The Curious Incident With The Jaffa Cakes

"78 year old male, DIB, daughter gave him a box of Jaffa Cakes."

Yep. Jaffa Cakes. Depending on what system ambulance services use to triage calls, they either use AMPDS or NHS Pathways. Call takers follow a series of questions and the answer lead onto another. Eventually you get a determinant, a diagnosis and a level of response. Or in this case, crucial information regarding confectionery.

I love Jaffa Cakes. Probably too much. It is impossible to have just one. Utterly impossible. I think I could easily live on them. They have it all. Now, as much as I love Jaffa Cakes, I did wonder why this information was deemed pertinent. There were a number of scenarios that went through my head:

1) He was given Jaffa Cakes and he doesn't like them. This caused a blind rage, resulting in a heart attack and subsequent DIB.

2) He was given Jaffa Cakes and he LOVES them. This utter joy took his breath away causing carers to think he had DIB.

3) He ate ALL the Jaffa Cakes so quickly that he forgot to breathe and now is struggling to breathe. 

4) He ate ALL the Jaffa Cakes and a Jaffa Cake or part of a Jaffa Cake went down the wrong way causing coughing and subsequent DIB.

5) He choked on a Jaffa Cake and isn't now breathing effectively. 

6) Someone took away his Jaffa Cakes, causing a panic attack and subsequent DIB. 

7) He had COPD and due to being distracted by Jaffa Cakes he forgot to take his medication. Now he has DIB. 

8) He was concentrating so much on his Jaffa Cakes that he didn't look where he was going. He tripped, fell down some stairs, punctured his lung and now has DIB.

9) He has run out of Jaffa Cakes and is now having a panic attack. 

10) He has DIB for an unknown reason. The Jaffa Cakes have absolutely nothing to do with it. 

Well, with all these questions running through my head it was probably best that I went to see the patient. 

No one was waiting for me at the care home so I found myself wondering the corridors saying 'Hello' at sporadic intervals. Eventually I was found and taken to the patient. Upon entering the room I instantly spotted an open pack of Jaffa Cakes. Unfortunately I didn't notice any DIB so that immediately discounts all of my predictions. There he was, lying in bed, not really communicating because of his dementia and there was me standing next to him looking confused. 

"What's the problem today?"

"He has a temperature and his blood pressure is really high. Like really really high."

"I was told something about Jaffa Cakes?"

"Yes, his daughter gave him two packs of Jaffa Cakes. He ate ALL of one pack in one go!"

What a lad! So, that cleared up the Jaffa Cake mystery for now. As scandalous as it was that he ate an entire pack of Jaffa Cakes, it didn't seem totally relevant to my examination. Surprisingly  his blood pressure was absolutely normal, as was his temperature. Back to the drawing board!

The crew arrived a few moments later. For the regular readers, it was the girl who threatened to send me a mongoose a few weeks ago. Her face said it all. She wanted to know ALL about the Jaffa Cakes! She also wanted a Jaffa Cake but she'll strenuously deny this accusation.

"As of yet, I haven't found anything wrong with him. Apparently he ate a whole pack of Jaffa Cakes. I don't think he shared."

Whilst doing his ECG the daughter arrived. The daughter who provided the Jaffa Cakes in the first place! I assure her that at this current moment we couldn't find anything wrong with her dad. I also had to ask about the Jaffa Cakes!

"He ate the whole pack!"

This really did seem to be the sticking point with everyone involved here. We had a man, who is normally bed bound, who by all accounts, had eaten a whole pack of Jaffa Cakes. Then someone phoned an ambulance. It really was a shocking state of affairs. Is this a police issue?! I mean it was a WHOLE pack of Jaffa Cakes and he didn't even share!

The crew sat him up and within about 20 seconds he had projectile vomited everywhere. By this point I was well and truly out of the line of fire, so happily stood at the back of the room by the door watching the clean up operation. (Whilst thinking about Jaffa Cakes)

Another resident of the care home appeared next to me. She was absolutely tiny! She stood next to me in her nightie, clutching tightly to her zimmer frame. 

"Hello my dear!"

"Hello. You do know he ate an entire pack of Jaffa Cakes, don't you? The whole pack. I'd be sick if I ate a whole pack."

"Has he?! What a pig! Did he share them?!"

"Nope, not one, ate the lot. He deserves to be sick."

With that, she toddled off. Clearly the rumour mill in this care home is rife! A WHOLE box of Jaffa Cakes! IN ONE SITTING! And NO sharing. It's an utter outrage and quite frankly I just don't know how he will recover from this. In fact, I don't know how the care home will recover from this. I'm assuming all the national papers have been notified. I expect the tabloids are frantically working on headlines as we speak. 

Whole pack of Jaffa Cakes. Well I never!

You Just Wouldn't.....Would You?

Recently East Midlands Ambulances Service launched a new campaign to try and reduce inappropriate calls. It was inspired!

You really WOULDN'T do either would you! For the people with any common sense and even the smallest amount of intelligence, it is clear what is meant by these posters. STOP calling ambulance for coughs, cold, cuts, scrapes, bumps, bruises, headaches, lifts to hospital, tiredness and the plethora of other minor ailments that some people seem to think warrant an ambulance! The new is overrun with stories about long delays waiting for an ambulance or 12 hour delays waiting for treatment in A & E. This is just fodder for the Daily Mail and Evening Standard to get their NHS bashing teeth into. What the stories don't expand on, is what was actually wrong with those poor individuals who had to wait 12 hours to be treated! I can assure you, it wasn't anything that needed treating immediately! In fact, I'd be happy to lay money on the fact that it probably wasn't anything that they even needed to see a GP about! Some people just don't seem to understand that people get ill!we all do! It sucks, we can't sleep, we cough, we splutter, we moan, we get hot, then cold, we ache and eventually we get over it. By 'we', I mean normal people.

Sadly, these campaigns appear lost on so many people, as today's shift proved......

"36 year old, diabetic problems"

Let's be clear. Just because you have diabetes does not mean than anything wrong with you is due to your diabetes. It is however a good trick to get a quick ambulance to your place of work. Lying in the first aid room like a dying swan was our patient. His 'diabetes with a reduced level of consciousness' was what got us there quickly. If he'd actually said what was wrong, we'd never have been sent. 

The reality was is that he was tired. Just tired. I know diabetes can bring fatigue but this guy had diet controlled diabetes. It was also well controlled and monitored. He had young kids and wasn't sleeping. His blood sugars was completely normal and he knew it. For effect he kept pretending to drift in and out of consciousness to the first aider. He 'couldn't walk' and 'couldn't open his eyes'. He 'couldn't talk' and 'couldn't be roused'. Needless to say, he was quickly roused, eyes the promptly encouraged open, he spoke when spoken to and obviously walked to the ambulance. Not impressed. Oh, and if you can’t cope with the tiredness that comes with parenthood, you should have kept the mouse in the house. Just sayin’.

General Public 1 - 0 Ambulance Service

"44 year old female, not alert with head injury, there is serious bleeding, abnormal breathing"

Blimey. SERIOUS bleeding. It MUST be bad. It appears whoever had called 999 had swallowed the textbook on how to get an ambulance quickly. 'Head Injury', 'Not alert', 'Bleeding' and 'DIB'. It sounded like the poor patient was in a whole world of trouble.

Has anyone ever had that horrible experience whereby you bend down to get something out of a bottom cupboard, stand up and hit your head on the open cupboard above?! Horrible isn't it?! Call an ambulance for it?! Didn't think so....

That is exactly what had happened. The head injury was a bump on the head as a result of standing up into a cupboard door. The serious bleeding created about as much blood as a paper cut. The patient was fully alert and putting on an Oscar winning hypochondriac performance. The was no difficulty in breathing whatsoever. He inability to walk was promptly converted into a walk to the ambulance. Another waste of a resource.

General Public 2 - 0 Ambulance Service

"30 year old female, drifting in and out of consciousness"

LOSING CONSCIOUSNESS! Quick, sound the alarm, send the cavalry, time is critical, run for your lives!!! OK, slight overreaction but she got the quick response due to her critical medical condition....

On arrival she was sat up grinning like a Cheshire cat, awfully proud of ailment. From her comprehensive handover it was clear that she had a degree in ‘Google Medicine’ and had self diagnosed an abundance of medical conditions. She busted out some medical big gun terminology too like ‘wobbly’ and ‘jittery’. Needless to say, her two week history of vague symptoms didn’t lead us to believe she had anything wrong with her that warranted an ambulance. This was confirmed by her feigned reluctance at going to hospital followed by an avid insistence it was the right thing to do! Better safe than sorry eh?! 

Yes, i’m safe in the knowledge that there is nothing wrong with you and sorry that you’ve hoodwinked the ambulance service into sending you ambulance.

General Public 3 - 0 Ambulance Service

“27 year old male, chest pain, DIB, fever, not alert, shaking”

Poor, poor guy. To have central crushing chest pain is bad enough, but difficulty breathing too?! No wonder he needs an ambulance! A fever?! He must feel awful and not to mention the shaking! Wow! What a trooper. 

After a thorough examination it was just as I feared. Neither of us wanted to break the news to him. These life changing moments are best delivered by trained professionals, not us meagre ambulance drivers. Eventually my crew mate plucked up the courage.....

“You have a common cold.”

Silence engulfed the ambulance as the gravity of what had just been said sunk in. As with any tragedy there are 5 stages of grief this guy went through them all bless him.

“I know my body, it can’t be a common cold!” DENIAL

“It is.”

“This is ridiculous, I want to see a doctor.” ANGER

“That’s fine, we’ll pop you up to hospital.”

“Are you sure it couldn't be meningitis?” BARGAINING

“I’m sure.”

“I just feel so weak and ill, I’m always ill, I don’t get it, I’ve got so much on my plate at the moment.” DEPRESSION

“*silence*”

“OK, but I still think I should see a doctor, be on the safe side.” ACCEPTANCE

“Good idea, put your seat belt on.”

Yep, always best to be on the safe side. I’m not sure what it is the safe side of but always best to be there. Another waste of an ambulance though!

General Public 4 - 0 Ambulance Service

It goes to prove that no matter how effective an advertising campaign is, ambulance services can only go by what they are told. People know the buzzwords, people exaggerate, people think they are the priority and people think they are entitled to an ambulance at the drop of a hat. The sad fact is, if someone wants an ambulance enough they will most likely get one. Today they won. And when they do, genuine patients will suffer, A & E departments will get overrun and the Daily Mail will have a field day. THINK before you dial! 

*          *          *          *          *

FYI!!!

It appears that in some of the comments it has been perceived I took all these people to Accident and Emergency and this, as such means I'm an awful clinician. On the contrary. Hospital doesn't mean A & E for starters. Most of my local hospitals have Urgent Care Centres (UCC) attached and when appropriate the patient is taken there. So, just to clarify.....

"36 year old, diabetic problems": Due to a history of diabetes, pre existing co-morbidities and a history of increased lethargy, to err on the side of caution, the patient was taken to an UCC attached to an A & E. Therefor, if as I suspected it was tiredness, and being run down he could be discharged by the nurse led centre. If on further examination it was deemed necessary to be seen by the doctors in the A & E, then he would be. For the ambulance service that is a good use of an Alternate Care Pathway and totally appropriate to his presentation.

General Public 4 - 1 Ambulance Service


"44 year old female, not alert with head injury, there is serious bleeding, abnormal breathing": After a thorough examination in the ambulance ensuring the 'wound' was clean and there were no signs of concussion or any other 'Red Flags' I deemed it that no further medical attention was required. Despite this, the patient was keen to be seen at hospital. She was taken to the nearest Walk In Center (WIC) to be seen by a nurse practitioner. For the ambulance service that is a good use of an Alternate Care Pathway and totally appropriate to his presentation.

General Public 4 - 2 Ambulance Service

"30 year old female, drifting in and out of consciousness": A patient with a need to repeatedly 'google' conditions will be a worrier. Despite her ECG being normal and all observations on presentation being normal it was decided that due to the history or dizziness it was felt that further investigations in the way of blood tests should be done. We contacted her own GP and made her an appointment later that afternoon. As it was a GP let health centre her blood test could be done at the same time, thus freeing up space in the overwhelmed hospitals. For the ambulance service that is a good use of an Alternate Care Pathway and totally appropriate to his presentation.

General Public 4 - 3 Ambulance Service

“27 year old male, chest pain, DIB, fever, not alert, shaking”: This patient, most likely had a chest infection. He was slightly tachycardic, slightly pyrexic, a slightly increased respiratory rate and a cough. If left at home I'm confident he would have been fine. As a paramedic, once he is in my primacy of care, it's not good practise to say 'he should be fine' when he has 'Red Flags' and a number of triggers on 'Sepsis 6'. As such, further care was needed, despite the reality of him having a cold, and needing bed rest. He too was taken to a UCC where A & E was on-site if needed. For the ambulance service that is a good use of an Alternate Care Pathway and totally appropriate to his presentation.

General Public 4 - 4 Ambulance Service


This post was about how patients bypass on-phone triage systems and get an ambulance response when realistically they should be making their own way to either a GP, WIC, UCC or A & E if they are worried. I don't routinely take people to A & E and I use the tools that are available to us to avoid it at all costs! Hope this clears up some of the confusion. They may get ambulance but we still score some points! ;-)

Coffee, Lizards and a Mongoose

"49 year old female, head shaking"

Sometimes you have simply awful days, other times you utterly fabulous days. Admittedly the latter is a rarity but I'm glad to report that today was one of them. A shift can be made or broken by the person you are working with. 12 hours in what is effectively a yellow tin can, can be an utterly trying experience with a total arse. On the flip side, 12 hours working with a certain few people can not only fly by, but also be great fun. After a hearty breakfast we dragged our weary and tired carcasses into the ambulance to trundle out into the 6am darkness. Joy. Deep deep joy.....

The day followed a pattern. Job, eat, coffee. Job, eat, coffee. Etc etc. After a plethora of patients who had either not needed an ambulance or not needed carrying to the ambulance the shift was almost at an end. We pulled up outside a rather bedraggled looking building of flats. Sure enough, we were needed on the top floor and with a rather vague history or 'head shaking' we rang the buzzer. 

'Who is it?' 

I wanted to say 'It's the King of Siam' or 'It's the second gunman from the grassy knoll'. You phoned an ambulance 4 minutes ago, we had sirens blaring as we pulled up outside the house and now there is a ring on the doorbell. It really isn't too hard to fathom. Anyway, despite what the inner sanctum of my psyche was telling me to say, 'ambulance' was all I mustered!

We plodded up the 6 flights of stairs and knocked on the door of the flat.

'Who is it?'

Really?! *insert sarcastic responses*

'Ambulance'

The door slowly opened and a lady stood in the doorway with a rather blank expression on her face. She invited us in, and disappeared off into her lounge. We duly followed. She started to tell me what was wrong but I couldn't concentrate. I was transfixed on the bizarre surroundings I had found myself in! Most people, myself included have some kind of theme to the decor of a room. Perhaps it's a colour theme, a feature wall, ornaments to match the furnishings. Maybe it's minimalistic, futuristic, antique. We trawl through catalogues stealing every good idea we can, in the vain attempt to pass off as our own inspirational masterpiece. However, a shrine to lizards isn't something I've come across at the Ideal Home Show. 

Yes, a shrine. To lizards. Models, photos, paintings, books and masks. I can assure you she was no herpetologist but she clearly had a penchant for reptiles. The drawings were bizarre and definitely not anatomically correct! The centrepiece to the room was a huge cage of sorts, inside was a lizard of some description. I was transfixed! It was one of the most bizarre things I've ever seen! 

It transpired that the patient had a mental health history and this 'head shaking' was something she had presented with before. The GP was aware and she didn't need to go to the hospital. Whilst checking her over I asked about the lizards.....

'They are my sons. He thinks that he is an alien. Maybe he is. I'm not sure.'

How does one respond to that? Either the fact that he thinks he is an alien or the fact his mother a) doesn't seem concerned about this fact and b) is under the impression it was a possibility! By this point my crewmate had disappeared from sight. I knew she was bound to have a beaming smile on her face and be seriously struggling to maintain any kind of composure. It was taking every bit of concentration on my behalf not to laugh. I know there are clearly underlying mental health problems but it's impossible not to find some of the things we see amusing, even if there is a sad tale running parallel with it.

Back in the ambulance, doing the paperwork, we had our laugh.  And we laughed hard. As is often the case, conversations tend to evolve based on our patients. In this case lizards in particular. From lizards we ended up discussing how the mongoose lives on lizards. Then it was what the plural of mongoose was. Was is mongooses? Mongeese? So many questions to answer! Apparently if I was a lizard, I'd be a Gekko. Why, I'm not entirely sure but despite my best attempts at pushing for something with 'dragon' in the title I was put in my place. We really are a weird lot!

A short while later, the time came for me to return to the lizard den with the paperwork. 

'If you're not back in 5 minutes, I'll send in the mongoose.'

She didn't even look up. 

I bloody love days like today! We really are a random bunch!

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.