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

Hot Stuff

"38 year old female, feeling hot"

Now, the question is, was she feeling hot because she was unwell and her core temperature has risen slightly? Or was she simply hot because it was a hot day? Or maybe she just had too many layers on? OR she was wearing little black dress and killer heels and as such, simply felt HOT and wanted to share this?! Hmmmm, the former was most likely but the latter would amuse me greatly! I headed round to the address anticipating this medical emergency with baited breath!

'Good morning my dear, what's the problem today?'

'I feel really hot'

'In what way?'

'I just feeling really hot'

'Any other symptoms at all?'

'No'

*facepalm*

'And what did your GP say?'

'That it wasn't an emergency so I couldn't have an appointment until Thursday.'

'I see, did they advise calling an Emergency Ambulance?'

'No, but I didn't know what else to do'

*facepalm*

'OK, let me just take your temperature............36.7, it's fine'

'Yeah I know, I already took it.'

'Well I'll check you over but without any symptoms there's not much I can treat.'

'I reckon it's because I'm due on my period. I normally get hot flushes before it starts.'

*facepalm*

And that is how my week started! Wearing green, living the dream, saving lives and making a difference. 

"Nothing in the world is more dangerous than sincere ignorance and conscientious stupidity." Martin Luther King

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?! 

A Life Of Grime

"59 year old female, collapsed behind closed doors."

There is that ominous feeling again! The one I get when those words appear on the screen. The apprehension that goes with the territory of entering someone's house, not knowing what you will find. Will the house be empty? Will you go from room to room hoping not to find a body? Will you find someone hanging? It's a horrible feeling and a job I never relish doing. 

We headed round to the house. It was an old Georgian terraced property in quite considerably disrepair. Flaking paint, rotten sash windows, dirty net curtains, ivy growing up the wall, an over grown garden, a boarded up window and a broken letter box. If I didn't know any better I'd have said the house wasn't occupied but we had it on good authority that someone was indeed inside. Two days worth of milk was in the porch which suggested that normally someone was there. I knocked and shouted through the letter box. To my surprise I heard a faint 'Help me' in reply. 

We couldn't get in and no one had a key so I requested police. While we were waiting a neighbour offered us access to her back garden. She also told us that the lady inside never goes out the house. We squeezed through a gap in the fence and peered through the window. Darkness! Luckily the old sash window wasn't locked and lifted up with relative  ease. I immediately wished it hadn't. The smell that hit me.....wow!

This job in general challenges your senses and often offends them. It is true that there are smells you can taste and this smell instantly made me gag. Covering my mouth and nose 

I pulled the curtain across and was met with literally a wall of rubbish. There was no way in, I couldn't see any part of the room. Back to the front!

By the time I'd clambered through the fence and got to the front door the police were on scene. After my explanation of the smell, we all donned masks and police forced the door in. I can't begin to describe the state of the house or convey the smell in words. It was beyond grim! As we made our way down the hallway, shuffling past the stacks of rubbish, I could feel the soles of my boots sticking to the floor. We followed the faint voice from the back of the house, all the while, the smell getting more intense. Maybe it's like touching something with a 'wet paint' sign on it, but despite knowing how vile the smell is I still found myself checking! 

My heart sank as I turned the corner at the end of the hallway. The piles of boxes and rubbish continued, making it almost impossible to get to her but my main concern was her! She was lying face down in the doorway of what I assume was her bedroom. When I say 'in the doorway', I mean literally wedged. She must have been 30-35 stone. There was no way to even roll her onto her back. She had also been there two days so was saturated in urine and faeces. For the first time in a long time, I didn't have a clue what to do, or where to start. How do we move her?! How do we get her up?! How do we get her out?! My crewmate checked her over and medically she was OK, apart from some dehydration. Clearly we couldn't manage on our own and our equipment wasn't large enough or strong enough to cope with her size. 

I phoned up control and had a discussion with our clinical support team. They decided to send HART (Hazardous Area Response Team) and an officer for starters. The benefit of HART, is like firemen, they tend to come on mass! There is normally six of them on their big truck so at least we'd have hands! Ideally we needed a removal company, pest control and a deep cleaning company but we don't always get what we want! Within 20 minutes or so the troops had arrived and like us, were perplexed as to what to do. 

The officer, rightly said we needed the bariatric ambulance to convey her, so he arranged that. Due to the lack of bariatric ambulances and the ever increasing number of obese people who need them they can only be requested by an ambulance officer, so they are not used inappropriately. Meanwhile, the head scratching continued. Eventually a plan was made!

It involved clearing the hallways for starters! Unfortunately, there was no space to put any of it! We ended up having to line the pavement with it all. Almost an hour later, the bariatric ambulance had arrived, a path was cleared, dead rats had been found amongst other unidentified dead creatures and we were all filthy. As for the smell, what smell?! We'd been around it for so long, I was over it! 

With a configuration of straps, sheets and a hoist we managed to get her onto her back, then to sitting, then onto a chair, out the house, onto the bed and off to hospital. We all then went for showers and a uniform change.

I've blogged about obesity at length and apart from saying how much this has cost the NHS in resources, I won't discuss the obesity issues. They are obvious enough. However, there are huge social issues and obvious failings in a flawed system. How can anyone be allowed to end up in a state like this? The council WERE aware of the situation and had done nothing. It was a council property and there was a resident clearly not able to cope. Why had social services not intervened? Time and time again we see people that have 'fallen through the cracks' in the system. I'm not being funny, but this isn't falling through a crack, this is simply not caring for people who need it. This hasn't happened overnight. This is the result of a lifetime of self neglect and being overlooked by the services that are in place to help. No one will be answerable for this situation. It's been left for the emergency services to sort out, again. No one should be allowed to live in such squalor, regardless of how obese they are, regardless of whether or not they are a hoarder and regardless of whether or not they can afford or want the help they need. Allowing anyone to 'fall through the cracks' is neglect. End of.