Saturday 2 March 2013

Trapped in Darkness - Part 2


"Male, U/K age, One Under"

Until now, I had been totally patient focused and hadn't noticed the commotion around me! There were about 6 Fire fighters under the train too with various member of underground staff trying to work out how to lift up the train. I'm guessing by the discussions that it isn't something that is done too often! In most One Unders they are either a) dead, in which case the train is driven off them or b) alive but trapped by a limb, in which case if a quick extraction is needed an amputation and dragging out will happen. Unfortunately, they couldn't drive off as it was his pelvis on the track and you can't amputate a pelvis for obvious reasons!

As minutes ticked by we got drugs flowing! In went morphine and ketamine and fluids. We cut of as much of his clothing as possible to examine what we could get to. There were minor cuts and abrasions but nothing major. All the while, the patient was getting more and more frantic so more and more drugs were given to numb the pain and relax him. Problem was there was no real access to his head. He couldn't see anything but  darkness and could only hear and feel what was going on, and for someone who is claustrophobic I imagine it was torture. I was starting to get very uncomfortable my self, the heat, the smell, the noise, the taste of air, it all made it a very uncomfortable atmosphere. Add to that the fact that realistically the patient could simply die and we would be powerless to do CPR, ventilate and remove quickly. It was a scary thought! 

"Sorry we're all talking about you. How are you doing?"

"Get me out of here"

"We are, it will just take a little while, I'm staying here right by you, if you feel any new pains or anything changes, please tell me."

"Get me out of here"

"We will, we will."

"Please, help me, I don't want to die" he cried.

Talking to someone who can't see you is bizarre. I could only imagine his facial expressions and the fear painted across his soot covered face. I felt totally helpless in all honesty. I tried to keep him positive but as the pain continued and the time went on and on he became more anxious. To be fair, so did I. 

Eventually, after about an hour they were ready to lift. I don't credit the fire service that often but credit where credit is due. They had been fantastic. The were working their nuts off, bringing us more oxygen, providing light and lifting 120 tons of train up! It wasn't a case of 1-2-3 lift! So, in a co-ordinated effort and a very detailed plan, the scoop was lowered down to the tracks and slid along, rope on 1 end. The pelvic splint was positioned and as many hands as could fit were placed on various parts of the patient. We are all told to stay away from the wheels as if the train drops we don't want to get trapped! 'Drops?' 'DROPS?' Encouraging! 

"OK, we are lifting......"

"He's free. Lower him down"

"We got him"

He let out a gut wrenching scream. Once on the scoop he vanished. Pulled the along the suicide pit and out onto the platform where the HEMS paramedic and my crew mate would take over while we crawled out. I shuffled backwards slowly, eventually making it to the platform where the light and underground breeze could be felt. The platform was full. Police everywhere, about 30 fireman, a few ambulance officers, a second crew and of course......HART team huddled together watching! The patient was being strapped up and wrapped in bubble wrap. Blood infusions were being prepared and he was being put to sleep by HEMS. I bet he wished he'd been asleep a long time ago. 

Within only 2-3 minutes we were ready to go. I took over the breathing for the patient and 8 fireman lifted him up and off we went through the maze of tunnels and escalators. FRESH AIR! Oh how I missed it. Behind us was the band of merry men and woman carrying all the kit. Everything was chucked on board, blue call placed and off we went. I was trying to take stock of everything that was going on. Suddenly, the doors swung open, we were at hospital, I hadn't even noticed we'd stopped. Into resus we went, a 30 strong team waiting for us. Luckily for me HEMS did the handover. I'd have probably starred blankly and said 'Hit by a train...erm...'!

We went back to the vehicle which  looked like a bomb had exploded inside. We tidied up and I started on the paperwork. Where the hell did that job come from! It really is true, EMS Rule number 10:
EMS is extended periods of boredom, interrupted by occasional moments of sheer terror.
Nothing can prepare you for things like this. It isn't for everyone. It is one of the few jobs that tests every part of you. The problem is you never find out if you passed the test. As all crews will say, he was alive when we got him to hospital so that's a win for us. It's a cover though. In reality, we are all desperate to know if he survived. We will probably never know. That's the reality of pre-hospital care....once you're at the hospital, your care is supposed to end. 

 My crew mate pointed at my face...

"You got a bit of dirt on your cheek!"


  1. Very good couple of posts Ella. I've got my LUL training day coming up in a couple of weeks, learning what to do when this happens (I'm sure when I actually go to a one under I'll have forgotten it all!).

  2. Hi Ella, great writing. Whilst you were in all that muck and pressure, i hope you remembered ...... band 5.....soon to loose any unsocial hours enhancement ( as we are in the NHS T&C changes)....... ;-)

  3. The only reason I wouldn't want to work in London is that hems take over, sounds a bit degrading to have them take the credit after all your hard work. Luckily in Manchester it's us and that's it!

  4. Do you know if he survived? I know you get no news from the hospital but wondered if had been in the news?

  5. Sounds like a good job, well executed. Loving the two part blog, the suspense was killing me! I've yet to have a one under but I expect it's somewhere down the line for me (excuse the pun).

  6. Brillant blog as always. Shame dont know if he was ok

  7. Crikey I can taste it as I did when a friend (tube driver) described a one under - horrible.
    I do hope he made it especially after the gallant efforts of you all, great team work.
    best wishes.

  8. Great posts Ella, cant speak for HART down there but maybe you should have a look at what they do... Not all are 'wannabe firemen'!
    An extra pair of hands (or 7) are always handy :-)

    Also, it aint nhs budgeted.. It's government funded in the event of another 7/7 etc.

    Great blog though, keep it up!

    A Northern HART Para :-)


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