The Nation's Health + trauma

24 - Season 2: Episode 4

continued......

WARNING: Some people may find the following post upsetting


The following takes place between the hours of 3:50pm and 4:30am


15:50

At last, an opportunity for food. I don't want it now though! Seriously, I don't! I'm not sulking and cutting my nose off to spite my face, but I really don't! I've got dinner at 7pm with my sister so there is no point in eating now! I'm also fully aware that I shouldn't make plans but a casual meal with my sis, at my house doesn't really count! At least not in my book! Typically, now that I no longer require food and have at last made it to a toilet, there was suddenly a lack of jobs! Having not had a break, I was off at 17:15 so I could really do with a job round about now. Obviously, that was never going to happen. Finish on time?! Not a hope in hell!

The minutes ticked by, my finish time loomed closer and closer. I was starting to get a little agitated. After the agitation came the anger about almost certainly being late off. Then came the text to my sister saying it was likely I may be late. Then came making peace and accepting being late off. As the minutes ticked by I was dangerously given hope, could I possibly not get a job?! Nope.....

17:01

"88 year old female, fall, can't get up, ? unconscious"

PANTS! OK, it might not be too bad. Hopefully it will be an assist only fall, I can help her up, check her over, do some paperwork and leave. At worst, it's likely to be a minor injury needing hospital, I'd have to wait an hour for a truck and then can go home! No point in moaning now!

Ten minutes later I was outside. An elderly man was anxiously standing on the pavement and explained he had heard her fall about 10 minutes ago but couldn't get in as the door was double locked and the keys were in the locks. I grabbed some bags and wondered up to the front door. I opened the letter box and peered through. Lying on the floor at the bottom of the stairs in a pool of blood was my patient. Her head was on the floor and her legs up the stairs. She was absolutely motionless.

I instantly dropped by bags and begun kicking frantically at the door, but to no avail.

"Red base, priority, this is a possible cardiac arrest, police required for access urgently, are other resources on way?"

"Received, police on way, ambulance eta 3 minutes, responder also on route, should be pulling into the road now"

I didn't reply, I just started kicking. Over and over and over again. I must have seemed possessed. On mass everyone arrived together. As the copper came up the path I went for one last kick! Amazingly the door splinter and swung open. We all piled in. I checked her pulse, nothing.

"Right, lets all grab a limb, support her neck and get her onto her back"

I told whoever was standing next to me to start CPR. Turns out it was one of the coppers. I just started barking orders and everything seemed to happen. From my initial assessment she had a mid shaft of femur fracture, rib injuries, possible collapsed lungs, dislocated shoulder, broken wrist, probably spinal injury and severe head and facial injures. There was so much to do, so little space and so much to think about. I was quite overwhelmed initially, just trying to think about whats what! Trauma though is simple A B C, airway, breathing, circulation. Let's go.

Airway was a mess, mouth full of blood, nose swollen and bleeding, we suctioned and I put in and secured the airway. She was then fitted for a collar. I passed the mask to someone and asked them to ventilate. Hardly any chest rise. Me and the other paramedic who had now arrived decompressed both sides of the chest. A small hiss of air and the lungs were inflating better than they were. That was breathing under control. For now! Circulation was being done with CPR but her femur fracture needed reducing. Pulling a fracture isn't pleasant job, but it had to be done. Luckily there was someone else on hand to straighten and splint her leg.

I got some IV access, all the while CPR was being done and rhythm checks at two minute intervals were being called out. Nothing we could shock at the moment. I was still barking out orders, not because I'm a bossy person, but because the first paramedic on scene takes the lead in cardiac arrests. That was me today! Suddenly we had a shockable rhythm, that's something at least.

"Stand clear, oxygen away, shocking now."

As the electricity surged through her body she jolted. CPR started up again, everyone turned back to the tasks in hand. With trauma it is important to get the patient to definitive treatment ie; hospital, as soon as possible. It's not a case of 'stay and play', it should be 'scoop and run'. That said, she had to be as stable as possible before we moved her and at the moment she wasn't. In the meantime, I sent someone with a list of things we needed, to get her out. Scoop, straps, head blocks, the bed etc. Minutes past and further shocks were given. She was started on Adrenaline at regular intervals followed by some Amioderone.

"Right guys, rhythm check please"

"Think we have her back...."

"Pulse check......"

"Strong carotid here."

"Right, I have a thready radial. Well done guys, return of spontaneous circulation (ROSC) at 17:31. We've got 10 minutes or so before we can move her but lets get her packaged and ready to go."

Like a swarm of worker ants everyone started getting her 'packaged'. By packaged I mean all clothes cut off (skin to scoop), all injuries dressed and splinted, pelvic splint on, put on a spinal board, head blocks on and strapped. While all that was going on, me and the other paramedic were going through the ROSC protocol in a trauma patient. We couldn't get a blood pressure, her pulse was slow and weak so we started giving fluids and Atropine to try and speed her heart up. Before long we were ready to go. She wasn't stable by any stretch of the imagination, but we had to go now. We still had a 30-35 minutes run to the nearest trauma centre.

Kit chucked on the truck, bags opened and the patient loaded we were just about ready to go. The chest rise on the ventilations was diminishing and her Co2 levels were dropping so whilst the blue call was being put in, we re-decompressed her chest.

"Ready to go?"

"Yep, shout on the corners please!"

17:43

Off we went, 3 of us in the back! 2 of us were standing up holding on with one hand and trying to snap glass ampules, draw up drugs into syringes and administer them! Do the maths, not enough hands! Forhissy fit!

the most part we were ambulance surfing. Bear in mind it is a legal requirement for motorists to be seated with seat belts on. We were standing up, not holding on, going at speed, into oncoming traffic! The health and safety executive with literally have a

We had only been travelling about 2 minutes when she arrested on us again. CPR was resumed and we started on our cardiac arrest drugs and protocol like before. There was now very little we could do but drive. We couldn't shock her because for all intents and purposes her heart was lifeless, and you can't shock a still heart.

18:19

Eventually, we pulled into the hospital. Over the last 10 minutes she had deteriorated more and more. Ventilations were poor quality due to the ever decreasing chest rise, Co2 was dropping and her airway was repeatedly filling with blood, despite suction constantly for the last hour. She was in a really bad way.

With CPR still in progress the back doors swung open. We got her out onto the lift and down the corridor to resus. Waiting, was the biggest trauma team I've ever seen. *gulp* We transferred her to the bed and then the team was silenced for my handover. No HEMS to hide behind, no team leader or clinical lead to do it for me!

"Right, this is an 88 year old lady who has fallen down 15 stairs we believe. On arrival patient was face down on the floor with her legs extended up the stairs. There was no respiratory effort and she was in asystole. After 6 minutes of CPR we were able to shock and did so 3 times whist she was in VF. We received ROSC after the 3rd shock. She has had Amiderone, Adrenaine, Atropine and 1.5 litres of sodium chloride. Her airway is compromised but until 5 minutes ago we maintained a good Co2. She re-arrested on route and has now been down in asystole for 32 minutes. Injuries from head to toe: we have possible fractures to the nose, orbit and mandible with a deep laceration to the occipital area of her skull, possible spinal fracture, possible rib fractures with punctured lungs, 2 sets of bi-lateral decompressions have been performed, she has a dislocated left shoulder, a fractured left radius / ulner, her pelvis is firm but splinted and there is a mid shaft right femur fracture that has been tractioned"

And breathe.....

The trauma team had a brief confab followed by an announcement.

"Time of death, 18:22."

There are no words. Dejected we all went back to the ambulance. 4 of us, covered in blood, sweating and a bit shell shocked. We aren't stupid, we know her chances were next to none by the time we arrived. However, we have just done everything in our power to keep her alive for over an hour in the most difficult of circumstances. We have travelled across the city to get to the hospital where the best people from each speciality are waiting for us. Couldn't they wait until we have left the room?! You sometimes think why do we bother?! Why did we put that poor lady through all that?! We are not after anything from the hospital but for our efforts to be simply dismissed? It's just a bitter pill to swallow.

We sat there cleaning up and doing the reams of paperwork that was needed. I can assure that it isn't done quickly, nor do we rush. We talked the job through but everyone seemed pretty quiet. It was a horrible job. It was one of the faces that will stick.

19:31

Now for the drive back to base. The traffic was solid and I just sat there on my own thinking things through. Probably not a good thing to left alone with my thoughts. I sometimes question whether I can carry on with it? Can I keep seeing the things I see? Is there only so much death and destruction that someone can see before they implode? I don't know how people have stuck at it for 30 years. Maybe you just carry one regardless.

20:48

I finally pulled into the garage. It was empty. I quietly emptied my vehicle and re-stocked it. Then I signed my drugs back in, tipped my stuff into my locker and climbed onto my bike. Over 15 hours after I started, I was finally leaving.

21:15

I started my cycle home. Every pedal a struggle. Maybe I should have eaten before that last job. My tank was empty.

21:40

I stepped into my flat, staggered up the stairs and dropped to the sofa. I text my sister 'Really really late, soz x' and dragged myself into the shower. As the water poured down my body it turned pink. The pool of watered down blood appeared at my feet. That's a sign of a bad day at the office if ever I saw one.

22:30

Cereal. That's all I could muster.

23:05

Set alarm and clambered into bed. Almost 19 hours after I got up! Laters......

04:30

Cue The Buble....

'Oh, the shark has pretty teeth, dear
And it shows them pearly white
Just a jackknife has MacHeath, babe
And it keeps it way out of sight'

*presses snooze*

That was one day shift. Can you recall all 8 of my patients without looking? Had you forgotten about the critically ill 2 year old boy from 21 hours ago? I had. Feels so very wrong doesn't it.

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Relevant to: 24 - Season 2: Episode 4 + trauma