After The Epilepsy Comes The Work

There is a 'genuine' job that I dislike above all others, and that is someone who has had a seizure in a public place and is now 'post-ictal'. The post-ictal stage of a seizure is the period after the fitting has stopped when the patient can become very drowsy or, and this is the bit I hate, can be extremely confused. These patients can also become violent and very distressed. It's normal and something that we learn to deal with, but I still don't like it.

We were called to a collapse in a supermarket, it's fun to go to these as you try to guess if the collapse is real. Wondering if the person was caught shoplifting, yes, I have a nasty cynical and suspicious mind.

Out patient was a young woman in her twenties, she was being restrained in the first aid room by the security/first aid officer. They could see that she was confused but probably didn't understand why the patient was fighting with them and wanting to walk off. The problem that we have is that we aren't really meant to restrain patients, but on the other hand if I let her waltz out into the traffic I think I'd be getting negative newspaper headlines unconnected with my book.

So we tried talking to her but she was still very confused. A quick check revealed nothing physically wrong, she was just in an agitated post-ictal state.

So we found ourselves essentially frog-marching the poor woman out the door to try and get her into our ambulance, she was fighting us the whole way. Again we aren't supposed to do this, but I believe that we are protected under common law to prevent someone from hurting themselves (something that really needs a post of it's own and some expert advice). She adamantly refused to enter the ambulance but she was in no fit state to be left alone.

Then our angel descended from the heavens.

A girl, about 10 years old, appeared from nowhere. To take one look at her you would instantly mark her down as one of those wasted youth who hang around on street corners. She came over and started talking to the patient, it turned out that she was her next door neighbour. After asking us if our patient had had a seizure she managed to persuade our patient to get on the ambulance where we could do further checks and provide a bit of treatment.

After some talking (and some persuasion from our 'angel') the patient agreed that we could take her home and as she was starting to recover we thought that this was a reasonable idea. It's something we sometimes do – provide a bit of treatment until the patient recovers and then the patient will ask to be either left where they are or to get a lift home. This is one 'taxi-ride' we don't mind.

All throughout our 'angel' was superb, she went back into the shop and bought the item that our patient had originally came out for, then she kept talking to her in order to keep her calm. Finally when we reached her address she made sure that our patient was safely indoors and offered to stay with her until her family returned home.

So because of our 'angel' a very tricky job became much easier and much more pleasant for the patient.

The reason why I don't like these jobs is that all the public sees is us 'fighting' with an aggressive and confused patient and no doubt forms the impression that the patient is either drunk, on drugs or insane. I hate it for the embarrassment that the patient must feel afterwards when they realise what had happened. I hate it because it's such a show we get the maximum number of rubber-neckers and you can hear people tutting as they walk past.

…And yes I hate it because I don't like forcing people into my ambulance.

25 thoughts on “After The Epilepsy Comes The Work”

  1. I think they meant misanthropic…Which, of late, it hasn't really been – I think I need to get some rants up in short order, I've been much too reasonable of late.

    Hmmm… I've just given myself an idea.

  2. You're doing a pretty good job of conforming to my stereotype of someone who, perhaps since the world was nasty to you when you were young, feels the need to be as abrasive as possible when no one is actually attacking you any more.You seem to have taken every ounce of negativity you could find on this blog, not just from Reynolds but from his many commenters too, and decided it's all from or because of him, and all directed at you, at various stages throughout your life. I don't loathe you, but I feel extremely sorry for you.

    Perhaps you could try looking for the positive. It may help you to be happier in life.

    As for taking one look and making fast decisions and judgements based on what is observed, but being prepared to quickly change those judgements based on new relevant information… sounds fair to me for the situation described.

    If an EMT is called to me, in an EMERGENCY, I want him/her to be monitoring me and making quick decisions about keeping me healthy, not going round having an in-depth chat with all the onlookers to see if any of them might be useful. I want assumptions like “unless one of these random people comes forwards and says they know the patient, they're all just annoying gawpers who have nothing better to do with their lives. Let the ambulance staff through.”

  3. That's a pretty 'grown up' 10 year old. Seems young to be wandering around solo, but maybe I'm just old fashioned or something. I know what you mean about seizures – there's really very little you can do, but you feel like you should be doing more. We were toned to a 12yo girl who was having a seizure (dispatch said 'We had two calls, one said she was breathing, the other says she wasn't'). On arrival she's conscious, breathing and very drowsy. She had no history of seizure. We had to wait for her Mum to arrive since she wasn't too far away, but when she did get there, she took one look at her daughter and said that she would 'meet her at the hospital later, since I have a lot to do at home'. The poor kid had to ride alone. Boggles my mind.

  4. I know what you mean. We have a nursing home and I once had to go and collect a very agitated and confused resident from outside some shops when he absconded. He was trying to hurl himself out of a wheelchair while lashing out and I was trying to keep him in the chair so he didn't injure himself on the glass covered pavement and not get my nose broken. So all the public can see is a 20 something woman wrestling a bellowing, screeching 1 legged, elderly man in a wheelchair. Disapproving doens't even start to cover it. One woman informed me I was a disgrace to be letting my 'grandfather' out like that. The urge to tell her to piss off and mind her own bloody business was overwhelming! You've got so much more patience than I would ever have!!

  5. Hmmmm…the tricky issue of 'consent'. I'm currently a Paramedic student at University and we get a lot of lectures about consent. According to our chief lecturer it seems to get valid consent these days we have to have a statement signed in blood and witnessed by a passing nun before we can cart anyone off in the circumstances you describe.But I suppose that's 'book-learning' as opposed to 'street-learning', eh?

    Hope this comment gets posted…I've had awful trouble getting anything on here in the past.

  6. People always want to “do” to make it better, when sometimes all that is necessary is to “be”. I've lost count of how many unwanted glasses of water I've drunk because I've had a wobble in public and someone's been desperate to “do something to help” and I didn't want them to feel rejected, even though all I actually needed was to sit quietly for a moment.I tried to write a helpful blog entry about it for non-emergency-responders, here.

    Preventing someone from hurting themselves further is definitely important though, if I'm having what I would describe as a “wiggins” I'd rather have slightly red marks on my upper arms for a minute or so because someone's restrained me from running off, than tyre-tracks across my head thirty seconds later.

  7. I've only seen an epileptic fit once

    Loading that one didn't look too good either – at one point there were 6 Johnnies and a police officer surrounding/holding down one runner in front of a large crowd (We had to hand over from a team of 3 First Aiders to an ambulance crew and a paramedic). Agitated didn't begin to decribe it – he was stuggling around on the floor, and pulled out a cannula inserted by our [LAS] paramedic three times – aparently the back of the ambulance looked like an abbatoir.
    Everyone's an expert when they're a bystander, the one advantage of our epileptic on the marathon course was we had a crush barrier holding the bystanders back. Shame these aren't standard ambulance kit.

  8. I've seen lots – an uncle suffers from severe epilepsy. I learned from a very early age that there really isn't a lot you can do apart from giving the sufferer space and making sure they don't hit themselves on objects nearby. It looks very scary.I suffered several fits in my late teens and I remember coming round the first time – I had a seizure at my desk at work, and my boss was shaking my shoulder to wake me up. I thought I'd fallen asleep at work. I still find it amazing that something so dramatic can occur to your body, and you don't even know.

  9. As a police officer I've been requested on several occasions to assist ambulance crews in restraining epiletic patients who have had seizures while they recover and the LAS do their thing. I'm sure you guys are covered in one or another… I certainly don't have any special powers to restrain people because of illness. One to look into me thinks!

  10. Hi there, I just found this blog and spent all day reading it. Entertaining and really, really interesting – brilliant!I used to work for RBAS, but only in the Patient Transport Control. Not nearly as many good stories.

  11. I am glad the 10 year old neighbor was on the scene and knew what to say to her neighbor. I've also seen victims gain remarkable comfort from just a few words by the EMT, often no more than being asked their name and hearing it repeated back to them. How are EMTs taught these things to say for comforting a victim? I'd like to learn them.

  12. You're not old fashioned at all. It is only recently that it was considered unsafe for children to go out alone, before – say – 1970, children of five or six played in the street and did short errands for parents. And anyone who knows anything about children will tell you that most children, when given responsibility and treated with respect, are amazing in a crisis. I'm pleasantly surprised to read such a positive report on this generally mysoginist blog. Why on earth would the child NOT help, for goodness sake ? A rare chance to be useful and treated with respect by adults who normally look at her and think “nuisance”

  13. “this generally mysoginist blog” – Where from this blog do you get the impression that Reynolds hates women? (incidentally the correct spelling is “misogynist”)

  14. When I was working at Tufnell Park, I had to deal with a passenger who had, had a fit in one of the lifts.I'm probably not as subtle as you when dealing with passengers who fit, as i normally tell the nosey passengers to go away in a not to polite way.

    Nice to see a 10 year old who seems to actually care for a fellow nieghbour though, as i thought nieghbourhoods were a thing of the past.

  15. Read the Daily Mail. Works for me every time.Or have a browse of the BBC's “Have Your Say”, that'll get some bile boiling if you approach it in the right frame of mind.

    Or take off The Boots and I'll run over your toes 🙂 just as a favour, like.

  16. I found your blog a couple of days ago and have spent quite a few hours reading. It's great writing. When I saw a picture of you I think I recognised you. It was Spring 05 and I was training for a 500 mile journey with my dog. I've always wanted to know what happened to him, and it's a long shot but I thought you might just know. He was near Tower Hill Tube.BLEEDING MAN!

    I was doing a late night mile or two when I saw a man on the pavement leaning against his bicycle. Dunno what, but something was wrong.

    “Are you alright?”

    “Ah just impaled my leg on my bike.” He said in a soft slightly northern accent. The words didn't register, but as he turned to answer me I was struck by the black apron of blood from groin to ankle on his tan trousers.

    “AAAAAooH! OH My!” I never swear when genuinely shocked.

    I made some small talk while doing ambulance look-out for him. He was worried about all the work he had to do.

    “Don't worry, I had to take two weeks off for a minor op, and at the end of the first week I knew I was going to change my life around. (DON'T TAKE THE PRESSURE OFF IT!) It was wonderful. I'm going to ride through Spain and France. You'll be fine, the work won't matter so much.”

    “It's my company.”

    I hate that. You're really confident you can distract and reassure someone that everything will be fine and you say exactly the wrong thing.

    “I'll come with you.” If only more people had that kind of clarity.

    “Do you like KEEP THE PRESSURE ON! dogs?”



    All settled.

    The ambulance arrived then. It must have been horrible waiting alone and he couldnt believe that I was willing to wait with him. I hope I don't impale myself on anything…. and I hope that man gets better soon. It was one of those intense encounters that only a crisis can generate. If I do get impaled I am sure that people would help and I now know that Ella doesn't like blood. Very reassuring.

  17. No, I meant misogynist – sorry for wrong spelling it was late at night. Just because I'm a pensioner, does not mean I fit into one of your female stereotypes (little old lady) who gets her words endearingly muddled.As for examples – quite right – they are mostly from comments, however the blog subtly invites us to join in blaming/despising/expecting little of particular groups. I've spent about 10 minutes looking for further examples, but am an old woman in a hurry, so you'll just have to settle for “take one look at her and you'd immediately mark her down as one of those wasted youth who hang around street corners”

    I certainly do not look at children and make judgements like that. And then, when she does what most children would do if given the chance – she is transformed into another tabloid stereotype – an “angel”. She wasn't an angel, just a normal little girl with a rare a chance to boss adults about – irresistable.

    Teenage mothers are another group – look, all my great grandmothers were teenage mothers – some of them were even married ! It's nothing new. I was an unmarried teenage mother, brought up in care, and you'd all no doubt have taken a look at the 10 year old me and considered me a waste of space, too – I still remember adults who – based on my crummy clothes and estuary accent – would not let me play with their children.

    Anyway, my precious life is trickling away – am off to the gym to pump some iron. Free free to loathe me because – like the rest of the world if you get to know them – I conform to no stereotype

  18. I agree Tom those jobs can be really difficult. Still acting within common law to prevent the patient coming to any harm more or less empowers you to treat them. On our BAA course, we were told that it's more or less a case of if the patient doesn't say no then they have consented!The biggest problem with ambulance work is that until you actually get into the front line, you can't make any hard and fast rules. Every job and situation is different and that's why EMTs, Paras and ECPs are some of the most resourceful people i know. They think on their feet, using common sense and often the complete lack of scant resources around them!

  19. Oh and I forgot to add…who ever said that all kids were hoody hooligans etc need to look again. There are some good kids out there, and they are the majority in my experience, they just get tarred with the reputation of a few. Good on you Tom for putting this blog in…the opportunity to praise this 10 year old could have been quite easily passed up!

  20. Hmmm. I don't hate women, I hate stupid people.So it is wrong to mention that some people would look at this child and think 'tearaway' when she actually turns out to be not as bad as other people would think?

    'Angel' is a metaphor, you have very dull and long winded writing without some metaphors.

    Are you seriously telling me that you walk past groups of youths hanging around on street corners without feeling a little threatened? I do, and I'm a 6'1″ bloke with a nasty streak.

    There are a *lot* of children out there who wouldn't have done as this girl did. So is it wrong to have a bit of praise for her.

    And I've never moaned about teenage mothers.

    Little old ladies are that because they are (a)little, (b) old and (c) ladies.

    I think that you have a chip on your shoulder and have decided to have a go at me for some reason. Not because you are old, but because of what you have written. Or am I wrong?

    (And I couldn't be misogynistic even if I wanted to – I was brought up in a one parent family and my mum would kill me!)

  21. I think I'm going to address this in a later post – as my training course update has explained a few things to me.It'll be handy for you as well.

  22. Exactly – I'll ask if they want a hand first, and if so what they'd like me to do. I tend to have a slightly different approach when I'm not in uniform as I can be a bit scary looming over someone.But if someone is likely to hurt themselves, then I have to do *something* (and would be a failure of my duty of care *not* to do something) – and again I stumble onto consent and capacity…

  23. Oh you're probably right, and it's a nice enough blog -stumbled on it when in Melbourne in January searching for generic name of drug I wanted repeat prescription of. Have enjoyed it since then, but you do all get a bit smug sometimes and I feel a loyalty to the young women I taught in HMP Holloway, and to my teenage self, they are so easy to attack.Anyway, am full of love for the whole world, including you lot – am in love ! Yes, at 62 have pulled – and he's younger than me ! Am having sex again, everything still works so this is last evening spent on web, just logged in to unsubscribe. Will be very gentle with him, don't want to have to call an ambulance, now do we ?

  24. You've raised an interesting point about the position in law if one uses force to prevent people from harming themselves.The starting point is that any deliberate use of force against a person is a criminal assault, whether or not it causes injury. The prosecution must prove that the person in question did not consent, although in some rather curious caselaw our courts have created exceptions to the defence of consent regarding sexual activity: gay SM sex bad; man branding his initials into his wife's buttocks good, the Court of Appeal finding – as recently as 1999 – that it is in the public interest that men should be able to do that kind of thing without fear of prosecution.

    Away from those rather unusual situations, the courts will imply consent if it's reasonable to do so, examples being contact sports and the situation where someone pushes up against you in an overcrowded train carriage.

    There would be a strong argument for saying that anyone suffering a violent epileptic fit may be taken to have consented to reasonable force being used to prevent that person from hurting him/herself until they return to their ordinary rational state. Once that happens, it's worth remembering that mentally competent patients have an absolute right to refuse consent to medical treatment, however rational or irrational.

    Finally, the law allows the use of reasonable force to prevent the commission of a criminal offence, for instance to protect oneself or a third party (someone other than the person using the force) from an assault. There's no magic about the word 'reasonable': it's what's reasonably proportionate in those particular circumstances.

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