The Fallen

I am sitting quietly in a cafe with MrsRRD, enjoying a few precious moments between dropping a MicroRRD off at a friend and picking another MicroRRD up (we have three of these, along with a MiniRRD and a Princess RRD, remember), when my phone rings, asking me to attend a call.  A 50 year old man has fallen down some stairs, and is unconscious and fitting.   With only one car between us, MrsRRD is forced to endure a heartstopping journey on blues to the patient (she LOVES it really) and then she drives off, after leaving me her oyster card, so that I can get back from the Major Trauma Centre that I am sure I will be going to, based on what I have been told.  Unusually, the story is as given, and I rapidly make an assessment:

The man is lying on his back, feet on the bottom step, head in the kitchen.  There is very little room to work, and I have to squeeze past the paramedics already in attendance.  They tell me he has been very agitated since they arrived, and that the son has told them that he watched his father miss the last few steps and fall into the kitchen, off the hallway, and then proceed to fit.

I take a look at Tom, kneeling on the kitchen floor in my jump suit.  His airway is maintained, despite him being on his back, and his breathing is good.  There is no sign of blood loss, and his pulse is regular and strong.  His Glasgow Coma Score at this moment is 11 out of 15, made up of eyes 4 out of 4 (they are open spontaneously), verbal 2 out of 5 (he is moaning incoherently) and motor 5 out of 6 (he is moving purposefully, but not obeying any commands).  That's not bad for someone who has hit his head, and is on the cusp of whether I intubate and ventilate on scene or not.

The crew are very keen for me to get on and intubate their patient.  They are worried about how they are going to get Tom out of the house.  He won't lie still, and they cannot control his head movements.  If he has sustained a spinal injury he is in danger of making it a lot worse.

I begin to get the kit ready for an intubation, hoping that Tom will begin to come round a bit more.  After all, he has had a fit, and after someone has fitted they are usually a bit confused and out of it, what is known as post-ictal.  I ask Tom's son if his father has ever had a fit before.  He tells me that this is his first.

There is something about Tom's son that doesn't seem to fit (sorry about the pun).  He seems a little too calm, considering the fact that his father is lying on the floor, semiconscious.  I think how I might be reacting if it were my dad, and he is just standing there, writing down his details for the paramedics to take with to the hospital.

I wonder for a few fleeting seconds whether he had pushed his dad down the stairs (far too many crime novels to be good for me!) and then it hits me.

"Does your dad drink much?" I ask him gently.  He nods, and tells me that his dad is an alcoholic, drinking about three bottles of wine a day.  He had been trying to cut down, and hadn't drunk any alcohol for 2 days.  This all made sense.  When someone comes off alcohol too quickly, especially if they are a long-term heavy drinker like Tom, they are very prone to fit.  I can picture Tom coming down the stairs, and having a fit just as he reaches the bottom step, falling forwards, unable to stop his fall.

I am directed back to Tom, who is trying to sit up.

"Where am I?" he asks, querulously.  We explain what has happened.  He does not appear to understand, but is far more awake than he was when we first arrived.  I look to the crew for confirmation that they are happy to take him awake to the nearest hospital.  They signal that they are.  We carefully get Tom on to the ambulance trolley, and in to the back of the waiting ambulance.

I look around, remembering: I have no car.  I jump in the back of the ambulance.  "We'll be fine without you," chirps one of the crew helpfully.  I suggest that, while they might be fine, I would rather be taken to the local hospital to be picked up, rather than wait outside Tom's house.

As we speed up to the doors of the A&E, I see my car drive sedately in behind us.  MrsRRD has my coffee.  Now, that's service!