Trapped!

It's 02:30. He's been trapped in the car now since 23:30 the day before. This man has spent the past three hours stuck in the wreckage of his brand new BMW, that hit a tree at high speed. I can't get him out. The fire crew can't get him out. He's cold and in pain. His right leg is embedded deep in the metalwork of the car, and, because the tree looks as though it has grown through the bonnet of his car, we are unable to do a dash roll to move the dash away and give us some more room.

I need my friend here, my mobile mechanic, to help decide what bit of the car is what. I peer at the leg, and pass my hand down slowly, to see where he is trapped, and by what. I cannot get my hand further than mid-calf - the rest of the leg and foot is completely buried. I have a chat to the fire crew, and suggest various bits of the car to cut off, knowing that this is going to take a long time. Fortunately for Timothy the foot injury seems to be the only problem he has. He is very chatty, telling me about his work as a Loss Adjuster for a local insurance firm.

Another half an hour goes by. I can now get my hand down to the top of his sock, but we are running out of options. The fire crew are cutting away down a deep hole, and it is proving increasingly harder for them to do anything without hurting Tim.

I regroup with the fire officer. I wonder whether we would be able to pull the car away from the tree. This is not something we would normally do because of the risk of injuring the patient, but in this case I can't see any alternative.

I decide to have one more look. Sometimes, if you clear some space behind the leg, this gives a small amount of manouevrebility, and the foot slips out. I run my hand down the back of the calf, and hit what I at first think is the leather seat cover. I look at the seats they are fabric. But this definitely feels more leathery. I ask for a torch, and peer down the hole, only to be greeted with the sight of his shoe. His shoe, toes pointing upwards, behind his leg. Pushing the shoe, prodding it with my gloved hand, I realise that his foot is still in the shoe, bent all the way back and up against the back of the leg. Furthermore, the sole of the shoe, and so the sole of the foot, is not the side of the foot that is resting against the back of the leg - it's the top of the foot. Try this yourself: take your shoe off. Now, keeping your shoe in the position it was when it was on your foot, bend it back all the way, until the sole of the shoe is against the back of your leg, with the toes pointing up towards the back of your knee. Now twist the shoe round, so that the laces are against the leg, rather than the sole, still with the toes pointing up to the back of your knee. Finally, imagine doing that with your foot still in the shoe! Well, that is the situation my patient is in...

Ok, so, although he has an obvious nasty fracture of his ankle, this will make extrication far easier, because the foot is not buried in the car - it is behind his leg. I decide to give Tim some STRONG pain-killers, and PULL him out. I am kneeling on the passenger seat (did I mention the roof and doors were removed ages ago?) and there are fire crews all around, to do the heavy lifting, while I pull the leg and foot out of the hole.

Nicely out of it on painkillers, Tim doesn't make a sound as I pull hard on the leg and foot. It still won't budge. I feel around again, confused, until I realise that his heel is getting stuck on the metalwork, and I cannot get it out. I call over my shoulder for a pair of scissors, and cut away at the shoe, until I can get his foot out of the shoe. It is very odd, seeing his toes right at the back of his leg, but at last he is beginning to move. It gets very dark, as the fire crew lean over and across me to grab a piece of the released passenger, and haul him up the waiting spinal board.

I glance at my watch - 04:30.

Don't Read His Blog!!!

No-one go to Insomniac Medic's blog, please!!  He just has to do better than me, doesn't he?  It's not my fault I can't run as far as he can.  Sponsor me anyway, even if it is only a measly 10K.

PS, good luck, IM.

The End? Almost, But Not Quite...

On Monday, I, along with a large number of BASICS doctors scattered across our nation, received a large, official-looking envelope. Upon opening it, we all found an identical letter, dated 16th December, 2010, along with a 100-or-so-pages form.

The letter was from CQC, the Care Quality Commission. They are the independent regulator of health and social care in England. What that means is that they ensure that anyone providing health care does so to an approved standard. All very laudable, I hear you say.

But now to the letter itself:

Dear RRD

As an immediate care doctor you and your organisation need to register yourselves with the Care Quality Commission. The enclosed form needs to be completed and back with us as soon as possible. If you have not sent in the form by April 1st 2011, you will need to cease all practice as an immediate care doctor, or risk facing prosecution under the Act, blah, blah, blah. Oh yes, and you need to pay us a whopping fee to cover our processing costs. Oh, and there's a yearly fee for being on the register.

Yours sincerely

The Care Quality Commission


I may have paraphrased some of the letter, but you get the basic drift:  fill in the form & pay us the money, or stop doing your work.

Ok, I hear you say, surely this is all right and proper.  Who else is going to make sure that you all are properly trained and acting in our best interests, if not the CQC?  Who is going to stop the cowboys, those just out for glory, rather than those who care?  Agreed and agreed.  And, I was expecting to have to register with the CQC at some stage.  The last we had all heard was that we needed to be on the register by April 2012.  2012, not the week after next.

So, let's have a look at this form:

Please provide evidence to show you take the views of your patients into consideration when providing your service. "Excuse me, Sir, but I need to ask a few questions for my Patient Satisfaction Survey, before I intubate you."  Or, "Pardon me, Madam, but could you please tell me if you are happy with the colour of the cannula I have stuck in your arm, before I am able to give you any pain relief?"

Please provide details of every location where you provide your service.  If you haven't got enough space on the form provided, photocopy the relevant pages and send them off with the form.  Provide evidence that, at each of these locations, health and safety is considered.  Right, pass me a local A-Z.  And I'll just go and have a look and make sure there are no dangers lurking on the M25, shall I?

You can see my predicament.  Not only did they spring this on us, but they dated the letter December 16th, then sent it out in the middle of March! To everyone working in BASICS!!  Why the change?  Well, according to the letter, the Department of Health have advised them that immediate care work is outside the normal practice of the GP's.  Sorry?  Ok, there are a significant number of BASICS doctors who are general practitioners, but the Department of Health are unaware that there are a significant number of BASICS doctors who are not GP's, and who work in hospitals.

So, is that it?  Does RRD have to hang up his jump suit and boots?  Can Mrs RRD get a full night's sleep?  Not quite.  Fortunately, I have been able to get in touch with the Medical Director of my ambulance trust, who has agreed to include me in their submission... for now.  Watch this space.

Mrs RRD To The Rescue!!

It was like something out of an orienteering test: "Go to the M25, Junction X. However, do not, I repeat, do not, travel along the M25." Oh. So, how do I get there, if I can't drive along my favourite motorway? I have all of the local junctions programmed into my Sat Nav, but this one isn't that local, and I haven't the first clue. The HEMS paramedic who has activated me for this mission, isn't able to guide me in at all - he doesn't know this area well enough. However, I know a special lady who does.

A quick call to Mrs RRD, and, with Google Maps loaded on her trusty MacBook Pro, she guides me along the 30 minute journey. She plots my position with pinpoint accuracy, giving me key sites along the way, so that I am able to concentrate on getting through the traffic.

And then I am there. I can see the accident, as I arrive at the roundabout over the motorway. The HEMS para has helpfully advised me that I will need to travel westbound, on the eastbound carriageway. Erm, that's the wrong way!! Isn't it?? I go round the roundabout twice more, just to be sure exactly what my plan of action is. Ok, I need to go down to the motorway on the sliproad that cars normally come OFF the motorway on. That's rather pants-wetting, especially when a fire engine is coming the other direction!!

Training Day 3 - 13.83Km in Total

Two big problems with training today.

Problem 1: my phone kept rebooting, meaning that my track didn't update properly. I had to spend a good couple of hours cleaning the track data, so that it was as real as possible. The total distance and time are right - the average speed may be a bit inaccurate, however.

Problem 2: now this one's a biggie, and I'm not sure what to do about it. Whle running today I was overtaken by Mrs RRD's mum and dad, out for a leisurely stroll... Hmmm, need to rethink the plans!!!

When Lewis Carroll Meets Richard Bachman

It's a Saturday morning. It's 2am. I get called to an assault, and blearily climb out of bed, don whatever is at hand (a t-shirt with the immortal words, "Ketamine, Just Say Neigh!", and go downstairs, trying hard not to trip over the cat, sleeping on the stairs.

I arrive to see lots of people milling around two ambulances, and, fortunately, a similar number of police. I still feel nervous, and breathe a sigh of relief when I am directed to the relative safety of the back of one of the ambulances.

Once inside, I am greeted by InsomniacMedic. We nod to each other, quietly, as if we do not in fact know the other's secret identity. It's odd, calling him by his real name. He has it easy, just calls me "Doc."

I am told by one of the other 6 ambulance crew that the patient, hidden from view by a sea of green, has been hit over the head by a road sign. "What sort of road sign?" I quip. "Hold on, I'll go and check," was not the response I expected, as one of the police officers also crammed into the sardine can scurries out to find out, only to return a few minutes later with the news that it was a Keep Left sign.

With that vital piece of information to hand IM and I are able to make our plans: the patient has a GCS of 8, but I think most of that is due to alcohol rather than his head injury. I decide that he should go to the Major Trauma Centre (MTC), because one can never be sure about what is alcohol and what is head injury until a CT scan is forthcoming. As he is lying quietly on the ambulance trolley I decide that I would try and get him there without resorting to intubating and ventilating him.

This is a bit odd for me. Those of you who read my blog regularly may have noticed a more conservative approach. Whereas anyone who closed their eyes for a short while would be tubed and ventilated, I now seem to be taking the opposite approach and holding off on doing so, unless the patient's airway was compromised. It has been a while since I have intubated a patient pre-hospitally, and I wonder to myself if I am losing it.

Still, we have a plan: as long as he behaves himself, he will be left alone. As I relate this to the others, and as IM raises an eyebrow in surprise, the patient makes the decision for me. Trying to get off the trolley, trying to remove his hard collar, and thrashing about in an altogether not-going-to-the-MTC-awake kind of way. So, it's a deep breath as IM gets intravenous access, and I draw up my drugs and prepare my equipment.

I wonder what on Earth is wrong with me - I have done this hundreds of times, in far more difficult situations than this one. And I don't always have someone like IM, whom I trust to help get me out of any sticky situations. I must be getting old, I muse, as the tube slides effortlessly into the patient's trachea.

Patient all settled in and comfy, I then turn to the thorny issue of my car. The last time I went to the MTC, it took over 2 hours to get me reunited with my vehicle, and I am in no mood to do that again. So I need someone to drive my car to the MTC for me. Guess who gets the job? Yep, my fellow blogger has the privilege of driving the RRD-mobile!!

An hour or so later, the patient off to CT scan, I have a quiet chat with IM, no-one else around, and the chance to speak openly about our "other" lives.

And, as I drive home, through the quiet streets of London, I reflect on the case, and on how it doesn't matter how many time you do something; it still has the potential to go horribly wrong. Maybe I am getting older. Maybe that's not such a bad thing.

Training Day 2 - 7.8 Km Total

Make the pain go away - sponsor me, please!!

Training - Day 1

Well, it's started. I am officially in training. On 31st May, in London, I and the rest of my team will be running 10 Km, to raise money for BASICS-London. Now, for those of you who don't know me, I'm not what you would call athletic. My idea of exercise is pressing the button on the electric recliner. I find I get short of breath walking too fast up the stairs (well, there are two flights in Chez RRD), and got a cat rather than a dog, to save on the walking.

And yet I have signed up as one of 8 runners, participating in the Bupa London 10K run, on May 31st. Princess RRD is running with me (well, far out in front of me), as are BigNeph, Scissors, Flasher, GasPasser and Shrink. Over the next couple of months I will need to get my fitness up to a level where I don't end up needing the services of my ambulance colleagues, who will be watching me from the side of the road. You will be able to see how I am doing, by looking at one of the panels to the right, which will be updated every time I do any training. Hopefully, by me knowing that you are all watching, I will be encouraged to keep up the effort.

What will also encourage me is if I start receiving some sponsorship for this run. After all, I'm not doing it for my own health!! In fact, at my age, the money I raise by doing this run may well have to go towards my knee replacement! But seriously, if any of you wish to sponsor me for this run, all proceeds going to support BASICS-London, and the doctors that volunteer, just click on the PayPal link to the right. Do post a message along with your donation - we always like to hear words of encouragement.

There will be regular postings, telling you just how far I have run in total during my training, as well as - hopefully - a live update on race day itself!!

Recognition

It's a scary thing, to be launched into an unfamiliar environment, and expected to function at a high level, to control the team in order to provide the best care for the patient. It's my first day as Trauma Team Leader at the new Major Trauma Centre. I get to come to an Emergency Department (ED) I have never worked in before, with staff who have never met me before, and when a trauma is brought in by the Ambulance Service I get to tell them what to do. All night.

And then the bleep goes off: the first call on my first shift. I have 20 minutes before they arrive, so I get up, get dressed and run down to the ED. The team are assembling, and I start introducing myself. When another member of the team arrives I introduce myself again. And again. And again. There are a LOT of members of this Trauma Team.

Five minutes to go, and my bleep goes off once more: another trauma call, this one in five minutes. So, that means I will have 2 at once. Hmmm.

OK, Plan B. Divide the team into 2 and run between them both. With a set of people who don't know me from Adam.

The first ambulance arrives. I look in delight at a friendly face. "Hello, Mr RRD!" calls out the paramedic. He's one of my locals, bringing a patient from my patch all the way to the Major Trauma Centre, and for my first call. The team looks on as we share pleasantries, along with a handover, of course.

The second crew are from down South, miles away from my home town. So, I was even more surprised to hear the "Hey there, Mr RRD!" from this crew. The para used to be from my patch, but moved about 3 years ago. The Team look on in awe; this new Trauma Team Leader knows EVERYONE!!

Putty in my hands...

We Got Rhythm!

I know this isn't pre-hospital, but I just feel I must share something with you:

We had an elderly lady into the hospital, in cardiac arrest. So, she has no pulse and isn't breathing. Unfortunately, there is a tendency for Nursing Homes to call 999 when one of their residents dies, and this leads to a sequence of events, culminating in them arriving at the hospital, only to be certified a few minutes later.

Anyway, we start off as usual, continuing the cardiac massage. We need to compress the chest at a rate of 100 beats per minute, 30 beats followed by 2 breaths. It just so happens that the nursery rhyme "Nellie The Elephant" has just the right rate, and 2 verses makes exactly 30 beats. So, it is not uncommon to see the person providing the cardiac massage mouthing the words to "Nellie" while doing the compressions.

Today, one of my junior doctors demonstrated another song that fits the bill, of 100 beats per minute, 30 beats to a verse. However, while some of you may not think it is entirely appropriate to be mouthing "Nellie the Elephant" while attempting resuscitation, even I balked at the sound of my junior singing, fairly loudly, "Another One Bites The Dust", as she vainly tried to keep this lady alive.