A Spot Of Bother

It was a rather quiet morning on the car! I'd taken the temporary lull in jobs as an opportunity for coffee with a fellow FRU! It's nice when you get some company on the car as it can me quite a lonely place at time. It's been described as prolonged periods of boredom, occasionally interrupted by moments of sheer terror. I think that is pretty accurate! 

"New Road @ Station Road"

Not two sips into my coffee, a job! A road name @ another road name, usually means an RTC. It could be someone just outside by more often than not it's an RTC. I had no other details yet so just started heading in the right direction. One of the problem with the FRU is when you're driving on blue lights it is very difficult to see any updates that appear on the screen. A buzzer goes of and the message appears in red when the call taker gets more information. The next update was the determinant, which is the main problem, i.e.; Breathing problems, Chest pain, Stroke, RTC etc.

"New Road @ Station Road, Stabbing / Shooting"

Really?! On a tuesday-bloody-morning! Come on! I upped my pace slightly, because despite my shock and horror at a stabbing or a shooting so early in the day, I bloody love stabbing and shootings! I'm not weird, most of us love a juicy trauma really! I started making mental plans of what I might see, what I might need etc. 

"New Road @ Station Road, 17 year old male, impaled on metal fence, report on arrival"

IMPALED?! How did he manage to get impaled?! What is he impaled on?! What is he impaled through?! No time to come up with a plan though, I was arriving on scene!

There was a small crowd beneath the patient, supporting him up in the air. All the heads turned to face me as I got out of the car. That look of expectation mixed with panic on all of their faces! 

*cue emergency face*

They were looking at me as the 'specialist in impaled human removal'. Sadly for them I was far from it! I'd never done an impaling so I was about as experienced as all of them! The patient was panicking atop of his spiked metal fence and to be fair, I would be to! The spikes were about 8-10 inches long and by the look of things he was impaled on two of them, through his inner-thigh. It was hard to tell because he was 8ft in the air! 

His panicking was getting worse. I wanted him to stay still, and wanted everyone to continue helping to support his weight. It really was a logistical nightmare! I radioed into control and requested Fire, Police and HEMS. Fire to chop the fence and bring some ladders, Police to block the road, and HEMS to.....well, just do what HEMS do best! Unfortunately, hearing me ask for the entire world and his wife, the patient panicked further and despite my shouting at him not to, in one big burst of energy he lifted / prized his body off the spikes and fell into our waiting arms.

"Red base, patient is no longer impaled, cancel fire, update HEMS, patient has an arterial bleed from his femoral artery."

There was blood everywhere. The good samaritans moved back, some freaking out at the blood, others just starring. I put all of my weight onto his groin where there blood was coming from. It took an incredible amount of pressure to stem the bleeding. The problem was I now had no hands! I barked order at people to get me things from my car, to press the talk button on my radio so I could get an ETA for my ambulance and to use my scissors to cut up his trouser legs. It was organised chaos! 

Within a couple of minutes the ambulance was with me which was a huge relief. I was getting cramps through my arms, they were literally shaking with the amount of pressure being used. A pressure dressing was prepared, as was an extensive wound dressing. In a fluid movement I swapped places with one of the crew and we got the dressing in place. The patient was white as ghost and sweating profusely. He was in hyopvolemic shock and needed surgery very quickly. 

I set about getting lines in his arms. Luckily for me and the patient he was athletic and had HUGE veins which just popped up nicely for me. As I was setting up the fluids the helicopter appeared above us. What a relief! The bed appeared next to use so whilst waiting for the HEMS team to be driven to us by the police (*cough* not just crime fighters!), we got him loaded onto the bed. Based on where they landed we would have to drive him to the chopper and we didn't want to waste any time. His blood pressure was in his boots, his pulse was racing and he was becoming increasingly groggy. To help stem the bleeding we gave him some Tranexamic Acid which aids clotting. 

With HEMS with us they took over. They started giving him units of blood as we all started loading him onto the ambulance. I felt quite satisfied that that was all they could really do. We'd managed to do everything else before they arrived and that is always a good feeling! Within a minute or so we were next to the chopper and transferring him. Having to keep huge amounts of pressure over his femoral artery made moving him slightly awkward but he was quickly on board and taking off. 

His friend had stayed with him until take off and was awfully worried. 

"How did he get impaled in the first place?!" I asked him.

"He dropped a £10 and it blew under the fence, he tried to run up and volt over, but it went wrong he got stuck on a spike."

"All that for £10?! Couldn't he have just gone through the gate down there?!"

"Oh year, didn't see that."

I had to laugh! Even his friend begun to smile, despite being covered in blood. I was covered to! I looked like Carrie! It was a sight to behold! My arms were literally red! It was time for a shower, uniform change, a re-stock, a fair bit of paperwork and my cold coffee! Just another tuesday!

Monkeying Around

"25 year old male,? Fall from height"

Aaahh, the old ? is back! It's like a magical mystery tour! What illness or injury is behind the closed door?! Or in this case, the woods! The ? is kind of important! HAS he fallen from height?! If so, is it extreme height?! I really need to know this stuff, especially as I'm on my own! 

UPDATE: No one available to meet you at the gate. Patient is about half a mile from the entrance near the stream. Caller staying with patient.

"F%#k!!!" (Sometimes you HAVE to swear)

I arrived at the entrance to the park. There was a height restriction on the gate which I could fit under, but the ambulance would not. I drove about 400 yards to the start of the footpath by the woods. Now a long walk.....

UPDATE: Fall from extreme height. ? 40 feet out of tree. Drifting in and out of consciousness.

"F%#k!!!" (Again, this is a 'sometimes' moment)

This job will not allow me the luxury of popping back to the car for kit. I needed to take everything I need or may need. I also have no idea how long I will be there due to the location. It could take a while to get him out! So, paramedic bag on my shoulders, oxygen bag and spare cylinder, dressing pack, Lifepack 15 (weighs a tonne), Entonox, spinal collars and a blanket. I literally couldn't carry any more if I tried. After 15 minutes of walking / shuffling / plodding I heard some shouting coming through the trees. I followed the noise and eventually saw my patient and the caller on the other side of a small stream. I clambered down the bank, tip-toe'd across, up the bank on the other side and go to work!

The guy was in a bad way and was indeed drifting in and out of consciousness. When awake he was in a lot of pain and had various obvious injuries that concerned me. Significantly, a head injury, a possible broken pelvis and a broken neck. That's not to mention the arm and leg injuries he had but I was limited to what I could do on my own. It is these jobs where you learn a lot about yourself and your abilities. The buck stopped with me to a point, I can only do what I can do but lone working means you put an awful lot of pressure on yourself to do a lot.

I requested HEMS due to his injuries and location. HEMS were unavailable. They were my safety net! (Ironic mention of safety net given the circumstances!) In a semi-angry / desperate rant, I basically said, and I paraphrase:

"This guy is literally in (not up) shit creek, I have no means to get him out quickly and safely, I don't care if HEMS are offline, I need someone and quickly. HART, extra crews, anything, but I need it 5 minutes ago. Capisce?!"

I think for poor girl on the radio sensed my stress levels and basically said, and I paraphrase:

"Oi! Chill your beans, leave it with me, I'll get you all the help you need as quickly as I can, we are here if you need us for anything! Comprende?!"

I got it and she got it. Our poor allocators often get the brunt of our heightened stress levels! The good ones understand that and respond with kid gloves and know it's nothing personal. I know it's not their fault HEMS aren't available and I know it's not their fault that I'm in the middle of nowhere, on my own and feeling out of my depth! I know that! Sometimes we all lose our cool! 

The helpful caller continued to be helpful. I got him lying on his front holding the patients head still. It transpires that my patient, James, had decided to climb a tree, on his own, in the middle of woods. About 30-40 feet up, the branch he was standing on snapped. He dropped like a lead balloon. The branch was lying next to him and I could see where it had been, high up in the tree. *shudders* By sheer luck, the caller had been walking his dog and happened to see James lying on the floor. We had no real idea how long ago he had fallen. It was a remote part of the wood and off the beaten track. If he hadn't been found when he had been I wouldn't like to think how long he could have been lying there.

I had oxygen on him and set about cutting off his clothes. I got him linked up to the machine and starting monitoring him. For now, his blood pressure was stable. I fitted a spinal collar and them got IV access in both arms. Still no ambulance!! 

Gradually James became more and more coherent which was a good sign. However, the more alert he became, the more pain he was in. I had Morphine available, but with his injuries I wanted to hold off until it was totally necessary. I began a top to toe survey, to check for all injuries and make sure I hadn't missed anything. I carefully ran my fingers slowly down the small of his back. I felt an ominous ridge in his spine causing him to gasp. As I assessed his legs, it quickly became apparent he wasn't aware of what I was doing, or that I was even touching him. 

After a brief radio conversation with control, I guided the ambulance crew to my location. Eventually they found me and had brought supplies! We now had a spinal board, head blocks and straps. One thing we didn't have was a plan. There was no way we could realistically and safely carry him back to the ambulance. We needed HART team with all their fancy kit and extraction expertise. They, however, were still 20 minutes away because they'd had to get their special off road vehicles ready. All we could do was treat what we could, keep James warm and reduce pain as much as possible. Time really does grind to a halt when you are desperate to fly by. There was a very real possibility that James could be paralysed or even die from his injuries and I think he knew it too. 

It's a horrible situation to be in. As much as you want to talk candidly and be honest, in a patient who must remain completely still, you don't want to cause panic. I made it painfully clear he mustn't move at all but the pain was making him fidgety. I decided that despite the potential risks of morphine, the benefit would outweigh them and with three of us now, any side effects could be managed. So I loaded him up with it and he responded well.

Eventually a guy from the HART team arrived, panting! He'd run! Run! Weirdo! He said they were all here and were trying to get their vehicles inside! Not 1, not 2, not even 3, but 4! The incident response vehicle (big ambulance with tea making facilities), the 4 x 4 jeep thingy which the boss drives and then 'Thunderbird 2'. Well that's what I call it anyway. This....thing has a crane, it lifts off a huge box, and then out the back of said box, comes a special ambulance golf buggy thing with blue lights and stretcher! Anyway, they all arrived and slowly but surely found their way to us. Amusingly, the HART team were stood around in their protective jump suits and hard hats and we were stood next to them in our normal uniform. They didn't get the joke! To be fair though, we couldn't have got him out without them. Today they more than proved their worth!

Once everyone was assembled we got James off the floor and into the vehicle. Whilst he was driven round to the ambulance, we traipsed back with all the kit and met back at our vehicles. James was loaded on board the ambulance and we took him off to the trauma centre. 

I often say that in this job you generally see people when they are having a really bad day. Let's be honest, if you need an ambulance, or think you need an ambulance, clearly things aren't great! That aside though, we are also in the unfortunate position to see people when they are suffering truly life changing events, often with disastrous consequences. People's reactions vary from fear to denial but they all have an unmistakable look in their eyes. Sometimes I think I know the right things to say, sometimes I don't. Today I didn't. James looked at me and said:

'I've really fucked up haven't I?'

Hope can be a dangerous thing and I didn't want to give him any on a false pretence. I suppose my avoidance of the question was very telling. 

'Let's see what the X-rays show.'

A tear trickled down his cheek. I guess the gravity of the situation had hit home. 

I have no idea if James ever walked again. 

Iron Man

"RTC, Car vs Ped, 8 year old male, injuries unknown"

Do you remember the energy you had a child?! You could effortless run and run and run! Especially in the sun! It was amazing! I remember playing on the pavement in my road all summer long! Kicking a ball against a wall, playing hide and seek, having water balloon fights with other kids across the road, it was amazing! It is probably the most memorable part of my childhood, and the kids I played with then are still my best friends today, 20 years on. I remember kicking a ball across the road causing a driver to slam his brakes on.  I ran into my house, through to my garden and hid! A minute later my dad appeared, red faced and telling me how stupid and dangerous I had been. It was a quiet road but cars still came down, in hindsight and with what I now know it was incredibly stupid but hey, I was 9! 

Today was a particularly hot summers day. A glorious Saturday, not a cloud in sight. Everyone was in their summer clothing, parks were bustling, kids were everywhere having fun, there was a smell of BBQ in the air and I was.....well I was wearing thick green trousers, heavy boots, a heavy green shirt and was sat in a car with no air conditioning! Living the dream! It had been a quiet day, I was looking forward to my own BBQ in the evening with friends so was heavily clock watching!

My peace and quiet was interrupted by noise of my MDT giving me a job! And it was outside in the scorching heat! Typical! The age of the patient worried me and continued to worry me as I raced round to the address. As I pulled into the road I saw the huge crowd of people and the blue lights of a police car. That would certainly make things easier! I grabbed my stuff and rushed over.

Lying in the middle of the road was a little boy. He looked absolutely terrified. There were tears rolling down his face and all the adults seemed more concerned with vilifying the driver of the car than tending to their son. Holding the boy's head still and talking to him was one of the coppers and he was doing a great job. I set about fitting a collar and assessing his injuries. It quickly became apparent the despite his crying and talking he was in a very bad way indeed. A life threatening kind of bad way. I had no ambulance and no idea how long one would be, so called for HEMS straight away. Luckily I was near a wide stretch of road so there would be plenty of room for the Helicopter to land. 

The little boy kept asking me questions and crying out in pain. I gave him Entonox to try and distract him from the impending needle that was about to enter his arm. He promised to be brave like Iron Man would be. We talked about Iron Man the whole time I was with him, only occasionally did we digress to other, lesser superheroes. I tried to keep him alert and talking but it was becoming harder and harder. I could see the bruising on his flanks getting worse and knew it was likely a ruptured spleen. His leg was also broken. I told him I had to move his leg and it would hurt. He nodded and starred intently into my eyes. While taking about who would win in a fight between Iron Man and Batman I straightened his leg.  He yelped.

By now the chopper was overhead. The police blocked the roads and it landed about 30ft from us. The Dr's and Paramedics came over to me. I handed over and they did their thing. They gave the boy a soft toy helicopter which lit his face up. The decision was quickly made to sedate him and get going. Only now did his parents start to realise the gravity of the situation. Because he was going in the chopper they couldn't go with him. As a parent I can imagine the pain that not being with him would cause. It was a highly emotional situation. To see your little baby, be loaded into a helicopter, unconscious, with tubes sticking out of him must be absolute torture. 

I watched as they took off and disappeared into the blue sky. The parents left in a police car and as usual I was left to clear up. For a child to survive an impact like that and to survive the injuries he had received would take a miracle as far as I was concerned. What a tragic way for such a beautiful day to end up. I could imagine the joy he was feeling, the fun he was having as he ran out between the cars on his quiet road. I spared a thought for the driver of the car. I couldn't live with killing a child, albeit accidentally. Just a tragic, tragic day. 

*Two weeks later*

I was in the thick of more trauma and again I had HEMS come to me! Same crew as before and I asked them about the boy. He was alive and well and is expected to make a full recovery. There are miracles.

Iron Man lives on.

51 minutes earlier

"You ready? 1...2...3...lift."

"Get me out of here!"

"Stay there, we'll be with you in a minute, OK?"

"Right, I'm on airway, I need some suction. Get the clothes cut off, start a top to toe."

"Have EOC come back to us yet?"

"Not yet.......excuse me, can you help us?"

"Sure."

"Can you go to other the guy in the back, talk to him, reassure him, find out where he is hurt, tell him we'll be with him in a minute."

*radio rings*

"HEMS on way, eta 12 minutes."

"Rog, we need another crew and the fire brigade. We have 3 casualties, 1 deceased, 1 peri-arrest and 1 trapped."

"Received, police and fire on way. Your second crew is 3 minutes away"

"Rog"

"I've got no respiratory effort now, pulse check?"

"Nope, no carotid."

"Time of arrest, 21:42, start CPR."

*police and fire brigade arrive*

"Hi guys, only 1 car involved, 3 occupants, driver is deceased, rear passenger is trapped but no obvious serious injuries and this guy, front passenger has just arrested on us."

"What do you need from us?"

"Can you take over CPR from my colleague......and can you guys deal with the guy in the back please. The other ambulance should be here in a minute."

"Right, let's get this airway sorted, chuck me a size 4."

"There you go, we are in asystole, I'll get a line in."

"Any long bone fractures?"

"Maybe foot, looks like it's just the head injury and anything we can't see."

"Stop CPR for a moment........I haven't got much air entry at all, let's decompress the chest. Carry on CPR, thanks."

"Here you go, I'll get the right side."

*second ambulance arrives* 

"Hi guys, what needs doing?" 

"If one of you could help here, and one of you help the fire brigade with the guy in the back, I have no idea what's going on there."

"What about the guy in the front?"

"Massive cranial destruction, in cardiac arrest on arrival and trapped. This guy was unconscious but breathing and the guy in the back was talking."

"F#%ing hell!"

"Yep........right where are we at?"

"Airway is being managed, chest is decompressed, CPR is constant, just getting fluids up now, he's getting dressings on the head.....want me to take over for a few minutes?"

"Yeah cheers fella, I'll stop after the next cycle."

"Does anyone know what happened?"

"That guy standing over there saw it, apparently they lost control, swerved around the road, flipped over and finished in this tree."

"Still in asystole."

"Carry on. Let's get stuff ready to move if we have to, can you get bed, scoop, blocks and straps. To be honest, I doubt we'll be going anywhere but you never know."

"Chuck me another cannula, I'll get a second one in."

"I'm all out of orange. Grey?"

"Yeah that'll do......how's the guy in the back?"

"Nothing major at the moment, seems stable, distressed obviously, having to cut him out"

"HEMS are here."

"Hi guys, where are we?"

"This guy was front seat passenger, on arrival he was unconscious, irregular respirations and some airway compromise. We pulled him out the car and he arrested a couple of minutes later. He's bleeding into his airway but it's being maintained with an iGel and suction. We've got bi-lateral IV access and bi-lateral chest decompression. He's been in asystole throughout. There was nothing we could do for the driver and the rear passenger is walking wounded by all accounts."

"OK guys, great stuff, let's move him a few feet so we get good 360 access."

HEMS took over and went about their business. We held units of blood and did what we were told! The scalpels appeared and they cut holes in his chest to assess his lungs properly.  It was at this point the police officer who had been helping us decided to go and stand somewhere else! 

After about 5 minutes the resus was terminated.

"Are we all in agreement?......*head nods all round*......time of death 22:03."

A blanket was places over the guy and everyone turned their attention to the one in the back of the car. The fire brigade were cutting the car away and one of them was holding his head still through the boot. There was a mass of bodies all working towards one common goal. I remember looking through the mass of people and seeing the lifeless dead body of the driver just sitting there. It was first time I'd been involved in a job where I've had to ignore the dead. It was an uneasy feeling, I have to admit. 

After about 20 minutes the patient in the back was freed from the wreckage. He was place onto a spinal board and loaded onto the ambulance. HEMS travelled with the patient and the other ambulance crew to the hospital. We picked up all our kit and followed, leaving the carnage behind for the police to deal with.

51 minutes earlier......

Three 18 year olds were driving along. Where they were going I don't know. Where they had come from I don't know. What they were talking about I don't know. I'm sure there was laughter and banter. There always is when friends are together. I'm sure they were enjoying the freedom that a car gives you. They had their lives laid out in front of them with endless possibilities. I don't know exactly what happened next, I only know what we were told.

"RTC Car vs Tree, 3 patients, 2 unconscious and trapped."

We weren't far away, I knew the road and knew it had potential to be serious. Nothing, however, could prepare me for what lied waiting for us. Within a few minutes of the call coming in we were on scene. A number of cars had stopped and blocked the road in doing do. The car itself was utterly destroyed. I was surprised to find anyone conscious to be honest. It was truly horrendous.

It was a 3 door car and due to the way it had impacted the tree I go only get to the passenger door. The driver was dead. I don't need to expand further than I have but there was nothing that could be done for him. The passenger in the back was dazed but talking. He was complaining of pain in various places but being behind the driver there was no way we could get him out without the fire brigade. The only person we could meaningfully help right now was the front seat passenger. 

He was unconscious, covered in blood and breathing very slowly. He had a pretty awful head injury and needed to be out of the car very quickly. The door wouldn't open fully but after some gentle persuasion it was bent out the way. I lent in and grabbed him under his arms. My crew mate grabbed the legs.

"You ready? 1...2...3...lift."

*          *          *          *          *

No matter how hardened we all are to this job, these events do effect us. Whether or not we lie awake thinking about it, day dream about it or just think long and hard about what has been lost, it effects us all. Three young men had their lives destroyed. One may have survived but you can rest assured that his life won't be the same again. Neither will that of their families. All I can think about and keep revisiting is how much fun me and my friends used to have whilst driving along in a car. Perhaps the only difference between a great time and a life changing tragedy is a mis-timed glance over the shoulder  and some bad luck. Who knows. Life is so fragile.

“To die is poignantly bitter, but the idea of having to die without having lived is unbearable” Erich Fromm

Running On Empty

“33 year male, RTC, Bike vs metal fence”

Let me start off by telling you how frightfully tired I am at this point in time and how desperate I was for the toilet! I was also thirsty and starving hungry but the last 4 patients hadn’t gone to hospital so for 6 hours I’d been without any of the essentials that human beings require to function! To be fair, it was kind of my own fault. (Totally my fault!) I had volunteered to do overtime without checking my rota. I knew I was on a rest day do just booked it! What I neglected to check, which subsequently caused said tiredness, was that I was on a night shift the night before. I was supposed to finish at 7am. I didn’t. I finished at 8:30am so was in bed by 9am. My overtime shift started at 3pm. Now do you see my problem?! Ooops! The rest of my needs ie: food, drink, rest and a toilet, were not my fault. That’s just what we do! 

Anyway, the reason why I am so frightfully tired now, is that it is 2:30am. I’d was at the end of my 12 hour shift and due to a lack of a rest break we were heading back to station to go home. We were done, finished, finito, terminé, fertig, terminado, call it what you will, we were offski! 

“General broadcast, all mobiles, any unit available for an RTC, motorbike crash, please press priority or go green mobile” 

That wasn’t meant for us, we were no longer on duty and as much as I felt for the motorcyclist, at some point we have to stop! Besides, I literally couldn’t keep my eyes open! I’d be useless in a trauma situation right now! We carried on back to station which was only a 4 mile drive. Oh god I needed the toilet! 

“General broadcast, all mobiles, we are still holding an RTC, motorbike crash, please press priority or go green mobile” 

Not a chance! Sorry! Nature calls! We pulled onto the road where our station was, all our bags were by the back door, paperwork was done with the I’s dotted and the T’s crossed. The station was visible now, 400 meters up the road. 300 meters......200 meters......100 meters......50 meters...... Ahead, blue lights. An ambulance, thank god! I need my bed! I need the toilet! Just as we approached the entrance to our station we were stopped in our tracks by a frantic policeman. 

“Can you come and help us?!”

I’m guessing I had a tired and confused look! There were two ambulances with blue lights on about 30ft away, why are we needed?! We are finished! And I need the toilet! 

“Apparently the men on those ambulances are “fleet support” and have no medical training. They just came across the crash! We have a motorcyclist who’s come off, I think he’s in a pretty bad way.” 

The penny dropped. My heart sunk. This was the job they’d been broadcasting. This is why they need an ambulance. We now had no choice but to help. The toilet was so close! 

We drove over, I jumped out, grabbed a few bags and the collars and went to assess the damage. Well, a motorbike helmet embedded in a metal fence is never a good sign! What was a good sign was the guy was conscious and talking, although he was trying to get up which obviously I didn’t want him to do! Despite my sternest voice and soft use of force and stood up. Unfortunately, the second he put weight onto his foot he dropped to the floor (into my arms) in a heap. 

Due to blood on his shoe, I decided my first port of call would be his ankle. As I rolled his trouser leg up my stomach turned. His foot was facing the wrong way and both bones of his lower leg were protruding from where you’d expect his shin to be. It was gross. By now my crew mate had come over with other bags and was trying to hold his head still. Unfortunately because of how drunk he was, and the fact he had a head injury he wasn’t willing to let is go near his head. 

“Red base, we had a male with a serious open fracture to his left leg, a potentially serious head injury and a very high mechanism impact. We are x-ray (ambo lingo for FINISHED) so could you send a unit to us urgently.” 

“Sorry, we have no units to send.”

Now, the sceptic in me says that even if they had a unit to send, there would be no intention to send it! Why?! Because we were there and would have to convey ourselves due to the condition of the patient! Due to his injuries we would also have to take him to a trauma centre, the nearest being a 25 minute blue light run away. Humpffffff!! 

We got the bed next to him and with the help of the police removed his clothes, got his leg bandaged and immobilised, head injury dressed, cervical collar fitted, pelvic splint applied, got him onto an orthopedic scoop, strapped up and onto the bed. That all took about 10 minutes. We were ready(ish) to go. Until now he had removed the oxygen mask every time it was put on. Just as we were about to roll the bed to the ambulance he went floppy for a split second and then begun fitting. 

It wasn’t just any kind of seizure, it was one of the most violent seizures I’d ever seen. 

“Chuck me my cannula roll” I said as I put a tourniquet round his arm. 

“Red base, our patient is now fitting, we have a long run to the trauma centre, are HEMS available?” 

“Negative, HEMS are busy on another job at the moment.” 

“Rog, this patient may need sedating, what about a Delta Alpha?” (Doctor in a fast car) 

“Standby................ negative, your nearest DA is 25 minutes away, coming from their home. The HEMS desk recommend you just leave now.” 

Thanks for the recommendation! Not sure what we would have done without it! My issue is I had a trauma patient fitting violently on the back of my ambulance with multiple fractures and probably spinal and internal injuries. I didn’t consider him to be stable enough to transport but hey, improvise, adapt and overcome eh?! 

I got a cannula in him and we got him loaded on board the truck. Although the fit hadn’t lasted long enough to give drugs according to the guidelines and although he hadn’t had repeated seizures which the guidelines also say you can give drugs for I decided not to wait. They are guidelines after all and I was happy to justify my actions should they be questioned. Five minutes of an extremely violent seizure post a traumatic head injury was enough for me to try it! And guess what?! It didn’t work. By the time I had decided it hadn’t worked we were well on our way to the hospital. The copper in the back of the ambulance was god send, I needed the extra hands! 

After 27 minutes we arrived at the trauma centre. That was 31 minutes after he had started fitting and I had given all the drugs I could. He was handed over to the waiting trauma team and we went to clear up the bomb site of the ambulance! And what a mess! Now for the paperwork! I hadn’t even started one because all my paperwork was put away at the END OF MY SHIFT! 

So, 45 minutes after arriving we were ready to go. We checked in on our patient who had stopped fitting and was being treated for his multitude of injuries. Maybe he’ll survive, maybe he won’t. It's not that I don't care, it's just I won't find out so I try to move on from it. It's easier that way. Let's call it self preservation! 

We now had a 35 minute drive home! Luckily I wasn’t driving! My adrenaline surge had well and truly ended, my second wind had gone, I was a wreck! 

Had it been safe for me to do that job? Doubtful! Do you think I was in a good mental place to deal with my patient?! Probably not! Should we carry on being expected to perform under these strains?! I’d say no! A fellow blogger, The Broken Paramedic, recently described what is expected of paramedics and what attributes we must have to do our job at times. 

“These carefully selected individuals are capable of superhuman feats of endurance. They do not require rest or nourishment, they can perform efficiently without sleep and can reabsorb their own excreta so access to toilet facilities is not required. They have cat-like reactions, heightened diagnostic powers and physical strength which only improves with fatigue and they can sustain emotional and psychological extremes far beyond normal humans. They are practically indestructible.

This is of course total rubbish”

I left for home just after 5am. I felt like a broken paramedic. Living the dream eh?! 

Into The Mixing Pot

WARNING: If you are squeamish, read no further. You won't like it!

"32 year old male, arm stuck in mixer, bleeding"

Oooohhh, bit of trauma! Love it! Yes, I'm morbid but I can't help it. I don't want anyone to be shot, stabbed, run over, have limbs cut off or fall from buildings, BUT, if people do, then I want to be the first there and I will quietly revel in the glory of it to myself whilst sporting my very serious 'emergency face'. Anyway, surely if you were seriously injured you'd want a paramedic who loves trauma and doesn't flap?! That's sound logic in my head anyway!

So, the patient. I was on the FRU and pulled up outside the building site in question. I was greeted by a large group of men frantically waving. I put on my hi-vis, my hard hat (yes, we have hard hats and yes, they look ridiculous) and followed them in. A couple of them  looked rather pale. 

"I hope you've got a strong stomach, his arm is fucked."

Well, at least he's not beating around the bush. They led me up some scaffolding stairs and carried all my bags for me. Makes a nice change! On the second floor was a man with his arm in a machine. He was surprisingly calm. The machine was some kind of mixer with blades in, what for exactly I'm still not sure. What I was sure about was a) his arm was inside it, b) there was a worrying amount of blood and c) despite his calm demeanour, he was white as a sheep. I asked for torches inside the machine to have a close look. He'd managed to pull most of his arm out and from what I could see, he was only trapped by his sleeve. I tentatively cut bits of his sleeve until suddenly his arm became free. I then told him to look away as I cut his sleeve off. 

As I did, one of his mates vomited. Not the most comforting thing for him to see, or me! I insisted he did NOT look at his arm. I wanted him conscious if at all possible! Now, his arm...... The guy's original description was pretty accurate. This was the first time I'd seen a completely de-gloved forearm and it wasn't pleasant. Flesh, muscle, fat all mangled and twisted. Large areas of bone exposed and his hand was a total mess. (I called for HEMS immediately and said I needed the ambulance NOW!) Blood was coming from what appeared to be everywhere so I applied a tourniquet. Until now he hadn't been in much pain. It was all numb. Well, the scream he let out as I tightened, and tightened and tightened the tourniquet was gut wrenching. I won't repeat the words he called me. I let it slide! Just as the bleeding stopped he passed out. 

We got him on the floor and I arranged his arm to be supported upright while I dressed what I could. Apart from the guy who was recovering from his vomiting incident, the rest were amazing. They couldn't do enough to help me and that makes jobs like this infinitely easier. The extensive wound dressing and non-adhesive dressings were placed over his arm and I bound it all together. I then remembered to write the '15:37 T' on his forehead in black pen. We were told to do this if you put a tourniquet on so it is never overlooked at hospital. His arm is now dying and that tourniquet needs to come off at the earliest opportunity. 

I managed to get a line in him and starting giving him fluids as the noise of the chopper blared out above us. The patient was awake again and talking. Turns out his wedding ring fell off and as he tried to grab it his hand went in too far. He kept asking how his arm was and I kept ignoring him. I didn't know what to say. His mate answered for me.

"Seriously buddy, you may have to start wanking with your other hand!"

Everyone laughed. It is amazing what a soothing effect humour can have on a situation. Through all the chaos and horror that was around, a joke can still be made and that probably helped more than any of the drugs we could give. Everyone knew his arm was bad, he knew his arm was bad, but the people who knew him best, knew he didn't need to be told that.

Within minutes the orange jumpsuits appeared! I love it when the grown ups arrive. I couldn't give anything as his blood pressure was too low and as the adrenaline started wearing off and the pain was getting worse he needed proper drugs! Cue the Ketamine! Still without an ambulance we used the HEMS scoop, strapped him in and carried him down. He was being given units of blood on the way. 

We loaded him on to the chopper and off they flew. I was left, covered in blood, and dust, to do the paperwork. I trundled back to my car and on cue the ambulance arrived. I didn't know  whether to laugh or cry! I did know I needed a shower! 

De-gloved forearm! Awesome! One for the scrap book!

Bridging The Gap

"18 year old male, on railway tracks, multiple injuries"

I'm assuming most of you have heard of The Darwin Awards?! If you haven't, they are basically a fictitious award that recognise individuals who have contributed to human evolution by self-selecting themselves out of the gene pool via death due to their own unnecessarily foolish actions. The awards are now more official after a serious of books and the criterion for the awards states, "in the spirit of Charles Darwin, the Darwin Awards commemorate individuals who protect our gene pool by making the ultimate sacrifice of their own lives. Darwin Award winners eliminate themselves in an extraordinary idiotic manner, thereby improving our species chances of long-term survival". Now, this nominee didn't die, somehow, but his actions and the similar actions of others is what provides us with job security! 

There he was, lying on the tracks, about 2 foot from the train. He was covered in blood. He had head injuries, broken teeth, a broken ankle and a dislocated shoulder. He found it all very amusing, due to the fact he was totally plastered. We found the general situation less amusing. I'm sure the 1000s of passengers at this busy station during the rush hour were also not amused.  Neither did the police, the fire brigade, the station staff, HEMS and the rest of the gang who'd arrived. That is A LOT of resources! Anyway, we treated all of his injuries, packaged him up, lifted him off the tracks and got him off to hospital.

"I don't know what all the fuss is about." he said. 

*Facepalm*

45 minutes earlier......

He had been drinking with friends all day whilst watching the cricket. He was well dressed and frightfully well spoken. He went to a very expensive, private school and made sure we all knew about it. Anyway, the cricket had finished and it was time to get home 'in time for supper'. He arrived at the station with friends and they were cutting it fine to get their train. If they'd have missed it, they would have had to wait a whole 15 minutes until the next one. They rushed up the platform in a loud and garish rabble. They had come up to the wrong platform and their train was approached. They were faced with a choice. Do they a) cut their losses and wait for the next one or b) run back down the stairs, along the corridor and back up to train. It appears our patient had a better idea. He had option c)!

*Facepalm*

Option c) involved a leap of faith. A jump of at least 16 feet, across two train tracks and onto the concrete platform on the other side. 16 feet is a long way, especially with a small run up and especially when landing on concrete!

With the train approaching, and to the horror of onlookers, he went for it. He ran, he jumped, and about 8 ft short, he landed. And landed badly. Despite breaking his ankle he managed to scramble, fuelled by adrenaline to the far platform edge and climb up. Somehow, he made it! In what was a pure act of bravado and showmanship, he stood up, and like Rocky Balboa, raised his arms above his head in celebration. 

FACT: Standing up straight when drunk can be a challenge. Standing up straight when drunk, with a badly broken ankle is never going to end well. 

Sure enough, with the train now 20 ft away he fell backwards. 

*Faceplam*

He again, land on the tracks with a thud. The train slammed on the brakes but not quite soon enough. By all accounts the patient somehow managed to stand before the impact and was then bounced backwards before the train came to an abrupt halt. 

He was alive and not critically injured. He had multiple broken bones, delayed 1000s of people getting home and needed the assistance of every emergency service. And all because he didn't want to be late for supper! Genius! One thing is for sure. There will always be candidates for The Darwin Awards and there will always be people intent on providing us with job security. I suppose that in itself is a blessing. 

Prat.

Sync Complete

I should probably start this post with an announcement. I HAVE A NEW LAPTOP! How amazing is that! I've been wanting / needing one a long time! My old one was bought in 2007 and can no longer cope with the simplest of tasks! 2007! It's amazing when you think back THAT far! My son hadn't been born, I was married, I was working Monday to Friday in a tragically dead end job! It is amazing what can change in just six years! Anyway, yesterday when I finished work I wandering into the Apple store and bought my new MacBook Air and totally abused my 'old' student card to blag the discount! I was pretty damn chuffed as I walked out, new toy in hand! I drove home, opened the box and started syncing! What a day!

Then I thought, 'yeah, what a day'. My mood descended somewhat into one of reflection. It's easy to get caught up in a moment. Like I said, it is amazing how much can happen in six years. It's also amazing what can happen in 12 hours. It is also amazing what I'd managed to forget over 12 hours. Maybe not forget, but certainly the prospect of indulging in a new laptop had become top priority in recent hours. So much so, that it wasn't until now, starring at the words 'Sync in progress' that I realized that there were other people, people who I had seen today who weren't enjoying their evenings. 

"09:05 - 57 year old female, cardiac arrest"

I shot off up the road, dropped into 'sport' and started tackling the remains of the rush hour. I knew the road well having walked down it twice a day, to and from school for many years. I knew I would be the first to arrive and wanted to get there as quick as I could. 

Four minutes after someone had dialed 999 I pulled into the street. I screeched to a halt, grabbed all my stuff and rushed inside. I was beckoned up the stairs by the distraught looking husband. Lying on the floor of the bedroom was my patient. There was nothing I could do. She was dead and had been dead for quite a while. Rigor mortis had set in and there was post mortem staining present. I exited the room and closed the door behind me. 

"I'm so sorry, but there is nothing I can do. I'm afraid your wife has passed away."

The man fell forward, wrapping his arms around me and began sobbing. As he cried, their son appeared on the landing in his dressing gown, also sobbing. I managed to escape his grasp and let them cry together. I went and put the kettle on to make some tea and I cancelled all other resources. In situations like this, tea always seems sensible. They came downstairs and sat on the sofa crying. They looked totally lost. No idea where to turn, no idea how they will move forward. 

I waited with them, comforted them as best I could until the police arrived. I left them to deal with their unmeasurable loss. A very tragic start to the day for all involved.

"12:09 - 33 year old male, ? slurred speech, ? stroke"

My initial thoughts on being sent this were skeptical. Come on! 33 years old! Having a stroke! Not likely! It only took me 3 minutes to get on scene and my patient was sat at the roadside waiting for me! He staggered towards me like someone who's been drinking! I kept him at arms distance whilst I spoke to him. Within about 10 seconds it was clear he wasn't drunk. He was having a stroke.....

His speech was slurred and he couldn't find his words. He was limping and had very little power on his left side, hardly any grip at all and he was drooling slightly. He had no risk factors which made it all the more bizarre. I called control to tell them it WAS as given and I needed an ambulance ASAP. 

33! Unbelievable. He was a successful guy, had a lovely house in a lovely area. He was very confused and had been found staggering around the front garden by a neighbor. He was due to get married in a few weeks time to the woman pregnant with his child. Surely his life can't be ruined at 33? Surely he will get a chance to do all the little things with his baby? Surely he can still get married to his childhood sweetheart? So much was suddenly unknown. So much had changed. 

The ambulance arrived and rushed him off to the stroke centre. I phoned his fiancée to give her the news......

"16:01 - 26 year old male, RTC, Car Vs Motorbike, ? unconscious"

Again, I knew the road well. It's a busy, fast, duel carriageway. This guy could be in a serious condition. That ominous sense of urgency engulfed me. As I approached the stretch of road, it was clearly serious enough to cause a complete standstill to all lanes of traffic. I managed to get myself into a bus lane and shot down the inside of the traffic to the incident. Lying on the floor, surrounded by people was the motorcyclist. About 100 meters further down the road was his bike. By all accounts he'd been clipped, flown through the air and then hit by a car. 

The guy was unconscious, he had a pulse but his breathing was extremely slow. Under normal circumstances, you need two trained staff to remove a helmet. It was just me and the ambulance would have a nightmare getting through the traffic. Based on my initial findings I immediately called and requested HEMS. Luckily the helicopter was 'on line'. ETA 8 minutes.

I couldn't wait to take his helmet off. I enlisted the help of a by stander and got it off. I got someone to kneel either of his head and hold it still whilst I started cutting of his leathers. His battered, blooded body was fighting to survive but I got the sense he was deteriorating. I attached him up to the machine to get his blood pressure. It was extremely low. I put in an airway and started ventilating him. I was aware of what was being said by people around me but was trying to ignore it. 

"Red base, this patient is about to go into cardiac arrest. Any other resources near by?"

"Rog, we have a car about two minutes away from you."

As she said that, I heard the sirens. What a relief.....

Too late....his pulse had gone and there was now no respiratory effort. I started CPR. The police and FRU arrived together and now the chopper was circling above. We set about running the resus. Airway, chest decompression, IV access and secondary survey. HEMS landed in the road ahead of us and promptly took over. He was given blood infusions, injuries were treated and eventually his heart started beating again. He was taken off in the chopper to the trauma centre by the HEMS team. 

He was pronounced dead shortly after arrival at the hospital......

"20:12 - 28 year old female, starring at new laptop"

Not such a great day after all. Whilst I sit here enjoying my new laptop there are three families who's lives have been destroyed today. Three families where I have been a huge part of their day. Telling them their wife and mother have died, telling them their husband to be and father to their unborn child is having a stroke and trying in vein to save a husband, brother, father and son. Two lives over, one changed forever. It is too easy to forget about these people. They aren't my family or friends and I have no obligation to mourn their losses and in all honesty, after today I'll most likely forget about them. That doesn't mean they didn't have an impact on me though. They did. 

'Sync complete'

Making Plans

There is an unwritten rule in all ambulance services. It is a rule we all know well. It is a rule that our friends and families know. It is a simple rule.

"THOU SHALT NOT MAKE PLANS ON A WORK DAY"

Simple. Why? Because if you make plans you WILL finish late and you WILL let people down. Again and again. Do we all follow this rule? In general, yes! Do we ever disregard the rule and think that just this once it will be OK?! Yes! 

On this particular Saturday I had a short shift. I was due to finish at 3pm so despite the obvious rule, I felt it was pretty safe to make some plans. My reason for this was a friend was visiting. A friend I haven't seen for a very very long time. They don't live anywhere near me but on this particular day they were free to see me for a few hours. In fact, they were free from 3pm until 8:30pm to see me! I was pretty dam excited, just a little shift to get through first!

12:03:  I got a text. "I'M HERE!"

The shift was ticking along nicely, I hadn't had a break so at 14:30 I was off into town for some catch up, coffee, cocktails and cake! Winning! I even gloated about it on a number of occasions!

13:35: "Hurry up! I'm bored!"

We finished up with our patient at hospital and made ourselves available for our last job. It was busy on the road, we had been going from job to job to job all day as per usual. I pressed the 'Green' button and waited for the job to appear......

And I waited......

And waited some more......

Nothing! As the minutes ticked by I began to get more and more annoyed! 13:45 came and went as did 14:00. 

14:10.....

14:20.....

14:25..... *crosses fingers*

14:28.....

14:29.....

"RTC Car vs Ped, 34 year old female unconscious"

ARE.....YOU.....SERIOUS?! Off we went, I had just enough time to send a message saying 'Late job, sorry!" We made our way through the now solid traffic. After about 5 minutes we arrived on scene. A crowd had already formed in a well formed semi-circle, 3 people deep all staring in fear and anticipation. Lying in the road surrounded, by a group of 5-6 people rendering aid was our patient. She wasn't unconscious but she wasn't far off it. Just a quick look at her told me that we needed HEMS and we needed them 5 minutes ago. 

The three of us on scene went about the routine. We utilised the public to fetch stuff while clothes were being cut off, primary survey was being completed and an assessment of her injuries was being done. This lady was big big sick. Major head injury, long bone fractures, likely spinal injury and who knows what internally. She had a collapsed lung and based on her blood pressure she was losing a lot of blood from somewhere. I decompressed her chest while my crew mate got IV access. So much was happening, it all seems a bit of a blur even now. Her leg fracture was pulled straight, to which she let out a gut wrenching moan. The police were had arrived and were doing everything that we couldn't manage with the 6 hands we had! 

I couldn't tell you how much time had elapsed but just as the patient started to have a convulsion there noise of the helicopter could be heard. Now there's a sound that filled me with joy! By now the patient was on a scoop, the injuries were being dealt with and the student was ventilating her. His eyes were so wide open, concentrating so hard on his task and he was doing it bloody well. This was his first trauma, first HEMS job and first really sick patient. I remember what an adrenaline filled gibbering wreck I was after my first! 

With HEMS on scene we got the patient onto the bed, still in the road, still with somewhat of a crowd! They decided to RSI (Rapid Sequence Induction) her which means to put her to sleep and take over her breathing. This was done, blood transfusions were given and we were off to hospital. The decision was made to convey the patient in our ambulance with HEMS on board. Off we went! Through the traffic, complete with police escort. We burst through the door of the resus and HEMS handed over to the waiting trauma team. The patient was transferred and we returned to the vehicle.

It looked like a bomb had gone off. The student was like a 5 year old on Christmas day, bouncing off walls with excitement! The truck took a while to clean and then there was a HEMS debrief and then all the paperwork!

16:39: Left hospital. 

Being a trauma centre, we were now no where near our station and had to sit on the Saturday afternoon traffic to go 13 miles across the city. I had a plethora of messages on my phone asking what was going on! Awkward......

18:03: Arrived back on station

18:20: Signed out and left work to cycle the fastest I could to get to the station to make the 18:44 train.

18:43: Arrive at train station. Lock up bike. Watch train pull out of station.

The next train was at 19:14. I was a 1 hour journey to get to the part of the city where my friend was waiting for me. Time for a phone call.

"I'm so sorry, I won't get there until about 20:15."

"Not much point is there!"

"I guess not."

It happens every single time. It has led to many an argument and many a tear. I'm still waiting to see my friend!

That'll teach me to think I can defy the ambulance gods. Gutted! Thou shalt not make plans on a work day. I won't be making that mistake again......until the next time anyway. :-(