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, two, three down”

(Everyone swaps sides)

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


“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.



  1. Absolutely brilliant, really good read, and so emotive.
    Great writing.

  2. Tears in my eyes Ella, beautifully written. Having family watching must be so difficult x

  3. What a hideous comment from "anonymous". Maybe you should impose comment moderation so that these mindless burks cant comment on what is otherwise a most brilliant post, thank you so much.

  4. Actually cried. What a wonderful job you all do. Xxx

    Control bod

  5. There should definitely be no more pictures or videos.

    The emotion conveyed in the writing alone is enough.

    Pictures and videos would ruin it.


    1. Thanks! I believe that comment was spam. I've deleted it! Been getting a lot recently. Such a pest! Thanks!

  6. Sobbing. That is an amazing post conveying so much; the frantic resuscitation, the emotions of family and of you guys as well. I'm so sorry that he didn't make it, you worked so hard on him. You have written an amazing tribute to him, it goes to show that when paramedics and ambulance workers attend accidents it does have an impact; my paramedic brother of 25 years has taught me that.

  7. Great post Ella, beautifully written.

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  11. One of my favorite posts of yours. Thank you.


  12. I'm an RN. Recently I was driving to have new tires put on my car and a guy in front of me was to impatient to wait for the car stopped on front of him. He went around and hit the elderly man who was crossing, the one the car was stopped for. It sent his shoes flying 20 ft away, across 3 lanes of traffic and across a sidewalk.
    I went to help, in the very limited way I could. LI felt so helpless only being able to assess respiratory status and circulation. No bleeding visible. No obvious fracture. Oriented. Complaining of hip, head and neck pain. All I could do was stabilize c spine and wait...and keep the good Samaritans from putting a blanket under him because the road was wet...i felt so hopeless. All that school and I was essentially helpless...

    1. Not really helpless, I bet you also reassured him that help was on it's way, and chatted to him, taking his mind off his possible injuries, plus checking his responses.
      Finding out about his next of kin, any medical conditions, and any medication he was taking - all useful information for the next part of the chain of people looking after him.
      As you'd seen the incident happen, you could also give a really good account of the mechanism of injury, so that your RN colleagues who see him in hospital will have more information needed to assess potential injuries.
      "Unknown gentleman found on road, says he thinks he was hit by something" becomes "This is Albert, a 75 year old gentleman, who was crossing Main Street when he was hit by an angry driver. The force of the impact was enough to send his shoes flying 20 feet. Albert has been concious and oriented throughout, no obvious bleeding or fractures, but complaining of head, neck and hip pain. Albert has osteoarthritis and had his right hip replaced 2 years ago. He takes (these tablets) and is allergic to (this)
      He lives in a retirement community with his wife Ellen, who will be at the hospital soon."
      Or something like that!

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  14. I hate that for some patients you never find out their names.

  15. Just had this pop up in my FB feed. Excellent read with the emotion of the moment evident. Thxs

  16. OMG!! I have been in EMS for over 20 years, Paramedic and RN. Reading your story I saw/relived so many TRUE emergency runs and the communication that happens when everyone works as a TEAM to save a life. The family standing nearby adds such a level of intensity. No matter what the outcome, I always take comfort in the fact that they see the responders working together for their loved one. I try to take comfort in the fact that they saw professionals at their best in a situation that was the worst for the family... and I have been on the other side, too. One nice thing about my small~town, but very involved, service is we are able to leave someone behind to comfort and inform the family. Well done and well written!

  17. That was amazing, Ella.

  18. This is why we do what we do. Thank you.

  19. He was in his 50's. We got the job dispatched as "unconscious/unresponsive, at the elementary school." It was New Year's Day. We arrive to find him in cardiac arrest, with a police officer doing CPR, and the officer's AED already in place. Around him stood his co-workers- janitors and maintenance men, working on the heating system. All they told us was, "He fell down." We get lines started and my partner intubates as I hook up the monitor and see Vfib. The AED advises shocks, and shocks are given. His co-workers, all burly men, watch as the shocks are delivered and I see them physically recoil. My partner misses the trachea and gets the stomach. The noises are not pretty. He tries again, and is successful. Vfib. Shock. Drugs. I am aware that someone is crying but I am focused on what I need to do. A second unit arrives. Hands to help. Voices, taut under pressure. "How long down?" "Fifteen, maybe? Vfib, no response to anything." We load him up and go. Enroute, we watch the vfib slowly, despite our efforts, resolve into asystole. We keep doing CPR. We arrive at the ER, the doors banging open, the gurney crashing against the bumper as the legs come down. Silence as we rush him towards the doors.
    I hear one voice, one word. "Daddy?" A voice, taut with emotion, on the brink of tears. We roll past and into the waiting cardiac room.
    Voices, a blur. Three different docs all shouting orders. Down 25 minutes. No ROSC. Asystole. Drugs, CPR, Ventilation.
    Fifteen minutes later they pronounce him. Ten minutes after that the nurses bring in the family. I hear them explaining the IV lines, the ET tube, the Dfib pads. They shuffle in and she closes the door. I am doing my paperwork, and I am angry.
    I am angry because the promises implied in my uniform, my stethoscope, and the accoutrements of my position were not kept. I did my best, as did everyone there. My rig, my monitor, my drugs and my years of training did nothing for this man. I do not know where this anger comes from; I'm not a newbie. At the time of this call, I had 13 years in as a paramedic. I had worked countless arrest calls. But this one stuck. 13 years later, it still sticks.

    I never knew his name either.

  20. Oh Ella. A very emotional read, even more so to write - and to live it day by day, I don't know how you do it. I'm glad you do, though. Thank you.

  21. This gave me shivers, you certainly have a way with words

  22. Still brings tears to my eyes, still one of my favourite posts x


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