Two years ago I went to help a lady called Kay. Today, she has written to me to tell me she would be happy for me to tell her story on my blog. Kay, this one's for you. You are a brave lady indeed.
It is 2pm, and I am just about to go into a Coroner's Court, about a patient who died in the hospital. As I go to turn off my phone, prior to walking in to Court, it rings. I deliberate for a second or two - the Coroner does not like to be kept waiting - and then answer the call. It is from Control. There has been a microlight plane crash in St Albans, can I attend? I know I am only a few minutes away, being at Hatfield Coroner's Court, but I also know that rushing away from Court will not go down well. And I can understand that. The family of the deceased have prepared themselves for this most difficult day, and it will need to be put off if I cannot attend. But, I have been called, and it doesn't sound like a simple trapped RTA. So I push through the line of people waiting at the desk, and tell the clerk I am off. The look of horror on her face says it all - it will be her that has to tell the Coroner!
No time for regrets - my decision is made, and I rush to my car, change, and drive to the scene.
It is an odd scene for me. I am parked at the edge of a field. Way over in the distance I see a tree, and at the base of the tree a hive of activity. I sigh, not being a good runner, grab my kit and set off.
I arrive at the tree. There is a pile of wreckage that I am reliably informed was once a microlight plane. It certainly wouldn't be flying again. I turn my attention to the two casualties. There is a man. He is being resuscitated by two ambulance staff. I know them both well, and they have worked with me often enough to know my thoughts at this time. If someone is being resuscitated, and has no heart function, after major trauma, their chances of survival are zero. And yet we have another victim to look after. I go across to her. "Help me! I can't breathe!" she calls out to me, her voice thin and wavery. "What's your name?" I ask, as much to find out her name as to find out about her airway, breathing and circulation. "Kay," she replies, "It hurts so very much!"
As I check her over, my colleagues come over - they have abandoned the futile resuscitation attempt on the man, and are awaiting instructions. I can see that Kay is very badly hurt, with severe chest and pelvic injuries. Her respiratory rate is around 40 breaths a minute, instead of the usual 12, and her pulse is barely palpable. I have only a couple of minutes before she will succumb. I turn to the paramedic. "We need to do an RSI," I tell him. RSI stands for rapid sequence induction, and is the standard way to give a general anaesthetic in an emergency. "I need your help getting the kit ready. We have NO time," I add pointedly. He gets the message, and we quickly get the equipment and drugs ready.
I have only been on scene for a couple of minutes, and already Kay has deteriorated rapidly. Her pulse is now completely impalpable, and she is rapidly sinking into unconsciousness. One of the paramedics has already found a vein, and passed a cannula into it, so I give her the drugs that will paralyse her and put her to sleep, and pass the tube into her windpipe, easily and uneventfully.
That was the easy bit. Now it was going to get tricky. I knew why her pulse was fading, and why her breathing was so rapid: Kay had a tension pneumothorax. This is a life-threatening condition, where one has a collapsed lung (a pneumothorax), but one in which air is able to escape a hole in the lung, and enter the space between the lung and the chest wall, but is unable to escape. Imagine 3 balloons in a sealed box. If the pressure in the box increases the balloons get squashed. Two of those balloons are the lungs, and one is the heart. If the heart gets squashed enough it no longer pumps blood around the body. That was bad enough, but now that I was forcing air into her lungs, I was also forcing more air into the tension pneumothorax, and making matters far worse. I had to equalise the pressure in her chest, and immediately.
I had prepared for this, knew what I was going to do before I had started giving Kay the drugs. I picked up a scalpel blade and made a 2cm incision in her chest below her armpit on the left hand side. I cut through the skin easily. I then used my gloved finger to push between her ribs, and make a hole into the chest cavity. A large hiss of air accompanied this, and I swiftly moved across to the other side and repeated the procedure. This time, not only was I greeted with a large hiss of air, but a torrent of blood as well. Damn! She had bleeding into her chest. I can do nothing about this on scene, and need to get her to a hospital quickly.
So, I've sorted Airway and Breathing. I reassess her. Her pulse is still weak, but at least I can feel a pulse, whereas before the thoracostomies (the cuts I have made) I could feel nothing. Now on to Circulation. I have already decided she has a fractured pelvis, so I need to splint that. I get a sheet and pass it under her hips, then, together with one of the crew, I tie it in a big knot across the front of her pelvis. There! That should hold it until we get her to hospital.
And, talking of hospital, where are we to go? Just as I am about to discuss this with the crew, there is the whir of helicopter blades. I look over, and there on the field is a blue helicopter. It's an air ambulance. I think fast: if we are to save Kay she needs to get somewhere fast, and an ambulance journey is not going to be particularly prompt, especially as it might take us 15 minutes to get out of the field and into the ambulance. So, I call over the pilot and ask him if he can help. "That's why we're here," he replies. "Want to go to Milton Keynes?" That's miles away!! I wonder why he suggests MK, and he tells me it is the closest unit with Neurosurgery, Cardiothoracics and a helipad. Smart thinking!!
We get Kay on to the special stretcher, load her on to the helicopter and I strap myself in. I can see the monitors, and can just get to one of the cannulae she has in her arm, but not much else. I settle myself in for a difficult, tense ride. I know that, if Kay deteriorates en route I will be able to do nothing. I check the equipment one last time, before signalling to the pilot that I am ready.
I get a flash back to my time with the London HEMS as the helicopter lifts off, and I watch carefully for any signs of the pressure in her chest cavity changing as a result of the change in altitude. Not that there will be much I will be able to do.
The journey is uneventful. As we set down, I unstrap myself and feel for Kay's pulse - it is present, strong and regular. For the first time since I arrived on scene I begin to think that she might survive. We rush her in to the Trauma Room, I hand her over to the waiting team, and walk off. She's no longer my responsibility. There is nothing more for me to do, except wait for three hours while a member of the ambulance service drives to MK to collect me and bring me back.
A couple of weeks later, Kay comes to see me in my A&E Department. We look at each other, saying nothing. She shakes my hand, then apologises for what she is about to do. She flings her arms around me and hugs me. "Thank you," she whispers.
Kay's partner was flying the microlight, and died in the crash.
11 months ago