Saturday 1 December 2012

92 minutes earlier

My cup of Costa went flying as our brakes ground to a halt at the same time as the second ambulance. The patient was lying there motionless. A woman was doing CPR. Blood was trickling out of his ear.  We all rushed over (no ambulance walk today) and each started doing our thing. As the crowd began to gather, I began to suction his airway. It refilled with blood almost instantly. Where was it coming from? He was still alive.....just. We stopped the CPR, he had a pulse albeit very faint. It was a case of two of us managing the airway, a combination of ventilating, suction and draining. We just had to make do. He still had a gag reflex so without ‘grown ups’ we were powerless. There was now 6 of us swarming around him. IV access was gained in both arms, 2 bags of fluid were hung up. He was attached to the heart monitor, his pulse was fast but regular. His blood pressure was still in his boots. 

“Can someone raise his legs please?”

“On it”

“Right, lets get these clothes off him”

“HEMS are on way”

“More suction please”

“How’s the BP looking”

“Try some more ventilation”

“What’s the SPo2?”

“About 77 over 40”

“80%, did we have an ETA?”

“I’ve got decreased air entry on both sides, possible bi-lateral pneumothorax”

“More suction please”

“18 minutes” 

“Want some cannulas?”

“Yeah, you alright to do the right side?”

“His left pupil is blown”

“Yeah, no probs”

“Can you grab us bed, blocks, straps and a scoop?”

“Who’s conveying?”

“Think the pelvis is gone, can we get a strap on here?”

“What was the resp rate when you arrived?”

“Did anyone see what happened?”

“I’ve got a sheet, we can use that until HEMS arrive”

“About 4”

“No idea”

“That’ll do, we’ll get it underneath on the log roll”

“I’ve got no respiratory effort, how’s the pulse?”

That’s the conversations that were going on between the 2 crews, the FRU and the duty officer. It’s probably worth mentioning I only knew 2 of the 5 people who were there. That was the same for all of us. At one point I thought to myself that it was amazing how we were all task focused on different parts of him without ever discussing who was doing what. There were two of us solely on the air way, two were getting IV access and decompressing the chest and two were removing clothing, getting kit and monitoring obs. 

The crowd was getting bigger by the minute. My crew mate lent over to me:

“His entire family are over there watching”

That always adds an extra emotion to an already chaotic scenario but for now we just had to ignore that. 

“Are we ready to move him?”

“I think so, lets get the scoop in here?”

The scoop was split into two, I was on the head so couldn’t move, leaving 3 of them to do a log roll, 1 to slide the scoop in and the other to carry on suctioning. 

“OK everyone in position?”

“Yep, on your count”

“OK, one, two, three, roll.....hold it there....one, two, three down”

(Everyone swaps sides)

“OK, one, two, three, roll.....hold it there....are all the clothes clear?”

“Yep”

“OK, one, two, three down”

“Right, lets get some straps on”

“More suction please”

“Police are here”

“How long for HEMS”

“About 2 minutes”

“OK, how’s BP, pulse and sats?”

“BP is up slightly, lets get the bed over.”

The beautiful sound of HEMS sirens could be heard in the distance. Being early evening the helicopter was offline so they come by car. The three orange jump suits came bounding towards us. A handover was given by my crew mate and then they took over. 

“Right guy, lets get him on the bed and move him over here. We need all round access”

We followed the instruction, all the while bagging and filling up our 4th suction unit. They were going to perform a Rapid Sequence Induction (RSI) which would basically put him into a coma. Once under, he would be able to be intubated and his airway would be protected. Whilst one of HEMS were setting that up, the other two were playing with scalpels! Two incisions were made in each side of his chest, fingers were inserted into the holes to see if his lungs were inflating properly. I could still sense the family watching from afar as well as the eyes and expectations of the crowd baring down on us. It was quite a scene, 9 of us standing around him, some performing procedures, some drawing up blood transfusions, some ventilating and others just doing.....stuff!

The drugs were administered and they managed to intubate. Now we could think about leaving. Or not......

“We’ve lost him, CPR please”

I started compressions and after a minute or so, couldn’t help but look over to the shocked faces 20ft away. Hands were over mouths, some people were crying. I could feel the hairs on the back of my neck stand up. 

“OK, he’s back with us, well done guys, let’s get moving”

In all honesty, I had zoned out, I don’t know what was done in those 4 minutes, I just know I was doing CPR and now I didn’t have to. The guy was loaded on. In the ambulance was the patient, 2 of HEMS, me and my crew mate and a copper. In the second ambulance was the other crews and all the kit that was lying where we had been. The police followed with the family and the HEMS car and another police car drove up front. Off went the convoy. 

24 minutes later we arrived at hospital. The bed was rolled out and onto the ramp. The door swung open revealing the long corridor ahead of us. The huge trauma team was waiting in resus and the now 8 of us did a rapid walk towards them. Some pushing the trolley, some holding fluids, 1 ventilating, others carrying monitoring equipment. He was transferred to the hospital bed while a handover was given. We then left to clean up the bomb site that was the back of our ambulance. About 25 minutes later HEMS came out to us.

“How’s he doing?”

“Not great, he’s got a sub-dural and extra-dural haemotoma, bleeding on the brain stem, a depressed skull fracture, a shatter jaw, fracture spine, bi-lateral haemo / pneumothorax, bleeding into the abdomen, a shattered pelvis and a broken mid shaft of femur.”


92 minutes earlier......


A man was celebrating his 75th birthday in a pub with his family. They had had a sunday roast. He had treated himself to a few whiskeys and why not?! He’s 75, he can do what he liked! He was with his wife of 55 years, his two sons, their wives and his 5 grandchildren. I can only imagine the joy he was feeling seeing all that was important to him sat with him smiling and laughing. It was time to go home, but before he got in his sons car he wanted to nip into the shop to grab a paper. He left them all getting into cars in the car park, he went to cross the road.

“RTC, car vs pedestrian, 75 year old male, cardiac arrest, CPR in progress”

In that moment, the joy was gone. In that moment 75 years was over. Maybe it was the alcohol that made him cross without looking on a bend.  Who knows? He’ll never be able to answer that. 

I remember looking down as his 3 piece suit was being cut off and his pocket-watch fell to the floor. I remember thinking to myself:

“I bet he was a lovely guy”

I never found out his name.

R.I.P