Tag Archives: RTA

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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Once in a career.

I promised in my last post I would write about the RTC (Road Traffic Collision) I attended last month. This was by far the worst I’ve seen in my short career and also the worst the Officer on scene had seen in his 19 years in the service!

-On a side note, I know I haven’t written for a while, I’ve been on holiday in Italy where I purposed to my girlfriend. So yeah, kinda busy-

Not long after the start of my shift in the city station, we receive an emergency where details state that there are “3 cars, 1 on fire, 2 persons trapped and critical”. This gets the adrenaline pumping let me tell you!

We arrive at the now dark scene which is a fast stretch of country road with no lighting, on a long sweeping bend down a steep hill. We can see that there are two cars (the third I later learned had been driven away as only had minor damage), each on their own side of the road but clearly showing signs of a high speed head on impact. I say high speed because the Traffic Officer estimated that the total impact speed would have been in the region of 130mph.

We were met by our Senior Officer who directed us to one of the patients trapped in his car. With him was a BASICS Doctor (BASICS Doctors are a group of trauma and medical specialists who choose to respond to emergencies in their own time. They are an enormous asset to the service – especially at a time like this).

In training, you’re taught to start assessing the patient ‘from the door’ to quickly ascertain if they are ‘big sick’ – that is to say time critical, or ‘little sick’ – meaning that it is a minor ailment that can probably be dealt with at home.  We’re taught to look at their skin colour (pale, flushed, grey), work of breathing and general appearance. This chaps general appearance was ‘on deaths door’.

So worried was the BASICS Doctor that he had tried to drag the patient from the car to begin treating him, but he was trapped.

I then looked to the car for the mechanism of injuries we were likely to find. I looked down and couldn’t figure out where his legs were.

The driver’s seat had been shoved forward 6″ and the steering wheel pushed back against his chest, so he was slumped over the wheel. The dashboard had been forced back onto his pelvis and the car’s engine block sat where his legs should have been.

We looked at each other and knew we had to get him out as soon as possible or there was a high chance he would die in the car.

We liaised with the Fire and Rescue Service (a separate emergency service here in the UK) who understood that it had to be a rapid extrication.

While the Fire Service cut away various parts of what was left of his car, my colleagues began treating the patient as best we could. We gained IV access in both arms so we could give him strong pain relief and fluids, we gave him oxygen and monitored his heart rate and blood pressure. From these observations, it was obvious he was in shock.

When the public say “he’s in shock”, they mean that they’ve had a nasty surprise and are in a bit shaken. When we say “he’s in shock”, it means the life threatening condition where the body is failing to get oxygenated blood to the brain and tissues of the body. When someone is in shock, they will die if untreated.

For 70 minutes the Fire Service fought to cut him free, and we fought to keep him alive.

Once he was cut free, it was a case of life over limb. That is to say that where we would normally work hard to protect the alignment of the neck by using a hard collar and a series of techniques to get them out while keeping them in a straight line. However, this man was on deaths door, so it was decided that we would drag him from the car and slide him onto our longboard to be carried to our stretcher. I was holding the top of the longboard and so could see down the length of the patient. I could now see where his legs were: broken in several places with open fractures and scissored beneath the car’s pedals.

We got him our and he was losing huge amounts of blood from somewhere internally. I covered the open woulds on his legs through which his broken bones were poking. Then my crew mate and I assisted the Doctor and the Air Ambulance Paramedic in sedating the patient so we could control his airway and breathing. It also meant that he was feeling no pain.

We loaded him onto our ambulance and drove quickly to the air ambulance which would fly him to the regional major trauma centre.

And just like that, my crew mate and I were in a field, in the dark with an ambulance full of broken glass, blood, cut clothes of the patient, used bandages and oxygen hose, empty bags of fluid, and a sense of awe for what we had just witnessed.

We radio’d our control to ask if we were needed back at the scene. They said the scene was in order so we could head to a nearby station to clean up, restock and have a debrief with the Officer.

We all agreed it was a horrendous incident. We spoke about what we felt went well, and what we thought we could have done better. We had a chat and a cup of tea – the ambulance remedy for witnessing something horrific.

It took us over an hour to clean the blood off the kit and restock the mountains of equipment we had used before we were ready to return to duty. I was glad of the extra time to compose my thoughts.

The following day, I received an email from the Officer who was at the scene. He had thanked us all for our hard work and forwarded an email from the BASICS Doctor who praised us for our teamwork and professionalism through what was a very difficult situation. He informed us of the patient’s injuries which included: Bruised Lungs, Bleeding in the abdomen a shattered pelvis and multiple open fractures in both legs. He had lost so much blood internally that they had to replace pints and pints of blood in the hospital before he was stable enough to be taken to the CT scanner. He was still sedated and was in an Intensive Care Unit. I was very pleased, but very surprised to hear that he was still alive.

The second patient in the other car who was also trapped had only minor injures. I didn’t even see him as we were so focused on our patient. But he had another crew, and doctor and another Fire team looking after him.

This was such a horrific incident that I may not see another like it. Then again, I may see one tomorrow – that’s the beauty of this job, it’s like a box of chocolates.

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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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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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