Sectioning, Swords and Swearing

We booked onto our double crewed ambulance. Today, my ECA and I would be with an observer from the local hospital. He was a nurse who wanted some insight into pre-hospital care. I was happy to have him. It makes the day go quicker, and he brings some more hands to the party if needed.

We logged onto the MDT and radioed control. “BG01 to Control, Log on and Radio Check”

“BG01 this is control, we have received your log on and hope you have a good shift.

We then set off from our station and did a few jobs. A fall, a chest pain and an abdominal pain. All was going well, with all of our patients left at home. However, the observer wanted to see more. He was hoping for a cardiac arrest, or as he put it “Something interesting” .

I had explained to him that ambulance work was 90% routine and 10% “interesting” so the chances of him going to a cardiac arrest for example were slim.

We were just cleaning the vehicle at hospital when my ECA pressed the button to say we were clear and ready for the next job.

Beep, Beep, Beep

The MDT came to life. Looking at the screen we could see that this job was to a 35 Year Old Male for “Mental Health”. The nurses interest peaked. He had never dealt with anyone with mental health before. He explained he had had very little training in mental health but always found it interesting. I explained that I was the same. However, I had undertaken more training to be able to assist me with these types of patients as unfortunately, it is something we come into contact with quite regularly.

Usually, mental health was all about communication. We would go in and build a rapport with the patient and see what we could do to help. Wether that was to refer him to a mental health unit, transport him to the emergency department or to a mental health facility. There were numerous options. I explained to the nurse that usually they are calling as they want assistance and are receptive to help.

I didn’t realise quite how wrong I would be.

We arrived at a block of flats and found the property. It was on the third floor. We gathered our kit and made our way up there. When we made it to the third floor we walked through a corridor filled with furniture. It looked like someone was either moving in or out.

One of the doors in the corridor opened and a man stepped out.

“She has been doing that all day, we can not seem to get her to stop”

I thanked him and then made my way to the address. I knocked on the door, which I noted had some repair work done from what looked like someone forcing entry in the past. The door opened and there stood the patient.

This was a middle aged lady, her hair was wild and she was wide eyed – she looked like she had been awake for weeks and not washed for longer.

“I told them I did not want any help”

I reasoned with her that we could just check her over and then give her the options and that we were there because people were concerned about her. She relented and let us in.

The flat was bare. She had clearly moved all of her possessions into the hallway. In what would have been the living room there was an arm chair and pile of books. On the wall there was a TV and on the arm chair was a remote control. The back of it was off and the batteries were loose on the chair. The windows were covered in newspaper, allowing a little light in but making it dark. Strangely, the curtains were open.

We introduced ourselves. I then asked how we could help and what had been going on. The patient seemed lucid and happy to converse. Initially.

We had managed to do a set of observations. The patients heart rate was 130, her blood pressure slightly elevated. As the ECA was getting these from her I was asking the usual questions about what had happened – I then asked about medical history. With this, something changed.

Suddenly the patient amped up her speech tempo. We were finding it increasingly difficult to get a word in and she was becoming agitated. Sensing the situation escalating my ECA started moving some of our kit into the hallway.

It was difficult to communicate with this patient, she was just escalating in front of my eyes. The ECA came back in.

“The nurse went downstairs to take a call”.

We both knew this was not the case – the nurse had been told to withdraw from the scene by my ECA. The patient was getting more and more agitated. Now she was pacing and had stopped making eye contact.

Ambulance service staff are trained to recognise when someone is becoming hostile. The conflict resolution training and experience ensures that when a situation is heading south, you know.

In the kitchen on the side, there were knives. We had noticed them earlier. The patient was slowly pacing towards them. She had also changed the subject. Now she was referring to voices. Voices telling her to kill.

At this point, the patient gave us an opportunity.

“My TV doesn’t work” She calmly switched back to apparent normality.

The ECA cleverly jumped on this. The patient was still clearly agitated. However, had stopped pacing. She was asked how it was broken.

“The batteries don’t work!” She snapped back.

With this the ECA asked her to show us – at the same time looking at me, and motioning towards the door. We were going to run.

At this point, everything slowed down. It was one of those moments. You become super aware of everything. The ECA went to pass the remote control to the patient, and dropped it. The patient bent, and we took off.

Unfortunately, the bags in the hallway had become a bit of an obstacle. Between us we grabbed them and carried on. In the background, the patient was screaming. It was not a scream I had heard before.

Not fear.

Not loss.

Not pain or frustration.

It was rage.

We got halfway down the corridor when I heard the sound of metal being slid off of a sideboard. The patient had a knife. At this point, it should have been time to press the “man-down” button on top of our radios. This is a panic button that opens a channel to all of the ambulance vehicles in the area as well as our control room; crucially allowing them to hear what was going on and arrange for immediate assistance. However, we both forgot.

I don’t remember how I got from the top of the stairs to the bottom. Somehow I was there. I looked up to the landing above in time to see the patient tearing out of her flat after us. Knives in each hand.

The door was in sight, the ambulance through the glass looking like safety. We pressed the exit button. The door slowly, painstakingly opened automatically and we got through. The nurse looking panicked stood by the vehicle.

“In! Get in the vehicle!” I shouted. He jumped in.

We climbed in the front. With no time to get the kit into the back as the nurse had shut the door I had it all on my lap. We drove out of the property and down the street. Parking over the road so we could see the doors and react if necessary.

I phoned control and explained the situation. I didn’t even have time to hang up before the first of many police cars arrived. We explained the situation. The police were not surprised – the patient had markers on her address for violence towards her mental health staff when in a state of crisis. The police had a plan in place to not enter the property without a team of them – all kitted in riot gear.

The police asked if she was medically well – we agreed. With that we were stood down and returned back into service ready for the next call.

“Well, that was interesting.” The nurse calmly said from the back.


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