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).