Wednesday, 6 May 2009

Watch Out!

14:03. I am at work, plowing through emails. My pager bleeps - again! All day long, my pager, linked to the Ambulance Service, has been notifying me about calls in the area - chest pain, abdo pain, asthma attack, more chest pain. I sometimes wonder why I agreed to have it programmed in for every damn call. None of these are what I would be called out to. Oh well, let's have a look. The code 29D04 flashes repeatedly on the tiny screen. I squint, just making sure, through all the dust that has collected from my trouser pocket under the screen. 29D04. 29 denotes a road traffic collision. D04 tells me the patient is trapped. Now, that's what I am (not) paid for! A quick check on the address - I could walk there from the hospital in under 5 minutes. I decide the car would be far better, and rush through the Department, pager in hand.

My colleagues are well aware of what that signifies - a chance to get out the hospital with me to a job. At the worst it will mean riding the streets of HomeTown at speed, blue lights blazing and sirens blaring; at best it will mean they get to experience first hand the joys of pre hospital emergency care. And they get to hear me jabber on about scene safety while we are on the way...

BabyDoc, one of the paediatric specialists, wins the arm wrestle contest over BeardDoc, and she rushes with me to the car parked conveniently at the entrance to the A&E. Seatbelts on, and I barely get past "Always look before you walk out into the road, even if the police have closed it off," before we arrive.

What I see is a car, right up against a lamp post, and a garden wall that has been knocked down by the car. I jump out, give instructions to BabyDoc to grab my kit (well, she wanted to come with), and I start hurrying towards the car, and the obviously injured driver, slumped against the wheel, his head being held by an EMT.

"Hi, RRD," calls a friendly fireman. "Can you smell gas?" I stop short, and turn to him. "Sorry?" "You know, gas!" he replies. Fortunately, he continues: "The car has hit the domestic gas main, and it seems to be leaking. A bit," he adds. I sniff. I don't know why I sniff, because the lining of my nose has been destroyed by 19 years of vomit, smelly feet, smelly wounds, faeces, and other unmentionables, and I can't smell a thing. Still, it seems the right thing to do at the time.

I have to start making a risk assessment. On the one hand, I have a seriously injured patient, just about to be released from the car. And on the other, I have leaking gas from a domestic gas main. A bit. I decide that gas is only a big problem if it is in an enclosed space, and this is, well, outside. So, I suggest to the police that they move the rubberneckers back 100yds, and proceed in with BabyDoc (fully laden) to the car.

The chap is breathing, but he really should have worn his seatbelt. His teeth were never again going to grace a Colgate advert, and his face looks like it had hit the indside of a windscreen - basically what had happened. He isn't talking, his eyes aren't open, but he is moving fairly purposefully. His Glasgow Coma Score, a measure of how awake he is, is 7 out of a possible 15. So, he is going to need to be put to sleep, and I will need to intubate him. I think about how much harder this will be with his facial injury, and mentally prepare myself for a surgical airway, where I will make a hole in his neck and put the tube directly into his windpipe. Not something I have ever done in real life, I am once again very conscious of how precarious life is out here on the roadside. Still, I have practised enough times on sheep larynxes - how much harder could it be on a real live patient, whose life will depend on doing it right. Anyway, I am getting myself stressed for nothing - this tube will go as well as all the others (I'll just put this scapel blade here, just in case, you understand...)

A quick check of the rest of him, while BabyDoc draws up the drugs for me: Airway - a little bubbly, due to the blood. Breathing - equal on both sides. Circulation - a good, strong, steady pulse. Disability - Glasgow Coma Score now 6. Ok, looks like an isolated head injury, let's optimise this baby by ventilating him properly, and ship him out.

Drugs in, laryngoscope in left hand, passed into the right hand side of the mouth, sweeping the tongue to the left and lifting the soft tissues out of the way to see ... the vocal cords! A straightforward intubation (I told you I wouldn't need that scalpel blade...) Tube in, tied in place, position checked, it's all going like clockwork.

"Holy F***!!!" screams one of the bystanders (I thought I had asked that nice policeman to move them all back!) "Get the hell out of there - it's going to go!!!!"

Bum, bum, bum, tits and bum!!!!!!! My assessment of the scene was screwed, and now so am I, BabyDoc, my paramedic and the patient. That gas main is going to blow!! I can see in my periphery BabyDoc and the paramedic fleeing, so that's two of us out the way. I decide that I am not staying behind, and stagger to my feet, dizzy from fear. As I turn to run, there is a horrible groaning sound from the ground beneath my feet, and the road gives a little shake. I picture the inferno, that is going to engulf this street, and like Lot's wife, I turn and look:

I see three very burly firemen grab the lamp post that is falling towards the car and the spot where I had been only moments before, and stop it just before it hits the patient. They pull hard, and bring it to rest inches away from his head.
Well, that wasn't expected!! I am shaking from release of adrenaline, but I realise my patient might need a few puffs of oxygen, as I have left him fully asleep, with no-one to breathe for him except me. I scurry back, and carry on, with a few, very sincere, words of thanks to the fire crew.


  1. Another fascinating post. Interesting mechanism. What kind of speed was he travelling? Wish I had the same opportunities working in A&E currently...

  2. Another excellent post. Does this mean that BASICS Doctors are only meant to go to RTA's or do they attend cardiac arrests and the like?

  3. Thank you Scott and Ralph. The info I have managed to glean from the police is that he had run the red light at over 40mph, barely missing a pedestrian, and swerved into the house, bouncing off and resting against the lamp post. And yes, Ralph, we will go to medical problems as well, if asked. This is less common than the trauma cases, mostly because there is much less delay in moving medical patients than trauma ones, and the paramedic skills mean that they can deal more effectively with medical problems, without the need for a doctor. Medical jobs I have been asked to assist with include the cardiac arrest I described in my post "Don't get Comfy" and a variety of young men, aggressive post fit.

  4. Great call! I love when the unexpected happens- glad nobody was injured when it fell. Here is one of my best trauma calls so far:

    The boy ends up making a complete recovery, and the crew won a state award for their efforts and role is stabilizing him. Thought it would be up your alley.

  5. I'm with the bystander, Holy F***!