Thursday 10 May 2012

The Law of Stairs

"24 year old male, fallen down 24 stairs, neck pain, head injury"

To be brutally honest, up until this point it had been a crap shift. We hadn't been abused, we hadn't picked up any drunks, but everything we had done had been nondescript and boring. No one really needed us or needed to go to hospital. It had just been 7 hours of blah blah blah! This popping up on the MDT woke us up at tad; it had potential to liven things up! We headed round to the address, only a few minutes away and pulled up outside some shops. I knocked on the door to the flat whilst looking through the window. I could indeed see 24 stairs, sadly for us there was no patient at the bottom of them. The good old Law of Stairs eh! We were met by our patient's friend. They were Russian and had been drinking. Vladimir, or Vlad as he wanted to be called, had fallen from top to bottom. By his friends admission he had been unconscious for a couple of minutes, then got up and gone to his room. His room wasn't 24 stairs up. His room was 24 stairs + 5 + 13 + 4 up and round various corners. Vlad was sitting on his bed, in obvious discomfort and bleeding from a large laceration on his forehead. He spoke very little English so trying to explain what I was doing was tough. I introduced myself in Russian which calmed him down, but after that I was lacking in any vocabulary other 'Da' and 'Niet'!

The position he was in made it rather difficult to assess him, my crew mate held his head still whilst I half clambered on to the bed to reach him. I began stepping my way down the spine asking about pain. Half way down the neck he yelped. If that wasn't enough to indicate a problem the lateral ridging that I could feel was. With the aid of sign language and demonstrations I explained what was going to happen then got to it. We fitted a collar and my crew mate went off for the scoop, the straps and head blocks. When he returned he told me there was no way we were getting him out on the scoop as there was no room to turn around the corners. Vlad was also becoming more and more combative and was becoming at risk of causing permanent damage to himself. Although only a spinal injury, which is something that ordinarily we can deal with without assistance, I decided to request HEMS. Firstly, we needed more hands, secondly, I suspected our patient may freak out when strapped to a board and due to the nature of his head injury and becoming combative, may need sedation. For those not in the know HEMS is the Helicopter Emergency Medical Services, though at night they work on cars!

HEMS agreed to come, so whilst they were travelling we decided to attempt some immobilisation. We carefully stood him up and placed the board behind him, all the while keeping his head manually immobilised. We performed a rapid takedown which is a manoeuvre where we lower the patient to a flat position using the longboard or scoop. Now on his back Vlad, as I had hoped he wouldn't, became agitated. We decided not to strap him to the board as it was causing more danger to him so I just held his head until HEMS arrived.

The EMS Law of Stairs: The severity of a patient's illness or injury is directly proportional to the number of stairs said patient has climbed to get away from the front door. The worse the patient is, the more stairs they will have climbed.

  • Corollary 1: If a patient can't walk, has chest pain or is fitting they will have gone upstairs to call 999 
  • Corollary 2: If a patient is heavy they will have gone upstairs to call 999 

Eventually HEMS arrived and I gave them a full handover. The HEMS doctor re-assessed the spine and agreed it was most likely a fracture. The only way to safely get him out to the ambulance was indeed strapped to the scoop but no amount of translation calmed him down enough to be able to strap him tight. He was more concerned about getting to work in the morning. I admired his work ethic but his decision making was clearly lacking. Due to the nature of his head injury HEMS decided to sedate him to make extraction easier and safer for everyone; it also stopped the considerable pain he was in. We got him strapped to the board and began the painstaking task to getting him down the 46 stairs. At times he was upright on the board, at times he was horizontal, at times he was on his side and at times he was at a 45 degree angle. Gradually we got him around every corner and down every flight, on to the ambulance. 

Due to his injuries we put in a blue call to the nearest trauma center and headed off with HEMS in the back. I'm always much more relaxed when the grownups are there. I know if the shit hits the fan they will clear it up and when it comes to the handover they will make sure nothing is missed. It was a 'good job' as far as jobs go, though many of the difficulties could have been avoided. I don't know why but ill people are always on the top floor of whatever building they call from. The Law of Stairs is so so true. I hope this job will serve as a lesson to anyone who reads it. If you fall down the stairs, stay downstairs! Please!


  1. Yet it is the entrance to your home which you go to at the end of the day and that any visitors view very first, therefore it creates a first picture of your house. In most of our homes, when you walk into the front area, you immediately look at the staircases Sheffield. Normally we all ignore the stairway as well as tend not to take a lot attention to it as being a feature, however your stairs can actually become a stylish feature in any house. Mostly individuals simply make what they have, decorate the staircase and look for the best use they can for the under-stairs' place.

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  2. Would you ever consider asking for HART in these kind of circumstances as well? I don't know how available they are to you but they have mibs stretcher which has rope attachments etc along with other useful equipment and person power. I request them fairly often in these kind of circumstances and they have proved very useful. Just a thought.


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