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

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?!