The Wrath of a Lion is the Wisdom of God

"16 year old male, fallen off a Lion"

The cab filled with screams of laughter. We see a lot of funny things show up on the MDT but this was one of the more amusing! Especially as that was the only details we had initially. Not even an address! Fallen off a Lion! What do you say to that?! Would this be a Lion tamer? Would it be a job for the Hazardous Area Response Team (HART)? Would be need the RSPCA or such like? Highly unlikely. If someone has fallen off a Lion it is likely to be a statue and in this case it was. But still, it put us in a good mood so off we went. 

We arrived and were met by a group of teenagers who surprisingly did not appear drunk. They were 'free runners' apparently. Freerunning is another term for Parkour which a relatively new urban sport where by runners known as 'traceurs' move through their environment be it natural or urban as quickly and efficiently as possible. They move around obstacles by vaulting, rolling, running, climbing and jumping and having looked at some YouTube videos it is of no surprise they get injured! To check out what they do take a look at this video. They do indeed jump off Lions! Anyway, we were directed to Cosmo, yes, that was his real name (apparently), who had tried but failed to do a backflip off the Lion and was apparently unconscious. He was indeed unconscious, GCS 3 and snoring. Shit! I was not expecting that. 

We jumped to work, I secured his airway and gave him o2 while my crew mate grabbed collars, a board, straps, blocks and splints. I started to get as much history as I could from his friends. He had landed head first onto the concrete, as they said that my eyes wondered to the small pool of blood and vomit about 3 feet away. He had got up and within about 30 seconds had vomited. After about 2 minutes he was complaining of a headache and began to stagger around. That's when his friends wisely called 999. About a minute before we arrived he lost consciousness. This was serious. I requested HEMS or a BASICS doctor. I was told HEMS were now on route and would be 8 minutes. This was going to be a long 8 minutes!

I assessed the back of his head and it was what we call a 'boggy mess'. No further description is necessary. I applied a large dressing to keep it clean and stop the bleeding. I suspected he had a fractured skull. Between the 2 of us we decided to forget the spinal board until help arrived and concentrate on stabilising and monitoring him as much as we could. A quick pulse check and alarm bells started ringing. It was 36 which in 16 year old with a head injury is a great concern. I did his blood pressure while my crew mate gained IV access and the bells continued to ring. 198/110. For his age he was severely hypertensive. Put those two observations with his head injury and development of irregular respirations and we had what's called Cushing's triad. That told us he had a raised Intracranial Pressure (ICP) which meant he was big big sick. I think his friends started to realise the gravity of the situation but despite this, they were fantastic. They phoned his parents, they got all his details, his allergies and passed us everything we asked for. I lost count of how many times they ran back and forward to the ambulance. We started bagging him as he began having prolonged periods of apnea. I looked up and saw 3 orange jumpsuits walking towards me! And breathe!

HEMS took over which was a relief! He was intubated and immobilised. We get got him onto the truck and after attaching him to monitoring we blued him in to the nearest trauma center. There was a lengthy discussion about whether or not to perform Rapid Sequence Induction (RSI) on him (basically, put in a coma) and breathe for him but the risk of raising his ICP was to high. We just ran! At hospital HEMS gave the handover and although I normally love the drama of a trauma handover to 20+ people, I was glad to pass the buck on this occasion. In vast contrast to the the jovial mood we were in on route to the job we were left in a bit of a daze. You really do never know what you're going to walk into in this job, maybe that's why I like it. I was pleased to find out 2 days later that he was recovering well in ITU. Hopefully in the future he'll give lions the wide berth they deserve. For me though, it was another life saved! Whoop!