Tag Archives: Injury

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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Lucky!

Our first call last night came from the Fire and Rescue service. They’d received a call for an RTC (Road Traffic Collision) where a car has left the road and come to rest in a wood, with two patients involved, injuries unknown (we rarely receive information on what sort of injuries are involved).

It was fairly close and I got there in 6 minutes on blue lights. The sight we were met with sent shivers down my spine. In amongst some very large trees, about 20 meters away from the road and buried in the woods, was the remains of what used to be a 4 wheel drive performance car. When you see a car that is so badly smashed it’s barely recognisable, you immediately think of the patients involved and my crew mate and I simultaneously said out loud with dread, “they’re gunna be dead”.

The fire service had arrived moments before us and the station chief came up to us and said “Two patients, one male 20 years old an a female 21 years old”

I immediately thought of the waste of life and how on earth the parents of these KIDS would react when they were told of their deaths.

Only then, he pointed to the grass verge and said “They’re over there mate, just cuts and bruises I think”.

To say that we were relieved would be an understatement. We looked once more at the twisted metal that lay buried in the trees and could scarcely believe that anyone could walk away from that in one piece.

We thoroughly assessed them both and found nothing more than a few minor cuts from the broken glass and twigs. In fact, neither of them needed to be transported to hospital! 

The story went that the young male driver was doing 80+ mph, when the back end of the car stepped out on a corner. He over corrected and began to ‘fish-tail’ for over 100 meters until leaving the road, smashing through a dry stone wall and by some sheer miracle, avoided the biggest trees and came to rest against an Oak tree.

This isn’t the first time I’ve arrived to the scene of a crash, looked at the car and assumed a fatality, only to find a patient with minor injuries. Although conversely, I’ve arrived to minor bumps where people are critically injured. 

A police sergeant read the riot act to the young lad, telling him that in the last 2 months, he’s been to 2 RTC’s with 5 fatalities of  young people (I know of one of them – it’ll will go down in history as one of the worst crashes attended by my colleagues for the absolute horror they were met with), and he should take a good hard look at his driving style!

We were very thankful they were both alive and uninjured, it’s not a nice day at work when young people die.

The rest of the shift was fairly uneventful, just lots of tea and chatter. Just the way we like it 🙂

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“Safe to approach”…..

…said our dispatcher over the radio, after sending us an emergency where a patient is cutting his arms.

“Sorry control, repeat your last. Was that safe, or unsafe? Over.”

“Yes, yes safe to approach. Caller states that the patient is ‘not violent’. Over”.

“All received, ummm, what is he cutting himself with? Over.”

“A bread knife. Over”

“Yep, [callsign] requesting police attendance prior to us committing. Over”

A real conversation between our ambulance and our control. 

How could we possibly know that this man was not violent? On the say so of someone with him willing to say anything to get help? How could we possibly know that as soon as we walk into that house, he won’t turn the knife on us and cut my crew mate and I to ribbons. We don’t. 

There was a story in the news recently where a lone, female paramedic refused to enter a property where a 999 call had been placed, as it was a known drug den, the patient had taken drug overdose and she could hear angry shouting and arguing inside. Comments made by the public were most unsavoury about our colleague of another trust, as the patient subsequently died after backup took a while to arrive. 

Ask yourself this question: You arrive, alone, at night to an address where the situation is unknown. You hear angry shouting. You’ve been told that there might be a knife (as in our scenario). Would you, as an unarmed medic, not equipped with pepper spray, a baton, or a stab vest, enter that house without backup?

The start of EVERY primary survey starts with ‘D’ for danger. Simple. If there is danger, do not proceed unless it can be made safe. 

*Hops off of soapbox* 

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Regulars and Regulars

There’s a problem faced by the ambulance service.

A problem faced everyday.

The problem of ‘Regulars’.

 

Regulars fall into two categories.

i) The genuine regular: These poor people have chronic conditions that, when they flair up, cannot usually be managed at home. Things like COPD (Chronic Obstructive Pulmonary Disease – a worsening breathing condition), angina or pain associated with cancer etc etc. Though we see these people often, they are for genuine conditions, so crews don’t mind dealing with them.

ii) The time-wasting regular: These people are a hideous drain on the services. Usually (but not always) alcoholics or dug users – yes I’m generalising but when you see these people almost every day, you see a pattern developing – who seem to get kicks from calling 999 and mentioning ‘magic words’ like, “chest pain”, or pretending to have Shortness of Breath.

When I used to take 999 calls in control, in one 12 hour period, we received 36  ‘999’ calls from ONE PERSON who’d claim they’d fallen 3,000 feet and hurt their leg!! Due to the litigious world we live in, these calls have to be triaged as with any other call and dealt with appropriately. It comes to the point where an agreement is made by the medical director, that this person (who has nothing wrong with them, by the way) will get one ambulance per day – ready for this? – just in case. It’s worth mentioning that this particular individual was ALWAYS abusive to ambulance crews and once threw faeces at them while they tried to help. Nice, eh?!

Sometimes, these people phone from a phone box, or pretend to be unconscious in the street, meaning a good samaritan calls 999 out of concern. As the phone number isn’t recognised, an ambulance is dispatched.

This leads me to my point: If you see an ambulance crew called to an ‘unconscious/drunk’ person in street. Don’t be too alarmed to the point of complaint if they look a little exasperated with the individual. It may be the 7th time they’ve seen, and been spat at by them, that day.

 

Apologies if this comes across a little ‘ranty’.

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The great pretender.

My overtime night shift last night was spent mainly dealing with students who’d had a little too much to drink.

“Goodness”, you may think, “on a Wednesday night??”

Well, yes. Sadly, this is becoming more and more normal for the ambulance service. What used to be reserved for Friday and Saturday nights, is now almost a 24/7 burden on the NHS frontline.

One of them got particularly ‘chopsy’ after his “mates” abandoned him drunk on the pavement in the  middle of the city. My crew mate and I, while being perfectly civil, reminded him quite sternly that he had gotten himself into this situation, and if he was grown up enough to go out and get drunk, then he was grown up enough to deal with the consequences and he would do so by showing respect to the healthcare staff that now had to treat him for nothing more than being drunk and unable to look after himself! (and breathe!)

We did consider calling the Police, but they’re busy enough as it is, and as he was unable to stand let alone walk, they wouldn’t want him in their cells in case he choked on his own vomit – a perfectly reasonable concern in my opinion.

The A&E were delighted to have their beds filling with people who’d had their first taste of a lager beer, a red wine or a spirit and gotten a bit giddy to the point they had vomited upon their finest evening wear. Oh dear, what a pickle!

We also had a man who was faking having a stroke. Now, a stroke is a life threatening emergency that we treat aggressively and rapidly. Within a certain time window, there is a good chance that an individual can make a good recovery. While our patient had right sided arm weakness, a facial droop and slurred speech, it was only when he remembered he was being watched (it’s worth mentioning that he was in his 50’s and was also drunk).

It’s not worth not treating it as if it was a stroke, so we gained intravenous access, performed the necessary tests and ‘blued’ him to the nearest A&E. The doctor shared our cynicism but had protocols to follow the same as we do, so went through the motions. I believe he was admitted ‘just in case’. People often pretend to have chest pain, abdominal pain, visual disturbances or anything else we can’t disprove (usually for some attention from an ex’, or for a bed for the night), but a stroke has some very specific symptoms that can’t really be faked.

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Home delivery (8 minutes or less).

Wednesday night shifts. Ahhh ,the bliss of a midweek night, where nobody is at the pub on a school night. Nobody is considering being awake at silly hours of the morning to injure themselves or become ill. No. No, this is not true.

The busiest shift in a very long time!

Our very first detail was a lady who’d “fallen in the garden, injuries unknown”. It was well out of our patch but nonetheless, we rushed there (as we do with every emergency call we go to), to find a lady who had tripped on a slab and hit her head on the floor. She wasn’t too badly hurt, but we took her to A&E for further assessment. We handed her over to the nursing staff, cleaned the stretcher and any equipment used and were asked to headed back to base.

But then…”Further emergency for you please”. Rush rush rush to a lady who had been diagnosed with Gallstones 2 weeks previously and had been given a load of meds to treat it. This included some pretty decent pain relief – which she hadn’t been taking. The pain became so bad that she rang 999 for an ambulance. Now, I don’t have a problem with people in pain ringing 999 for an ambulance. But if you’ve had to do so because you haven’t taken responsibility for your own health, it gets a little frustrating. A good assessment showed that, yes, it was the pain associated with gallstones. What did we do? Gave her her own painkillers and do you know what? They started to take the pain away.  We see this all too often; people will ring 999 but will have only taken HALF a dose of painkillers of none at all. The cause of the pain can be a simple thing that doesn’t need A&E treatment, but because they “don’t like taking tablets”, an ambulance gets taken off the road. As I said, frustrating. But we’re never rude about it, some gentle chastising perhaps, but never rude. I don’t believe in giving substandard care because someone’s panicked. We discharged her at scene and cleared from the job.

“Thank you, further emergency call just coming in”

We were sent to a lady who’d attempted suicide by attaching a hosepipe to the exhaust of her car and putting it in the car window with her in the driver’s seat. Her neighbours saw her doing this and dragged her from the car and called us. The police were also called.  On arrival, she was stood in the kitchen smoking a cigarette, I said hello and she told me to “f**k off!” That was a good indicator of how this call was going to go. I eventually persuaded her to let me in so we could check her over. All the while she’s saying “nothing’s happened” and “she’s fine” and “F**K OFF!!” She even dropped the ‘C-bomb!*.

Assessment showed that her Carbon Monoxide levels were higher than normal, and she needed to go to A&E for treatment. She was adamant that she was NOT going anywhere. This is where the job gets difficult. The patient clearly needs treatment, but they refuse. At this point, we assess the patient’s ‘mental capacity’ to see if they can make an informed decision about their treatment. We have a tool we use, which I won’t go into now, that allows us to test this. As she was unable to retain the information, or repeat our concerns back to me, it was deemed that she did not have Capacity. Meaning that under the mental health act, she could be removed from her property and taken to hospital. This is when I was glad the Police were there. for nearly an hour we tried to persuade her to come with us to the ambulance, but she wouldn’t, so the Police ‘escorted’ her. We took her to A&E where the Sister in charge told us she’d been discharged only 24 hours earlier following a drug overdose.

This is how the night continued. Emergency to emergency to emergency.

Not long before our finishing time, and thankfully after we’d had time for a sandwich, we got a 999 call in to nearby city for a lady in labour. We were a second crew being sent to assist if needed. We nearly got there when we were stood down, as the first crew that arrived were happy to deal.

“Further emergency for you…you won’t believe this….in your own town”

“*laugh* Roger all received”

“You won’t believe this either…..female in labour”

Blue lights on, off we go. The roads were quite at 6am and I made good time. When we pulled up, we were met with the sound of carnage!!

“How can I do that when I’m holding a f*****g baby?!”

*Female screaming*

“YES, I CAN SEE THE F*****G BABY!”

We grabbed our maternity pack and response bag and ran to the door…locked…1st floor window was open we shouted up to let us in.

“I CAN’T, I’M HOLDING A BABY!!”

“Give baby to mum and come down to unlock the door.”

Seconds later, the most terrified looking man I’ve seen in my life opens the door and sprints back upstairs.

Up we run to see mum on the bed, with a newborn baby between her legs. The baby was a good colour and wriggling like a good’n. My crewmate looked after baby while I reassured mum that everything was fine. We did a quick check of mum and baby and everything was in order. She delivered the placenta in good time (sorry to those that are squeamish) and the community midwife was called.

My crew mate and I both agreed that after a 12 hour thrashing, the joy of an uncomplicated home birth and the smiles of the new parents made it all ok. We left on a high that night, ready for whatever the following night shift could throw at us.

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