Tag Archives: Helicopter

Green cross code

The morning had been a busy one.

We’d attended a lady who’d fallen out of bed, was uninjured so we helped her up, checked her over and left her to her breakfast, we’d taken a 57 year old man with chest pain to hospital with a possible heart attack, and rushed a 60 year old man to hospital who was having a bleed on the brain – what we like to call ‘big sick’! 

We were almost back to our station for a much needed restock and cup of tea when we received another call. 

It came through as a road name in the next city. No house number, just a road name. Usually that means someone has fallen in the street, or there’s been a car crash. 

We received a message which said: “14 year old hit by car – unconscious, massive head injury”

Shit! Pedal to the floor and off we go. My colleague driving as I don my hi-vis jacket and think about how I might treat the patient depending on what we’re presented with. 

We receive another message:

“Ambulanc officer is on scene, he states the patient is GCS5 (which means barely conscious!) and has requested priority 1 backup and the air ambulance as a priority.”

Double shit!

We arrive shortly after to exactly the sort of thing you’d expect to see at an incident like this. An ambulance officer’s car straddling the road, a pickup truck parked awkwardly at the curb, a man sat beside it in tears while members of the public console him, a police car screeching to a halt to block traffic and a lifeless child led in the road with a stream of blood trickling down the Tarmac, our officer colleague at her side rapidly assessing her. 

The clinical handover was brief, it didn’t need to be complicated, we could all see what had happened and all knew what we needed to do. 

Her level of consciousness raised after some oxygen. She was in pain and distressed. 

“Quick ABC; airway clear. Breathing adequately and chest clear on auscultation, radial pulses present, she’s tachycardic (fast heart rate) and pale. Let’s get some IV access and get her off the floor.” 

Another paramedic arrives in a car to assist. I look up and see several more police cars now on scene interviewing witnesses. The patient’s mum arrives in a frenzy! Now we have 2 to look after, the paramedic who’d just arrived set to reassuring mum that we were working hard to save her daughter.

With some volunteers holding up a blanket to make a screen for some dignity, we cut her clothes off to assess her fully. She had a large head wound that we had pressure on, a presumed neck injury, large abrasions on her back and shoulders where she’d rolled down the road like a rag doll. She had wounds to her lower legs but as far as we could tell, no broken bones. We gave her some pain relief, a drip, some anti-sickness medicine as she’d vomited profusely (another concerning sign of head/brain injury). She was a little more ‘with it’ now. The helicopter had landed at a nearby school as the road was too narrow for them to safely land. A police car sped off to collect them. A HEMS paramedic and critical care paramedic arrived just as a critical care doctor arrived by road from another base. We told the story and it was agreed we would take her by road to the nearest children’s major trauma centre under blue lights with the doctor on board. 

We scooped her off the floor and onto our stretcher ready to load onto the ambulance. Another quick ABC check and we were ready to leave. The helicopter left having offered their opinions and assistance and we prepared to leave he scene. 

It was around 40 minutes to the trauma unit, with my crew mate driving and me in the back with the doctor and patient. She was fully immobilised and calmed by the pain killers we’d given via the IV. She vomited twice en-route meaning we had to roll her on the spinal stretcher she was on. Not easy with just two of you while doing 70mph through city streets, but this is the career I chose! 

We arrived to a resus room full of doctors, nurses, surgeons, orthopods, paediatric specialists and porters, around 18 people who would now take over her care. 

There was silence as the critical care doctor gave his handover. As soon as he’d finished, the trauma lead set everyone to work. 

Each was allocated a task from airway and breathing to assessing neurological function of her feet. Every inch rapidly assessed for defecit before whisking her away for a CT scan to see what was happening under the skin level.
Absolutely exhausting and emotionally draining, as dealing with children often can be. The police had driven mum to hospital, leaving us space to work in the back of our cramped ambulance. 

Hoping for a good outcome for her thanks to our interventions, we’ll probably never find out though. 

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Trauma trauma trauma.

It doesn’t take a genius to figure out that a large van travelling at 30mph making contact with a human male man is going to cause a considerable amount of damage. I can now confirm that it does.

We received an emergency as given above. When we got there, we found a typical RTC (Road Traffic Collision) scene; lots of bystanders, rubbernecking car drivers, a few stopped cars etc etc. This time there was one addition – an unconscious person led on the floor with a rather unhealthy amount of blood on the outside of his body

He was unconscious and his eyes were looking different ways (you don’t need to be medically trained to know that that is not a good sign!). 

He was breathing OK and his chest was a) in one piece with no dents or holes, and b) had good air movement throughout. 

We gave him some oxygen while fitting a hard collar around his neck to protect his spine in the likely event of a fracture. He then woke up, not fully, but enough to start shouting abuse and trying to punch and kick my crew mate and I.

Now occasionally with a head injury, comes something called Cerebral Agitation. This is when the brain has taken a pounding and reacts by causing the person to become violent, even when they could be the most peaceful, calm person normally. 

In this state, he was very difficult to manage. In an ideal world, we would fully immobilise him, fully assess him and convey him to A&E, however, it was taking 4 of us to hold this chap on the stretcher. We don’t normally restrain our patients, but if you feel in danger, or the patient is in danger of further injuring themselves, it’s ok to use reasonable force. 

We requested a Critical Care Doctor to come on the air ambulance and sedate the patient, purely for his safety. The good Doctor (and they are all very good doctors on the air ambulances) flew in and obliged. Once he was sedated, we could secure his airway by passing a tube into his lungs and breathing for him with a ventilator. 

We then had a good top-to-toe assessment for any broken bits, loaded him onto the chopper and they flew him to a major trauma centre. 

Major trauma like that doesn’t come along all that often, but when it does, it’s nice to know that you have additional clinical support where necessary. 

I’m not sure of the condition of the patient now – that’s one of the downsides of the job, you rarely get to find out a final outcome. 

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Today was my first experience of a serious burns patient. My only previous experience was a child who put his hands on an electric hob. Painful, but not life threatening. 

A young man at work was asked to burn some old wood in a large metal container. This young man decided that using petrol would be a good way to ignite the fire. When the match hit the fumes from the petrol, it created a fireball that engulfed our patient, catching his clothes on fire. 

He was immediately hosed by his colleagues as they called 999. 

We arrived to find him sat on a chair shivering and obviously in pain. We carry a special cooling gel dressing that is fantastic. We also use humble cling-film which stops any air getting to a burn and reduces the pain. We also had to check that he didn’t become hypothermic from the cold water, and wrapped him up in a blanket – counterintuitive, I know. 

A full assessment of his injuries showed about 16-18% burns with 5% partial-full thickness. His face, neck, chest and arms were badly burnt. His hair was singed back to level with his ears and he had also burnt his tongue. This was a problem, as it meant that the fire had potentially entered his airway. The result of this is swelling as fluid rushes to the area. As this happened, it would block his airway and he would asphyxiate. 

We were 25 minutes away from the nearest Emergency Department and 45 minutes from the nearest specialist burns centre as an emergency drive, so I called for the air ambulance to attend. 

They arrived swiftly and agreed that the 6 minute flight would be better for him in case he deteriorated. So off they went. 

A fast paced, potentially life changing/threatening job where we all did what we needed to do.

He’ll recover well as he has age on his side (he was only 20), but he will be left with some life long scarring. I got an update later in the day and he was transferred to a specialist burns unit for ‘plastics’ assessment. 

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