So, why is it that I am awoken in the early hours by a strange yet insistant buzzing sound? Ah yes, forgot to turn my 'phone off vibrate last night. Oops! Good job it still woke me. Ambulance Control are at it again, sending me to a job near my own hospital. A motorcycle has been in collision with a bus, and the rider is in a serious way. My immediate thought, apart from "there goes my lie-in", is that, unless the rider has gone underneath the bus, he is unlikely to be trapped, and I suggest that the crew might want to consider scooping and running to the hospital, rather than delaying waiting for me. I ask Control to advise me if the crew are not going to wait, and I get dressed and hurry down to the car.
As I am getting in to my car, Control ring again. Am I stood down? Well, not exactly. As I made the comment about the crew running with the patient, they have called upon another BASICS doctor, who lives the other side of town, and asked him to attend. My arch nemesis, GasPasser2! There have been a number of occasions when he has wrested jobs from me, arrived before me and taken charge. But this one's mine!! I'm not relinquishing control to him today!!! I let Control know that I will go as well, jump into the car, and the race is on!
I don't want anyone to think I drove any faster than I normally would, just to get there before him. That would be highly irresponsible and dangerous. But, as I come off the motorway, and see his flashing lights in my rear-view mirror, I must admit to a feeling of satisfaction, knowing that, this time, he would be aswering to ME!
As we weave through the early morning traffic, sirens blaring in harmony, I think back to how rare it is for me to work with another BASICS doctor.
We arrive and jump out of our cars. I feel like I'm in a Bond movie: "So, Dr GasPasser2, we meet at last!!"
Despite the fact we so rarely work together, this makes no difference, as we squeeze into an already very full ambulance, and assess our (my!!!!) patient:
He is a big chap, well over 120kg, and is being less than cooperative. He is trying to sit up, and is being restrained by a police officer who outweighs him by at least 10kg. Told you it was a tight squeeze! It's not easy to assess someone while they are being sat on, but I do my best. "What's your name?" He tells me. So, airway and breathing are ok. I lean in close. "Now, listen to me. If you want this policeman to stop sitting on you, you need to cooperate with us. Are you prepared to lie quietly?" He nods, and I gesture to the police officer to relax his grip on the unfortunate. In an instant he is sitting bolt upright, struggling with all of the crew in the ambulance. Bad call. With Mr Bobby replaced on his chest, we quickly go to work, securing intravenous access, and the decision is made - he cannot be transported to hospital in this agitated state, and will need to be intubated and ventilated.
For those of you who might be wondering, agitation such as this is commonly seen in trauma cases. There are a number of causes, the most important being poor oxygenation, blood loss and head injury. Only when all of these have been excluded can one conclude that the agitation is due to alcohol, drugs or just bloody-mindedness. If it is any of the former it is important to gain control, by intubating and ventilating the patient after the administration of a general anaesthetic.
Because I got there first, GasPasser2 has to defer to me, and I get the opportunity to intubate this one. It's not that there's any competitive nature to this BASICS lark, honest. But, he is an anaesthetist (hence the name) so he gets to do this every day...
The drugs are given, the tube slides in easily, and he is finally quiet and still. Mr Bobby is released from his duties as human paperweight, and we get ready to leave scene. I say my farewells to GasPasser2, little knowing that, in less than 5 hours, we would be once again racing to the scene of another accident, and that this time he would beat me!!