Tuesday, 7 February 2012

Eight Miles

The radio vibrates against my shirt, the phone beeps in my pocket and I run back to the car to see the screen flash up a new call. Eight miles isn't all that far, particularly at night, but even at an average of sixty miles an hour, it will take eight minutes to get there. To average sixty, I need to be going ninety for at least some of it. In London, even at night, it's barely possible and for the most part unsafe. Unsafe for me, unsafe for pedestrians, unsafe for other motorists, unsafe for my patient if I never make it to where they are.

Eight minutes is a long time to wait for an ambulance. I know. I've been there. I've had to make that call, had to wait that wait, watching and worrying. I understand. And I want you to know that when I have to travel that far with the screen shouting at me that someone isn't breathing, or someone is seriously injured, I feel the same as you do.

The trepidation that ninety miles an hour just isn't quick enough. The worry that eight miles is just one mile too far. The feeling that each and every speed bump in the road that's meant to slow me down and as I encounter it makes the patient's chance just a little worse. If I could somehow jump over those bumps, skip around the width restrictions, fly over the cars that block my path, I would. But I can't.

The address is eight miles away, 8.2 to be exact. The junction of two suburban streets is also the meeting point for a car and the bicycle carrying Hayley on her early-morning paper round. At six in the morning, traffic is starting to build and people city-wide are starting to consider their commute to work, just as I start to see the light at the end of the shift.

The caller is the car driver, distraught, distressed, disturbed. Scared not so much of the long term consequences, but more of the immediate danger to Hayley as she lies unconscious in the road. The call-taker gives some basic instructions, to check the airway, the breathing. Not to move the patient, but to wait for the crews to turn up.

We arrive on scene together, two of them in the ambulance and me in the car. 

"Six miles we've had to run for this!" says the frustrated attendant as he grabs another bag out of the side cupboard.

"Tell me about it. I ran eight."

One look at Hayley tells us we're going to need some extra help. She's starting to come round, moaning in pain and confusion. A large, dark patch is slowly spreading across her jeans from just above her knee. Her femur, the thigh bone, is clearly broken, the angle of her leg telling us more than we needed to know.

"I'll get HEMS running. I think we're going to need more pain relief than we can give her."

"Good idea. Bet they have further to run than we did."

During the hours of darkness, HEMS teams travel by car, leaving the helicopter to a better night's rest than most of the people who work on it during the day. It takes them some time to get to us, by which time we've tried to stabilise Hayley as much as possible. I give her a strong dose of Morphine, hoping to reduce the pain at least a little, at least enough to let us straighten her leg. It's not enough. Even doubling the dose to the maximum we're allowed to give doesn't allow us to move Hayley's shattered leg at all. HEMS arrive and the doctor on board gives Hayley some ketamine, finally relaxing her into a state where we can pull the jigsaw-puzzle femur straight enough.

We finally settle her on the stretcher, the minimal warmth of the blood-soaked blankets now assisted by the heater in the back of the ambulance. Hayley is well looked after - a couple of paramedics, a doctor, a mother who ran frantically to the scene when she finally heard what had happened. It leaves me with nothing to do but to clear up the scene as much as I can without upsetting the police.

I sit in the car and watch the clock tick over to the end of the shift. The tail-lift is raised and the back door is shut, the blue lights start to flash and the ambulance pulls away with its injured cargo, leaving me to wonder if we had done all we could, if it would be enough. I start the engine and begin my journey back. 

It's a lonely, subdued eight miles. 


TAZ THE AMBO said...

I'd be happy if it was my leg.
What is you max dose 0.5mg/kg? Mine starts from scratch 30 min after I reach max dose but ICP here have Midazolam.

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