Out of Depth

On days like today, warm, sunny aberrations from the norm, being ankle deep in water isn't so bad. Just the thought of it conjures up images of sitting by a pool, a lake, or even at a stretch, sitting on the beach, feet dangling in the cool blue waters.

Ankle deep in water would probably be a blessing for those affected not so long ago by torrential rain and devastating floods all over the world. Sure beats being knee or waist deep in the stuff.

Ankle deep really isn't all that bad, unless you're ankle deep in blood.

*

A call to the local bus garage isn't unusual, more regularly to patients whose blood alcohol volume is a little high and who are looking for somewhere warm and dry to sleep it off. So when the call came in as a young adult male unconscious, it sounded like business as usual.

The car had its hazard lights on, just as we'd been told it would. Abandoned rather than parked between two buses, with Rami stood at the back of the car, frantically flagging us down. Something about his demeanour said it was serious, but as we stepped out of the ambulance, there was no patient.

"What are you waiting for?" screamed Rami. "He's in the front seat!"

Didn't expect that.

And there, in the front passenger seat, was our unconscious man. 20-something years old. Ankle-deep in blood. And dying in front of us.

"What happened?" The question was more to keep Rami out the way and his mind occupied, so that he'd keep out the way and let us do our job.

Airway - clear.

"We were in the park and got attacked. They came out of nowhere, about six of them. They hit us with all sorts. He had blood all over him but we managed to run away. I didn't see where the blood was coming from. I thought it'd be better if I just took him to the hospital, but I got lost. Now I don't think he's breathing! I stopped to call you guys! I didn't know what else to do!"

Breathing - present, but laboured.

We reassured Rami that his friend was breathing, but was unconscious. His shirt was crimson red, his breathing laboured and his pulse rapid. We didn't need to check his blood pressure to know that it would be dangerously low - the amount of blood on the floor of the car told us what we needed to know. He needs fluids, preferably blood, and in a hurry. Out in the real world, pre-hospital, the only fluids we have are basically salty water. Better than nothing, and enough hopefully to get him at least as far as hospital.

Circulation - problematic.

We found the source of the bleeding, multiple stab wounds in his lower back and abdomen. Too many holes to plug, and not enough time to do it. We'd asked for assistance from HEMS, but as it was night and they weren't flying they would be coming in the car. Luckily, they'd been on a call not too far away, and even though they're normally based the other side of London from where we are, they wouldn't be more than 10 minutes away. Just as we were getting him into the ambulance, we were given an update that HEMS weren't coming. Apparently they'd crashed, and although it was only very minor, they were now tied up with paperwork.

With no assistance on the way and no way for us to give him anything more than fluids, we opted not to delay any longer, made him as comfortable as we could in the ambulance, and began the mad dash to hospital.

Police were with us.

Rami was with us.

Time was very much against us.

And we were back where our patient started.

Ankle deep in blood.