Thursday, 9 April 2009

One Under

20:05 - I am called to a "One Under". This is the terminology for someone who has fallen or jumped under a train. These are, as you can imagine, quite nasty calls, or "Shouts", with usually devastating injuries. The other issues are of safety - more on that in a moment.

So, off I go, to CountryStation, to meet up with the crew. I say that because one can never be certain exactly where the patient is going to be. Think about it: when there has been an RTC, you can usually see a lot of wreckage, and that's a fairly good clue as to where the patient is going to be. Sure, they may have been ejected from the car, but you've still got a reasonable chance of seeing them.

When someone is hit by a train, there are two main differences. Firstly, there is generally no damage to the front of the train. The train may carry on for some time before coming to a stop. Also, the victim may be thrown many hundreds of yards from the track. Add to that the fact that, as this is an overground train, the victim might have been anywhere, between stations, at the time of impact. Oh, and it's dark.

I was always warned against playing on railway tracks. Two main dangers; the trains and the electricity. So, my first port of call, find someone in a uniform, and not a green one. I need to find a Station Manager or a member of London Transport Police. Plenty of them around. I ask if the power is off. They tell me, "We think so." Huh? You think so?? So, I gesture to the Station Manager, "After you!" He's not best pleased, and hurries off, presumably to find someone more expendable than him to go onto the tracks.

The second danger is that of the trains themselves. A train that has the power shut off to it can carry on moving for up to 4 miles. Plenty far enough if you 3 1/2 miles in front of it. Also, London Transport, and other rail companies, are keen to keep the service going, so they will often only turn off one line, and keep the other trains going in the other direction. Uh, uh, not for me.

So, I and my ambulance colleagues, along with the LT Police, who clearly feel the same way as I do, are left peering through the railings by the road, trying desperately to see if we can spot anyone. I have my head torch on - makes me look like a knob, but what the hell!

Suddenly, we spot something, way away in the bushes next to the line. It looked like a pile of rags - that's what one unders look like, I'm afraid. So, we have a patient. Alive or dead? We've got to go look.

About this time I hear the sound of a blue light vehicle approaching - HEMS is here. At night they drive a car, just like the rest of us, and they have been tasked on the job along with me. The protocol is simple; whoever gets there first is in control. Yippee, it's me!!

So, power off, trains in BOTH directions halted, and we're off to check on our patient, probably 30 minutes after it all happened. Not quite the Tick Tock of my previous post...

We clamber down, off the platform. Anyone who knows me will snigger at the image this brings to mind. I am not the fittest of doctors. I am also clumsy when I am walking on the straight, so the sight of me clambering is not one that would win me any agility awards. Still, I managed, with the help of a friendly fireman. Traipsing down the tracks, in the dark, is something I will never get used to.

We reach the body. The body that is still breathing! When I say breathing, there were a few, very shallow breaths, but where there's breath there's life. I remember that I am in charge, and kneel down to get a closer look: severe head injury, multiple limb fractures, no chance of survival.

If I would have been there without HEMS, that would have been it: I would have called it soon after. However, with two doctors on scene, things were different. We rapidly turned her onto her back. I intubated and ventilated - no drugs required. That is always a very poor sign. Multiple lines were inserted to give her fluid. About 40 minutes later, she was ready to be transported to the ambulance, a slow journey of another 15 to 20 minutes. The HEMS team decided they were going to take her back to a London Hospital, a journey of about 45 minutes. I was happy to let them take this one.

And then we are left, the ambulance crew and I. We look at each other, tired, cold, wet (it rained). Was that worth it? Was there any chance of survival. We all knew what I would have done, and knew that the outcome, while delayed for a few hours, was not going to be any different.

And then it's the clean-up. We had left a fair amount of kit at the scene, and it needed bagging up and removing. I offered to go down with one of the crew to give him a hand.

Oh bum! The trains are running! We were going to be escorted by two linesmen, across two sets of live tracks, to hunt around in bushes for the odd laryngoscope. Great! I thought it was bad before, now for some real fun! The linesmen instruct us to walk swiftly but carefully, always keeping between them. I do so, looking down all the time, so as not to trip. The trains rush past. The linesmen tell us we have a window of 1 minute before the next one to cross. I am not at all happy, but have offered my assistance; I can hardly back out now.

We cross safely, and approach the scene. It looks weird, without the patient. Quiet, somehow. Where before there was a mass of people, activity, lights and noise, now there are just 4 of us, and the wind blowing the rubbish about. We set about picking everything up, the silence punctuated by the occasional train rushing past us. At last it is done; one final sweep of the torch to make sure we haven't left anything behind. The return journey was no better - we had witnessed what happens when a train hits you.

Safely on the platform, we both glance back, then look at each other. "Just make it a basic RTC next time," I suggest. He just nods, obviously as shaken as I am.

I ring the next day - the patient died as they pulled up at the hospital.


  1. Just out of curiosity RDD if HEMS hadn't of turned up could you not still have done all the same things? Or was it a double EMT crew and no Paramedic?

  2. Hi Mac, yes, I could have done all the same things as the HEMS crew, but I wouldn't...

  3. I would be somewhat thankful you don't live any closer to the East Coast Mainline:
    On Monday 6th April, there were two (yes, two) 'one-unders' - the first was 11am at Hatfield, the second was 5pm at Finsbury Park.

    Found your blog from NeeNaw, btw, and enjoying the reading so far!

  4. To be honest, I am only 15 minutes from Hatfield. Begs the question, why wasn't I called?

  5. Good question indeed...
    Maybe because they'd already decided it was purple?

    I was glad my train didn't hit either of them - we were only about 35 minutes behind the 5pm incident!

  6. Possibly, but they should send as soon as the job come through, and stand down if necessary.

  7. My Grandad worked on the railways and he told me the best way o check if the third rail was live was to drop a five foot long metal bar across the rails. If the track was life the bar would short out the power, effectively switching it off for the next few hours.

    This is however seen as an emergency solution as the bar will in all probability weld itself to the track...