A Tale of Two Bloggers

All I can see in the distance is a set of hazard lights, emitting an intermittent orange glow against the dark background of the night. Maybe this RTC won't be quite as given - trapped and unconscious - but as I approach at a rapid pace I can see that the hazard is not the car with the lights flashing, but a car facing the wrong way, lying on its side, perched up against a street light.
At four o'clock in the morning there's very little traffic, very little life about. The world sleeps as I do my small bit to keep it safe and well. The call rate to the ambulance service drops, but so do the number of available ambulances. I know I may be on my own for a while. I stop by the car, take one look at it and its unfortunate occupant, and call for help. I need everyone. Fire Brigade, police, at least one ambulance and a Basics doctor. This patient could need a lot of help, and quickly.
I’m fast asleep, having just finished a late shift in the A&E. How weird, then, that I can hear the drum solo from “In The Air Tonight!” Wait a minute, that’s my ‘phone, Ambulance Control. I blearily answer it, and accept a job nearby – car overturned, entrapment and unconscious.
I climb into the car through the boot, hoping that my assessment of its safety was correct and that the kerb would hold the car from tipping further. The patient was clearly unrestrained, lying with his head on the passenger window against the road, and his legs wrapped around the steering wheel. His breathing is a little slow, which concerns me but just putting an oxygen mask on him is a struggle. He tries to fight me off, making me think that this could be anything from a diabetic coma, to alcohol, to a serious head injury.
The journey is uneventful, and I pass the police barricade a few minutes after leaving home. It usually takes a little while for me to wake up fully, but the sight of the car on its side, facing the wrong way, and the lamp post knocked down, is like a splash of cold water. This doesn’t look good. I jump out of the car and grab my pack – anything else I will come back for. I jog round to the car, and am directed to the rear.
The Fire crews turn up first, and I ask about taking out the windscreen, but that would apparently take some time. I need him out quicker, but have no way to move him and no where to move him to. As I'm still fighting to get a primary set of observations done, three pairs of legs appear at the back of the car, two of them green belonging to the crew, and one of the pairs of legs orange. I recognise the voices and thank everyone who needed thanking for them turning up in a hurry. The orange pair of legs belongs to RRD, and I was fairly certain that when I'd asked for a Basics doctor, it would be him that I woke from his slumbers as I knew I was on his patch. At least now I could share my thoughts and decisions.
I peer in through the hatchback of the car, and see a familiar face – Ben! Excellent! This is going to be entertaining, if nothing else. He quickly appraises me of the situation – an unrestrained driver, was deeply unconscious, now has a GCS of around 8. Difficult to get access to the patient, no obs done. We discuss what options we have; peel the roof down or bring out through the back. I want this man out here, so I suggest to Ben that he tries to wind the seat back down, so that we can bodily drag him out. I wander over to the Fire Chief, and let him know what we are doing. He doesn’t look best pleased – I guess he was looking forward to some cutting, but offers all assistance with lifting etc that we might need. I go back to the boot of the car, to see Ben struggling vainly with the seat controls. “Got a problem?” I ask. He just grimaces, reaches under the patient, and the seat magically drifts back, giving the crew room to get him out. I leave them to it, and go and set up for the inevitable intubation.
We extricated the patient out the car the same way I'd climbed in, through the boot, and onto a rescue board. He was still trying to fight back. By now I could smell the alcohol, but still couldn't rule out that his behaviour was due to a head injury, and we treated as such. RRD knocked him out, intubated him, and made sure that our transfer to the hospital would be as event free as possible.
I watch as, first Ben and then the patient, are born(e) from the back of the car, the patient on a spine board. The crew wheeled him into position, near my kit dump, and we start to cut through all his clothes, so that I can make a formal assessment of his injuries. Ben is set the task of getting iv access. I check him over, head to toe, and find little else wrong with him, apart from the obvious – he is eyes closed, occasional groans and localising to pain. Glasgow Coma Score is therefore… anyone?? 8. of course!! I’ve got the kit ready, the team are ready, Ben gives the drugs, and the tube is in. We get him on to the vehicle, and I ask Ben to travel with us.
I travelled with them, abandoning my car at the scene and remaining in charge of the patient's ventilations as we did the breathing for him.
The journey is uneventful, and the three of us in the rear chat about stuff – other jobs we have done, BASICS, the state of the country, that sort of thing. All the while, we are closely monitoring the patient for signs of deterioration, of which there are none. We get to LocalNeuro, and hand over the patient, with some playful banter about whose IV access is better, Ben’s or mine (mine, of course)
All that remained was the tidy-up, paperwork, NHS tea in paper cups, and to get back to my car and return to base for the end of my shift. Maybe, if I asked really, really nicely, RRD would take me back in his cool car...
And then it’s all done. It’s early in the morning, and there’s a bit of paperwork and a lot of clearing up to do. We stand around, drinking our tea, before I offer Ben a lift back to his car.

Note to Self

You'd think that over the years, and after the previous post, you'd have learnt your lesson.

Don't say out loud what you're thinking.

It's damned likely to happen.

Twice.

So, if you feel the need to say to the The Mrs just before you leave for work that you feel like there's a big job out there tonight, don't. Just don't.

Even if it does mean you get to wake up certain people in the middle of the night.

Thus endeth the Note to Self.

Cen-Tree

I have an ex-crewmate, Jim, who, when frustrated with the job and its ensuing politics, would threaten to go and work for the council as a lawn-mower. No, not as the machine, but as the operator of one. No grief, out in the open air, music blaring. What more could you ask for?

*****

Al, a local-council gardener for several years, loved his job. It wasn't taxing, he loved the open air, loved working at his own pace, loved listening to his music. No managers, no hassles, never home late. Just him, and the flora and fauna of the local area. Today was his turn on Daisy, the industrial-sized ride-on lawn mower. Daisy was used when the big jobs needed doing. Parks, large verges, anywhere that a normal sized machine would take days to complete, Daisy could do the job in a fraction of the time. Daisy's twin, Belle, was also sent out on the mission, piloted by Sue.

The weather forecast had promised a bright sunny day and for once had delivered on its promise. Al and Sue were thrilled. They moved from place to place, leaving behind them the scent of freshly cut grass whenever they journeyed on. Daisy and Belle were in their element. With Sue and Al chatting throughout, the morning flew by, and as the midday sun began beating down, they found a shady area that needed cutting too. A wide grass verge with several large trees dotted around.

Sue went left, and Al, right. He'd just remembered a funny story he was going to tell her and turned round to call out. Two seconds. That's all it took. Two seconds looking in the wrong direction. Sue barely had the time to scream: "AL! LOOK OUT!!!!"

Al turned round to face the front again, just in time to see the huge branch. Most trees would be proud to have that branch as their trunk, but on this tree it was just a branch. Perpendicular to the tree-trunk, parallel to the ground, and about six feet above it. Daisy was about four foot high. Al sitting down another two. He took the full impact straight in the face. Ten miles an hour isn't fast when you're surrounded by a tonne and a half of metal, but it's lightning speed if your face meets a tree and has no protection at all.

When we arrive, Daisy is the other side of the tree, with Al a crumpled heap on the floor. There's blood everywhere. I take a few seconds to assess and work out what's going on, in which time, Jim, my crewmate suggests that immobilisation may be a good idea. I wholeheartedly agree, and curse myself for not thinking of it immediately too. Right, brain back into gear. Trauma. ABCs.

Airway - clear at the moment, but some bleeding in the mouth. Unknown source. Regular reassessment required.

Breathing - yes. At the moment. Clear chest, no funny noises, no missing sounds.

Circulation - yes. At the moment. Several areas of blood loss, none that are obviously too heavy.

Disability - Sue's unsure if he lost consciousness, but thinks that he did. At the moment, he's conscious but very confused and a little agitated.

I'm still worried about Al's airway. We need to immobilise him on a board, with a neck brace, on his back. And there's something bleeding in his mouth. Not at all ideal. Ideally I'd like to have the patient knocked out and intubated. That would ensure that his airway and breathing are secure and I could deal with the other problems.

I ask for HEMS. They're unavailable. (Not once, in my whole career so far, have they come when I've called them. I've done calls with HEMS, when other people have asked for them, but never when I have. Either they've been busy, had no helicopter, or a myriad of other excuses. Once, they even crashed when they were on route to me. Before you scan old newspapers for news of a HEMS chopper crash, they were coming in the car. But still, it must be some sort of conspiracy...)

I ask for a BASICS doctor. The nearest one is at least 40 minutes away.

We're ten minutes at most from the nearest A&E, not one known for its trauma care. The nearest Trauma Centre is an extra twenty minutes drive away. Al has an airway problem, so we don't really have a choice. We package Al, load him into the ambulance, warn the local A&E that we're on the way, and apply diesel. Jim's driving, which is a good thing, as he's a much faster and smoother driver than I am. On route I constantly suction the blood from Al's oral cavity. I have flashbacks to the dental surgery. Not a good thing.

His observations remain stable. A quick look shows that he's lost several teeth, probably fractured his jaw and eye-socket, possibly fractured his skull. As his face took the full force whilst Daisy kept going, we had to suspect a serious spinal injury too. When we arrive at the hospital, there's a full trauma team to meet us. I'm impressed. They obviously understood the significance of the injuries that we'd tried to relate over the radio. Al's handed over to the team, and I never find out what happened to him after that.

Whilst we're cleaning all the blood, mud, and carnage we'd left in the ambulance, Jim mentions that he's not so sure about his alternative career path after all. I'm not surprised.

*****

PS. This is my 100th blog post. My century entry. What started out as a little bit of a trial run, has turned into something that has taken over my life! I'm shocked I've made it this far, and honoured that I seem to have captured the interest of so many people. I hope I keep going for a long while yet, and I hope you keep coming back. But in the meantime - thank you.

Underground, Overground

One of the advantages of wearing a uniform for work is that you become instantly recognisable for the job you do. You also then become totally anonymous when you take it off and become a civilian again. A little bit like this blog where I can hide behind my pseudonym. Apparently not totally though...

There I was, visiting a relative in a hospital not far from home, when I came across a doctor who I suspected of being RapidResponseDoc . You can see the conversation we had by following the link.

His is another one of the blogs that I'll be following closely....