A Life In The Day Of A Basics Doc

It's A Long Way To The Trauma Centre, It's A Long Way To Go

2012-01-14T00:29:00.001Z

Ah, peace at last!! My gentle drive home from the hospital is in stark contrast to the week I have had. Busy doesn't cover it. But, at least I am free all weekend. I have great plans for tomorrow morning - I won't be surfacing until at least noon.

Before that, however, I have an evening at home with the family. A nice quiet, relaxing evening, that I have been looking forward to all week.

Arriving home, I am assaulted by the wonderful aromas of my dinner, simmering in the oven! Can it get any better? RRD-Dad rings, and we have a chat about who's been busier than who.

My other phone rings.

My heart sinks as I realise that, at least for me, dinner will just have to wait.

As I ride the motorway to my destination, I muse on how long it has been since I have been called to a job. Sure, I have been woken; on one occasion I even got to the car and started driving. But, an actual job - well, many weeks. And then I start to wonder quite how I will manage this one. Will this job be the one where I find myself unable to make the right decision, where someone's life depends on me, and I get it wrong?

Uneasy now, I arrive at the police roadblock, and am waved through. The road is eerily quiet now, so unusual for a Friday night. The mass of blue flashing lights up ahead signify I have arrived. I get out of my car, then leave the road and scramble down an embankment to the waiting crew.

She's been thrown from the car. That's bad. Ejection equals serious trauma. It also suggests a lack of a seatbelt. The car has definitely rolled over - dents and damage to the roof make that a cetainty.

She's not moving. Her left leg is at a very unusual angle. But I have to ignore the obvious injuries, and search out the immediately life-threatening ones.

She is breathing spontaneously, and her chest is rising and falling symmetrically. Her tummy feels ok, and her pelvis is intact. But, she is not conscious.

I decide that, as she is out of the vehicle already, the best thing to do is to scoop her onto the stretcher and carry her back on to the road, where it will be much easier to assess her. A couple of minutes later we are by the ambulance; lots of space and lots of light. Also, being on the stretcher means she is at a much better height for me to examine her.

She is still breathing normally, and there are no sounds of snoring, suggestive of an obstructed airway. This is unusual in someone who is unconscious from a head injury. I file that titbit away, and carry on looking. Her chest is clear, and the movements are still symmetrical.

Into the ambulance and some further observations: pulse rate 130, blood pressure 170/110, oxygen saturations 98%, respiratory rate 18. For those not in the know, she has a very high pulse rate, a very high blood pressure and a moderately fast respiratory rate. This could all be due to the pain from her obviously broken leg.

I ask about distances to hospitals. My own hospital is a mere 15 minutes away, with the Major Trauma Centre about 45 minutes. I know what the right thing to do is: we need to go to the Trauma Centre. I don't like these long journeys, but I know it is better to spend a longer time in the primary transfer from the scene to a specialist centre. The decision is made, and the crew get ready to depart. I think for a moment about intubating her, but decide that, as her breathing does not seem at all like that of someone with a significant head injury, we would wait and see how she goes.

We set off. She's very cold, and the saturation probe finds it difficult to get a consistent reading. The blood pressure is a lot better now: 110/ 60. She starts to moan and open her eyes, and ParaGirl and I smile, knowing that this is a good sign.

She starts to vomit. Not a good sign at all. As she is strapped to a spinal board, if she is not conscious enough she will be unable to clear the vomit from her mouth and will inhale it. Aspiration is a leading cause of death in trauma patients. But not this one. She lifts her hand to her mouth and coughs. Good. That means she has an intact gag reflex, that will protect her airway. She spits out the vomit. Good for her, not so good for us in the back of the ambulance.

She vomits again. And again. And again. We have the sucker ready, but this is ridiculous. What on Earth has she been eating? And so much of it??

We have by now stopped on the hard shoulder while we try and sort her out, stopping her from drowning in her own vomit. We manage, but ParaGirl is gagging. "I don't do vomit", she gasps between hiccups. Well, you are in this job, and in the back of an ambulance swimming in it, so you just have to.

She's now stopped vomiting, and has settled back into her previous unresponsive state. I check the observations as we set off again: pulse 145, blood pressure 69/50, saturations 95%. Hmmm, her pulse rate is climbing, and her blood pressure, while initially high, has fallen dramatically. I open up her drip, and give her more fluids, willing the ambulance faster.

It's a Friday night, and the roads get busier. We are getting slower and slower as we approach the Trauma Centre. The blood pressure now reads 47/20, and I am sure we are going to lose her before we get there. I squeeze the bag of fluid harder, pushing another bag into her. ParaGirl asks if I want another blood pressure. I shake my head, knowing that, as long as she is still breathing, there is precious little else I can do, and seeing another blood pressure will only add to my anxiety. Her lips are pale, and I know that she is bleeding somewhere; presumably into her abdominal cavity. I alert the Trauma Centre of our impending arrival.

We arrive. She still has a pulse. She begins to moan again as we wheel her in to the resuscitation room. I wonder again whether we should have gone to the closer hospital. But, when, 5 minutes later, she is being rushed to Theatre, a surgical team ready to save her life, I know I have done the best thing for her.

Rope

2011-12-15T11:31:00.002Z

I rush into the Department, pager in hand, and am swamped with people wanting to join me on another shout, High Tower and New Boss are the chosen two, and we jog over to the car, the two of them jostling for the front seat. There's a lot of joking around: with High Tower in the car I am not going to have the same acceleration as I would normally get. New Boss is very excited at the chance of seeing some action on the streets. I'm quiet; I know what we are going to, and I know the impact it will have on these two.

New Boss is in the front seat, holding on for dear life as I hit the road. The two of them continue to joke about my driving skills, and about how different I am out here, compared to in the Department.

The rope hangs from the banisters: a mute reminder of what this man has done. The screams from the back room echo around us as we determine what we already know: this man has managed to do what he wanted to.

We drive back to the Department, each lost in our own thoughts of what we have witnessed.

I have seen many hanging victims, and so have High Tower and New Boss. But they had never been to the house before, and the sights and sounds at the scene of a violent death can never be explained, can never be shared with someone who has only ever dealt with the victims in the sterile, cold environment of a hospital resuscitation room. And what they continue to see in their mind's eye will remain with them forever.

The rope.

Avoidance

2011-12-15T11:17:00.001Z

I've been avoiding you, dear Constant Reader. I look back, and see that the last time I ventured here was three months ago. It's not that I haven't thought of you, nor that I haven't had anything to say, no jobs to post. In fact, quite the contrary. There are some that I want to tell you about, and some that I need to tell you about. It's not even the dreaded writer's block. Posts and stories rise unbidden into my mind, and ache to be transposed to the page.

But I can't.

My anonymity on this blog has always been paper-thin. Some comments have even refered to me by name, and I have rapidly removed them, or asked the commenter to edit them. Those of you across the pond, or just in another part of the island, won't know me, and therefore won't know my patients. But, let's be honest: anyone who works where I work knows who I am. There aren't many of us around, and it only takes one or two jobs for the connection to be made.

I cannot have my patient's confidentiality breached. That's an absolute. There is no grey area. Anyone who knows me (here we go again) will know how precious I value confidentiality.

If I tell you about the police officers who spun their car off the road, you will say, "ah yes, I remember them." If I don't say they are police officers, the story is missing the part that makes the story worth telling.

If I tell you about the chap found hanging (and I will, but with anything patient-related taken out) you will remember reading about it in the local news, and that patient's confidentiality will have been breached.

So I sit here, musing over what I can, and what I cannot, say. And I end up saying nothing.

But I still have the need.

So, dear CR, read on...

2.3 x 10!!

2011-09-15T22:31:00.000+01:00

Oh my legs!! And other parts of my anatomy!! I can barely stand, let alone walk up the stairs to my room. But, as I lie here, a mass of knotted muscle, I can't help but smile at what I have achieved today. And, I mustn't forget that MiniRRD was there too, struggling with the ups and downs, but mostly the ups, that today brought. In fact, the downs were what we were both looking forward to, more than anything.

Brands Hatch Race Track is a killer. I can say this with authority. It is 2.3 miles of pain and effort. How can most of it seem to be going up? It felt like I was riding in a picture by M C. Escher. You know, the one where the steps just keep going up and up, and yet still join in a circle.

Let me just take you through the first little bit of the circuit, just so you get a feel for what MiniRRD and I experienced today.

Come out of the pit lane and speed up, before a gentle incline slows you down as you go through the timing arch. Turn sharply right and shoot down a VERY exhilarating hill (I reached a top speed of 39.6mph on this one), which finishes with such a steep climb that all your lovely momentum disappears in an instant, and you are back in the lowest gear and crawling up, in a fair amount of pain may I add. Round the corner and a cheeky drop for a second or two before ... yes, you guessed it, a climb. This time it's not at all steep; just a gentle climb that slowly but surely saps your strength, until you are gasping for breath, and barely able to turn the pedals (well, that's how I felt). And so on.

But, and here's the bit that makes it all worthwhile, if you look at the title of this post you will see that I went round a total of 10 times! Yes, I managed to conquer this gruesome course 10 times today. And MiniRRD? Well, he had to beat me, but only by one.

My main claim to fame for today? My fastest time of 14 minutes was slower than anyone else's time on the track. I did manage to pass one rider over the whole day. My pleasure was short lived; just after I passed him, he wobbled and fell off!!

I'm off to have a hot bath, and a loooong sleep. Oh no, wait. I'm at work first thing in the morning.

Decisions

2011-09-09T14:56:00.001+01:00

What a busy day I have had!! On the shop floor all morning, meetings all afternoon, and now I am sitting in my office sorting out the multitude of emails that have built up over the week. I decide that enough is enough - my family are all at home, and that is where I should be. I power down my computer, get my coat and leave. I need the loo, but decide that as it's only a short drive I would forgo the pleasure at work, and wait until I get home.

5 minutes from home my bluetooth phone rings. Assuming it's MrsRRD, checking on my arrival ETA, I answer with a "Hi, Darling!!" After all, who else would be ringing me?

Control are quite surprised at my friendliness, but it doesn't stop them from tasking me, to a pedestrian hit by a car, in MilesFromAnywhere Town. They tell me that the crew are having difficulty with the airway. I sheepishly begin to explain my forwardness, then give up and hit the blues and twos, and set off.

I find myself on the M25. What on Earth am I doing here?? Fortunately, my faithful Sasha (the SatNav - don't you have a name for yours??) is just avoiding all the traffic on the small roads around MilesFromAnywhere Town, and I am grateful for the decision when I come off at the next junction, and see the tailbacks behind me, presumably from the accident I am now racing towards. My bladder gently reminds me of the last decision I made before leaving work, and I shift uncomfortably in my seat.

I arrive on scene: well, the point at which Sasha tells me I am on scene. Nothing. Just queues of traffic. I keep going, thinking that, if the patient has an airway problem, I cannot waste any time. Fortunately, round the corner is a police roadblock, and I am swiftly directed around the police van to the waiting team of ambulance crews.

This girl is in a bad way. She is lying on her back, blood around her mouth, a paramedic bagging her. I rush over and assess the situation:

Airway: well, at this moment in time she doesn't seem to have one. There is very little of the precious oxygen getting into her lungs, despite the efforts of the crew.

Breathing - wait a minute, you all know the drill now. If there is a problem with airway, it needs sorting, and straight away.

I unzip my trusty Thomas Pack and reach for my intubation pouch, grab a laryngoscope and prepare to have a look. I can't see much, as there is so much blood in the mouth. I use the suction proffered me, without me even asking (good crew, know what I need before I do) and clear the view. She coughs and gags as I do, and I breathe a small sigh of relief - at least there are still some signs of life. I have a good view of the cords, and a tube in my hands. Despite the fact that I have given her no drugs at all at this stage, I decide that she has been starved of oxygen long enough, and I am not going to delay any further. The tube goes through the cords, and she coughs and gags plenty more. That's not good for raised intracranial pressure, what you get when you have a serious head injury, but, then again, nor is not being able to breathe.

I quickly grab some sedation and paralysing agent and do what I would normally have done prior to intubating the patient. She is now still, and we are able to ventilate her with ease.

Phew!! On to the next stage.

Breathing: Well, at least we are now doing that for her. I think about my next decision - do I perform bilateral thoracostomies? For those who don't know what I am talking about, a brief synopsis. Those who do can skip to the next paragraph. When there is chest trauma, the lining around the lung can be punctured, allowing the entry of air from the lung into the space between lung and ribcage - a pneumothorax. If someone is pumping air into your lungs, as I am now doing with this lady, the air is also pumped out of the hole in the lung and its lining, and fill up the space between the chest wall and the lung, compressing first that lung, then the heart and other lung, leading to fairly rapid death - a tension pneumothorax. By making a small (well I think it's small, you might disagree) hole in the chest wall with a scalpel, I can equalise the pressure, and stop the heart and lungs being compressed into inactivity.

So, back to the story. I have to decide about how this girl's breathing will be best managed. She has a tube in place, and we are breathing for her. Her chest rises symetrically on both sides, and she has normal breath sounds. However, she did have a lot of blood in her airway, and her oxygen saturations are in the low 80's, instead of the 100% I would expect / like to see. I have a careful feel - I cannot see any signs of chest injury, and there doesn't appear to be any broken ribs or surgical emphysema. Surgical emphysema is the result of having air in the tissues of the chest wall, and feels like cornflakes under the skin (honest). This would be a certain indication that she had a lung injury requiring a thoracostomy. But, no corn flakes can be felt. Also, her blood pressure is good, and, if she had a tension pneumothorax, her heart would be compressed so much that her blood pressure would be very low indeed. And it's not.

So, decision made: I will not cut this girl's chest, and watch carefully for any signs of deterioration. If she does deteriorate, I will make the incisions.

Next, circulation. Well, her blood pressure is high, and her pulse rate is high. A high pulse rate can be due to blood loss, or lack of oxygen. But, then again, the high pulse rate and high blood pressure could equally be due to having a tube stuck down your throat without an anaesthetic. I decide to give her more sedation, and the pulse rate and blood pressure stabilise to normal.

And now I have the big decision - where are we going. I look around me. We are really in the middle of nowhere. She definitely needs a Major Trauma Centre, but how far is that? Blank looks from the crews and the police when I ask them driving time to MTC. One of the police runs off to plug the address into his version of Sasha, and returns a few minures later with the news: we are an hour away. On blue lights you might knock off 10 minutes or so. 50 minutes does not sit comfortably with me, especially with oxygen saturations like she has.

What about helicopter? There is one available. I ask them to lift, while we look at getting her packaged and in the ambulance. I ask for an update of how long the flying time to us will be, and the answer comes back: 30 minutes. Where the hell am I, that it will take half an hour to get here by helicopter?? Turns out that the only helicopter available is in Cambridge. Fair enough. I leave them running while I consider my options.

Closest hospital by road, my old stomping ground: 15 minutes
My own hospital by road : 15 - 20 minutes
Major Trauma Centre: by road: 50 - 60 minutes
Major Trauma Centre by air: 30 minutes for helicopter to arrive, 10 - 15 minutes to hand over and load, 20 - 25 minutes to fly back (they will go back to Cambridge)

I make my decision: we are going to my hospital, with the knowledge that we can stabilise and continue our journey to the Major Trauma, probably within an hour or so of arriving there.

I get into the ambulance, my full bladder reminding me that my first choice of the evening wasn't so hot. I hope and pray that the rest of them turn out to be better ones.

What's in a Name?

2011-09-04T23:22:00.002+01:00

I am angry! No, not really angry. More frustrated than angry, to be honest. I've been shouting at the TV for the last 30 minutes. Fortunately, I like my TV too much to throw anything at it.

So, what programme has insensed me so much? Well, MrsRRD and I sat down to watch "Emergency" with Angela Griffin. This is an excellent programme, where the star of Waterloo Road follows the ambulance crews of the West Midlands, and does a damn good job of portraying the highs and lows of the work the crews do.

This evening's programme, recorded a few weeks ago, had good old Angela shadowing the CARE team as they went about their business. The CARE team are a group of volunteer doctors, nurses and paramedics, who are called by the ambulance service to provide more advanced medical care to the victims of serious accidents and assaults, and to patients with severe, life threatening illness, at the roadside or in their own homes. Sound familiar? Yep, CARE is the West Midlands arm of BASICS, just like BASICS-London are the London group. It's just that our name leaves nothing to the imagination, as to who we really are.

So, what great publicity for BASICS. You'd have thought, wouldn't you? But, despite the BASICS logo, and the word BASICS being visible on all of the team's jackets, BASICS wasn't mentioned. Not even once. So, folks, according to this programme, the CARE team are unique. No-one else like them in the country. All that possible publicity for BASICS, all gone to waste. Not a dickey-bird.

Well, dear Constant Reader, you know who the BASICS team are. There's probably one in your neighbourhood. They may be called CARE, or MAGPAS, perhaps LIVES or SAVES, maybe even BEARS or NARS. But, whatever they are called, they are all BASICS doctors, nurses and paramedics. They are sitting at home right now, probably thinking about tucking themselves in for the night, all knowing that their sleep may be interupted tonight, at 3am, when someone goes off the road, or is stabbed, or falls off a roof.

Remember us, and please, spread the word!

Only Joking!

2011-09-04T11:30:00.001+01:00

There's not a whole heap of blood around, considering he has a gaping wound in his neck. Probably because he had crawled half a mile or so before anyone had spotted him, and lost what he was going to lose someplace else. He's very, very drunk!! He tells me he was having a lark with some youngsters in the town when one turned nasty at some comment he had made, some funny joke that went wrong. The joke led to him having a bottle shoved in his neck, and a beating he will remember far longer than any of the punchlines he has stored up.

He is refusing treatment, and six burly policemen have cuffed his wrists behind him, and strapped his legs together to stop him lashing out. He is struggling hard against his bindings, and the cuffs are digging in to his wrists, leaving angry marks.

I lean in close. "Jimmy, do you want those cuffs taken off?" He nods. "Then stop p***ing around and let us look after you." He calms for a moment and looks at me. "You get one chance, and one chance only. I'm not joking around here. You muck about once, and these cuffs are going back on and staying on."

The cuffs come off, and the police crowd round nervously. He thanks me for getting the cuffs off, and I start looking at his neck wound. "I need a big torch!" I say. "I've got one, in me pants! Wanna see?" replies Jimmy.

Anyone got another bottle?

For All The Wrong Reasons

2011-08-10T16:45:00.000+01:00

It's a quiet day in A&E. Not all that unusual; after all, a lot of people are on holiday in August, so the population has gone down. The emergency 'phone rings in the Department. It's for me! A call to the M1, where a car has rolled multiple times. The occupants are not badly injured, Despatch tells me, but, as there is only one ambulance available, I may be able to help by triaging them away from hospital, thereby saving a vehicle or two. This is an occasional use of my time, and I am always happy to oblige.

I call out to the staff that there is an opportunity to accompany me. There is a scurry of activity, as Baldy and Newby fight for the right to join me.

"Steady on, lads!" I say. "It's not that exciting a job! No point getting all worked up."

"We know," replies Baldy. "It's not the job, it's the possibility of being mentioned in your blog!"

*sighs*

Surreal

2011-07-16T13:06:00.000+01:00

I lead a surreal existence, I think to myself at 04:45, lying next to MrsRRD, sleeping soundly. Only an hour ago I was asleep too, after a long day at work, and a relaxing(!) evening with the family. And yet, 45 minutes ago I was in a dingy alleyway, cutting across a man's sternum in a vain attempt to save his life after he had been stabbed in a robbery gone so fatally wrong. 5 minutes after that I was holding his heart in my hand, stitching up the wound in the left ventricle, knowing that no amount of surgery was going to save him.

And now, only 30 minutes after I have pronounced life extinct, I am back in bed, chasing sleep once again, knowing that, for now at least, it will be just beyond my reach.

Watching

2011-07-10T22:06:00.001+01:00

The car is on its roof, having collided with another vehicle and gone off the road, onto a tree. Three youngsters are lying on the ground around the car, one trapped by his legs, all shouting out, but it is the fourth that holds all our attention. He is quiet and almost still, perhaps a flicker of one arm, trapped by the wreckage and the tree.

We can't get to him. His left arm is accessible, and a paramedic has already cannulated him. His head is pressed against the door, and we can't get to his airway. The dashboard has come forward, and is tight against his chest. We watch his chest rise and fall, slower and slower. There is no way to get him out. We will need to roll the car over if we have any chance at all to extricate him, and we can't do that at the moment, because of the chap whose legs are still entwined in the wreckage.

There is nothing we can do, except watch.

His breathing slows.

Stops.

Challenge

2011-07-09T18:36:00.000+01:00

I told one of my best friends that I was planning to do the Brands Hatch Cyclothon in September. After he picked himself up off the floor, he explained the humour of the situation. You see, Brands Hatch is not the flattest of race-tracks. In fact, it's rather hilly. My friend showed me a youtube video of the track. It's very scary.

And now he's thrown me a challenge: get round the track once without getting off my bike, and he will donate £100 towards BASICS. That seems worth it. Not so bad, really. I accepted the challenge, and went out on my bike to find some suitable hills to ride up. I found one. I couldn't get up it. Hmmm. Think I need some more practice.

Avoidance

2011-07-03T09:58:00.000+01:00

It's late, as usual. I am on my way back home, after having been called in for a paediatric trauma - the patient, a 13 year old boy, was bigger than me, and virtually unharmed. I am driving along the motorway, looking forward to bed, when I see, right in front of me in the fast and middle lanes, two cars, both stationary, one pointing the wrong way. Brakes, swerve, stop. I can see one of the drivers, but the other car, the one with it's bonnet towards me, is empty.

I flick my blue lights on, park appropriately to warn other drivers, and get out. I don my flight suit, so that I am safe, and approach the driver. He is unharmed, somewhat shaken, and rather worried about his cargo of china that he has in his car. I help him across the motorway, where the other driver is sitting on the hard shoulder, unharmed but somewhat shaken.

I call 999 and let the police know what has happened, and tell them that I am in a blue-light vehicle, and that I have parked appropriately, in order that other drivers can see. The police officer I am speaking to tells me that is inappropriate, and that, as long as there are no injured parties, I should continue on my journey. I think this is somewhat odd, but decide to do as I am told.

Making my way back across the motorway, I watch in horror as a car hurtles towards to the accident scene at breakneck speed, swerving all over the road and coming to a very unsteady stop, mere inches from the cars. I think about what might have happened had my blue lights not been visible, and know that I would have been called back.

I'm staying.

It's A Long Way...

2011-06-27T20:10:00.000+01:00

"You want me to go where??" I ask Control. "But, that's miles away, through all the Sunday traffic. Where's the helicopter?" They tell me, and I wince: not quite next door to me, but, with a prevailing wind I could probably spit on the rotors from where I was sitting, comfortably ensconced with the family and a good Disney film on the box.

Off to the car (now I'll never know what happens in the film) and off I go. As I turn on the engine, my fuel guage gently reminds me that I meant to fill up the last time I was out, but thought I would wait until the next time. Hmmm, may be a problem. My car eats fuel the way I drive it. Well, at least I have my wallet in the car, so that I won't be completely stranded.

The traffic isn't as bad as I thought it would be: it is far worse. I spend most of the journey on the wrong side of the road, as cars come hurtling towards me, then swerve around me at the last moment.

Up ahead, I can see the lights of the ambulance, fire tender and police. Nearly there. The traffic has slowed to a crawl, not unsurprisingly, this close to the accident, and I drum my fingers impatiently on the steering wheel, changing the tone of my sirens every few moments, trying to persuade the drivers to give me just a few more inches.

My mobile rings: it's Ambulance Control, standing me down. The patient was initially very agitated, but has settled down, and the crew are happy to transport him to hospital. I suggest that they wait a few minutes, considering they have made me miss my film, and I roll on scene.

He is in the back of the ambulance, having been cut out of his car. His daughter, sitting next to him, tells me he had gone all vacant, just before colliding with the car in front. She is unharmed, just very shaky, and he is calm and coherent. He remembers what happened with a clarity I don't often get from patients. He remembers driving his daughter to a friend, when, all of a sudden, he couldn't speak. Then, he remembers his right hand dropping to his lap, lifeless, and his right foot become heavy and glued to the accelerator. He recalls pulling the steering wheel over to the left, hard, so that, when he struck the vehicle in front, it was with his side of the car, not his daughter's.

I look at his drooping face, his lopsided attempt at a smile, and hear his slurred speech. He asks me if he has had a stroke, and I nod. He sighs. It's going to be a very long journey for him...

Next Venture

2011-06-27T11:55:00.002+01:00

When I wrote about the BUPA 10K run, I mentioned that there was something else on the horizon, and that I would let you know soon. Well, here it is. Those eagle-eyed Readers will already have noticed that I have been doing a lot of cycling recently. Also, the panel on the right now says "Training for the Brands Hatch Cyclothon." Yes, yours truly, along with MiniRRD and 2 others, will be cycling round Brands Hatch for 8 gruelling hours!!

I love cycling, far more than I like running. I decided I needed a new bike, especially if I was going to be doing this Cyclothon. I went to my local bike shop and bought one. Bear in mind that I know precious little about bikes. I wanted to ride home on it, so off I went.

1 minute later, the back tyre was flat. I walked back to the shop, and they put in a valve. The fact that it didn't have one originally did cross my mind, but hey, anyone can make a mistake!! I decided to ride home again.

2 minutes later, the back tyre was flat. I walked back to the shop, where they refunded my money.

I went to a proper shop, where they know what they are doing. I test rode 3 or 4 bikes, and found the perfect bike for me. It's a red one!! I decided not to ride it home, as we live a good 10 miles away...

Later that evening, like an impatient schoolboy ("can I ride my bike now? Oh please, oh please!!) I waited for the rain to stop, then went for a ride on my brand new (red) bike.

1 minute later I fell off. I scraped my left elbow really bad, and my knuckles on my right hand. Undeterred, I got back on and carried on my journey, blood dripping off my elbow and my hand.

20 minutes later I got a puncture. And then it started raining. And then my elbow started hurting. I called MrsRRD, and she came and collected me.

I'm really looking forward to my Cyclothon...

Difficult

2011-06-20T11:25:00.002+01:00

You may have noticed I haven't written for a while. There is a good reason for this. I have been to a job so difficult, one of the hardest I have done in my 10 years as a pre-hospital care doctor, and yet one so unique that to write about it in any way would breach the confidentiality that is so important to all. The family, with whom I spent such a long time at the hospital, don't want anyone to know about what really happened at the house, and, to be honest, I don't blame them.

So, where do I go with this? How do I move forward, writing about the "simple" jobs, those that don't touch my heart as this one has? I'm not sure, to be honest. I worry that the images of what I have seen will seep through into my posts about the "ordinary", as they have been seeping into my waking and sleeping thoughts. MrsRRD, as always, has been a tower of strength; understanding what only she can. And, holding my children, one at a time or all together, is a balm around my heart.

And, if this is how I feel, what must the family be feeling? I cannot begin to comprehend how any family can rebuild after such an event as this. And yet rebuild they must. They have to go about their daily lives; school, work, shopping, living, even though their lives have been shattered.

I know this all seems so cryptic to you, dear Constant Reader. Thank you for reading, thank you for letting me offload to you, in the only way I can.

Alice's Bucket List

2011-06-09T23:24:00.000+01:00

Just go and have a look at this brave young lady's blog. Make sure you have some tissues ready!!

Excuse me, but it has suddenly got very dusty in here...

Done It!!

2011-05-30T16:31:00.001+01:00

Well, it's all over. Except, that is, for the pain, the tiredness, and the wonderful sense of achievement. There is something very special about crossing the finish line of a your first 10K. The whole day was very exciting. We woke up early, and had a light breakfast, then met up with the rest of the team at Green Park. I cannot begin to tell you how it feels to be standing in a sea of people, all waiting to set off.

Scissors was by my side the whole time. He has run 8 marathons, so this wasn't going to be a challenge for him. He kept shouting at the crowd, urging them all to cheer us on - very amusing!

MrsRRD is there, at the 2km mark, along with the rest of the support team. I probably looked quite fresh at that time! Not so later on, as I wind my way through the streets of London, onwards, ever onwards.

And then I reached the 8K mark - uncharted territory for me. The pain in the hips was slowing me down, and my leg felt like jelly. Scissors turned to me (running backwards as he did - show-off):

"Do you want to spend a whole year, until the next BUPA 10K, wishing you had got in under your target (1 hour 20 minutes), or do you wish to spend the next year being pleased you did?", he asked me. Hmmm, tough one. My brain told my legs to speed up. My legs told my brain to sod off, then grudgingly stepped up the pace.

I have a GPS watch. I bought it with money from my birthday (yes, I still get money for my birthday, what of it??) It tells me exactly how fast I am going, how far I have gone, what my pace is. I have been using it to plan my race, and to optimise my training. I charged it up, so that it would be ready for race day, so that I could keep to just under 8-minute kilometres.

I left it at home.

So, I was dependent on Scissors to keep me on pace. If he is telling me I need to pick it up, then pick it up I will. And I did. Somehow, I managed to find those extra few muscle fibres, the ones that hadn't given up the ghost, and put them to work. I pass MrsRRD again, pushing myself harder and harder.

And there it is in the distance - the finish line! I have 400m to go, and I start to sprint, with Scissors muttering, "There's no grey - it's either black or white." No idea what he meant by that, but the sight of the finish line getting closer and closer spurned me on, faster and faster.

And I'm through!! I turn to Scissors, gave him a big hug, then asked the question? Was I in or was I out? He looks at his watch, and tells me the news: 1 hour 16 minutes 1 second!

And then, in true form, we meet everyone else, and have a picnic in Green Park.

And what of Princess RRD and Ginger? Did I beat them? No. 1 hour 5 minutes. No training. Nothing. Big Neph? 57 minutes. No training. Ah the joys of being young.

What's next? Something very exciting, but I'll keep that for another day!

Thank you to all of you for all your support. Without you watching me, I would never have managed this.

Race Day!

2011-05-29T23:52:00.002+01:00

Well, the day is finally upon us. After almost 140km of training, tomorrow I am running for BASICS. I feel quite proud, to be honest. I have often seen on the television the runners as they cross the line, and tomorrow that will be us!

I'm supposed to have had an early night. It's nearly midnight here, and I'm not quite ready for bed. After all, life doesn't stop at Chez RRD, not even for a 10k run. There are children to get to and from parties, wallets to find (mine), and hair to be trimmed (mine).

And, of course, the preparations for the race day itself. Ginger, one of Princess RRD's friends who is also running tomorrow, is staying over tonight, and the girls had a very giggly time. They spent the afternoon decorating the back of their running shorts with the BASICS logo. Oh, and the Union Jack on the front!! Mrs RRD has been making the food for the after-run picnic. Lots of food!! Camera batteries have been charged, so I will be posting the evidence here tomorrow evening...

Shrink will not be running tomorrow. An over-exuberent dance session over the weekend has left him hobbling on an injured ankle, so he will have to watch from the sidelines. Scissors, a veteran marathon runner, has elected to keep me company all the way. So, his time won't be any good, either!!

I have set things up so that any of you can follow my progress, inch by painful inch. If you go to www.sportstracklive.com, and search for me, rapidresponsedoc, you should be able to find a live, as it happens, track. My aim is to keep my speed as close to 8 minutes per kilometre - see how well I do and cheer me on. Start time will be about 11:20, UK time.

Right, I am off to bed. See you at the starting post!!!

Death

2011-05-26T22:38:00.000+01:00

I see death every day. Not many people can say that. Not many people understand what it is like to be confronted with the fact of one's own mortality so often. It's part of what I do, it goes with the territory. That's not to say I don't get affected. I believe if you don't get affected, then you are in the wrong profession, and it is time to move on. But that makes it hard. Hard to sit and watch the widow, the son, the father, after you have given them the worst of all possible news.

Death comes in many forms. There is the expected death, often a blessed relief for all, patient included, perhaps after a painful, drawn-out illness. There is the unexpected death, home just two weeks following a successful heart bypass, then found lifeless in bed one morning. There are the deaths from trauma, car accidents or stabbings.

And then there are those that deal the fateful blow themselves. Those that I get called to are invariably the more violent: the blade, the rope, the train, the 5 storey fall. These cases affect me more than anything. They leave me numb. That anyone could want to end their life is one thing - to end it in such an aggressive manner is another. They drain me, both the the act itself and the intent behind the act. They often leave me empty and low for days after.

I had two today.

Countdown

2011-05-16T17:37:00.000+01:00

In two weeks time exactly, I will be in agony, having successfully completed the BUPA 10k. my legs will be on fire, and I will be falling asleep on my feet. My time? Only time will tell. Less than 1 hour 20 minutes will make me happy. Getting all the way round before I collapse in a heap will make me happy!!

And what about the sponsorship? Well, so far, with two weeks to go, I have managed to get just over £1000 of pledges!! How much will it be before the end? That's up to all of you...

Thank you to everyone who has sponsored me and supported me. And thanks to all who are going to before the 30th May.

The Fallen - Take 2

2011-05-16T08:53:00.002+01:00

My cat sleeps on our bedroom floor, in a bag. We try to discourage him, mainly because being woken up at 4:30am is too much like having a new baby, and not at all conducive to happy living. But he likes his bag, and he likes our floor.

04:30, and the gentle miaow wakes both of us from slumber. It's MrsRRD's turn, and she disappears downstairs to open a pouch, the diminishing tinkling of the cat's bell signalling the fact he has chased after her.

04:35, and the insistent ringing of my phone drags me back from sleep once again. Can I attend a man who has fallen out of a 4th storey window, and now has a Glasgow Coma Score of 3. After falling out of a 4th floor window, I would be surprised if he was walking around uninjured!! I take the details while I pull on some clothes (socks!!)

MrsRRD is a bit surprised to see me downstairs and dressed, but quickly kisses me goodbye, and I rush to my car.

Sasha, my Sat Nav, seems to be having trouble waking up this morning - when I look at the overall map of where I am going, it shows me going round 3 sides of a square. I set off along what looks like the shortest distance. The no right turn at the end of the road doesn't stop me, but does explain somewhat why Sasha was sulking.

The ambulance is moving! They are off without me. The police look surprised to see me, and hesitate before lifting the police tapes to let me through. The Station Manager bangs on the side of the ambulance and they stop to let me on and see the patient.

He is around 50 years old. The crew had been called to a person who was threatening to jump out of a window in a block of flats. They were forced to watch him as he fell, despite the efforts of the police negotiator. It cannot be nice watching something like that - usually we get there after the incident has occurred. He's in a bad way, with signs of a serious head injury. There is no doubt that he needs tubing and ventilating, and I look for a vein to put a line in. There is nothing. There are marks of intravenous drug use, which has caused all of his veins to become damaged. I look at the veins in his neck - even these are looking difficult to cannulate. The paramedic suggests we go for a needle straight into the bone of the leg. Sounds bad, doesn't it. But, an intraosseous needle, as we like to call them, is a great way of getting drugs and fluids into a patient when there are no other veins available. We have what is essentially a cordless electric screwdriver, which we use to drive the needle into the tibia, just below the knee joint. I ask the para how many he has done. He tells me that he has so far inserted three. I tell him to make it four. The shaking is barely perceptible, as he drives the needle home.

Just as I am unzipping my intubation kit, the door of the ambulance opens, and there are two more men in orange jumpsuits. Great!! The HEMS team have arrived. We have a little chat about where we are and what has occurred, and I maintain my authority over the case (I got there first) as I tell the HEMS medic that I will be intubating the patient. She suggests that we regroup, with patient, outside the ambulance, as there isn't enough room for everyone. No, not now you are here!!

As we are wheeling the patient back outside, I hear the grumbles of the ambulance crew, suggesting that it might have been better to have just gone. I hush them, and we get to work, setting up a formal kit dump with everything we do need, and everything we might need if there are any untoward circumstances.

I have written about this before: my way of just opening my bag, grabbing what I need and getting on with it contrasts starkly with the HEMS way, where everything is laid out neatly and ticked off a checklist before proceeding. Which is the right way? Well, my way works, but only for me. I can grab what I need, whenever I need it. I am aware of the dangers of what I am doing, and mentally prepare myself. The HEMS team are a team: there will be different doctors working with each paramedic. Nothing can be left to chance. Everything has to be prescriptive.

Anyway, back to this patient. He is now being given an anaesthetic, to facilitate me inserting a tube into his windpipe. He's a grade 1 intubation, which means I can see the windpipe through the vocal cords so easily that I could, if I really wanted to, drop the tube in from 100 metres away. But I refrain - after all, there are a lot of people watching, and I don't want to show off too much. My one consolation is I am able to refuse the bougie, a device to make intubation easier, despite the fact that the HEMS paramedic tries to insist - after all, it is standard procedure for the HEMS team to use one for every intubation.

The tube goes in easily, and we package the patient for transfer to the Major Trauma Centre. The HEMS doc is more than happy to travel with the patient, so I formally hand him over to her, and leave her to it. Before getting back into my car I have a quiet word with the paramedic, suggesting that, despite the delay, the patient will definitely be better off travelling tubed rather than untubed. He reluctantly agrees.

When I get home, my cat is sitting on the doorstep, waiting for me. All is forgiven!

The Fallen

2011-05-15T23:15:00.000+01:00

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!

Training Update

2011-05-04T22:14:00.000+01:00

Well!! It's all going swimmingly! Those of you keeping track may have noticed that I am getting into my stride now. I am starting to run and cycle every couple of days. I have managed to run 5.5km non-stop in 40 minutes, and I'm really proud of how I am getting on.

Or, I was until I made the mistake of looking at some of last year's finish times - just to see, you understand. You just enter a runner number, and their time is displayed. There are thousands of numbers to choose from, so I will start with runner 1000. Hmmm. 10km in 44 minutes. That doesn't sound promising. Must be a good runner. Try another one... Runner 179. Erm, 10km in 37 minutes. How about runner 2659? Nope, 48 minutes.

I'm going to be last, behind the granny on her Zimmer frame.

Tachycardia

2011-05-02T01:10:00.000+01:00

He lies there on the ambulance trolley, waxy skin, pale, tachycardic. His pulse rate way above normal, a sure sign of blood loss. I don't need his tachycardia to tell me that: the pools of blood on the floor of the ambulance is sign enough. I sit next to the trolley, my hand pressed firmly against the pad applied to his mangled limb, but it seems to do little to stem the flow of blood.

His eyes roll up, and Para-Girl calls to him. His eyelids flutter, and he is with us once again. But for how much longer? His skin is drenched in sweat, and yet his body feels alabaster-cold. We are losing him, and we know it. I tinker with the intravenous fluid, but know that what he needs is blood. I have already called ahead to the hospital to tell them to have some ready for when we get there, but will he last the journey?

As we come off the motorway, and slow to a crawl behind the selfish drivers, who want their lane and will not even relinquish it for us, I want to jump out of the ambulance, run up to the drivers and thrust my blood-stained hands against their windows. But I sit there, pressing harder, while Para-Girl, almost as pale as our patient, mouths something unintelligible to me. I know what she is saying, that we are not going to make it.

G-Man, our driver tonight, hunts down the spaces like a heat-seeking missile, and we are moving once again. As we approach the last few minutes I grasp our patient's wrist, feeling in vain for a pulse. He is hanging on by a thread, as we storm up the ambulance ramp, to the waiting Trauma Team, to bags of blood, and to a life snatched from the jaws of death.

The Phone Call

2011-04-25T01:12:00.001+01:00

What a lovely day! We are all very bubbly, despite the lateness of the hour, as we drive home. I've spent the day with Besty, Mad Dog, our wives and children. We have eaten too much, spent too long in the sun, even played some rugby with the kids, and now it's off to Chez RRD, and then to pack the kids off to bed.

My phone is ringing. We are in Mrs RRD's car, so the Bluetooth remains inoperable, and by the time I have wrested it out of my pocket, and passed it to Mrs RRD, it has stopped. We wait for a few seconds, and sure enough my other phone starts its insistent ringing. I am just parking up, so grab the phone and answer the call from Ambulance Control. A stabbing victim awaits me. I open the door to the house and usher the waiting hordes in. Mini RRD keeps asking me what the call is - I know that if Mrs RRD knows I am on the way to a stabbing she will worry, so I blank him, and rush out to my waiting car.

Damn! I have been out in the garden all day, and when I slip off my trainers to change into my boots, the sight of my naked feet is a reminder that I haven't got any socks on. Oh well, no time to waste. They'll just have to rub a bit.

I arrive at the address I have been given. It's all very dark. I can see a few police cars (phew!) and an ambulance, but there are no blue flashing lights, and, while there are quite a few people milling around, none of them are in uniform. Hmmm. It's not just Mrs RRD that is worried this time. I am the first to admit that I am a coward. I will avoid danger, and never walk into a difficult situation.

So, I could sit here, and wait for someone to come and get me. But that does seem a little silly. So, I put my blues on, and sit and wait for someone to pop their head out of the back of the ambulance, and beckon me in. It was only a few seconds, but I wasn't getting out of my car until I knew where I was going.

There are quite a few people in the ambulance. There are two ambulance crew, and a paramedic off of the car. There are two police officers. There is Dave - seeing as he is the one lying on the ambulance trolly, his clothes soaked in blood, I thought he might be my patient. It wasn't all that obvious, as he was on the phone! Not many people who need my attention at midnight are chatting away on the phone, you see. But Dave was.

"Hello, Dave! I'm RRD, a doctor."

"F*** off! I'm on the phone!" replied Dave.

"Yes, I can see that, but I can also see you are bleeding, and in need of medical attention" I countered, helpfully.

"When I have completed this conversation with my dear mother, then I will be happy for you to attend to my chest wound, kind Sir". Or words to that effect.

We all wait patiently, while Dave relates the evening's events to his mother, before dealing with the very well spoken patient.

I do love being appreciated!

Last Passage

2011-04-23T22:44:00.001+01:00

They come out in their droves: the young and the old, in dressing gowns and slippers. They have their mobile phones and their cameras, all the better to record this moment. Held back by the police tapes, they crane their necks, anxious to see all they can.

I kneel down gingerly by the bonnet of the lorry, and peer beneath. He is lying there, his head resting by the wheel that has run him over. He is still, no signs of life. I slide under the lorry, taking heed of the blocks that have been placed there by the fire team, raising it the few centimetres I need to be able to reach him. My hand reaches out, and I feel his neck. No pulse beats beneath his skin. I place my stethoscope in my ears, and press the bell against his chest. No heartbeat, no respiratory sounds. I slide out, and shake my head at the paramedics, police and fire crew waiting for my verdict.

He needs to be moved, from under the lorry and into the waiting ambulance, for his last journey. The crowds remind me of spectators in a Roman Colosseum, baying for blood. I don't want to be the one to provide them their sport. I don't want him to be the object of their scrutiny. I direct the fire crews to grab some tarpaulins and hold them up as screens against prying eyes, as we gently, reverently draw him out from underneath the lorry, place him on the ambulance trolley, and wheel him into the back of the waiting ambulance. Behind closed doors, we complete our paperwork, before arranging for him to be transferred away from here.

As I leave the ambulance, as I grab my bag from the ground and walk slowly back to my car beyond the police line, I am afforded no such privacy. The crowds, denied what they have come for, call to me, begging for whatever scraps of information they can get. I shut myself in the relative safety of my car, and drive home.

Excuses

2011-04-21T19:32:00.000+01:00

Some of you eagle-eyed readers may have noticed that my training has dropped dramatically. Here are my excuses, one of which may be true. See if you can spot which one...

1. My phone has stopped working, so I have been unable to upload any of my training episodes.

2. I have been too busy at work.

3. My trainers (sneakers, for you on the other side of the pond) don't fit any more, and I haven't had the time to get a new pair.

4. I decided I would have an unfair advantage over the other runners, so I should stop and give them a chance.

5. I have had man-flu.

6. I broke my leg.

7. I broke someone else's leg.

8. I've been on Jury Service.

9. It's been too cold / wet / hot / snowy to run.

Yes, you guessed it, number 5. Seriously, it's no fun having man-flu. Everyone takes the Mickey, and you still feel as sick as a dog! So, not only are you suffering, you get no sympathy either. And, being medical as I am, I know all about the dangers of exercising while you are ill. You can get myocarditis and everything!! Not pleasant. So, I've been taking it easy for the past week or so. I am sure it all started with my hepatitis jab. There was definite blood, and a very big bruise, that's still there a week later.

But anyway, today I decided that enough was enough! I decided to start off nice and easy, with a gentle bike ride in the park with Mrs RRD and one of my Micro's. Checking my pulse every few hundred yards for any signs of irregularity, I soldiered on through the shortness of breath, and it felt good!! So good that, when I returned home I decided to go for a run afterwards.

Big mistake!! Even a very gentle run (overtaken by a little old lady and her Zimmer) left me gasping for breath, and aching all over. Still, I'm back on track, if a little far behind everyone else.

Please make this worth my while, by pressing that tempting "Donate" button on the right of the screen. Whatever you can afford, every little helps...

Thank You To JB

2011-04-12T17:12:00.000+01:00

I have been told about a group of 15 people who have clubbed together to raise some money for BASICS-London. They each changed their name by Deed Poll to a famous Formula 1 driver, then raced round a track for a few hours, all to help those in need of the services we provide.

So, a big thank you to Jenson Button, Jenson Button, Jenson Button, Jenson Button, Jenson Button, Jenson Button, Jenson Button, Jenson Button, Jenson Button, Jenson Button, Jenson Button, Jenson Button, Jenson Button, Jenson Button and of course my good friend Jenson Button!!

Trapped!

2011-03-26T22:47:00.001Z

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!!!

2011-03-25T00:14:00.001Z

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...

2011-03-24T23:44:00.002Z

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!!

2011-03-20T22:41:00.001Z

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

2011-03-19T15:04:00.001Z

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

2011-03-17T18:06:00.005Z

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

2011-03-15T12:31:00.001Z

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

Training - Day 1

2011-03-13T22:16:00.001Z

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

2011-03-12T16:16:00.003Z

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!

2011-03-10T12:05:00.000Z

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.

Blood!!

2011-02-25T10:30:00.002Z

As I lie there, awake, listening to the gentle breathing of MrsRRD sleeping next to me, I marvel at how precious is the time between first and second alarms. I have a whole 10 minutes, just to savour the quiet in the house.

Phil Collins shouldn't be here!! "In The Air Tonight" resounding around the room pulls me from my stupor, as I answer my phone from Control.

I am called to an RTC on the motorway, possibly fatal. I throw on my work clothes (thank goodness I am a slob, and I don't have to go into my cupboard for anything), kiss MrsRRD goodbye ("Did your phone ring?". "Go back to sleep.") and run down the stairs, thinking, Oh well, there goes my morning shower and ablutions.

The journey is easy today - kids off school, roads quiet, but I am stood down just as I approach. I decide that there is no time to return home, and I continue on to the hospital.

I stumble in to the Department, to various comments about the local bum turning up for work. This prompts me to a caffeine fix (well, NHS tea) and a decision to use the "value" razor I have in the office for just such an occasion.

There is no mirror in the loo, and I run the blade over my lathered face by feel, rather than sight. Ouch!! That's a small nick under the left nostril. Must remember to utilise the well-known haemostatic agent close at hand to that area when I'm done - wouldn't want to get any blood on my shirt before work!

I leave the makeshift bathroom, and go to my office for a 5-minute break. I have a mirror on the outside of my door (don't ask - it was there before I joined) and I look in horror at my ravaged face and my blood-spattered shirt. The blade has done a very nice job of removing all the stubble from my neck, along with most of the surface skin!! I look like a victim of the Barber of Seville!!!

Ok, regroup!! The blood on my shirt is only a few minutes old, and I know that washing in cold water will remove it. So, it's back to the loo, and, shirt off, I start the painstaking job of soaking and scrubbing the collar.

5 minutes later, and the shirt is clean, the flow of blood is (virtually) stemmed, and I am ready for work.

One problem - soaking wet shirt.

Another problem - meeting in 5 minutes.

Solution - wear shirt, put electric heater on, and make self-depreciatory comment about surgeons and blades!!!

Mornings

2011-02-19T23:04:00.013Z

I've decided. I'm not a morning person. Especially 3am. That's not really morning, is it? That's still night time, isn't it? Ok, then, I'm definitely not a night-time person.

This is an unusual comment to hear from a chap who regularly jumps out of bed at 3am, drives at ridiculous speeds, and makes life-altering (hopefully -saving) decisions. I do all of those things, and, I hope, do them rather well.

What I find difficult is biting my tongue. When well-meaning, worried family members ask me questions in the middle of the day, I try hard to alleviate their fears, empathise with their need to know, and help them deal with the difficult decisions that are being made around them.

At 3am, when I am asked if a drug I am considering using to sedate a man to help get him down a steep set of stairs has any side effects, I answer "Yes, but they're better than just leaving him here all night." Not the most empathetic comment I have made in my life.

But it could have been worse. When same family member asks me if the neurosurgical centre I have chosen for their beloved is the best choice, I don't say, "no, I just chose it because it is near to where I live, and I'll be able to get back to bed quicker." I simply say, "yes."

Maybe I can cope with 3am's after all!

Nothing to do all day!

2011-02-16T22:59:00.001Z

I've had nothing to do all day today. My nothing started at 5am, with a call to an agitated man, collapsed as he got out of his bed. The team were unable to get him down the stairs, because he was thrashing about too much. By the time I arrived, he was quiet, and easily transported down the stairs. I didn't help the crew this time... I decided to follow behind the ambulance to Local Neuro Hospital, just in case. Nothing happened

About 6 this evening I was just getting ready to go home, when I am called to a stabbing near by. He had been stabbed in the chest, and was in the back of the ambulance before I arrived. The crew were happy to wait, and I travelled in the back with them on the way to Major Trauma Centre, just in case. Nothing happened

I got home about 8.30. My new cat was waiting for me (more about him in another post), and so was my family and my dinner. About 8.35 I get a pager for an RTA not all that far away. I couldn't not go. After all, that's what I do. He had been thrown from the car at high speed, but seemed reasonably ok. I decided that, since we were only 5 minutes away from Local Hospital, I would travel in the back, just in case. Nothing happened.

I'm home now. Please let me have my supper!

I Hate You

2011-02-14T23:09:00.000Z

You make me sick!! You think it's ok to go to the pub, have "a few" drinks, and then get into your car. You think it's ok to then drive like a lunatic, so hard into a parked car that you shunt it 20 feet.

THAT COULD HAVE BEEN A CHILD!!!! That could have been MY child!!!

And then you stand there, saying that you got unlucky, because you got caught.

Unlucky would be running someone over, or hitting a car with people in it. Unlucky would be driving into a bus shelter, with a queue of waiting people.

So you are going to lose your licence. Big deal! You should lose more than that, and, if I had my way, I'd be at you with a scalpel blade to your rather needed parts.

But instead I have to be polite, treat you like a human being, rather than the animal you are. At least I get to hand you over to the waiting police.

Phew!! That feels better - back to work.

Confidentiality Revisited

2011-02-13T16:31:00.000Z

It's tough, you know. However hard I try, whatever I do to maintain confidentiality, events continue to conspire against me. People know people. My community is small, and my patients have family. Family have friends. And the friends read my blog. No matter what I do to try and change the facts, the facts are still there, in some form or other. And that means I am taking a risk, every time I write. For every one of you who lives so far away that the stories are just stories, there is another of you for whom these stories are ever so real.

And what does it matter? Well, I try so hard to include only enough reality to make the stories real to you, Constant Reader. I ensure that any medical information is couched in such terms as to negate the breach of confidentiality that these tales perform.

But, what if it were your kith or kin that were written about? What if you knew that what was written was at best inaccurate, and at worst a fabrication, would that matter to you? I am, on occasions, a little irreverent. How might it feel to you, reading that, at least I had gained a pair of scissors while attending to your loved one, injured so badly in a car accident that he lies between life and death on a hospital bed?

I don't know the answers to these questions. Maybe soon I will. Maybe the family of the lady I wrote about in "Scissors" will tell me. And, maybe, their words will bring this blog to an end.

You see, I write how I feel. And I cannot change the way I feel. Without the humour, the irreverence, I would not be able to cope with the endless sea of nameless faces.

To all of you out there, to all the families of those I have saved and those I haven't; please forgive my breaches, my fabrications and my irreverence. The patient is always first and uppermost in my mind, both at the roadside and at the keyboard. If you cannot forgive, then please try to understand.

Odd

2011-02-08T01:19:00.001Z

I've just come back from a job on the M25, and seen I'm wearing odd boots. One's a Caterpillar, and the other's a Magnum. Funny thing is, I've got another pair, just the same, in my car!!

Goodnight!!!

Plants

2011-02-07T23:23:00.000Z

My back hurts. Specifically, my left shoulder, up into my neck. We have about 50 people descending on Chez RRD this afternoon, to celebrate Princess RRD and Mini RRD's birthdays. No, they're not twins, just have their birthdays quite close in the year. Mrs RRD has resigned herself to sorting the house out herself, as a result of my incapacitation. She is doing it with her usual good grace - after all, it's not my fault that my back hurts so much...

Yesterday I get a call to assist a crew with an analgesia problem. This is not all that unusual, and, if I am not too far away I will try and attend. I carry more potent pain killers than the paramedics, but often I just support and supervise the crew to use what they are familiar with, only in much higher doses. If something goes wrong, if the patient's breathing slows too much, I can always take over their breathing in the time-honoured fashion of sticking a tube down their windpipe and ventilating them.

But I digress. This call was for a man who had fallen out of bed, and landed awkwardly between bed and wardrobe. So awkwardly, in fact, that he had broken his leg. He had managed, somehow, to drag himself to the top of the stairs, but was then in too much pain (surprise, surprise) to go any further. The crew have given large doses of morphine, and he was still in so much pain that they couldn't do anything with him.

By the time I arrive, the morphine has kicked in, and he is feeling much more comfortable. I assist the paramedics with getting a splint on his leg, and rolling him onto a scoop stretcher, and strapping him down in preparation for the journey down the stairs.

The stairs have a lovely bend in them, just the right place to have a window ledge, complete with pots of plants. Lots of pots. I spend a few minutes carrying the plants downstairs, so that we have a clear way down. The crew suggest we get another ambulance, so that we have enough pairs of hands - Jim is no lightweight. I realise that this will be a wait of another 30 to 40 minutes, and suggest that we three can manage.

For some reason, I find myself going down the stairs first, with all of Jim's weight in my hands, as I manhandle the stretcher. The tight curve means that the stretcher, with Jim firmly strapped in it, has to be almost vertical. Oh, and did I mention Jim is coming down head first?

So, Mrs RRD, it wasn't just one of those things that meant you had to do all of the schlepping today - it was my fault.

Next time, I'll stick to the pot plants.

Swimming Run; Running Call

2011-02-03T23:57:00.003Z

It's Tuesday. Princess RRD has swimming on a Tuesday evening. It's my job to take her the 20 minutes to swimming, come back, wait about half an hour at home, and then go and collect her. I enjoy the time we spend together on those journeys. I just wish that the Blackberry had never been invented, so that we could have more time to chat. Still, it's good she has such an active social life.

On my way back, the traffic near home is a little busier than usual. I see some blue lights behind me - the other side of the road is clear, so I know he will have no problems getting past, even though some idiots are trying to overtake everyone sitting in the traffic jam, just because they are turning right in half a mile!

It's one of the local First Response Units. How I don't envy them their job. The thought of turning up first anywhere, then knowing that, once you are there the clock has stopped for the Ambulance Service and you might be there on your own for an hour or so fills me with dread.

I see a bus up ahead. The FRU drives past, then stops. Oh ok, I can guess the scenario: unwell woman on bus. As I approach, I can see that the paramedic is still kneeling on the road in front of bus. Change of scenario: woman hit by bus. I pull over, hit the rear blues, and jump out, rushing to the boot to don the tango suit.

It's Mabel. All the local crews know Mabel. Even I've met Mabel at my hospital, some miles up the road. She's, not to put too fine a point on it, the local drunk. Well, one of them, to be precise. The FRU who is here today tells me he usually gets called out to Mabel at least once a week, suffering with collapse. There's never much wrong with her, and she usually gets on her way as soon as the team arrive. Not today, though.

The pool of blood around her head where she lies corroborates the information provided by the shattered windscreen: today, Mabel has been hit by the bus, and has a head injury. How much of a head injury is yet to be seen.

Mabel opens her eyes when I call her name. She tells me, in a slurred voice, that she is just having a rest, and why don't we all F*** Off! Mabel is renowned for her careful choice of words, le mot juste. I lean in to take a look at her pupils, and sense the heady aroma of Mabel's favourite perfume: Eau de Pub.

I look around: we are on a main shopping street. The world and his wife, their children, the Au Pair and the next door neighbour have all gathered to watch. One woman, complete with shopping bags, nudges me a little, to move me out of her way, so that she can get a better view. I remind people that if they want some street theatre, Covent Garden is a short train ride away, but they remain glued to the scene. I ask a couple of police officers to prevent me from committing a criminal act on the closest individuals, and they hastily set up a cordon around us, to give Mabel some privacy. The only two who are left are the two who kindly stopped and helped her before we arrived. One was holding her head, the other was, well, I'm not sure, really. She was giving some very helpful suggestions, suggesting that we get an ambulance, advising us not to move her, except, perhaps, the recovery position?

The ambulance arrived a few minutes later (or, in my case, a phew! minutes later). We quickly get a scoop stretcher under her, to the accompaniment of the passer by suggesting that we don't move her! I wondered if she thought we should help Mabel set up home in the middle of the high street, but bit my tongue, much to the amusement of my colleagues.

By this time Mabel was as awake as she ever was, and the crew were happy to take her to the local - hospital, not off-licence!

I popped back to my car, just in time to turn round and drive back to the swimming pool.

As I am driving Princess RRD home, I told her all about my running call. For this journey, at least, her Blackberry was left in her pocket.

Scissors

2011-02-01T12:52:00.002Z

She's 65. She's in a bad way. She's lying on the floor, moaning incoherently, with blood from her left ear, and her left eye swollen shut. Her arm is bent at a funny angle as well, but that's not bothering me now. What's more concerning is her head injury. I look at the car: the windscreen has been hit hard from the outside, and is now mostly in the car, on the passenger side. Thank goodness there was only the driver in the car, when it hit the lady as she crossed the road, iPod headphones bought for her by her granddaughter for christmas drowning out any extraneous noises.

The HEMS crew arrive shortly after me. They are in the car, it being night-time (oh, and it's raining - again!!!). I confer briefly with the HEMS doc, who is happy for me to run this one, and happy to take the patient for me to St Mary's Hospital. I am on call for my own hospital tonight, so can't be going on any road trips...

I call for assistance to stabilise the patient: scissors to cut up each trouser leg and across each sleeve, a cannula in the uninjured arm, blood pressure and other vital signs.

She's a bit more awake now, calling out, and asking for her mother. She's very confused and agitated, so will still need tubing before transfer.

The HEMS team do things a bit differently from me. They set everything out very neatly and ordered, whereas I have a tendency to unzip my bag and turn it upside down. And then there's the checklist. Before I tube a patient, I have a look around and make sure I can see the bits I might need. The HEMS crew have a laminated sheet, with a list of equipment, drugs and personnel, which is called out, much like the checklist before flying an airplane.

Please don't get me wrong: I agree in principle with the idea of a checklist, but it's just not me.

I call out the items on the list, and receive a "Check!" from the paramedic assisting me. I take a breath in, inject the drugs and insert the laryngoscope. Easy view! The tube goes in, we secure the tube, and the patient is wheeled into the back of the ambulance. 5 minutes later, the ambulance is off, with the HEMS doctor inside.

I look around at the mess that is left: discarded packets, gauze, blood from her head wound, and the tuff-cut scissors I used to cut the patient's trousers. I look around - no more ambulance crew here. I feel strangely deflated, giving over the patient to the HEMS crew and not being able to complete the job through to the hospital.

But at least I've gained a pair of scissors.

The Last Journey

2011-01-31T20:57:00.000Z

Oh how I hate these kinds of jobs. Hangings never go well. The patient usually is in a very bad way and they are often at home, found by family members, which adds to the intense emotion of an already tense situation. So, I am very wary of this job. Also, the fact that I haven't been out on a call for many weeks doesn't diminish my concerns. I mentally run through the contents of my bag. Did I replenish the drugs after my last call? Do I have enough syringes? Are the batteries in my laryngoscopes still live? There is nothing I can do about these things now, as I drive into the car park to a block of flats near to where I live. This is not a particularly selubrious area, and I am comforted by the number of blue lights and police vehicles I can see parked up. I jump out and grab my gear.

Ok, number 63. Where is number 63? It's dark, and despite the presence of what looks like most of the emergency services in London, I can't see a living soul. Oh,a nd surprise, surprise: it's raining.

Erm, what now? I tried a tentative "Hello?", but got nowhere. Then, from a balcony above, I hear some murmuring. This sounds promising. I move towards the stairs leading up, and see, in very small type, the words "15-63". I start making my way up the stairs.

Now, for those of you who don't know me, I don't really do stairs. Lifts are good, escalators I can cope with. But not stairs. And not this many. And not with a 25kg bag on my back and a 5kg monitor in my hand. But, this building doesn't look like there is going to be a lift. Or escalators.

I stumble on to the 4th floor, and call out again, rather breathlessly. This time, I am answered, and ushered into a tiny hallway, and my first glimpse of Jake.

Jake is lying on the floor underneath a loft hatch. He is being held down by two policemen, whuile the boys in green tend to him. He is agitated, and has the marks of a noose around his neck. He has, according to his flatmate, fallen from the loft, with a rope around his neck. The rope held him for mere seconds, before he fell the last remaining feet, to land in this tight space between front door and the bedroom.

I think quickly: he is currently maintaining his airway, but is very agitated. He has clearly suffered some hypoxia (lack of oxygen) making his brain not function properly. He needs intubating and ventilating, and getting to a trauma centre.

We are 4 floors up. If I tube him now, it will be incredibly difficult to keep ventilating him all the way down the stairs. The likelihood is that any brain injury from his hypoxia will only be made worse by the journey down the stairs, not better.

So, we need to get him down awake. But he's not the most cooperative of gentlemen. Not at the moment, anyway. He's moving all his limbs, the lower ones quite agressively, so he hasn't broken his neck. But we still need to be very careful in how we move him.

I decide that he needs to come down awake, and we strap him to a scoop stretcher, before making the precarious journey down with him. Well, when I say "we", I mean the ambulance crew. I go on ahead to set up my equipment and drugs for the inevitable intubation when they bring him down.

It's a good 15 minute journey down the stairs, and I am completely set up by the time they bring Jake down to me. I need to reassess him, just so that I have a baseline set of observations. Pulse, 96. Blood pressure, 130/75. Oxygen saturations, 98%. Glasgow Coma Score, 15. Sorry? Let's just check that. Yep, he is fully conscious. Hmm. I decide that tubing this one may be a little more than he needs. I'm not sure how he could have improved so dramatically in such a short space of time, but I'm not arguing.

He still has had a major insult, and needs to go to a Major Trauma Centre. It would be inappropriate to ignore the low GCS initially, nor the mechanism of injury. I look at my watch: 22:30, T-1. T being the day that my local Major Trauma Centre opens its doors 24 hours a day. Yes, tomorrow at 8am, I can go to my local at any time of the day or night with my patients. Not tonight, tomorrow. Tonight I'm off to the Royal London. That's a looooong way. Over 45 minutes. Still, I have no choice.

What I do have a choice in is how I get there. The patient is going in the back of the ambulance. I'm not happy to have the crew take him there all on their own, not on a 45 minute journey with a man who, 15 minutes ago, had a GCS of 6. But, if I travel in the back with them, then someone will have to somehow get me back to my car. However, if I follow in my car, I can still jump out and help if they run into trouble en route, yet I will have my car available to drive back immediately.

Decision made, we package the patient securely, and I start on my last journey to the Royal London.

Puddle

2011-01-29T16:16:00.001Z

It's raining. I guess that's normal. What's not normal is that I am underneath a 4X4 looking after a young lady who was hit by aforementioned 4x4, and is currently lying on her left side, completely under the car. She's fully conscious, and tells me what happened. She was walking across the road, when she saw a car slide towards her. She ran, slipped in a puddle, then watched in horror as the car came inexorably towards her, then over her. She closed her eyes and waited for the end.

The end didn't come, and now she lies there, while the fire crew use hydraulic lifting gear to raise the 4x4 off of her, and while I lie next to her, in a puddle of rainwater, putting a cannula into her vein to give her enough pain-killing medication to allow the ambulance crew and I to move her on to a board and drag her out. My discomfort, that of the water seeping inexorably through my flight suit and my trousers, is nothing compared to her pain from her fractured pelvis.

Eventually she is out, and we get her to the hospital to be checked out. I make a mental note to myself to get my suit cleaned, and waterproofed at the same time.

Flying!

2011-01-29T15:34:00.000Z

He loves driving. He's quite good at it, actually, having been driving for well over 6 months. He can handle his car with ease. So what if he drives a bit fast sometimes. He can cope. He never drinks and drives. That would be silly.

He's out with his mates. His girlfriend is driving her car, and is in front of him at the moment. She can't drive properly. She sticks to the speed limit. It's 2'oclock in the morning - what's the point of a 30mph speed limit. After all, it's not as though there is anyone else on the road.

Ok, time to show her just how to drive!! No room on the right, so have to undercut on the left. Drop back a bit to give some accelleration space, then floor it, and onto the pavement.

He hits the concrete bollard at well over 50mph. The bollard is partially uprooted, and ends up at a 30 degree angle, just perfect to act as a take-off ramp.

The car sails through the air, at a height of 2 metres, and comes to rest on the roof of a Volvo S60 (band new, from the look of the plates) that was parked in the owner's driveway.

I arrive to see 4 young lads walking around, somewhat dazed by what has occurred. None have any significant injuries. Not one. The girlfriend doesn't look happy, and I wonder, as I drive away, whether the only thing that has been broken in this accident, (apart from the unfortunate S60) is the relationship.

I go home, so pleased that my teenage son isn't like the others. Oh, and that he can't afford the car insurance, so won't be driving any more.

Bad Boy

2011-01-29T14:59:00.001Z

I am a bad boy! I have been told off, by my friends, by my father, by the paramedics who work with me. I complain about not going on any jobs, and then, when I do, I don't write any blog entries about the jobs I do go on.

The only ones who really matter are you, Constant Reader. I have let you all down, by neglecting my duties as a Blogger.

I could tell you about how busy the Hospital has been over Christmas. I could tell you about the lack of staff, leading to me working more hours than there are. But, the bottom line is that I haven't written. And that has to be rectified.

I will try, try very hard, to keep the writing going. There has been a hiatus (more of a huge hole!) but I will make all endeavours to bridge the gap.

To be really honest, I miss the release that I get from writing. I feel emptier as a result of not writing.

So, without any further ado....

The Essentials

2010-11-15T08:48:00.000Z

Ah, Monday mornings!! How I love my Monday mornings! You see, I don't go to work until 4pm on a Monday, so for me it's a continuation of my weekend, just without the noise of 5 smaller people.

It's a dressing gown morning for me. Mrs RRD has been up at the crack of dawn to take Princess and Micro2 to the bus stop, and I am enjoying a hot cup of tea and some 'us' time, while we work out what to do with our day together.

The ringing of my 'phone sends a small shiver of anticipation through my bones: yes, the screen reads "Unknown." Control seem to have got the message that I am still alive, and this is a call to a trapped RTC nearby.

"Want to come with?" I enquire of Mrs RRD. She acknowledges that this might be fun, and I rush upstairs to get dressed.

As I run down the stairs she is passing in the opposite direction! "Get into your suit and program the SatNav," she suggests, "while I get my essentials."

Thirty seconds later, the engine running, the SatNav all ready and the lights flashing, Mrs RRD jumps in beside me; flask of tea, book and make-up bag at the ready.

As I ease out of the drive, the 'phone rings again. I answer on BlueTooth (before anyone says anything!!): "Can we cancel you down on that job: no-one trapped or injured." We climb out and continue our day.

Jaded??

2010-11-01T09:37:00.001Z

Some of you eagle-eyed readers may have noticed that I haven't posted for a while. Why? Well, mainly because I haven't had anything to write about. I haven't been on holiday (apart from a weekend in Holland - more about that in a moment), just haven't been called out to anything. Nothing. Sure, there have been some serious incidents in my area; someone falling out of a tree and landing on his head, a couple of fatal accidents on my stretch of the motorway. But no calls.

You may be wondering why. Well, so am I. I call the Desk regularly, they thank me very much for letting them know that they can call, day or night, and get me running. But they don't. I ring and ask them about the call the night before, and no-one can tell me why I didn't get a call. So, I begin to wonder: have I upset someone? Nope, I'm just out of the radar.

Cut to this weekend: a great break in Holland with the whole family, visiting more family. Let me tell you something; 8 children between the ages of 16 months and 17 years in one house isn't conducive to sleep!! We get back at just before midnight from the airport. The kids are tired. The adults are tired. The phone rings as I open the door to the house. Yep, nothing for almost 2 months, and then a call at midnight on the day I get back from holiday.

It's a call for assistance to a man who has rolled his car and is now deeply unconscious. Sounds reasonable. And yet I am looking for excuses not to go. This is so unlike me. How far away is it? Oh, that would take me at least 30 minutes to get there - they shouldn't wait for me, just scoop and run.

This isn't like me at all!! Whatever the distance, wherever the call, I would normally be out of the door like a rat out of an aqueduct!! But not this time. I know I have just got back from holiday, but it was only a weekend, and I'm not that tired. And I have been complaining bitterly about not being called. I get off the 'phone wondering what has happened to me, why I am feeling so jaded for the first time about driving out at all times of the day and night.

And then the 'phone rings again. Control tells me that the crew are running to the local with the patient, and I breathe a sigh of relief. But they continue: can I run to an alcoholic who has fallen and hit his head? It's a close one this time, so I shrug my shoulders, jump into my suit and drive off to pick up the pieces of an overindulgence at the pub.

A Night Out

2010-09-23T14:33:00.003+01:00

Why is MrsRRD nudging me? Surely it can't be time to get up already? No, it's my 'phone. I'm so sleepy that even the dulcet tones of the drum solo from "In The Air Tonight" have failed to penetrate my dreams. No wonder: I had already had one call tonight, and only been asleep for a couple of hours. Fortunately, MrsRRD is awake enough to remind me that my jump suit and boots are in a pile on the floor of the bedroom, or I would have had a bit of a shock when I got down to my car and found them absent.

A few minutes later, SatNav programmed, I shake my head repeatedly to get rid of the last vestiges of sleep, and start my journey.

The car is on 4 wheels. That's always a good start. I see the airbags have deployed. That's not bad. The windscreen has a spiderweb pattern of cracks on the driver's side, the centre of which is pushed out alarmingly. You and I both know what made that mark - yes, Constant Reader, the classic sign of a bullseye, made when the driver's head impacts at speed with the windscreen. Not so good. Not good at all.

I survey the scene for patients. There's a woman, looking ok, with a piece of gauze on her chin. She's walking around, so she can wait. There's a young chap, looking very much the worse for wear, but from an alcohol point of view, rather than injury - at least that what it seems at the moment. He is jawing away in his phone, and the police seem very interested in him.

Ok, to the car. There is a young man being extricated on a spine board through the passenger door. He has a deep gash on his head, and looks as though he has a broken femur. I presume that this is the driver, who is being brought out this way because it was easier, but, when I question the ambulance crew, it turns out this is the passenger. The driver is the rather drunk chap, who is wandering around in the company of the boys in blue! Hmmm.

I check the passenger out - he is in a lot of pain, and will need stitches galore to repair the scalping he has had, but will be ok.

Wait a minute! This is the passenger! Not the driver. But it was the driver's side that had the bullseye in the windscreen. I rush over to the car to check the position of steering wheel, just in case I have got this wrong. Nope, wheel on right, with pedals underneath. So, man who has bullseyed the windscreen is - somewhere.

I have a chat with one of the officers. Apparently, the police have taken him away into custody. (Crazily, my mind repeats a sleep deprived litany, "Rhubarb and custardy, rhubarb and custardy!"). I try to get my mind round this one. Has anyone medical seen this chap? Nope. Well, you'll just have to bring him back, then. Boys in blue not too pleased about this turn of events, but agree that they were probably a little hasty in dragging him off to the cells.

I hang around scene as he is returned. It doesn't take me long to examine him and find he is completely uninjured, save for a probable fractured toe. I relay this information to the waiting police.

"What??" he exclaims. "I've broken my toe?????!!!! Will they have to operate??".

It took all my restraint not to drag him over to his friend, lying in the ambulance, a laceration you could keep a bottle of WKD in, and show him what he had done.

I go home, and eventually fall into a troubled sleep, with dreams of car crashes and damaged teenagers.

Filling the Coffers

2010-09-05T16:28:00.000+01:00

Once again, MrsRRD helps our Charity to gain much-needed funds. She wrote to Waitrose in Mill Hill and nominated BASICS-London for their Community Matters scheme. Each month, three charities are chosen at each branch, and £1000 is split between them, based on the number of tokens each charity gets. The tokens are handed out to all the shoppers, and they chose which of three boxes to place their token. So, for the month of September, if you live anywhere near Mill Hill in London, do pop in and support your favourite charity. Who knows, you may meet someone special there...

Kids!!

2010-09-02T11:03:00.000+01:00

My 7 year old niece told my sister-in-law that drinking too much coca-cola would kill you. She knew this was true because she had seen it on the television. She hadn't been paying too much attention, because she was playing with her brother at the time, but the man reading the news definitely said that drinking too much coca-cola would kill you. A repeat of the news show later revealed an interesting story about the dangers of alcohol. Close, so close!!

Sudden Death x2

2010-08-30T21:20:00.000+01:00

He lies there, the driving rain beating down on his upturned face. I look at him and know, without a doubt, the eventual outcome. The tube in his windpipe lets the paramedic inflate his lungs, but there is no movement of their own. His body shows me all too clearly the trauma that he has suffered, when the cars collided, when he was ejected through the windscreen. I pierce his chest, deflate the tension pneumothorax, and again on the other side. But still, the monitor attached to him shows a straight line, asystole, death.

His family watch in horror, as I stand, my job done, and the paramedics draw the blanket over his head.

---------------------------------------------------------------------------------------

He lies there, unable to stay still, unable to catch his breath. He calls out, pleading for me to help him. I look at him, and know, without a doubt, the eventual outcome. I have nurses, monitors, a whole hospital at my disposal this time. I listen to his chest, fight to find a vein to give life-saving drugs, and watch as his eyes glaze over and he takes his last breath in front of me. I pass a tube into his windpipe, breathe for him, and give him clot-busting drugs, in an effort to dissolve the clot that is blocking his pulmonary vessels.

His family are brought in as we continue the resuscitation attempt, and watch in horror, as I switch off the monitors, and the nurses draw the sheet over his head.

Leather

2010-08-22T22:32:00.004+01:00

Well, Constant Reader, I would like to share with you something about me. Three years ago tomorrow, I stood beside a beautiful lady, slipped a ring onto her finger, and turned her into MrsRRD. Yes, tomorrow is our 3rd wedding anniversary, traditionally celebrated with a gift made of leather.

And, very publicly, I want to say thank you, MrsRRD, for standing by my side three years ago, and for continuing to stand beside me. You are the one who makes everything possible, who supports me in what I do, and who always helps me make the right decision. Without you, I wouldn't be RRD. I wouldn't be anyone.

Dreams, Rain and Driving

2010-08-21T23:07:00.002+01:00

Sitting down with friends, talking about dreams. We've just come out of the cinema, having seen Inception. Princess RRD isn't sure, not totally, what had been going on. Mrs RRD isn't sure, not totally, whether she liked the film or not. Break Dancer wants to know what her dream about chasing a labrador around the garden in her nightie means. Break Dancer's husband is checking it out on www.whatsmydreammean.com. And I am just sitting there, enjoying the company of true friends.

Buzz!! Buzz!! I glance at my pager, set on silent during the movie. I must remember to bring my reading glasses out with me. Squinting, and holding the pager at arms length, I can just make out the characters: 29D02, local motorway junction. My pager is linked to the Ambulance Service coding computer. AMPDS, for those who care, is the way in which the computer translates the information the call taker gets from the caller into coded information for the crews, including the priority of the job. 29 is the code for an RTC (road traffic collision - don't call it an accident, oh no!) and D02 is high speed. Well, it is a motorway, after all. I sigh, theatrically. My family and friends know the score - I might be off. A lot of these are simple shunts, and don't amount to anything. I generally wait for at least 2 calls before calling in my availability. And anyway, I still haven't heard about the labrador and the nightie!! The sound of rain on the conservatory roof is a comforting backdrop to our conversation.

Buzz!! Buzz!! I sigh theatrically again, and squint at the characters: 29D05. Suddenly, all thoughts of dogs, dreams and gardens are swept away. D05 - all services required. I call it in, and hear that there has been a 3-car pileup, with one man unconscious.

As I enter the motorway, the rain starts in earnest. I can barely see out of the windscreen; my wipers are ineffectual in this weather. And it just gets worse. Cars are stopping on the hard shoulder, but I grimly carry on, my speed dropping lower and lower, my hands gripping the steering wheel knuckle-white. I am leaning so far forward that my nose feels as if it is pressed against the window; like I used to in my old house, watching the rain from my bedroom.

I can see blue lights ahead, but know that my journey is not yet over - they are on the other carriageway, and I have to go up to the next exit and back down again.

My eyes flick across to the scene as I am about to pass it, then flick back ahead again.

What the ....!!!! Twisted metal appears in my windscreen through the driving rain. A lamppost is down, and the lantern arm is across my lane. I swerve to the left (we're in the UK, remember) and slide past it with inches to spare. Fortunately, my 4x4 is able to cope with the maneouvre, and I regain control of my beating heart.

A few minutes later I am jumping out the car and running through the rain towards the waiting casualities; I know that getting there is only the beginning.

Half Price, Special Offer

2010-08-18T19:14:00.004+01:00

"Oh, he's gorgeous!" exclaims MrsRRD. "You must buy him, especially as he's on special offer."
"Half price," I said. We buy him, and I put him in the back of my car, staring out of the window. He looks so funny, and so appropriate to what I do.

Later that evening, as I am stashing my gear into my boot, the pouring rain against my hood, his lopsided grin seems so wrong, so out of place. His blue body and bandaged head mirrors the body lying behind me, my lights reflecting off his skin.

And there he sits, my special offer, half price, Mr Bump.

An Image From Vancouver

2010-08-11T16:55:00.003+01:00

So, there we were, about to get on our rented bikes, when I see a young kid with a bike helmet. It must be the first time this mother has been asked for a photo of the back of her son's head, but I just couldn't resist!!

Another One Bites The Dust

2010-08-10T21:41:00.006+01:00

First Medic999, now NeeNaw. There seems to be a trend appearing here. No-one comes out and says why. Not in so many words. We all know why we write. I can guess why some of us stop. Pressure. Pressure from above, to stop giving away our sectrets. To stop giving away the secrets of those we serve - our patients. Confidentiality is one of the cornerstones our our professions - without it, no-one would ever trust a doctor or health care professional again.

I believe strongly in confidentiality. Mrs RRD could tell you a thing or two about being the wife of someone who holds as a sacred secret anything they find out in the course of their work. It wasn't easy for her at first; the cryptic phone calls from friends and family, asking for advice, or occasionally for a visit. And she hears nothing! Our friends don't always get it either. "Didn't your husband tell you I was really ill?" they ask, expecting her to know all about their ailments, expecting her to be party to their secrets.

And why do you, Constant Reader, come back for more? Isn't it the same need to know, need to see, that makes people slow down to gawp at accident victims? Do you think I don't slow, even if I know that I can do nothing? Even while on holiday these past few weeks, I would casually wander past a parked ambulance, "just in case they needed some assistance." Some assistance, my foot!! I just want to know what's happening. I'm nosey, just like everyone!!

I think I do quite well in my blog. I don't breach patient confidentiality. Some bloggers retain anonymity, and so have little problem with confidentiality. That was how I started out, but it soon became apparent to many out there just who I was. So I had to change tactic, and modify the stories, so that they became just that - stories. Sure, someone who was there may think they recognise a patient or an event. But they don't. I change enough so that it is not possible to discern which patient I am describing. Some are recent; others far less so. And remember, I have been a BASICS Doctor for nearly 10 years, and a HEMS Doctor before that. So I have a lot of cases to call upon.

But it is still a risk. If someone thinks they recognise a case, that might be enough to cause trouble from one's seniors. And, I guess, that is where I have an advantage over my ambulance colleagues. Up until now, I haven't really had a boss, when it comes to my prehospital work. I am tasked by the Ambulance Service, but I am not employed by them. That is, I wasn't. There is a change afoot in London. We will all have contracts with the London Ambulance Service, a contract which, I have no doubt, will have a clause somewhere about keeping confidentiality. And, at that point, I will be in exactly the same situation others have found themselves. And I will need to have a long, hard think...

When Words Just Won't Come

2010-07-12T22:18:00.004+01:00

I have tried, so many times, to write this post. Words can't express the emotions that this job evoked in me; I don't know how to write it and still keep patient anonymity. And yet, it needs to be written. It has been a number of months, but it is still as fresh today as if it was yesterday:

The call comes through: can I attend a 4 year old girl who has fallen into a pond at the local park, and is now in cardiac arrest. My heart sinks - every call this month has been to a child, and all very serious. This one sounds bad. I tell Control to let the crew know I am about 10 minutes away, and that they shouldn't wait for me, if they are ready to go before I arrive.

As I am driving to the scene, I am hoping that they leave before I get there. I don't want to be involved in this case. I know I can't refuse, but this is my nemesis, this is what I fear more than anything (it used to be the "one-under" - someone hit by a train, but desperately sick kids took over from that some time ago.)

I arrive to a scene of horror: a child, lifeless, blue, distended abdomen, vomit around her face; two paramedics working on her, another getting a monitor attached; the monitor showing a straight line, no electrical activity at all; the family, screaming and wailing. My heart, already in my boots, sinks even lower.

I rush over, my paediatric bag banging against my hip, my monitor slung over my shoulder. As I kneel by her head, I look into her eyes: the glassy stare of an arrested child. The deep blue skin and vomit over the face tell me all too clearly what I don't want to know: this child has been without oxygen for a long time, perhaps too long. I need to get a tube into her windpipe and breathe for her. It's all very well using mouth-to-mouth or a bag and mask, but most of the air goes into the stomach - the distended abdomen is the result.

Age over 4 plus 4. Age over 4 plus 4. My mind shouts the formula for calculating the size of an endotracheal tube in a child, yet I cannot work it out. I reach, blindly, for a size 5, and take a breath in before inserting the laryngoscope blade that has been handed to me by the paramedic. This isn't like an adult intubation. It's not just the size: in an adult we use a curved blade, the tip of which fits into the space between the tongue and the epiglottis, whereas in a child, because the epiglottis is usually much floppier, we use a straight blade that is designed to pick up the epiglottis as well as the tongue. In with the blade and lift. There are the cords, there goes the tube.

A few puffs with the bag attached, and the chest rises and falls. But that's not good enough; I need to be able to hear breath sounds on both sides, but, with the noise of the crowd, I cannot be certain. I need, instead, to get my monitor attached, and see if there is any carbon dioxide coming out of the tube. But, there are only us three, and we have lots to do. So, in between bagging the child, continuing chest compressions, finding intravenous access and giving adrenaline, we manage to get the monitor attached, and I see the reassuring rise and fall on the carbon dioxide tracing.

We move her on to the ambulance gurney, and wheel her into the ambulance, still giving chest compressions and ventilating her. I tell the crew that I don't want the family in the back with me; I need to keep my wits about me for the short journey; but, in reality, I cannot bear the thought of the questions, the hope, the need to know that she is going to survive this awful turn of fate.

Back home; I am quiet, sullen even. I talk, but I am not able to express just how I feel. The fear of not doing it right, of not doing all I should be doing. The anger at a death so unnecessary, so preventable. And the fear, that one day it will be someone I know. Later, after tears, Mrs RRD holds me, as I fall into a troubled sleep

More Thoughts on The Tree

2010-07-04T22:41:00.004+01:00

You may recall that my last post was about how I had to think very hard about where to take a young child after his fall from a window. While the resultant comments were very interesting, and demonstrate very clearly that, on occasions, these blog entries develop a life of their own, I wanted to be able to write a bit more about the new directions that trauma care in London are heading, and how it affects me and my colleagues.

There are now three Major Trauma Units in London, The Royal London, Kings and St Georges, with St Mary's Hospital coming on line some time soon. Now, for those of you who don't know, this leaves my patch quite isolated. My jouney time to the 'local' Major Trauma Unit could be as long as 45 minutes. That's a long time to have an unwell patient in the back of the ambulance. And yet, for a discussion about the pros and cons, read a little 'story.'

"He had fallen out of a window, onto the driveway. Another child, this one only 9 years old. This one was accidental - the boy had been trying to open the window because he was hot, and had fallen out when he succeeded. When I arrive on scene he is stable, but not responding appropriately. He is very agitated, and, despite his eyes being open, they are not fixating on anything or anyone. The back of his head reveals a large swelling. He needs urgent care, but where from? We are outside of the LAS (London Ambulance Service) territory, and this crew will go where I want them to. I'm a few minutes away from my own hospital, and yet we don't have neurosurgery on site. The nearest neurosurgical unit that deals with paediatrics is one of the Major Trauma Units, 45 minutes away. I am not happy to travel all that way with a child that I will have to intubate if we are going that far.

And another point to consider: I am currently on call for my A&E Department. I have a contractual duty to be available if I get called. If I commit to a 45 minute journey on Blues in the back of the ambulance, I will probably be unavailable for the job I am paid to do for 3 hours or so. I decide; we are going to my own hospital, 5 minutes away, with the child awake.

The journey is easy and uneventful. He is intubated soon after arrival, and we get him up to scan. Damn! He has a depressed skull fracture and some bleeding in his brain. Now he needs to be transferred. 2 hours after arriving at the A&E Department, he leaves for the neurosurgical centre, and arrives there almost 4 hours after his accident. If I had taken him, he would have arrived there an hour after his accident. 3 hours wasted."

This really has set me thinking about my role, and about how it interacts with my work in a very busy department. If I attend a job while I am on call, and take a patient to a Major Trauma Centre, then I run the risk of a disciplinary which could result in me losing my job. If I attend a job while I am on call, and take a patient to a hospital that is not a Major Trauma Centre, the patient is not going to get the best possible care.

It's more complicated: if it is an LAS crew, they will, if I am not there, take the patient to the Major Trauma Centre. Therefore, the patient will potentially be disadvantaged if I attend. If it's not an LAS crew, then they will go to the local hospital, even if I am not there. So, if I attend those, I can provide immediate care and take them to the local hospital, knowing that they have not been disadvantaged by my attending!!

So, I am now prepared. I won't go out on ANY jobs for LAS when I am on call, but will go to other calls. I am ready for the long haul: if I go to a job when I am not on call, I will make sure that I can get the patient all the way to the Royal London, and that's a long and scary way! Watch this space.

The Tree

2010-06-12T23:32:00.002+01:00

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.

Naming the Dead

2010-06-08T19:39:00.004+01:00

I sit there, in front of them all; the coroner, the jury, the press, the families. The latter stare at me, no signs of emotion, as I am walked through my evidence. And then, the pain begins to show on their faces, as I am asked to name them, one by one; Austin, Jonas, Lin, Wu, Emma. Each time a name is mentioned, images return to me from the past, memories that have no business here in 2010, 8 years on, yet I need to remember every detail, for the families, and for those that died on that fateful day.

May they rest in peace, and may this finally mark the beginning of peace for their families and friends.

No Rhyme Or Reason

2010-06-06T12:22:00.003+01:00

She swerves all over the motorway, crying and calling out. Her daughter sits quietly beside her. She knows not to argue or cry, not when her mother has been drinking so much, not when she's in this state.

And now she sits by the wreckage of the car, the car that has flipped over and landed on its roof, not a scratch on her.

----------------------------------------------------------------------------------

He carefully checks his young daughter's crash helmet, and adjusts the straps, before they get on to his motorbike. She loves riding behind her dad, does it every day to school.

But now she lies unconscious on the road, blood from both ears.

Drive-By Triage

2010-06-04T09:42:00.004+01:00

Just dropping Micro-RRD3 (our youngest - must think of a name for him soon) off at school, when I received a pager for another RTA, motorcyclist vs car. Control tell me that the road has been blocked off, and I decide that, based on past experience (see my previous entry) it is worthwhile me running on this one.

I arrive, and pull up alongside the scene in my car and wind down my window. I can see a chap, lying on a spinal board, shuffling himself into a more comfortable position. His hands are behind his head, and he doesn't look particularly unwell. Darren / Steve (see earlier post of mine) looks up. "We're fine here, see you at the hospital."

I wind up my window and drive on.

Underwear

2010-06-03T13:31:00.003+01:00

Another standard job: motorcyclist vs car. No further details available. I have 'phoned this one in, because I have received a number of messages on my pager about the job, and just wanted to check whether I am needed. As there are no other details, I book myself on to the job, and get on the road.

I test out my new sirens: I had an "issue" a couple of weeks ago, when my sirens just suddenly stopped working - I was left with hooting and sticking my head out of the window, shouting "nee naw, nee naw!!! They work beautifully - thanks, Tone!

As I am driving, I wait for the call to stand me down; none is forthcoming, and I sigh to myself as I reach the small road. This won't be anything, and I will be able to wend my weary way home and go to bed (it's been a bit of a stressful week.)

Just as I park up, I see one of the paramedics, Blondie, running from her vehicle with a monitor in her hand. Ok, clearly not nothing.

I can hear her long before I see her: the noisy breathing of a partially obstructed airway is VERY distinctive. She is lying in the road, face up, with a LOT of blood around her, and over her face. Now, face up is not a good position to be in when you are unconscious and bleeding from the mouth and nose. Essentially, you drown. And that's what she is doing. In front of my eyes.

So, we have an unconscious female, who has come off her bike and hit her face on the road. So, you eagle-eyed readers, why is she lying on her back? Enter the helpful passer-by...

I could turn her on her side again, but that would potentially cause more problems to her neck, and she's already been moved once. So, I need to get on and intubate her, and quickly.

First step is to get intravenous access. I'm on the right and Blondie is on the left. I miss the first attempt; so does Blondie. The race is on for number 2. Damn: she beats me by a second or so, but it was definitely a photo finish!

Now, those of you who have read this blog regularly should be able to do this next bit yourselves - drugs in, laryngoscope in, sweep tongue over to left, visualise cords, pass tube between cords, etc., etc.. I know, I keep writing about the same technique. Ok then, here we go:

Drugs in, laryngoscope in... hold on, I can't open her mouth. Erm, hello. How am I supposed to do all of the rest of those steps if I can't open your mouth, young lady. She starts to go blue. Erm, hello?? Saturation probe starts to bleep at me. I start to get a little nervous, here. If I can't get her mouth open, I can't intubate her, and I can't oxygenate her. I will have to make an incision in her neck and place the tube directly into her trachea. Sounds nasty, doesn't it? Well, despite the fact I have been doing this for A LONG time, I have never performed a cricothyroidotomy (don't you just love the name?) Ever!! And I don't want this to be the first.

Why on Earth is her jaw stuck closed. I presume it is as a result of the severe trauma to her face and chin that has done this. Well, I have to get on with whatever it is that I am going to do. I force my fingers between her top and bottom teeth and FORCE her jaws apart. There is just enough room for the laryngoscope blade - I cannot see much more than her tongue, but it's enough for me. I grab my trusty bougie (a long piece of sturdy plastic, goes between the cords and then the tube goes over the plastic, like a guide) and just blindly push it where I know the cords are. I feel the clicking of the bougie tip as it passes over the rings of the trachea, and then railroad the tube over it. Feels good!!

Next time I go out on a job, I'm taking a change of underwear!!

Goodbye, Uncle

2010-05-30T23:55:00.004+01:00

It has been a very emotional weekend for me, leaving Mrs RRD and the kds and flying off to be with my cousins, as they said their final farewell to their father. Meeting family that I haven't seen for many years, seeing the children I have never seen before, reminiscing, laughing, crying.

And seeing one of my family, his life changed forever about two and a half years ago, the motorbike he loved and cherished turning against him for one, fateful moment, a moment that echoes through time, and through the generations. I sit with him, talk with him, not expecting a reply. He is gone: what remains is a husk of the man I once knew.

And then back to the house of mourning; pictures, memories evoked by a chair, by a sound, by my sadness.

Goodbye Uncle.

Confessions Part 2

2010-05-22T09:36:00.002+01:00

I need to get Princess RRD to the train station - she's meeting all her friends and going to Thorpe Park. But it is REALLY early, and I'm feeling rather grouchy. In an effort to give the impression that I am happy to be getting into my car at 7 in the morning, when I could have had a nice long lie-in (to 7:30), I graciously move my car away from the bush that is blocking her passenger door. I reverse out of the space, and hear the sickening crunch of metal against metal. Bugger!!!

I jump out of my car and hurry round to the rear, spitting expletives as I go. Can anyone guess who's car I have hit?? Yep, Mini-RRD's!!!!! I cannot believe it!! How on Earth am I going to own up to this one? Here am I, rapid response driver, constantly correcting his driving, telling him to check his mirrors, ete, etc., and I'VE HIT HIS CAR!!!

Ok, regroup. Check damage: My car - big dent in bumper, could fit my head it in (or someone else's.) His car - tiny scratch. That's it? How ridiculous! I am now going to drive around with a car that looks like it came off worse in a Demolition Derby, and he gets away with nothing?? Unfair!!

Ok, regroup. I hit him. Not the other way round. Maybe I can get away with this - after all, he might not notice. Then I look up at the house. His face, staring at me, through his open window, tells me that I need a Plan B.

What's The Point?

2010-05-08T11:22:00.002+01:00

She lies there, between life and death. Sure, she breathes, she eats what is placed in her mouth. When her father comes to visit, as he does every day, is there a glimmer of recognition? Does her face light up, just the tiniest bit? He'd like to think so. He tells me, with a tremulous voice, that she squeezed his hand today. Six months ago, she was wrested from the jaws of death, dragged from the wreckage of her car, and FORCED to stay alive, with drugs and tubes. But, what is this life she now leads; what is the life her family now leads?

I walk down the stairs, heavy hearted, doubting myself, my purpose.

And then I see her: Kate. She's 19 this week. She smiles so sweetly at me as she walks towards me, a little awkwardly, as she often is with me. She kisses my cheek, that gentle act of tenderness. She tells me how she has been accepted to college, and we talk about her new life, always skirting around the events of two years ago, when she, too, was dragged from a wrecked car, and from death's cold embrace. And I know: as long as I can, I will always try.

Fight!!!

2010-05-03T22:38:00.002+01:00

He slams his fist into the other's face repeatedly. His opponent falls to the floor. I glance up at them, then turn a page, slowly. The big man picks up a chair, and brings it down towards the smaller guy's head. Quick as a flash, he rolls away, and sweeps the big man's feet out from under him. He comes crashing down, and lies there, still.

Suddenly, there is an explosion, and another man enters the scene. He hurls expletives at the little guy, and runs at him, murder in his eye. I turn another page. The two of then are nose to nose, shouting and screaming at each other. The crowd of people watching are in a frenzy, urging them to more violence. One elbows the other in the face, and he falls to the ground.

Unnoticed, the big man rises to his feet, walks calmly over to the scrapping pair, and jumps onto both of them.

"One.... Two.... Three!!!" The bell rings, signifying the end of another bout, as I continue to read my book. Oh how I love being the medic for World Wrestling Entertainment.

Hmmm

2010-05-02T00:27:00.002+01:00

So, call this evening to the M25, multiple car RTC, bodies strewn across the carriageway. Driving through the rain, I get a call to update me: not required, 1 car, minor injuries only! Hmmm

CFR x2 Part 2

2010-04-28T00:03:00.001+01:00

CFR 2

She sits in the car, her boyfriend driving. They are off for a celebratory meal - she has just been promoted at work. Suddenly, the traffic slows, and a flash of blue lights up ahead tells her that something is amiss. As they crawl past the wreckage of the car, she notices that there is no ambulance - a lone Paramedic struggles in the rain. Just past the accident, she instructs her boyfriend to pull over. She jumps out of the car and rushes to the boot, from which she pulls out her Community First Responder jacket and Response Bag. She has only been a CFR for a few months, and has never dealt with trauma before, but the sight of the single yellow-jacketted soul brings back so many memories of wishing there was someone else there with her.

She runs over to the para. He looks up with a smile of such relief that the cold and wet become insignificant. She looks down. The driver of the car is already out. How he has crawled from the tangled metal she has no idea. She gasps in horror as she sees the swelling on the left side of his chest, which rises and falls with every breath; in as he breathed in, out as he exhaled. Her mind jumps crazily to her childhood, of sailing with her father. His ribcage looked ... billowy, like a sail flapping in the wind!

"What on Earth is that!?" she exclaimed.

"It's called a flail chest, and it's going to kill him," her new partner tells her, between gritted teeth.

A flail chest, where two or more ribs are broken in two or more places. Yes, she remembers reading about them. But this doesn't look like two broken ribs. More like 10!!

She does as instructed: she places her hand FIRMLY against the flail segment, pushing it in, so that the expansion of the ribcage can at least get some air into the rest of the lung, the area that hasn't been crushed to a pulp as his car flipped end over end over end. He doesn't like that one bit, and tells her so, in language that, under any other circumstance would have earned him a slap round the face. Not here, not now. Now, he hears the gentle voice, calming him, telling him he is going to be ok, telling him she won't leave him.

Double sirens in the distance herald the arrival of an ambulance and a BASICS doctor. She starts to move out of the way, only to be told, quite firmly, to stay just where she is, as she is undoubtably keeping him alive. She is asked to take her hand away very gently, so that the BASICS doc can have a little look. He pales and his jolly demeanour is suddenly replaced with a flurry of activity. His voice is filled with tension, as he quietly tells the ambulance crew, who have by now packaged the patient, that we are leaving NOW.

"What about me?" she asks. He looks at her: "Can you stay - we need you." She gets one of the police to tell her boyfriend, and the doors close.

In the ambulance, she sits by the patient, chatting to him as she presses the flail segment, now with her fist, as her hand has cramped up. The BASICS doctor has a laryngoscope and tube in one hand, and a scalpel blade in the other. He tells her it's "just in case." She begins to pray.

Moments later, they arrive at the hospital, and she rushes, bent double, next to the ambulance trolley, as the patient is wheeled into the resus room.

"Don't leave me now," he whispers. "You said you wouldn't leave. I'm scared I'm going to die."

She stays with him, still with her hand pressed against his chest. She can't feel her fingers, but nothing else matters. She is draped with a lead apron as x-rays are taken; she listens as anxious conversations ensue between the BASICS doctor and the anaesthetists: do we intubate and then put the drain in, or put the drain in while he is awake.

Finally, a decision is made. The drugs are given, and, at a word from the BASICS doc, she releases his chest. A slash of metal, and the chest drain is in. His eyes close, as he is anaesthetised.

She sits down, job done, and waits for her boyfriend to take her to dinner. "Double celebration", she thinks.

Thank you to all the CFR's out there. You do a fabulous job. These two cases happened within 24 hours of each other. This man survived, and all thanks to the CFR.

CFR x2

2010-04-26T22:33:00.001+01:00

CFR 1

He was just on his way to work, this Community First Responder. He couldn't keep going, not when he can see the cyclist lying there, his bike a tangled wreck beside him. Sure, this isn't what he would normally deal with; cardiac arrests are his usual callout. But he'll be able to do something, before the ambulance arrives.

He stops his car and jumps out. His car is protecting him and the casualty, so that's sorted. He bends down to assess the chap, and realises that this one is a bad one. He is not moving, has no pulse and is not breathing. He quickly checks to make sure that an ambulance is on the way, and then proceeds to make use of the bystanders who have also stopped, getting a team together to turn him carefully onto his back, still keeping the spine immobilised, before starting chest compressions and breathing for him.

A few minutes later, the ambulance arrives, and he stands, to make way for the experts. They know a useful resource when they see one, however, and he continues with CPR, while the crew get their lines and monitors attached.

A few minutes after that, the BASICS doctor arrives. Once again, the CFR feels the need to move out of the way, and, once again, is encouraged to continue helping. He works around the "experts" as the patient is intubated, as the chest wall is incised, to ensure that there is no collapsed lung. And all the while, the patient receives expert CPR.

"Hello, I'm a Consultant Anaesthetist, can I help?" A curt "No thanks" sends him away, as the team of five men and women struggle in vain to save the young man's life.

A little later, and the team debrief at the side of the road, the shrouded body of the cyclist a silent reminder of what, this time, had been the result of their endeavours. Once again, the CFR tries to walk away, to leave the experts to their debrief, and, once agin, he is pulled back. The team is incomplete without him.

Debrief over, handshakes all round, he gets into his car and drives to work.

...to be continued...

The Handover Carnival

2010-04-01T18:25:00.003+01:00

Well, folks, another month and another Handover Carnival. Head on over to Life Under The Lights, and see if you can find my guest appearance - co-written with InsomniacMedic. Lots of really good stuff, here. Enjoy!!

This Time, Please!

2010-03-31T13:47:00.003+01:00

This time, please let this time be different. Let this 18 year old survive. Altered consciousness, breathing noisy, Control have told me, as I rush to the scene of yet another RTC. As I negotiate the roundabout, and I see a motorcyclist swerve out of my way, my mind, inevitably turns to three hours earlier:

He was 17, only 17. Why he had come off his motorbike, no-one knew. There were no other vehicles involved, he just clipped a kerb and lost control. I wasn't called - it probably wouldn't have made a difference anyway. He might have been conscious on scene, but he wasn't right, according to the crew. He was very combatative, and very VERY pale. And then he had a cardiac arrest in the ambulance, six minutes away from the hospital. As I gathered the Trauma Team, I was in no doubt that this man would not survive, had in fact already died, even before he arrived in the hospital. But we worked on him anyway - he was only 17, after all. Into automatic mode, we tubed him, decompressed both sides of his chest, and poured in as much fluid as we could. Six minutes later, I called it, the inevitable end result. And then, I get the inevitable backlash, from all the staff: how could we have stopped so soon? He was only 17; we should have tried more, done more, spent more time. Doing what? Doing anything, comes back the answer. And this is from the nurses and from the doctors. Despite the fact that they all agree that the resuscitation attempt was futile, that he was dead before he arrived in the Department, they all still wanted to carry on, to throw all the resources, all the magic of resuscitation, to try to achieve the impossible. I leave the hospital with a heavy heart.

And, now, here I am, 3 hours later, hoping that, this time, there will be something, anything, that I can do.

100,000 Visits - Now It's Your Turn

2010-03-19T18:59:00.001Z

Dear Constant Reader,

Today, just over a year since this Blog went live, I have reached the 100,000 mark! 100,000 visits to my blog. I accept that most of the hits are from Mrs RRD, but still, that's a whole heap of people who now know about BASICS, who previously had never heard of us. I look at the map of where visits have come from, and I am astounded at the interest from so many different countries.

My life has changed so much, as a result of this blog. I have found an outlet, a way of expressing myself, that I never had before. I have joined and become part of a community, the blogging world, and been accepted by it. I have "met" and made new friends. I have a new name, and so have my wife and children.

There was always a purpose in writing this blog - to raise the profile of BASICS-London, and try and get as many people as possible to be aware of who we are and what we do. But now we move into Stage Two, and this is where you come in.

BASICS-London is a charity. It costs a lot of money to put a doctor on the street, and every penny comes from donations. The doctors themselves get no payment for the work they do, and pay for the extra fuel, insurance and wear-and-tear on the vehicle out of their own pockets.
Each doctor needs blue light driver training (£1000), modifications to their car (£1500), personal protective equipment for themselves (£1200) and the necessary medical equipment to save lives (over £10,000). All of the doctors currently on the road have the first 2, most cadge some form of protective equipment, and few have all the necessary equipment needed. There are currently 15 active doctors in London and the surrounding regions. Many more are standing in the wings, waiting to be trained and equipped.

You may have noticed a new button on the top right of this Website, entitled "Donate". Press it. Give something, anything. There are about 250 visits per day. If every one of those visits paid £2, then, in 2 days we would be able to get another doctor trained on blue lights. In a week, I could have him equipped and ready to go. If you pay more, it will happen sooner.

This is a legitimate request. We are a Registered Charity (look us up on the Charities Commission website - http://www.charity-commission.gov.uk/, Number 1002819). Your payment is securely sent direct to the Charity's bank - I will have no individual access to any funds coming in. I will keep you informed of how much is being raised.

For my part, please watch this space, as I will be telling you about some exciting ways in which I will be trying to raise some more money for BASICS-London.

Thank you

RapidResponseDoc

Annual Leave

2010-03-16T08:28:00.003Z

Another week off this week, so that I can use up all the remaining holiday before March 31st. So, what do I have planned? A trip to Costco, paint the toilet (the bathroom, for my trans-atlantic readers), daily visits to the gym. Not going to the hospital, not worrying about the Department, is a holiday all on its own.

So, just getting ready for my first trip to the gym this week, having spent FAR too much at Costco, and having looked at the walls and deciding that the preparation will, as usual, be far worse that the painting; guess what? "Can you attend an elderly lady, who has fallen off a ladder?"...

He sits there, on the front step, pulling his dog to him, in an embrace that is born from fear. She lies on the ground in front of him, not moving. The three of us work silently, securing her cervical spine, getting intravenous access, assessing for injury, and moving her from the ground where she lies to the back of the ambulance. He watches every move, his gaze a mute plea to save his wife of 49 years, his wife who was well enough to climb a ladder to clean the upstairs windows, yet not lucky enough for the ladder to not slip on the wet grass. Her stillness, her silence, tells him more than I do, later, after I have seen her CT scan.

Back at home, forgoing the gym for today (tomorrow, definitely tomorrow!), I look once again at the toilet walls, and start the grim task of stripping the old wallpaper.

The Book Sale

2010-03-10T23:22:00.001Z

They come knocking on our door, in ones and twos, laden with bags or boxes of books to add to the growing pile. Mrs RRD bustles around them, proffering tea and biscuits, as they search for a literary gem, for a much loved author. The questions: "Who brought this fab book?" "How much for this one?" The chat, about the kids, about school, about ailments, about BASICS. And then they leave, carrying with them treasures for an evening soaking in the bath, for a train or plane journey, or to shade their eyes from the sun on the beach this Summer.

All of them are here to support our charity. All of them give generously, both of books they no longer want, and for books that they have found.

Thank you to all of you, but especially, and as always, to Mrs RRD, for caring so much.

Good News!!

2010-03-09T19:52:00.002Z

I feel good tonight! I just wanted to share something with you all:

About a month ago I went out to a man hit by a taxi cab. Unsurprisingly, he wasn't in a good way. I tubed and ventilated him and transported him to my hospital. A little later that evening he was transferred to a cardiothoracic centre for major aortic surgery. I didn't expect he would survive, and indeed, I didn't hear anything positive from the hospital, just that he needed more surgery.

Fade to this evening:

I am standing in A&E, coat on, just about to leave to go home. BlarneyNurse walks up to me. He stops, and points his pen at me. I wait, patiently. "Someone's looking for you," he mutters. I wait, patiently. "Cubicle 2," he eventually says, and wanders off.

I pop off my coat and go and see who wants me. A family member? A barely recognised friend, who wants to jump the queue? No, not this time.

Lying there in Cubicle 2, smiling up at me, is the man from the taxi. (Well, from under the taxi, but you get my drift.) He looks well, considering. He and his wife have been asking after me. They are in because one of his stitches needs removing.

We chat, the three of us. She tells me about the agonising wait outside Theatre, repeated only a few days later. He tells me about waking up in ITU, 2 weeks of his life just ... gone.

Then they both tell me about their family; how their 8-year old and 10-year old want to thank me for making sure they still had a Daddy.

I take out his stitch, wish them both well, and float home.

Musings

2010-03-07T00:46:00.004Z

I could have got there in less than 25 minutes. Maybe 20. Less than that, if there wasn't too much traffic.

Mrs RRD and the Micro RRDs could have got themselves home from the restaurant. I know it was cold, but they could have got a taxi - we were only a few minutes from home. It wouldn't have cost much.

I had eaten well at lunch, and had had the starters tonight, before the call came in. I wouldn't have suffered unduly, had I skipped out of the main course that was on its way from the kitchen.

True, it might have been difficult getting Mini RRD and Princess RRD back from their party, but I'm sure I would have been back well before then.

The caller said the patient was unconscious - he could have benefitted from my presence.

But I still said no.

I have a right to a life, to some 'time out' with my family. What I do is voluntary, and I need to be able to choose. My family also have a right to be with me. The Micro RRDs need me, need to spend time with me. Mrs RRD is always so long-suffering, always understands when I rush off. Yet, she'd much rather me stay, and she, too, deserves some time off from coping with the difficulties that my BASICS volunteering causes. And, there are plenty of times when I rush off, only to find that the call was not as given, and I wasn't needed after all.

But I still feel guilty.

Hello Down There!!

2010-03-03T23:03:00.004Z

Something a bit different today:

I am on my Rounds in the hospital when my 'phone buzzes in my pocket, I excuse myself from the patient and his family, and answer the "Unknown Caller". Surprise, surprise, it is Control. Can I attend a chap who is trapped in a hole? I decide that Rounds will have to go on without me, and I rush into A&E to see if anyone wants to join me on my trip.

Beardy jumps up, as usual, then looks around in dismay at the department devoid of junior docs - they have all gone to teaching, and he is one of the few docs left to man the Shop Floor. Sadly, he gives up the opportunity, and Ginger chases after me, hotly pursued by two nurses - that's a first for him!!

We all bundle into the car and I program the Sat Nav. Ginger, a new Medical Student, is looking rather bemused - he's not quite sure what's going on yet!! Fasten your seatbelt, Ginger, we're going for a ride!

We turn up at the address -it's 2 doors away from Princess RRD's friend, so I know I'm going to be quizzed big-time by her when I get home. I jump out and hand bits of equipment to my rather green- looking passengers.

The scene is a simple one; builders putting up extension, man digging deep hole for foundation, walls of hole collapse while he is in it, man trapped by clay up to mid-thigh.

First difficulty - none of my passengers have ppe (personal protective equipment), so none of them are going to be coming anywhere near this hole. They don't look happy about this, and go and sulk in the back of a fire truck to keep warm.

Second difficulty - there is very little access to Johnny, the man in the hole. There is a large piece of hardboard that he has been using to shore up the sides - rather unsuccessfully, as it happens - in front of him, and a fence behind him. He is well and truly stuck. Fortunately, he is standing upright, and is fully conscious. Unfortunately, the clay is beginning to set.

You may at this stage be wondering why I had been called. Well, to be honest, so am I. I know that there are dangers associated with crush injury, especially when the blood supply to a limb is cut off. Toxins build up in the affected limb, then, when the pressure is released and the blood is able to flow again the toxins rush around the body, and can cause circulatory collapse. It might happen, but I am unconvinced. Still, if I complain about not being called when I am needed (which I do on a regular basis) I can hardly complain when I am called.

So, I stand around for an hour or so while Johnny digs himself out. Yes, you heard that correctly. There was no room for anyone else down the hole, so the fire crew lower empty buckets down to johnny, who fills the buckets up with lumps of clay that he has dug out with his bare hands. There really is no other way we can help him, despite the three hundred and fifty seven different suggestions offered by the attending fire crew.

Eventually, he has removed enough clay from around his legs to be free. He is lifted out of the hole, placed on a spinal board, and carried out of the area, to the waiting ambulance. I remember my three passengers, and they join me on the back of the rig, as I cut up his trouser legs, and find cold legs, with no injuries.

"You've got away without any injury," I tell Johnny. He asks me about his shoulder, and I see a hugely deformed fractured collar bone. "This hurts a bit," he says. I think about how he has been able to dig himself out of a hole with a fractured collar bone, and decide that he's a braver man than I will ever be.

RVP Part 2

2010-02-28T00:04:00.002Z

To recap, I have just arrived at an RVP for a 17 year old who has been stabbed multiple times. Why an RVP? Well, the police go in to the scene first, ensuring that it is safe for the ambulance crews to enter and treat the patient. It may take a few minutes to clear the way, but ambulance and prehospital docs need to keep ourselves as safe as possible.

So, this RVP is mighty close to the scene itself. I can see about 5 or 6 police cars, two police vans, and both an ambulance and a rapid response car. There also appears to be a small riot! A large crowd of civilians are being held back by the police, including 2 very menacing-looking dogs. The bottles being thrown at the police look equally menacing, and the shouts from both sides do nothing to inspire confidence in my safety. Apparently, the crowd are angry because we, the health care professionals won't go in, and the police have entered first. Go figure!! A scenario, where I walk calmly up to the henchman, pull him close by the collar of his jacket, and ask him if he wants to quit fannying around so that we can attend his friend, flashes through my mind. Then I remember - I'm a coward, and I wait patiently to be escorted quickly through to the front door of a small house.

Here's another break from my run-of-the-mill road traffic accidents (collisions - we aren't supposed to use the 'A' word any more) which always unnerves me. I enter someone's house, and there, alongside their possessions, their items of daily life, is blood, pain and chaos. This strange juxtaposition always puts me off-kilter for a few moments, while I do my best to re-focus.

I can't get near him - he is surrounded by his friends. They hold him close, and I can't yet tell if he is even alive. They part for me, without a word, and he turns towards me. Alive, then.

Stabbings, penetrating trauma, are a very special type of injury, with their own rules for management on scene. The phrase 'scoop and run' was made for stab wounds. There is little to do on scene. The longer you 'stay and play', the more likely, if there is any serious internal injury, for the patient to suddenly lose blood pressure and die. There is only one possible intervention that might be required on scene, and that is a thoracotomy.

If someone is stabbed in the chest, there is a possibility that the blade has penetrated the heart. If that happens, the heart itself will bleed. The heart is enclosed in a sac, rather like a plastic bag. If the sac fills with blood, then the heart is compressed and cannot pump blood around the body, and the poor unfortunate will die. Unless, that is, there is someone brave enough to take a pair of scissors, cut through the chest wall between the ribs, from one side of the chest to the other, cutting through the breastbone as he goes, thus opening the chest - a thoracotomy. From there, with heart and lungs exposed, he can cut open the sac, thereby releasing the pressure on the heart. That's why I've been called.

At this moment in time, Jamie is very much alive, but he does have three stab wounds to the left side of his chest, right about where his heart is. If one of those has nicked his heart he could be bleeding into the sac right now, and any moment might stop breathing and collapse. Now you can see why we don't hang around. I have done 2 pre-hospital thoracotomies in the past, and they are not pleasant experiences.

Right, a quick needle into a vein, just in case, and we lift Jamie on to a carry chair and take him out into the early morning air. On the back of the ambulance, we lie him down and I make a quick assessment. He has slightly reduced breath sounds on the left, so his lung is probably damaged, but he is still getting normal amounts of oxygen into his bloodstream. We need to go, and now!!

I decide that we need to go to a cardiothoracic centre. The nearest is 25 minutes away - not a nice thought for me. I get ready my scalpel and scissors, just in case.

We then have an agonising 10 minute wait while the police move enough of their vehicles out of our way, so that we can start our journey. I see the seconds ticking away, and urge them to hurry.

Jamie looks up at me. "I'm scared," he whispers, the fear so evident on his pale face. And then it hits me. He's 17 years old. This kid, lying in the doorway between life and death, is the same age as MiniRRD. My own son could be lying here! Suddenly, I am overwhelmed with the knowledge of just how young my patient was, so young, and yet old enough to have been in a situation where he could be stabbed three times in the chest!

I know that there is nothing more I can do for him, that whether he lives or dies depends solely on the path of the knives that penetrated him. No, that isn't quite true. I sit close to him, and place my hand on his shoulder. "You are going to be fine," I tell him, and we stay like that, as the ambulance races through the streets of London to his future.

RVP

2010-02-27T08:13:00.004Z

"The RVP for the job is at the corner of ... and ...," Control tell me, at 3am this morning. Oh, how I hate these jobs. Mrs RRD murmurs sleepily for me to be careful as I go. I don't tell her what I am off to - I know how much she worries, just about me travelling to an RTA. If she knew I was on my way to an RVP (rendezvous point, the place the ambulance service meet while police clear the scene of the evil-doers), she wouldn't get back to sleep at all.

Being shot in the chest isn't a recipe for a long and happy life. Three times with a shotgun, and you are probably rolling fate's loaded dice. That's what Control have woken me with. These are the jobs I dread.

As I am getting in my car, there is an update: a 16 year old, stabbed in the chest three times: the RVP has moved a little closer to the scene, and I am asked for my ETA. I know this place well. I am only about 3 minutes away.

I can hear the RVP long before I can see it. Sirens blare, and yet, even above that noise, I can hear the sounds of shouts, of voices raised in anger, of dogs barking. Oh, how I hate RVP's

...to be continued...

Donation

2010-02-27T00:12:00.002Z

Someone has just given a whopping donation to BASICS-London!! And I mean whopping!! Apparently, they were involved in an accident, and the insurance has just paid up. All I can say is, "Thank you." You know who you are, and I and my BASICS-London team are so very grateful to you. Love Ya!!

Stalker

2010-02-25T09:49:00.002Z

Ok, this is getting ridiculous!! I'm driving to an RTC on the M25, getting totally stuck between the fast and middle lane, trying to get the cars to part, a la Moses and the Red Sea. Im thinking to myself that I need to get over to the hard shoulder, but finding the traffic too tight to get there. I hear sirens behind me, and look over to my left to see GassPasser2 passing me on the hard shoulder! What!!! Where the heck did he come from?? Is he following me? Listening in to my 'phone calls??

3 minutes later and I arrive at the scene of the RTC, and assist GP2 to get a fairly well man out of his car, after he had lost control and hit the central reservation. No intubation needed, just an extra pair of hands (x2!!)

GP2 and I chat about the increased call rate that we have both noticed over the past few weeks, and wonder if has anything to do with the fact that we have both got very shirty on the phone to Control when they have not called us for jobs we were needed at. Then we notice that a) it is night time, b) it's freezing cold and c) it's pouring with rain, and we get into our respective cars and drive home. See you soon, no doubt!!

MrsRRD Speaks

2010-02-20T00:12:00.002Z

I've never done this before. Tonight, Constant Reader, I hand my blog over to a guest writer. It is my pleasure to bring you my greatest fan, as she tells you about my second encounter today with GasPasser2. So, without further ado, I give you, Mrs RRD:

Today I had a rare treat; in fact to be honest it was a privilege. I was on my way home with RRD after a rare trip out together, without the RRDettes! His phone rang, not unusual in itself, but it is a colleague BASICS Doc, en route to a call, in far away town. A couple of trapped and unconscious patients, too many for him to deal with alone, can RRD assist? RRD calls into ambulance control, tells them he will run on the call & finds out more details. Car versus lorry, 2 people trapped & unconscious plus one other patient, Air Ambulance on scene, but no Doctor onboard.

We head for the motorway; heavy traffic greets us early on & I witness first hand the difficulties in getting through: the drivers who seem oblivious to the ‘heat seeking missile’ fast approaching in their rear view mirrors, lights & sirens blazing. The lorries, that move swiftly out the way, despite their size. As the cars part, I think of Moses parting the Red Sea! RRD heads for the hard shoulder and we cruise down steadily, through the dirt & rubbish on the road. Our passage blocked by stationary cars, we weave out into the clogged lanes. Finally we get through to our junction. We leave the motorway & speed up, soon we’re approaching a Police road block. We, unlike the other vehicles, get waved through. The roads are eerily quiet now; we approach another junction, another roadblock, another wave. Suddenly the road is filled with flashing lights, blue & red, there is a stillness I don’t expect.

RRD slows to a stop, a little way behind the helicopter, and we get out. I am handed the camera, for the BASICS–London website; to capture the scenes, the faces, to tell the story. He gets into the obligatory orange jumpsuit, grabs his heavy bag, his monitor and his helmet. He leaves my side and strides quickly forward, approaching the scene.

What lies ahead of him is a line of 2 fire tenders, two “ambos” and a crowd of uniformed personnel. Beyond, a car, the roof already pealed back, like a tin can, full of people, working together to extricate a victim.

I am suddenly struck by the collaboration of these professionals. So calm, so organised, no shouting, no running about, they all work as one. The teams don’t all know each other, nor do they usually all work together, but here they are, striving for one purpose. There are clearly those in lead roles, taking quiet control, guiding and overseeing, but everyone else is an integral part of an efficient team.

Suddenly the patient is removed from the car, clearly the most seriously injured of the three. She is smoothly & quickly transferred to a trolley where a cluster of emergency medics, paramedics, EMT’s, the helicopter crew & our two BASICS Docs all gather around, taking their part in saving this woman’s life.

We are so fortunate that we have such amazing emergency services; they are such an incredible group of dedicated and hard working people. So committed to supporting us all at our worst and most vulnerable.

I felt truly privileged to witness this today, so grateful to them all and those like them and so appreciative of their care.

Thank you all.

So, We Meet At Last!!

2010-02-19T16:02:00.003Z

I'm on annual leave at the moment. It's really quite enjoyable, not having to go in to work. Today is my second day, and I spent the greater part of yesterday on the 'phone to the Department, sorting out this and that. So, today is a day to spend with the family, but not until much later in the morning, after a proper night's sleep.

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!!

Danger in the Classroom

2010-02-16T22:29:00.003Z

This is just awful. I stand there, wondering how I had got myself into this situation. Only days before I had been dealing with Danny, a 5-year-old, crushed by a car in his own playground, and now I have to deal with 60 five-year-old's, all at once. I look around at them all, sitting there in front of me. I feel so uncomfortable, my jump-suit seems so tight, and I find it hard to draw a breath.

Dammit! This is what I do. I have to focus!

"Hello, children," I start. "My name is David, and I'm a doctor. I've come to your classroom today to tell you about what it's like to be a doctor." Hey, this is going ok, I can do this.

One little boy puts his hand up. "I've seen a dead person. My granny died at home and I saw her. Have you seen a dead person?" Ah, didn't take long to get on to dead people, then. I quickly skirt the subject, and show them my stethoscope. I get a few up to listen to my heartbeat, thinking that might be fun. Another hand shoots up. "Do you make dead people better, too?" Now what? I look across at MrsRRD for some guidance, but for once she is not any help at all - she is trying hard not to laugh, and the effort is bringing tears to her eyes.

I plug gamely on: "No, once someone is dead, I cannot help them, but I can stop some people from being dead." Shaky ground, this. Why, oh why, did I agree to come here? Surely a policeman is more fun for 5 year olds. And suddenly it hits me. "Who wants to come and turn the sirens on in my car?" I ask. I am quickly surrounded, and we march off into the rain (hats and coats first) and they each press the buttons for the lights and sirens, using up the last of my 20 minutes, allowing me to escape with no more tales of dead grannies.

Back in the car, I turn to MrsRRD. "Never again!" I exclaim. "No," she says softly. "Not after the next three schools I've booked you in for."

Danger in the Playground

2010-02-11T15:29:00.003Z

"5! He's only 5!" my mind screams at me, as I drive to my latest call - a young child pinned between a wall and the bumper of a car. For those of you not regular readers of this blog, children are my one fear in pre-hospital care. They are remarkably difficult to assess, wherever you are, and this becomes even worse without all the usual diagnostic equipment found in an A&E Department. Also, injured children decompensate very rapidly. One minute they may look fine, the next they may have no blood pressure or pulse. Add to that the emotional aspect of dealing with a young child, and you have a recipe for severe anxiety.

I arrive at the school, and rush into the playground with my kit, my paediatric bag as well as my monitor. I have to keep focused, despite the urge to run back to my car and hide somewhere.

He's lying on the ground. The car has been moved back a little, and there is just enough room for me to crouch down beside his tiny frame. He looks up at me. "It hurts," he cries. Well, that's a good start!

A quick check, and it is clear that he has a fractured thigh bone, but is, fortunately, conscious and talking. But I am well aware that a little one such as Danny here can bleed out into his thigh, and, as I said at the beginning of the post, their condition can deteriorate at an alarming rate. First things first, I need to cannulate him, so that I can get some fluid into his veins. If I wait much longer, the veins will all shut down and be harder to see than they are now. He's shivering - not just from the cold but also as a sign of blood loss. Come on, RRD, calm it!!

I let Danny and his mother know what I am planning - he is crying, but I don't think he noticed as the needle went into his arm. Damn!! Whilst I am able to get the needle to puncture the vein, it won't thread through. The vein is just too small. I know what needs to happen, and I am less than happy.

In a child, if a vein is not immediately accessible and fluid or intravenous drugs are needed in an emergency, the quickest way to the circulation is via a needle inserted into the shin bone. Yes folks, you read that right. It is called an intra-osseous needle, and it is as nasty as it sounds. I have put lots of them in in my time, but all on unconscious or arrested kids. And it is looking like I am going to have to do my first one on an awake child in the next couple of minutes. My mind goes back many, many years, to when I was a junior doctor, fresh out of Medical School. Her name was Fiona, and she was 2 years old. She looked alright when I first saw her, but, only 45 minutes later, I was helping to resuscitate her. And all because the doctors looking after her wouldn't admit defeat when they were looking for a vein, and wouldn't put an intraosseous needle in early enough. Not this time...

I know the score; 2 attempts at cannulation, then intraosseous. I have one more to go. I take a deep breath, turn to the other arm. Nothing at the elbow. One tiny thread on the back of the hand. I reach for a yellow venflon - tiny and short. My hand steadies. I look at Danny's little face, then back to the task in hand. The venflon slides effortlessly through the skin. I feel a barely perceptible pop as it pierces the vein. A tiny bead of blood appears in the venflon. I slide the assembly forward, so that the plastic tubing over the needle is in the vein. Pulling back the needle, I watch as the blood flows gently through the venflon. Success!!

I've only been on scene for a few minutes. I secure the venflon to Danny's hand (certainly don't want this one falling out) and attach a bag of saline to it. Next, we turn to splinting his leg and carefully we get him on to the ambulance trolley.

Double damn!! I watch in horror as Danny's skin goes deathly pale, as he fades out of consciousness. I reach up and squeeze the saline bag, forcing the fluid in as fast as I can. There's more than just a fractured thigh bone here. I suspect that his pelvis may have been injured, so we cut away his clothing from his abdomen and legs. Oh 5h1t!! He has a 5cm wound on his lower left abdomen, deep and bleeding. He now looks as though he has multiple injuries, and we haven't a moment to lose. We pass a sheet under his buttocks, and tie it across the front of his pelvis, tight, to splint a possible pelvic fracture, and stop any further bleeding. Straight on to the ambulance, and we are off to hospital. En route, I somehow manage to get another line in, despite the fact that we are bumping along a motorway - can't do it while we are stationary, but able to at 65 miles an hour!

By the time we arrive at the hospital, Danny is talking to us again. He has had half a litre of fluid, and this seems to have perked him up. He's out of the woods for the moment, but he's got a way to go before he's going to be on his feet again.

A few hours later I give the hospital a call. He's in Theatre, having his spleen removed and the wound to his abdomen debrided (cleaned up). I say a silent prayer for him, and get ready to go home for the inevitable kid-hugging session.

Please

2010-01-28T22:33:00.004Z

Tomorrow, MiniRRD turns 17. Tomorrow he becomes another one of those legally able to get behind the wheel of a car. He is desperate (BOY is he desperate!!) to start driving. Mrs RRD and I have heard little else from him in the past few weeks. He's not starting just yet; he needs some cash first, but this is, even so, a special milestone in his life.

Understandably, my thoughts turn to the youngsters who thought they could drive, who drove fast to impress their friends, who couldn't say no to just one more drink before we go home, to the 17 and 18 year olds whose families now spend each and every birthday grieving for their son or daughter, and so I send a plea to you, MiniRRD:

Remember, Son, that nothing is more precious than life, and no-one is more precious to me than you, your brothers, your sister and Mrs RRD.

Remember that you are not invincible.

Remember that it only takes a second, so take a minute, just to be safe.

Remember that it might not be you who can't drive, but that there are many out there who shouldn't be on the road - watch out for them, because they won't be watching out for you.

And remember, we all love you, and want you to stay safe, always.

Have a fab birthday tomorrow.

Help!

2010-01-27T22:47:00.002Z

Why is it always between 2 and 4am? Why is it always raining? Why didn't MrsRRD and I go to bed early, rather than staying up to watch ANOTHER episode of "Modern Family?" These three questions run through my head as I jump out my car and rush towards the car wreck. At least the rain is waking me up, clearing my head, and making everything crystal clear in my mind.

The car has come off the road and struck a railway siding. There is just one occupant, and she looks at me as I squeeze my way between the burly fire crew, all intent on cutting away the metal that is trapping her. She is conscious, complaining of pain in her right shoulder. At least that means we have some time - her airway is intact, and her breathing and circulation, at least for now. I am, however, concerned that the shoulder is not all that far from the chest, and so there could easily be associated lung injury, that may make itself apparent only if we watch carefully for it. The saturation probe, placed on a finger and used to measure the amount of oxygen getting into the bloodstream, is pretty useless in a cold patient, where the arteries in the peripheries are closed down. So, we'll just have to use our eyes instead. We'll watch her conscious state, her respiratory rate and her colour. Much more preferable (but it is nice to hear the reassuring "beep beep" as well.) I ask her some questions, mainly to assess her conscious level, rather than for the answers. She tells me her name is Sam, and that she doesn't remember the accident. "Where were you going?" I ask. She replies, "Just out for a drive." Hmm, a bit late for a drive, but, there's nowt queer as folk.

She remains stable, as we prepare to lift her out of the car, along a spinal board placed behind her back. I am very careful as I hold her right arm to her side, to minimise any movement of her shoulder, but she still cries out in pain.

Out of the car, and on the ambulance trolley, she shivers from the cold, and we quickly roll her into the back of the ambulance, so that I can assess her better. I need to see her chest wall, to check for rib injuries and to ensure the movements on both sides are equal. I reach for the shears, asking half-jokingly if the jumper she is wearing is one of her favourites. Fortunately for her it isn't. I begin to cut the jumper, starting at the bottom.

Oh.

A criss-cross patchwork of scars is revealed as I expose her abdomen. All old, and none of them surgical. I glance at her left forearm - the pattern is repeated here, some newer than others. I look at Sam's face, and her eyes stare back at me, the fear and the guilt so evident. And, suddenly, it all makes sense.

I know

2010-01-18T20:33:00.004Z

I know what happens to you. I've seen it. I know what you look like when you drive too fast and hit another car, or spin out of control into the central reservation. I know what happens when you get hit by a bottle, or get stabbed in the chest. I've cut you out of car wrecks, watched you fall from a second floor window. I've cannulated you, I've tubed you, I've even opened your chest and held your barely-beating heart in my hand. I've saved your life, and I've watched you die. You are my patients, and while you owe your life to me, I owe mine to you.

Circle

2010-01-15T23:48:00.003Z

They stand there, the three of them, holding hands, a family circle so much smaller today, because of the one who lies only a few yards away, and yet who is unreachable. They call out, beg, plead for her life to be saved, but I know, as I walk out of the resuscitation room towards them, that this is one prayer that will not be answered.

No!

2010-01-11T00:16:00.002Z

3am, I am woken from troubled sleep by Control. Can I attend FarAwayPark, where a man has been sledging (at 3 am!!!???) and has hit a tree. Massive head injury, CPR in progress? My muggy brain starts doing the Math - 2-3 minutes to get up and dressed, 5 minutes to dig my car out of the ice, 3 minutes to get to the end of my icerink of a street, another 20 - 25 minutes to get to the entrance of FarAwayPark (maybe longer in this weather), and a final 3-4 minutes to get from my car to the patient, without going a over t in the snow. That all adds up to - No!

Weather Report

2010-01-04T20:55:00.002Z

I'm at work in the hospital. Nice and cosy, not too much in the box. I am suturing up a thumb when my 'phone rings. Not much I can do at this stage, but I am on the last stitch, so I cut the thread and, stripping off my gloves, reach for the 'phone when it starts its insistant ringing for the second time. Can I attend a call on the M25? No probs, I leave the cleaning up to my junior and head on out to the car.

The wind hits me as I leave the relative comfort of the A&E. Blinking heck, but it's cold!! I throw on jumpsuit and boots (steel toe caps an essential for M25) and start the engine. As I speed out I depress the lever to spray windscreen wash over my front windscreen. Big mistake. I now have a thin sheet of ice barring all but the tiniest view of the road ahead. I glance at my outside thermometer gauge - -2.5 degrees centigrade! I hit the wipers and they quickly clear enough of a hole in the ice for me to start rolling.

The journey is uneventful, and I reach the scene in record time.

The car is on its side, the driver buried beneath a mound of groceries. He had clearly been shopping, and the bags had had as much of a tumble as the car rolled over and over as he had.

We are all standing around as the fire crew dig him out of loaves of bread, milk cartons and bags of pasta. He isn't badly injured, so the fire crew are taking things steady.

Only one problem - it's blinking cold out here!! We are all shuffling around, trying to keep warm, and yet he is stuck, immobilised both by the fireman at his head and the tins of peaches, the crumpets (oh how good they would be right now, toasted, with a smidge of strawberry jam!) and the root vegetables that surround him.

Eventually he is freed, and we slip him gracefully out on to a spinal board.

"Where to?" I ask the crew. The hospital isn't mine and the patient is only suffering from the cold, so I leave them to it, jump into my car and turn the heater on full blast.

Back at my A&E Department, I decide that my boots are staying on - far to cold to change in the car park.

Double - Not Quite

2009-12-29T12:42:00.006Z

"He's up here," calls one young police officer to me, as I enter the house. The night sky is bright with blue flashing lights, my own amongst them. "Mind the glass as you go."

I gingerly ascend the stairs of the tiny house, wondering just what I will find. The window on the landing is broken; glass is strewn across the stairs. Just because it's in a house doesn't mean I shouldn't wear my steel-soled shoes. Oh well, I'll just have to be extra careful this time.

Three ploice officers point me wordlessly towards a closed door. I push against it, only to hear a grunt from the man behind the door. It's a paramedic, who swiftly moves out of my way to let me enter. I wish he hadn't.

It's a bedroom. There are pictures on the wall; family in various poses, holidays around the world; memories of better times. It's not a big room, and the double bed, dresser and large oak chest of drawers seem out of place.

He is lying on the floor. Blood is everywhere. The bed is soaked in it, and large clots lie on the bedspread and the pillows. The carpet is saturated with it. He, on the other hand, is pale, almost translucent. There are multiple lacerations and stab wounds, on his face, his head, his neck and torso. It is difficult to get into the bedroom because he is lying across the entrance.

I slide around the partially opened door, trying hard not to tread on the body. Yes, body. This man is clearly no longer alive. And yet, until we, the medically trained personnel in the room say so, he is legally. Until I check the monitor, see the straight line, confirm that there is no life present (passing a tube into his windpipe while all this is going on), until I utter the words, "Let's call it. Time of death...", he is still alive.

All of this has happened in the few minutes I have been on scene, and yet I am exhausted, mentally shattered. What started off as a pleasant evening at the in-laws, turns into a frantic, futile effort, while kneeling in the life-blood that should still be running through his veins.

I make my slow, careful way down the stairs, carrying my bag and monitor, and I wonder what had happened.

Outside the house, I am chatting to a police seargeant. He wants my shoes, as evidence. Fine; I'll wear the boots I should have donned before going in to the house. He wants my bag and monitor as evidence, too. I argue with him. Without them I am off-line, and I know it will be weeks, if not months, before they are returned.

As we talk, I am aware of another man being questioned by another officer. The cuffs go on, and I look a little more closely at him, wondering what might have led him to commit the act, the results of which I had witnessed upstairs.

Suddenly, there is a flurry of activity: two police officers run to their car and drive off in a flash of blue lights. Moments later, their sirens pierce the night. The seargeant's radio crackles into life, and he excuses himself for a moment - life goes on.

He rushes back to me. "We've got another one, and she's alive!" I find out where it is, and rush to my car. I turn, and ask, "Is the ambulance crew coming with?" He shakes his head, and explains that, if the same crew attended both scenes, it would definitely muck up the evidence. Oh, great!! Now I have no idea when I will get backup.

As I am driving the very short distance to where my next patient lay, I contacted the Ambulance Service, just to be sure that they knew where I was going - they didn't. A good phone call to make.

The second scene is as awash with police as the first. I am directed to behind a restaurant, where there is a small, walled off area for preparing meat. She had been stabbed multiple times, and struck on the head with what looks like a baseball bat, left lying in the corner of the room, matted with blood and hair.

She is lying in another corner, on her side, facing away from me. Only the faintest rise and fall of her chest suggests that she was still alive. There was blood everywhere: I was standing in pools of it, there were splashes up the walls, and on every surface of the "kitchen".

I move carefully towards her, trying not to slip, nor to gag on the stench of blood. This is unlike anything I had seen before. How could she still be alive, having lost so much blood?

I reach her, and put my gloved hand on her skin - it is icy cold, deathly. I realise that the cold is what has probably saved her life, and I am determined that my actions will continue that trend. With the help of some very green-faced police, we move her in to the centre of the room, and I begin to assess her. She is, surprisingly, conscious, but only just, and has good air entry on both sides of her chest. I cannot feel a pulse.

She has multiple stab wounds, but none of them are bleeding. I am unsurprised at this: she has no blood pressure to pump any more out. Perversely, I don't want to raise her blood pressure at all out here - if I do, she will start bleeding again, and probably die at my feet. She needs a hospital, and now!! I get the police to radio through to Control, and tell them we need transport immediately. I keep looking for a vein while I wait - there is nothing, not even in her groin, where the usually drainpipe-sized femoral vein has collapsed to nothing.

The ambulance arrives, we load and go. This is a journey I won't forget!!! The speed of the driver made me look up in surprise, expecting, perhaps, Jenson Button to have taken up a new career after getting his MBE. But no, it's just Tim, as anxious to get this lady to hospital as me.

As we drive, and the temperature in the back rises, she begins to bleed, and I get Tim to turn off the heating and open all the windows. We might just make it!!

A very short time later, we arrive, and hand over to the waiting team.

My drive back to my family is a sober one, with visions of blood-splattered walls, and of the evil that men do.

Flowers

2009-11-19T13:34:00.006Z

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.