It is, to put it bluntly, cold enough to freeze the balls off a brass monkey, which is really cold. No matter, it keeps the drunks off the street…well, mainly it keeps the drunks off the street…
I got sent to a '50 year old man, fallen in street. blood from ear'. The location was given as 'Outside Red Lion Public House'. I could guess what had happened.
I pulled up, leaving the headlights pointed at the patient who was laying on the ground covered by a blanket borrowed from the pub. surrounding him were:
A lot of police (about five or six officers).
Two sons, both of which were crying and worrying about their dad dying.
Some bystanders, most of them had come from the pub, and…
One off duty fireman, who was clutching the patient's hand.
“Fair enough”, I thought, “best get to work”.
The lighting in the street was bad, but my headlights, and some police torches made that a little better. The patient had been celebrating in the pub and had tripped over a kerb while trying to walk home. He had possibly been knocked out, and there was some blood coming out of his left ear.
The first thing that you think of when someone who has fallen has blood coming out their ear is that they may have fractured their skull. With a fractured skull you will sometimes get cerebro-spinal fluid coming from their ear. Cerebro-spinal fluid is the liquid that your brain and spinal column float in, and should not be outside the body at all.
The standard test is that blood and C.S. fluid don't mix, so you'll see yellow streaks in the blood. Given the poor light it was hard to see, so I fell back on an old trick. You stick your (gloved) finger in the blood and if there is C.S fluid in it, the blood will feel 'slick'.
The side effect is that your gloves get covered in blood. It was cold. I wanted to wipe my nose. My gloves were right out, and I wouldn't like to wipe my nose on the cuff of my jacket because it's a disgusting thing to do, and also (mainly) because my jacket is horribly unclean.
The patient also had a large swelling to the back of his head, and because of the way that he had fallen, I couldn't rule out an injury to his neck. In a perfect world I would have liked to have put a cervical collar on him to immobilise his neck, but this is far from a perfect world. A cervical collar only really immobilises a patient if they want to be immobilised, in a drunken or combative patient this will often make them thrash around trying to get it off. So often a better course of action is to tell them to lay nice and still and leave the collar until you need to move them.
The off duty fireman had obviously had a bit of first aid training, because he was keeping the patient constantly talking. This was fine, as it meant I didn't have to talk to the patient too much, apart from assessing him, and getting his details.
The crowd were pretty well behaved, I kept hearing one of them moaning that the disabled ramp to the kerb was the reason behind the fall, and that they were 'bloody dangerous'. I didn't want to mention that walking while drunk was perhaps more of a contributing factor…
I threw another blanket over the patient because there was little else I could do until the ambulance turned up. Unfortunately I'd been waiting a long time for ambulances all night, and I suspected that this would be the same.
My nose still threatened to drip on the patient.
Suddenly behind me was a flash of a high-visibility jacket, “Excellent”, I thought, “the ambulance has turned up”.
But, no, it was one of our duty managers come to see how I was doing. They knew the ambulance would be some time, and wanted to make sure I was alright.
“Ah”, he said, “I can see you have everything under control”, and left.
He could have wiped my nose for me…
By now I was losing sensation in various small, but important bit of my anatomy. I looked at my watch and saw that I'd been with the patient for over thirty minutes, I was cold, but at least I wasn't laying on the cold wet floor.
Finally the ambulance arrived, they had travelled from out of their area to attend this call, and I was very grateful for them turning up when they did. We put the collar on the patient, strapped him to a stretcher and loaded him into the back of the ambulance where it was much warmer, and I could remove my gloves and wipe my nose.
Can you see what was uppermost on my mind?
The patient was swiftly taken to hospital, and as I prepared to face the crowd of people and explain exactly why the ambulance took so long to arrive, I was instead mobbed by people who wanted to shake my hand and thank me. None of them were bothered by the forty minutes it had taken the ambulance took to arrive, and they were actually happy that we had done our jobs, accepting that as it was a Friday night we might be a bit busy.
It was only later that I found out that there had been another shooting in the area (some drunk men had been apparently been thrown out of a pub, they then returned and fired a pistol through the pub windows, hitting a barman).
15 thoughts on “Monkey, Balls Loss Of.”
Most men I know wouldn't be bothered about wiping their nose on their jacket sleeve (regardless of how dirty it already was).
Good post Tom, its that time of the year when you guys really do this for the love of the job, I don't want to be waiting in the cold for 40 minutes no matter how many layers of clothes I have on, and to not be able to wipe your nose! Absolute torture! Keep up the good work.The Driving Instructor
Don't your wear some sort of thermal underware? Even pantyhose is great for helping keep your legs warm.I remember coding a patient who had used some strong cheap aftershave, and a lot of it, it caused my nose to start running. There is nothing grosser than having to continually suck it up.
Good job and good post.
Do you all do a halo test for CSF? Fold a 4×4″ up in fourths, stick one corner in the blood, the CSF will “wick” faster than the blood and make a neat halo around the blood when you unfold the bandage. Good crafts project.
so whilst waiting around on street corners, you did have your special jacket/vest on didnt you?
Brass monkey – brass plate on old fashioned gun limber where cannon balls were stacked. In the Crimean war a frost used to form on the plate and balls so they slid off, hence the expression.
Thanks Nigel. I never did understand how brass balls could be frozen.Pat
thank God you didn't sneeze, poor guy would have had to add drowning to his list of woes.
Glad to see you're back at work! Shame about the cold in London… one of the things I don't miss about it. Anyway, I didn't comment about the 'Joans', but I have to say that I like these real-life posts much better. Phrases such as 'cerebro-spinal fluid is the liquid that your brain and spinal column float in, and should not be outside the body at all' are pure genius – they are informative, but also just plain brilliant.
Mind you, most of the men I know/work with are firefighters.
How about wearing something light, breathable, and that also keeps you warm?For nightshoots/outdoor filming in the cold, I'd be lost without my thermals. I can highly recommend these Long Johns: your body temperature will stay pretty constant with these – even when you're going into the freezing cold from the warmth of inside.
And they come with a matching top too.
Another test for csf – put a bm stick in it. Sky high equals high probability of csf. Don't know what snot reads.
As far as I know 'brass monkey' refers to the 3 balls that hang outside pawn shops, freezing weather would create cracks due to imperfections in the brass casting and the balls would crack off. Keep warm Reynolds.
So I take it none of you clicked on the link in the post where this is specifically debunked?
In Malta we usually use the Halo Test to determine if there is CSF mixed with Blood. I had never heard of the BM stick being inserted in the fluid. Great post Tom!