I’m spinning in the final moments of leaving the house for a shift when my phone rings.
“This is Kal.”
“Kal? It’s Scott.”

Scott is a first aider. He’s come a long way from the student at the first aid course I met several years ago and now occupies the dubiously honourable position of President of the Red Cross First Aid Society at Edinburgh University. He was one of the first aiders in the team that I accompanied to Germany this summer and, through my camera lens, I watched him handle simualtions that posed catastrophic chest trauma and full thickness burns.

“Mate, I’m planning the lectures for the group meetings this Autumn. Any chance you could do a presentation on Paediatrics, or bring a vehicle along and show the new guys around the kit?”

“Sure.”

“Which one?”

I’ve been neglectfully absent from the first aid group this semester, my writing class clashes directly. But my class has finished, my Monday nights are free and I want to get involved again.

“How’s about both?”

“Are you sure?”

“Sure I’m sure.”

“That’d be brilliant, cheers.”

We coordinate diaries and organise dates. I’m about to say my goodbyes when he stops me again.

“One other thing?”

“Yeah?”

“Any chance I could come out observing with you some night?”

“Sure, I’ll let you know my shifts and you can pick some.”

We hang up, I go to work and shake hands with Hoggle, a new-start with the personality and dress-sense (in the words of Pally) of a stack of fucking Opal Fruits. She’s magic, this lassie, used to sing in a band with Node, she oozes banter and has developed the skill of talking to patients like they’re humans while still eliciting clinical information from them under the table.

We’re part way through checking the vehicle when the phone on station rings, a man has been found “unconscious and vomitting” in a square in the middle of town.

On scene we park behind bollards and hike into the square, a scruffy man lies in the recovery position under Victoriana lampposts, a squad of urban drinkers crowd around him. One man kneels by his side, pinching the patient’s ear.

I grin as I recognise him.

“Alright, mate?”

He smiles back at me.

“Scott, meet Hoggle. Hoggle, this is Scott. He absolutely knows his shit.”

Hoggle is attending, so I take a back seat and swing my eyes over the scene. On one side of the crowd a man, possibly Polish, is shouting at us. I’d missed him when we walked on, but now he’s pointing at the patient and yelling at us all. I raise my left hand, fingers spread and gently lower it.

“Calm down, sir.”

He shouts louder, steps forward. I lift my Maglite, rest its end on my shoulder and click the button; the blue/white beam dazzles him as I repeat, louder.

“Calm. Down.”

He skulks back to his plastic bottle of cider on the steps opposite.

Scott is handing over to Hoggle, he concludes by turning to me.

“I’ve had a bit of an argument with EMDC. They wanted me to leave him on his back, but I wanted him in recovery…”

I look down at the patient, his mouth and nose smeared in drool and vomit and shrug.

“Until we get here, it’s your airway mate. You do what you think you need to.”

“But they said…”

“The instructions aren’t written for people who know what to do. They reckon it’s easier to notice a respiratory arrest if you keep him supine. With no kit? I’d have him on his side too.”

Hoggle is pinching the patient hard.

“Kal, I’m getting nowhere.”

I step to her side and deploy my complete range of painful stimuli.

I also get nowhere.

There aren’t many drunks you genuinely can’t wake up, but this guy’s done it. I suddenly realise that this may not be your average D&I.

“Blood sugar?”

“Please.”

Hoggle digs in the bag and we find ourselves remembering the risks of being fired out on a job before completing our daily checks.

“Shit. Kal, we’ve no lancets.”

“Just use a small needle.”

She does so, drawing blood from his finger, but then comes up with a more concerning shortfall.

“No sharps bin either.”

Not having a sharps bin makes me sweat, the thought of anyone getting a needlestick injury from a sharp I’ve used is a nightmare. I take the needle from her and, using a pair of forceps, slide a sheath back over it and push the whole bloody thing into the mud between two paving slabs.

Scott body-checks the patient and helps me roll him onto his back. I slip an OPA into his mouth, but he immediately gags on it.

“Down the nose, then…Hoggle, can you get the bed and the suction? Scott, gimme a jaw-thrust here, please?”

They step to it while I lube up a nasal airway, lewd and long and rubbery. Twisting it into his right nostril it stalls, stutters, caught on some unseen nasal ridge or architecture. I’m about to retract it when it slips in to its hilt and I turn to the bag to get an oxygen mask out when Scott’s voice calls me back, alarmed.

“Whoa! Shit! Whoa!”

Bright arterial blood bubbles up the NPA, its lipstick crimson stark against the artificial pistachio of the rubber airway; maybe I’ve torn a polyp, or banged into the nasal wall. Blood looks dramatic, but at least we’ve got a way to move air into him if we have to.

The nosebleed stops spontaenously, but we leave the patient on his side, jaw thrust in place while Hoggle arrives with the bed and suction. I pass a suction tube down the nasal airway and sook fresh blood from its lumen.

“Let’s get him in the motor, hey?”

Hoggle has, in her rush to grab the suction, forgotten to put a blanket on the trolley, I’m buggered if I’m lying this puking, bleeding monster straight onto the mattress. Would you want your granny to lie on that afterwards?

“Can you run and get a blanket, Scott?”

He nods.

“First cupboard on the right, yeah?”

“That’s the one. Cheers.”

He legs it. Hoggle pats the patient down for ID and MedicAlert while I roll his eyes open. Pupils reactive and equal, but definitely no blink reflex when I brush my gloved finger over the surface of the eyeball.

Scott returns, Hoggle takes the blanket from him and lays it out on the bed. He reaches into my field of vision.

“Thought you might like this, too.”

Daffodil yellow, clean and bright and welcome as sunshine on a rainy day, he’s grabbed a new sharps bin from the vehicle. I retrieve the errant sharp from between the paving slabs and drop it into the proffered bin.

It’s a little thing, but it marks the start of us really taking hold of this scene. Everything is tidy, everything is under control. Airway is secure, sharps are disposed.

Scott helps us haul our kit and patient back to the vehicle, he laughs at me.

“When I asked to come out observing? I didn’t mean so soon.”

We thank him for his help and move to transport. At hospital Hoggle raves about Scott, I text him with her compliments - “Hoggle wants to know if you can be a bystander at every job?”

Observers are hard work, however slick they are. As the qualified member of staff on a vehicle you are responsible for the safety and actions of yourself, the probationer, the observer and the patient.

But an observer that spots problems and solves them without being asked?

Sure, Scott. You can come observing.