Trapped in Darkness - Part 2

continued.....

"Male, U/K age, One Under"

Until now, I had been totally patient focused and hadn't noticed the commotion around me! There were about 6 Fire fighters under the train too with various member of underground staff trying to work out how to lift up the train. I'm guessing by the discussions that it isn't something that is done too often! In most One Unders they are either a) dead, in which case the train is driven off them or b) alive but trapped by a limb, in which case if a quick extraction is needed an amputation and dragging out will happen. Unfortunately, they couldn't drive off as it was his pelvis on the track and you can't amputate a pelvis for obvious reasons!

As minutes ticked by we got drugs flowing! In went morphine and ketamine and fluids. We cut of as much of his clothing as possible to examine what we could get to. There were minor cuts and abrasions but nothing major. All the while, the patient was getting more and more frantic so more and more drugs were given to numb the pain and relax him. Problem was there was no real access to his head. He couldn't see anything but  darkness and could only hear and feel what was going on, and for someone who is claustrophobic I imagine it was torture. I was starting to get very uncomfortable my self, the heat, the smell, the noise, the taste of air, it all made it a very uncomfortable atmosphere. Add to that the fact that realistically the patient could simply die and we would be powerless to do CPR, ventilate and remove quickly. It was a scary thought! 

"Sorry we're all talking about you. How are you doing?"

"Get me out of here"

"We are, it will just take a little while, I'm staying here right by you, if you feel any new pains or anything changes, please tell me."

"Get me out of here"

"We will, we will."

"Please, help me, I don't want to die" he cried.

Talking to someone who can't see you is bizarre. I could only imagine his facial expressions and the fear painted across his soot covered face. I felt totally helpless in all honesty. I tried to keep him positive but as the pain continued and the time went on and on he became more anxious. To be fair, so did I. 

Eventually, after about an hour they were ready to lift. I don't credit the fire service that often but credit where credit is due. They had been fantastic. The were working their nuts off, bringing us more oxygen, providing light and lifting 120 tons of train up! It wasn't a case of 1-2-3 lift! So, in a co-ordinated effort and a very detailed plan, the scoop was lowered down to the tracks and slid along, rope on 1 end. The pelvic splint was positioned and as many hands as could fit were placed on various parts of the patient. We are all told to stay away from the wheels as if the train drops we don't want to get trapped! 'Drops?' 'DROPS?' Encouraging! 

"OK, we are lifting......"

"He's free. Lower him down"

"We got him"

He let out a gut wrenching scream. Once on the scoop he vanished. Pulled the along the suicide pit and out onto the platform where the HEMS paramedic and my crew mate would take over while we crawled out. I shuffled backwards slowly, eventually making it to the platform where the light and underground breeze could be felt. The platform was full. Police everywhere, about 30 fireman, a few ambulance officers, a second crew and of course......HART team huddled together watching! The patient was being strapped up and wrapped in bubble wrap. Blood infusions were being prepared and he was being put to sleep by HEMS. I bet he wished he'd been asleep a long time ago. 

Within only 2-3 minutes we were ready to go. I took over the breathing for the patient and 8 fireman lifted him up and off we went through the maze of tunnels and escalators. FRESH AIR! Oh how I missed it. Behind us was the band of merry men and woman carrying all the kit. Everything was chucked on board, blue call placed and off we went. I was trying to take stock of everything that was going on. Suddenly, the doors swung open, we were at hospital, I hadn't even noticed we'd stopped. Into resus we went, a 30 strong team waiting for us. Luckily for me HEMS did the handover. I'd have probably starred blankly and said 'Hit by a train...erm...'!

We went back to the vehicle which  looked like a bomb had exploded inside. We tidied up and I started on the paperwork. Where the hell did that job come from! It really is true, EMS Rule number 10:

EMS is extended periods of boredom, interrupted by occasional moments of sheer terror.

Nothing can prepare you for things like this. It isn't for everyone. It is one of the few jobs that tests every part of you. The problem is you never find out if you passed the test. As all crews will say, he was alive when we got him to hospital so that's a win for us. It's a cover though. In reality, we are all desperate to know if he survived. We will probably never know. That's the reality of pre-hospital care....once you're at the hospital, your care is supposed to end. 

 My crew mate pointed at my face...

"You got a bit of dirt on your cheek!"

Black Wednesday

“77 year old female, everything is fine.....no wait.....she’s dead”

The first wednesday in August each year is known as Black Wednesday and so begins the ‘killing season’. It is the day that junior doctors start working in a hospital. It is also when a lot of other doctors change job role and as such, this day results in a significant increase in mortality of emergency patients. It is fair to say that Black Wednesday and the two days that follow are the worst days to fall gravely ill in the NHS. Saying that, is there ever a good one?! Up to 7000 graduates enter the halls of their respective hospitals and with it, the sudden burden of responsibility of the lives of their patients. The death rate in these three days each year rises by 6%. 

I don’t blame the newbies for this, they are thrown in at the deep end, they are made to do operations and procedures on patients way beyond their capabilities. On top of that they end up working the graveyard shifts when there are little or no senior staff around. They are in charge of wards, departments and health and wellbeing of all patients inside them. Someone who has just passed their driving test drives off and starts learning how to drive, someone who passes their law exams then goes off to learn how to be a lawyer. These kids, and they are kids, have spent years with their heads buried in text books. Their only patient contact and bedside manner has been learnt from corpses so it’s no wonder the proverbial shit hits the fan. 

I’m all for a steep learning curve. In those situations you learn a lot. In most walks of life, when you are learning, the mistakes that are made, end up costing time and money. In health care, the mistakes that are made, end up costing lives. It was daunting the first time I was in an ambulance as a crew of two! I didn’t really have a clue what I was doing. I always had a safety net. Firstly, I was never alone, secondly I was always with someone better trained than me and finally, if the shit really did hit the fan we were never more than a short drive to a hospital where the grown up could take over! Junior doctors don’t always have that safety net. The buck stops with them and that added pressure probably has a lot to do with labeling of ‘killing season’.

Personality has a lot to do with it to. Becoming a doctor is very competitive and as such there are egos at play. When we have dealing with a junior doctor there are generally three types that we me. 

• The Flapper: These newbies are terrified. They know their stuff but don’t show it! The pressure is all to much. They look around to everyone else for the answers and are yet to have any confidence in their abilities. They drop things and actually look scared. Their patients will likely die from their inaction.

• The Ego: These ones think they have made it. They know all there is to know. They walk around looking the part, walking the walk and talking the talk. They won’t ask for help because let’s be honest, they don’t need it. They talk down to nurses and ambulance staff because they are a DOCTOR. They try to do to much over and above their ability. Then patients die. They are ignored by all and they slowly realise they are not god.

• The Awkward: These guys have all the social skills of grizzly bear. They know their stuff, they were probably top of every class they have ever been in. The problem is, they have absolutely no people skills and no bedside manner. They will not spot a sick person because they won’t look at their patients. They will not talk to their patients because they don’t know how to. They just look at numbers.

All three will learn and all three will improve, however once an arrogant arse, always an arrogant arse in my experience. 

This year during Black Wednesday week the A & E was absolute chaos. We were coming and going every hour on the friday night with another puzzle for the newbies to solve, as was every other ambulance in the area. Although they didn’t take the handover I could see them looking as the double doors swung open, hopeful there was nothing majorly wrong with them. At about 3am, we’d handed over our patient to the nurse, my crewmate was booking them in and I was changing the sheet on the bed. Suddenly, in a cubicle a few feet away there was a commotion. A junior doctor was in there with a patient and her son. 

“What do you mean she’s dead?”

“Sorry”

“You said 3 hours ago that she was fine.”

“I know”

“You said she was asleep.”

“I know”

“How can you not know she was dead?”

“...................”

*awkward*

I left the department so as to avoid the furore. Ah.....Killing Season, and so it begins with a key lesson......check your patient is breathing at regular intervals and ensure the monitoring equipment you have connected them to is switched on!