Flowers

As I drive past the accident scene, I see fresh flowers adorning the trees along the side of the road and down in the ditch where the car came to rest. I wonder who it was who didn't survive: the passenger? The driver? My patient, or the one managed by the HEMS crew? Both? In a blink of an eye, I am transported back to that fateful night:

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The scene is not an easy one: the car has slid down a steep bank, and is now jammed against a tree. There is noise; lots of shouting from the crews, the rumble of the generator and the engine of the fire truck. There is little light, and I quickly get out my headlamp and strap it on.

"Where do you want me?" I call to one of the ambulance crew. He shrugs his shoulders, and I stop in my tracks: how many people are involved in this accident?

I run over to someone being attended to, lying some feet from the wreckage, the car that I haven't yet been able to get close to. He looks up at me, and the crew tell me that he is ok; there are worse cases to deal with.

Ok, time to get to the car. It's not easy; the slope is very steep and very slippery. I grab hold of a passing fire officer, and he assists me down. What awaits me is very shocking:

I am approaching the car from the passenger side. The car has clearly rolled, as the roof has collapsed down on to the passenger. There is a sheet of metal across his chest, yet, somehow, his head is exposed, presumably through the side door window. He has his eyes closed, and is making some respiratory effort. I reach over to his neck to feel for a pulse, expecting none, or perhaps something weak and thready. But no, his pulse is strong and bounding. His colour is ok, and, despite him being so severely pinned, he certainly is someone who might have a chance, albeit very slim. I turn to the fire crew, and ask what their thoughts are. I explain that this man is time-critical, and that we need him out immediately. He shakes his head: "It'll be at least 20 minutes, minimum." It is my turn to shrug - if that is what it takes, then so be it.

I hear a shout from the other side of the car, and hurry round to see what's what. There is another ambulance crew, dealing with a third victim; the driver. He is already out of the car, lying some feet away from the vehicle. He has obvious head injuries, with a Glasgow Coma Score of 6. He is breathing and has a good pulse.

This is really bad. I am not going to be able to do this on my own. There are two patients who need intubating and ventilating. If I am alone I will only be treating one, and it will be the one already out of the car. But the one still in the car might have a chance. What to do?

I get on the phone to GasPasser, another BASICS doctor, not too many miles away from where we are. No answer. Bum!! Looks like I am on my own after all.

Just then, I hear another set of sirens. I look up to see a very familiar car coming to a standstill next to mine. It's the HEMS car!! Phew.

I rush up, and before they have even got out of the car I have begun to appraise them of the situation. As I am first on scene, I am in charge, and I let the HEMS team know what it is I want from them: they will need to look after the one already out, and I go back to the passenger, still in the car.

Just as I am sliding down, I hear a call from the crew down below, shouting for suction. Not good! I rush over, to see that the patient is now making gurgling noises, and is not breathing well. I quickly take over from the paramedic, and push his jaw forward with one hand, and insert the suction device into his mouth, to clear the blood from his airway. This seems to make a difference, and he settles once again.

That's a sorted for the moment; now to get some IV access. There is one arm free, and I put a tourniquet round his elbow. Sliding a cannula into the vein, he jerks his arm away! He is responding to pain, something he wasn't doing before. Things, while still looking pretty poor, are not as bad as I first thought when I first came across the accident.

The fire crew have done sterling work, and his upper body is now free. This lends itself to more problems, as the car is at a good 30 degree angle, and he is tending to slide towards the driver's side. That's not good, as we need to ensure that he moves as little as possible, in case he has a spinal injury. I have his head at this time, because his airway has once again become a problem. I am at such an awkward angle that my upper arms begin to cramp up, but I mustn't let go, or even shift position. I ask the crew how much longer, and they tell me it will be another 10 minutes or so. This is looking badd again.

Just then, the HEMS doc taps me on the shoulder to update me on the situation: his patient has an isolated head injury, and they are going to intubate and transport to the Royal London Hospital. I think quickly: my patient is far more seriously injured, and definitely would benefit from going to the major trauma centre. However, I am supposed to be on call for my own Department (remember, this is my voluntary "work", and I have a job in a local hospital), so there is no way I can go all that way with this one. However, there is a more local neurosurgical centre, and I could definitely go there with the other chap. This is well against protocol - it's not best practice to swap patients in mid-treat, but I can see no other way around it. So, I hand over the passenger, scrabble up the hill to the driver, who is with the HEMS paramedic. Together, with the assistance of the ambulance paramedics, we swiftly anaesthetise the driver, pass a tube into his windpipe, and connect him up to the ventilator.

By this time, the passenger has been extricated, and a bid a fond farewell to the HEMS para, as he goes off to assist with the driver.

Packaged in the ambulance, we make the uneventful journey to the neurosurgical centre, and I hand over.

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I shake my head, clearing the visions, and continue home, where my family awaits, hugs at the ready, still wonderng what the final outcome had been.

Curry

Our friends arrive for a night at Chez RRD, takeaway curry. The phone doesn't ring! We decide what to order (that takes a while) - the phone remains silent. Mr A drives off to get the curry (the restaurant's car has broken down, so sorry, no delivery tonight). No calls. We start the repast, a fine spread!! Still we are not disturbed. Then, just as I breathe a sigh pf relief, as the last of the CTM is mopped up with the final piece of peshwari naan, my phone goes off. A job about 20 minutes away. A car has hit a tree, and the driver is unconscious.

I learn something this evening: it's not easy to bend down to tie the shoelaces of your brand new, free(!) Magnum boots with a gut full of curry! It's even harder sliding down a ditch to help get a now fully conscious, if rather inebriated, driver out of a Peugeot. And, don't get me started on the journey to the hospital...

Tomorrow - Chinese!!!

Eyes

He lies there, hardly a mark on him. Just a small graze on his forehead. Not much at all. And yet...

And yet, the car windscreen is shattered

And yet, he has a GCS of 4; eyes closed, no verbal response, limbs extending

And yet, when I lift up his eylids, his eyes tell all.

Pupils widely dilated, eyes diverging.

His eyes, windows to the soul, fortellers of death

A Tale of Two Bloggers

All I can see in the distance is a set of hazard lights, emitting an intermittent orange glow against the dark background of the night. Maybe this RTC won't be quite as given - trapped and unconscious - but as I approach at a rapid pace I can see that the hazard is not the car with the lights flashing, but a car facing the wrong way, lying on its side, perched up against a street light.

At four o'clock in the morning there's very little traffic, very little life about. The world sleeps as I do my small bit to keep it safe and well. The call rate to the ambulance service drops, but so do the number of available ambulances. I know I may be on my own for a while. I stop by the car, take one look at it and its unfortunate occupant, and call for help. I need everyone. Fire Brigade, police, at least one ambulance and a Basics doctor. This patient could need a lot of help, and quickly.

I’m fast asleep, having just finished a late shift in the A&E. How weird, then, that I can hear the drum solo from “In The Air Tonight!” Wait a minute, that’s my ‘phone, Ambulance Control. I blearily answer it, and accept a job nearby – car overturned, entrapment and unconscious.

I climb into the car through the boot, hoping that my assessment of its safety was correct and that the kerb would hold the car from tipping further. The patient was clearly unrestrained, lying with his head on the passenger window against the road, and his legs wrapped around the steering wheel. His breathing is a little slow, which concerns me but just putting an oxygen mask on him is a struggle. He tries to fight me off, making me think that this could be anything from a diabetic coma, to alcohol, to a serious head injury.

The journey is uneventful, and I pass the police barricade a few minutes after leaving home. It usually takes a little while for me to wake up fully, but the sight of the car on its side, facing the wrong way, and the lamp post knocked down, is like a splash of cold water. This doesn’t look good. I jump out of the car and grab my pack – anything else I will come back for. I jog round to the car, and am directed to the rear.

The Fire crews turn up first, and I ask about taking out the windscreen, but that would apparently take some time. I need him out quicker, but have no way to move him and no where to move him to. As I'm still fighting to get a primary set of observations done, three pairs of legs appear at the back of the car, two of them green belonging to the crew, and one of the pairs of legs orange. I recognise the voices and thank everyone who needed thanking for them turning up in a hurry. The orange pair of legs belongs to RRD, and I was fairly certain that when I'd asked for a Basics doctor, it would be him that I woke from his slumbers as I knew I was on his patch. At least now I could share my thoughts and decisions.

I peer in through the hatchback of the car, and see a familiar face – Ben! Excellent! This is going to be entertaining, if nothing else. He quickly appraises me of the situation – an unrestrained driver, was deeply unconscious, now is combatative. Difficult to get access to the patient, no obs done. We discuss what options we have; peel the roof down or bring out through the back. I want this man out here, so I suggest to Ben that he tries to wind the seat back down, so that we can bodily drag him out. I wander over to the Fire Chief, and let him know what we are doing. He doesn’t look best pleased – I guess he was looking forward to some cutting, but offers all assistance with lifting etc that we might need. I go back to the boot of the car, to see Ben struggling vainly with the seat controls. “Got a problem?” I ask. He just grimaces, reaches under the patient, and the seat magically drifts back, giving the crew room to get him out. I leave them to it, and go and set up for the inevitable intubation.

We extricated the patient out the car the same way I'd climbed in, through the boot, and onto a rescue board. He was still trying to fight back. By now I could smell the alcohol, but still couldn't rule out that his behaviour was due to a head injury, and we treated as such. RRD knocked him out, intubated him, and made sure that our transfer to the hospital would be as event free as possible.

I watch as, first Ben and then the patient, are born(e) from the back of the car, the patient on a spine board. The crew wheeled him into position, near my kit dump, and we start to cut through all his clothes, so that I can make a formal assessment of his injuries. Ben is set the task of getting iv access. I check him over, head to toe, and find little else wrong with him, apart from the obvious – he is eyes closed, occasional groans and localising to pain. Glasgow Coma Score is therefore… anyone?? 8. of course!! I’ve got the kit ready, the team are ready, Ben gives the drugs, and the tube is in. We get him on to the vehicle, and I ask Ben to travel with us.

I travelled with them, abandoning my car at the scene and remaining in charge of the patient's ventilations as we did the breathing for him.

The journey is uneventful, and the three of us in the rear chat about stuff – other jobs we have done, BASICS, the state of the country, that sort of thing. All the while, we are closely monitoring the patient for signs of deterioration, of which there are none. We get to LocalNeuro, and hand over the patient, with some playful banter about whose IV access is better, Ben’s or mine (mine, of course)

All that remained was the tidy-up, paperwork, NHS tea in paper cups, and to get back to my car and return to base for the end of my shift. Maybe, if I asked really, really nicely, RRD would take me back in his cool car...

And then it’s all done. It’s early in the morning, and there’s a bit of paperwork and a lot of clearing up to do. We stand around, drinking our tea, before I offer Ben a lift back to his car.

Confession

Ok, so my Dad comes in to the hospital today, and needs iv access in a hurry. So, I get the kit, and go for the right wrist. Damn!! I missed!!! My own father, veins like drainpipes, and I missed.

I am sure some would say, that is why you don't treat your own family. I know, but, when your father is in front of you, and he needs a line, and you are the most experienced person there, you just do it (or, in my case, botch it!)

He's fine now, just been discharged.

Speed!

Saturday:
Post for me! Excellent. Looks official. I open it to find a Notice of Intended Prosecution. Excess speed of 40MPH on a 30MPH restricted road. I check the date, and let out a sigh of relief as I see it is on a date I went out on a job - a double stabbing, one survived, one died. Ok, no problem, just knock off my usual standard letter, giving CAD number and whoosh! All sorted.

Thursday:
More post. Looks official. Another letter from those friendly souls at Traffic Criminal Operations Unit. This time, it is an offer. I can agree to pay the fine and get 3 points on my licence. Or I can go to Court and contest it. Oh dear! I have another, closer look at the letter. Ah, I see the issue. The time of the speeding was a good hour after the incident. So, I wasn't on my way to the incident. I must have been on my way back home. Still, surely that is mitigating circumstances; having attended such a disturbing scene. Ok, no problem, just knock off a rather more in-depth letter, explaining what had been going on, and hope that will all be sorted.

Friday:
I am driving towards the hospital, when I see the drated camera that got me. Wait a minute! The camera is pointing TOWARDS the hospital. So, that means... wait another minute! I was in the back of the ambulance with this patient. So, someone else was driving my car. I rack my brains. It was definitely not one of the ambulance crew - they were too busy with me and the patient. It must have been one of the police officers. Oh, well, too late now to do anything about it.

Monday:
I try to find a number for the Traffic Criminal Justice Operational Command Unit, but there is no way of getting hold of it. I ring the local station, and am advised that I need to send the original form, with the name of the police officer who was driving. Not so easy, on two counts. I haven't got the form, and I haven't got the name. I ask for someone in Homicide to call, to get some advice.

Friday:
The Homicide Officer calls, and I explain once again what has happened. She promises to deal with it for me. Phew!!

Normal vs Para-Normal

NORMAL:

It is 7pm, and you are sitting at home. Your rest is disturbed by the sound of your mobile phone ringing: "The Boys Are Back In Town", by Thin Lizzy. It's your mate Ben, wondering if you might like to meet up for a drink later, as you haven't seen each other for a while. You go out to a quiet pub, with a roaring fire, have a few drinks, and reminisce about the old days, and complain how no-one seems to do their job properly. You get back home around midnight, and go to sleep.

PARA-NORMAL:

It is 4am, and you are in bed. Your sleep is disturbed by the sound of your mobile phone ringing: the drum solo from "In The Air Tonight" by Phil Collins. It's Ambulance Control, wondering if you are available for a job, as your mate Ben has called in a serious RTA. You jump out of bed, go out immediately, into the pouring rain, to help Ben get an unconscious chap out of an overturned car. You travel in the back of the ambulance with him, then. once you have handed over your patient, you stand around in the freezing cold, drinking NHS tea out of paper cups, and reminisce about the old days, and complain how no-one seems to do their job properly. You get back home around 6am, and lie awake.

Nice to see you this morning, Ben.