51 minutes earlier

"You ready? 1...2...3...lift."

"Get me out of here!"

"Stay there, we'll be with you in a minute, OK?"

"Right, I'm on airway, I need some suction. Get the clothes cut off, start a top to toe."

"Have EOC come back to us yet?"

"Not yet.......excuse me, can you help us?"

"Sure."

"Can you go to other the guy in the back, talk to him, reassure him, find out where he is hurt, tell him we'll be with him in a minute."

*radio rings*

"HEMS on way, eta 12 minutes."

"Rog, we need another crew and the fire brigade. We have 3 casualties, 1 deceased, 1 peri-arrest and 1 trapped."

"Received, police and fire on way. Your second crew is 3 minutes away"

"Rog"

"I've got no respiratory effort now, pulse check?"

"Nope, no carotid."

"Time of arrest, 21:42, start CPR."

*police and fire brigade arrive*

"Hi guys, only 1 car involved, 3 occupants, driver is deceased, rear passenger is trapped but no obvious serious injuries and this guy, front passenger has just arrested on us."

"What do you need from us?"

"Can you take over CPR from my colleague......and can you guys deal with the guy in the back please. The other ambulance should be here in a minute."

"Right, let's get this airway sorted, chuck me a size 4."

"There you go, we are in asystole, I'll get a line in."

"Any long bone fractures?"

"Maybe foot, looks like it's just the head injury and anything we can't see."

"Stop CPR for a moment........I haven't got much air entry at all, let's decompress the chest. Carry on CPR, thanks."

"Here you go, I'll get the right side."

*second ambulance arrives* 

"Hi guys, what needs doing?" 

"If one of you could help here, and one of you help the fire brigade with the guy in the back, I have no idea what's going on there."

"What about the guy in the front?"

"Massive cranial destruction, in cardiac arrest on arrival and trapped. This guy was unconscious but breathing and the guy in the back was talking."

"F#%ing hell!"

"Yep........right where are we at?"

"Airway is being managed, chest is decompressed, CPR is constant, just getting fluids up now, he's getting dressings on the head.....want me to take over for a few minutes?"

"Yeah cheers fella, I'll stop after the next cycle."

"Does anyone know what happened?"

"That guy standing over there saw it, apparently they lost control, swerved around the road, flipped over and finished in this tree."

"Still in asystole."

"Carry on. Let's get stuff ready to move if we have to, can you get bed, scoop, blocks and straps. To be honest, I doubt we'll be going anywhere but you never know."

"Chuck me another cannula, I'll get a second one in."

"I'm all out of orange. Grey?"

"Yeah that'll do......how's the guy in the back?"

"Nothing major at the moment, seems stable, distressed obviously, having to cut him out"

"HEMS are here."

"Hi guys, where are we?"

"This guy was front seat passenger, on arrival he was unconscious, irregular respirations and some airway compromise. We pulled him out the car and he arrested a couple of minutes later. He's bleeding into his airway but it's being maintained with an iGel and suction. We've got bi-lateral IV access and bi-lateral chest decompression. He's been in asystole throughout. There was nothing we could do for the driver and the rear passenger is walking wounded by all accounts."

"OK guys, great stuff, let's move him a few feet so we get good 360 access."

HEMS took over and went about their business. We held units of blood and did what we were told! The scalpels appeared and they cut holes in his chest to assess his lungs properly.  It was at this point the police officer who had been helping us decided to go and stand somewhere else! 

After about 5 minutes the resus was terminated.

"Are we all in agreement?......*head nods all round*......time of death 22:03."

A blanket was places over the guy and everyone turned their attention to the one in the back of the car. The fire brigade were cutting the car away and one of them was holding his head still through the boot. There was a mass of bodies all working towards one common goal. I remember looking through the mass of people and seeing the lifeless dead body of the driver just sitting there. It was first time I'd been involved in a job where I've had to ignore the dead. It was an uneasy feeling, I have to admit. 

After about 20 minutes the patient in the back was freed from the wreckage. He was place onto a spinal board and loaded onto the ambulance. HEMS travelled with the patient and the other ambulance crew to the hospital. We picked up all our kit and followed, leaving the carnage behind for the police to deal with.

51 minutes earlier......

Three 18 year olds were driving along. Where they were going I don't know. Where they had come from I don't know. What they were talking about I don't know. I'm sure there was laughter and banter. There always is when friends are together. I'm sure they were enjoying the freedom that a car gives you. They had their lives laid out in front of them with endless possibilities. I don't know exactly what happened next, I only know what we were told.

"RTC Car vs Tree, 3 patients, 2 unconscious and trapped."

We weren't far away, I knew the road and knew it had potential to be serious. Nothing, however, could prepare me for what lied waiting for us. Within a few minutes of the call coming in we were on scene. A number of cars had stopped and blocked the road in doing do. The car itself was utterly destroyed. I was surprised to find anyone conscious to be honest. It was truly horrendous.

It was a 3 door car and due to the way it had impacted the tree I go only get to the passenger door. The driver was dead. I don't need to expand further than I have but there was nothing that could be done for him. The passenger in the back was dazed but talking. He was complaining of pain in various places but being behind the driver there was no way we could get him out without the fire brigade. The only person we could meaningfully help right now was the front seat passenger. 

He was unconscious, covered in blood and breathing very slowly. He had a pretty awful head injury and needed to be out of the car very quickly. The door wouldn't open fully but after some gentle persuasion it was bent out the way. I lent in and grabbed him under his arms. My crew mate grabbed the legs.

"You ready? 1...2...3...lift."

*          *          *          *          *

No matter how hardened we all are to this job, these events do effect us. Whether or not we lie awake thinking about it, day dream about it or just think long and hard about what has been lost, it effects us all. Three young men had their lives destroyed. One may have survived but you can rest assured that his life won't be the same again. Neither will that of their families. All I can think about and keep revisiting is how much fun me and my friends used to have whilst driving along in a car. Perhaps the only difference between a great time and a life changing tragedy is a mis-timed glance over the shoulder  and some bad luck. Who knows. Life is so fragile.

“To die is poignantly bitter, but the idea of having to die without having lived is unbearable” Erich Fromm