He's only 10, and he's jumped out of the window. Only 10 years old, and he's jumped. This litany keeps running around in my head, as I kneel down to assess the young lad at my feet. I can't remember the last time I had to look after someone so young, someone who, even at that tender age, had decided to try and end his life. His parents stand by anxiously, as I take a look.
He doesn't look all that bad. He is lying on his right side, and his eyes are open. He tells me his name when I ask him, and he tells me that his right wrist hurts. I'm not surprised; he has clearly broken it. He says his back hurts a bit, but he can wiggle his toes without any problem.
The main issue we have is that he is in the front garden, and there isn't a whole lot of room for us to work in. Still, we manage to get a scoop stretcher next to his back, and then roll him on to it, with only a modicum of difficulty. And then it's a simple matter of lifting him over the wall and on to the waiting ambulance trolley.
I find out that he has been treated at the local hospital by the psychiatry team fora while. As he doesn't seem too bad, I decide that the local hospital is the best place for him; once the A&E has sorted out his wrist they can get the psychiatrists to look after him, and that's what he needs more than anything else.
I suggest this to the crew, and a look of horror comes over their faces. "But, what about the tree?" they ask. I panic, and look up in confusion, wondering if one is toppling over towards us.
But no. The crew are talking about the new Trauma Tree. Now, when you go to a trauma case, you call up a clinical coordinator in Central Ambulance Control, and they will tell you where to take the patient, based on a tree-like decision tool. And oh the trouble you get into if you don't do as suggested.
I tell the crew that I don't want to go anywhere else, and that I will make the decision, as the senior clinician on scene. They relent, but ask me to make the call, so that they don't get into trouble. Now I'm worried. Will I get into trouble? The crew tell me that all calls that are blue-lighted into hospital are scrutinised. I think quickly: the local hospital is only 3 minutes down the road, and he's not all that badly injured. We can just drive him to the local A&E without blue lights. They agree, sort of, with the proviso that I come with them, so that I can explain why they are bringing a 10 year old who has fallen two stories, without calling it in as a Trauma Call first.
Now, I am all for assistance to the crews when they need it, and wholeheartedly support the idea of a clinical coordinator desk, where crews can call in if the are having difficulties. But the idea of a clinical decision tool that is inflexible, and which has to be used on all trauma patients regardless of what the crews at scene feel, makes me worried. As this was a child, and as paediatric trauma is not well resourced in London, I can only imagine that we would have been directed to the closest hospital in London with paediatrics and trauma, and that would have been a journey of over 15 miles, and about 30 minutes or more. Worse than that, he would have been far away from his family and the support mechanisms he needed most.
11 months ago