The Tree

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

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

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.

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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

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

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!!