introduced myself and she said her name was Sonia (changed).  She was in her early 20s and from her early teens had suffered with depression.  She admitted that occasionally she harmed herself by cutting and I could see the faint lines of healed scar tissue confirming this on her left forearm.  The last few days had been particularly bad she said and today had got to the point where she felt she just could no longer cope.  I asked how she came to be here on this bridge and she said that she had gone to her GP surgery by the car park at the end of the bridge for help but had been turned away without seeing her doctor or any other of the doctors in her centre as there were no appointments that day or indeed that week.  This is a growing problem in the UK: GPs are so overstretched that it is really hard to get an appointment to see them, one of the reasons ambulances and hospital EDs are stretched is that people try to get an appointment and when this is not possible have to resort to going to hospital or dialling 999.

All the while Sonia was talking, she was crying and kept saying:  “I’m just not worth it, go and help somebody who deserves help, I’m going to jump now.”

She was standing on the ledge holding the railings and kept leaning back.  She was wearing a pair of flip flops so she was at risk of slipping and falling even if she didn’t intend to jump.  By now there was no traffic on the motorway; the police had stopped traffic entering this stretch in both directions to remove the risk to traffic passing beneath us.  I asked if I could check her pulse, any excuse to make contact so I could grab hold but she was smarter than that and refused, saying she was going now.  A quick glance at Tom and a quick nod, we both knew we were going to have to grab her, she was looking down between her feet and seemed to be steeling herself for the drop – we each grabbed an arm.  Her feet slipped from the ledge and Tom and I were pulled tight against the barrier as we held her up.  She was screaming, wriggling and swearing at us to let her go.  Things were happening quickly but I seemed to have lots of time to notice things.  I could feel the pressure of the barrier in my armpit and had time to hope that it would hold the combined weight of the three of us.  A pen in my sleeve pocket slipped out and I had time to notice it tumbling end over end until it hit the empty road beneath us.  We couldn’t lift Sonia; we just had to wait for the police to join us.  Suddenly I felt arms around my waist and more sets of arms reaching over to grab Sonia.  Somehow between the police officers and ourselves we manhandled her to safety.

Later at the hospital I handed her over to the triage nurse for a review by the mental health team.  I never got chance to check later that shift but have often wondered how she got on and how she is now.

We never did get the services of the trained negotiator that day but thankfully the only casualty was the pen which had fallen to its destruction from my sleeve pocket.