There is a reason that I came off the FRU, I don't like sitting on scene with patients that (for whatever reason) I can't transport. Sick patients need to be in hospital, not in their houses being stared at by my ugly mug.
I was working on the FRU and was sent to a child who was suffering an allergic reaction. These are normally pretty minor things, mum has changed the washing powder and the little 'un has a bit of a reaction to it.
Not so in this case, the child looked like something from a horror movie. The two year old's skin was covered in itchy and painful looking blisters, his lips were swollen and he was generally a funny shade of red.
The first thing that I checked was is mouth, allergic reactions can cause the tongue to swell up and if this blocks the airway then they can easily choke to death. Luckily this wasn't happening to this child, while his lips were swollen his tongue looked fine. The next thing that you do is to get the stethoscope out and listen to the child's chest, an allergic reaction can have the same sort of effect on the lungs as an asthma attack. Once more the child's lungs sounded fine, maybe a bit of an infection though.
I asked the parents what had happened.
They had realised that the child had developed a runny nose, so they took his temperature and discovered it to be a bit high. Then, unlike a *vast* majority of the parents in the area, they had given him Calpol and Nurofen in order to keep his temperature down. This is something to be applauded as there are large numbers of families who would call out an ambulance for such a thing.
As soon as he swallowed it – pop, pop, pop, the child developed the blisters and his lips started swelling. So it looks like the child was allergic to one of the ingredients in the medicine.
Now it was time to wait for an ambulance, I knew we were short of trucks that night, I'd been bouncing from call to call including a couple that I shouldn't have been sent on but was asked to go because there was nothing else to send (yesterday's post for instance). So we waited, and waited and waited.
Then we waited some more.
And a bit longer.
And even more.
By now the parents were, quite understandably, beginning to get upset. Their child was a bit distressed, although not as much as most kids would have been. There was little I could do as, while I have an injection to reverse life-threatening reactions, it's not very nice to give it to a patient whose tongue isn't swelling up. I've sat around with patients like this before and it isn't much fun as all you can really do is monitor them and if it gets worse give then a shot of Adrenaline/Epinephrine (whatever it's called today).
I phoned Control to see if there was any chance of an ambulance. They told me that they had already put a 'general broadcast' out for this call, but there was only one crew at the hospital and they were the ones I'd just done a job with, so they would still be unloading the last patient.
I even tried phoning my station to see if there was anyone there who was waiting for an ambulance to dry after mopping out after a mucky job. There was a crew there, but they were tied up talking to an officer because they had been assaulted and were also filling in one of our emergency referrals for a child being at risk. I know the crew well and if they could have come to my rescue then they would have.
I can't take small children to hospital as the FRU doesn't have a child seat and it's unsafe to transport a small child in it's mothers arms. I asked the father if he had a car/child seat – but they use public transport. If the child was in danger of not breathing then I might have taken the risk, but while the reaction looked severe the child was more uncomfortable rather than likely to stop breathing – actually the child was having a great time playing with my car keys…
So all I could do was to monitor the child and keep both him, and the parents, calm. I like to think that I'm pretty good at this as, perhaps due to writing this blog, I can explain exactly what is happening in quite simple language. I'm also not quick to panic and my general attitude tends to lend itself to keeping people relaxed.
Listening to the child's lungs he had started to develop a little wheeze, exactly what happens to asthmatics, so I gave him a salbutamol nebuliser (our treatment for this) and it settled down almost as quickly as it had started. His tongue was still the normal size although his lips had become more swollen.
Then the ambulance crew who had been to my last job walked in through the door. They had 'turned around' their last job in just over 40 minutes, which is very fast and had then ridden to my rescue. I love the look on parents faces when they realise that the ambulance has arrived and I love the relaxed feeling in my gut when I have a sick patient and they walk in through the door.
It all worked out fine in the end – the child didn't need the injection and perked right up after some oral medicine, he spent the night and next day in the hospital under observation and made a full recovery. While it might sound daft it probably worked in his favour – at least they'll have a good idea what started this reaction and can plan on avoiding it.
While we go to a lot of rubbish on the car, this was a 'genuine job', it was just a shame that the ambulances in the area were probably going to drunks who have fallen over in the street or other minor illnesses. While the FRU is mainly used to get the government mandated targets it can sometimes be clinically worthwhile. This was such an occasion. I'd also like to applaud the parents for keeping calm while their child looked so ill, they were worried but polite and understanding. A rare combination…