Thursday, 9 April 2009

Teamwork

Day shift: Six calls; All by ambulance.

Stats: 1 Transfer; 2 RTCs; 1 Testicle pain; 1 Head injury; 1 Birth.


No matter how many times we bitch and moan about our lot (and these days we should be thankful to have a job at all), every now and then we get shifts that remind us we are all part of a team, or at least most of us can work very well together in high tension circumstances.


The first call of the day was a typical ambulance job – a transfer from one hospital to another. The patient was a methadone user who’d had a TIA (one of many in his history) and needed to be taken to a specialist unit for observation. He walked on and off again, reading his paper and relaxing in the back of the ambulance during the trip. There was nothing for me to do – I didn’t need to attend at all and so I chatted to my crew mate as we trundled along.


Two RTC’s today and this first one was a minor injury. A 40 year-old female was standing behind a bus when it turned out of a station, clipping her on the back at 5mph. She almost fell but didn’t quite although an ambulance was called because she complained of back pain. The solicitor was on her way to work and her husband was with her to see her off. Both ended up going to hospital – she went for treatment and he went for a visit. The husband drove himself there in the family car as his wife sat in the ambulance with me, hugged her Prada bag, cried, vomited and winced all the way. Eventually, at our destination, I got her to smile a little.


My crew mate had just finished telling me how she attracted only dull jobs and that the record for dragging crew mates through slow days was unbroken until we got this call; a woman cyclist had been run over by a cement mixing lorry and was trapped underneath. As we got underway, the details updated to ‘cardiac arrest’.

On scene, an ambulance crew, FRU paramedic and several CRU medics were attending to the patient. Police had sealed off the road but hundreds of people lined the pavements to see what was going on. What they witnessed was horrific.

The young woman had been caught underneath the lorry as it turned a corner – I’m not sure if she was cycling on the inside of it and couldn’t be seen. She was dragged under and crushed by the wheels. Now she was dying on the road with massive injuries.

CPR was in progress and my crew mate and I became part of that team as soon as we got her out from under the rear wheel. Fire crews had cut away her bike, which was a mangled mess, because it had trapped her legs, making it impossible to move her body. When she was clear we quickly got her into the ambulance and I continued to ventilate her as compressions were carried out. Everything that had to be done was completed before we’d moved her and as far as I was concerned she was as stable as we were ever going to get her.

Just before we left for hospital, a doctor appeared – she’d been requested as a matter of routine because of the nature of the incident. She climbed on board and began to do what she felt was needed. As is commonly practiced by emergency doctors, including those on HEMS, a scalpel was used to aid access to the internal organs – one hole on each side of the chest in preparation for a thoracotomy.

The woman had become very pale and her pupils were dilated, so all the signs were bad. When we arrived at hospital I looked down to see blood pooling on the floor of the ambulance – lots of blood. The efforts to save this woman’s life had been extreme, as necessary but she had lost a lot of fluid as a result, despite the replacement saline. Every compression had simply pushed volume from her – a dramatic and unfortunate consequence of the attempt to keep her going.

We returned to the scene because our ambulance was still there – we had travelled with the other crew. The police very kindly drove us back and as we recovered ourselves and sat in a coffee shop right next to the lorry, the manager asked us if she’d made it. She knew from our faces that she hadn’t – it had been called by the doctors twenty minutes after arriving in Resus. Then she went to the door, began to cry and lit up a cigarette. I went to see if I could say anything to comfort her.

During the conversation with her I discovered that she had been one of the first outside when the incident took place, right at the door. She had held the woman’s hand and spoken with her for a few seconds before she had ‘faded’, as she put it.

Inside the cafĂ©, the police were talking quietly to other witnesses, including a pregnant lady who had been next to the woman when she was hit. These people, including the lorry driver, would have to live with this for the rest of their lives and someone’s family would grieve for a long time about the tragic loss of a loved one.

I am wary about reporting these incidents because I really don’t want to upset people who might know the patient – I try not to be dramatic because this isn’t entertainment, it’s horrible and real but I for one don’t want to see any more young lives destroyed by incidents like this – if she was cycling on the inside of this large vehicle and the driver could not see her, then a tragedy was inevitable. If she was being careful, then we need to re-evaluate the purpose of having large vehicles moving around in tight spaces during busy periods when cyclists are everywhere. Or the roads need to be re-mapped to accommodate them safely. This article shockingly highlights the problem we face, particularly for female cyclists. I was on shift the day of the first incident but hadn't been called to it because we were too busy attending a hoax call just up the road.

I left the scene with my crew mate when the circling cylinder of cement was finally switched off.


The man with testicular pain was a 40 year-old Italian who had endured months of pain because his GP had given him antibiotics without even examining the problem. A CRU was on scene and we had a look at the problem - nothing was obvious but his history of pain and discomfort was in no doubt. We took him to hospital in the hope that someone would actually look at his injured area before diagnosing it.


A 75 year-old fell while going to the toilet and his son called us because this wasn’t the first time he’d stumbled and hurt himself. He had an old injury on his head and a fresh one where he’d landed on the toilet seat as he collapsed. He’d had a TIA last year and was left with speech and movement problems – this made it difficult for me to understand him and moving him was awkward. The lift we travelled in had to be the smallest I’ve ever come across – I was practically hugging him in it, such was the squeeze.

He remained alert and stable during the journey to hospital and I had finally mastered listening to him when he spoke, slurred and muddled as his language often was.


We get to witness the great contrast in life and death on this job – it’s a privilege and a shocker at the same time. For once the day ended with something to remind me of life after the cyclist's death earlier.

We were on our way to an imminent birth and fully expected to be delivering a baby on scene but were beaten to it by the FRU EMT, who’d arrived a few minutes before us. A MRU was also on scene and as we knocked on the door we could hear the cries of a new-born.

This should have been straight-forward; it was the woman’s third child and the baby was fine – wrapped in a light blanket in the arms of the EMT. Mum was lying on a bed in a tight little room and the father stood at a distance as if he was barred from the ceremony. The baby was handed to him so that he could say hello to his new son and let the other kids see their new sibling – he was so happy that he began to hand out drinks to everyone – bottles of still water.

The placenta had not yet been delivered and the mother had contractions, so we waited. A midwife was requested, so that we could have the mum and baby checked and left at home but she could not be reached – the on-call midwife was on voicemail!

I waited for another half hour and the MRU paramedic left the scene. Another crew arrived and I made a decision – we would take her to hospital for the delivery of the afterbirth – it could get complicated otherwise. Syntometrine is used routinely by midwives in these circumstances but we only use the drug if there is significant bleeding associated with the birth, so she was best taken to a place where it could be given if necessary.

Again, we worked as a team to get the woman out of the little bedroom and into the ambulance – it took five of us to do it but it went smoothly. Both mum and baby were taken up to the delivery suite and left in capable hands. If the midwife had come when requested, I have no doubt the trip would have been unnecessary. Some teams work and some don’t I guess.

Be safe.

13 comments:

Danielle Gohin said...

What an awful way to start your day. That poor woman. I have to admit, it was only after I started reading your blog and others that I realised how dangerous it was to cycle up the inside. I often used to do it. Especially at stationary traffic.

james said...

I've been a lurker for a while now (via RSS so I don't usually even see the comments) but I wanted to share a story.

I had similar job last summer in Connecticut. We had a guy riding his bike on the inside of a dump truck full of asphalt.

We (well, the cops) seem to think the handlebar of his bike was pushed against the rubber of the truck tire at a red light. When the light turned green, the truck must have driven forward quickly, pulling the handlebars of the bike downwards and catapulting our patient under the the two massive rear tires.

He was conscious and talking to me on my arrival, but by the time I got him boarded and collared he was in respiratory arrest. Once on the monitor in the ambulance, he was asystole. The force of the truck did some horrendous things to his abdominal cavity although the only visible outward abd. trauma was some distension. Compressions did the same thing to him as they did to your patient. Pronounced by the docs at the ER about 30 minutes after our arrival.

We were promptly requested to return to the same scene for the dump truck driver complaining of chest pain.

Good lessons there: something needs to be done about cycling (even in small town USA) and always think of other possible patients, especially if the town only has one crew on!

medicblog999 said...

XF,
Wow, tough day at the office to say the least.
Hope you are getting the support you need from your colleagues (even if you think you dont need it!!)
Its always nice to have a delivery as well to lift you slightly.
Isnt it strange when that happens though - one death, one birth!!

Anonymous said...

What a horrid day on balance.
However, may I point out - by definition, the difference between a TIA and a stroke is that the effects of the TIA resolve within 24 hours. Your elderly faller had a stroke last year, otherwise he would not have been handicapped from it.

Anonymous said...

Oh, and the bit that says how many comments isn't working, for some reason.

Downfader said...

I've been cycling since a child, and on the roads since 14. I passed my Cycle Prof at 12 or 13 and had read the highway code by that point also.

Sadly - I have had to say many a time thesedays - we now have a generation that has grown up with the motorvehicle as the first vehicle they use on the roads. Cycle training is disparate at best (Bikeability being great IF you can find someone teaching it) and often not given to kids at school.

They used to train kids up the road from me, but an incident with a driver made the school who had organised it all withdraw the training.

Many take up cycling and simply give up after a few weeks due to some drivers attitudes and behaviour. I have had many a large vehicle overtake me actually at the junction I'm navigating through, or through tight spaces. My instinct is to hammer on the brakes and duck left (or where ever is safe) and scream out loud a warning.

I can therefore sadly beleive either way that the cyclist may have been overtaken at the junction or have undertaken, though CCTV will hopefully show exactly what happened.

Cycling is only as safe as we all make it, and sadly the courts and authorities are failing the public in this respect, and I know you will attend many more accidents such as this in the future.

TonyF said...

I have seen a couple of 'near dos' with cyclists/mopeds (if that's what they are called these days)and even pedestrians stepping out too early..I sometimes tow a cherry picker on a pedestrianised area, and although it's big and easily visible, some people still fail to see it. I have a horror that someday, someone small will be hit by it. I think in these cases, only an awareness campaign may make people think.

On an aside to awareness. ipods and the like. A chap walked out of a shop, straight into the front of my van. He had absolutely no awareness of what was going on around him. He could not hear anything other than what he was listening to. No horn, no shouts. Fortunately, I had stopped, and he gave me a shitty look? More and more we isolate ourselves.

Xf said...

Anon

Yes, true but I'm only reporting what the patient's son told me...I should really have parenthesised the fact that it was more likely a stroke he'd suffered.

When queried at the time, the son was adamant that the doctor had told him it was 'just a TIA' and not a stroke...but there you go.

Anonymous said...

gosh what a tragic accident as indeed there are so many these days.....what I don't get is that we have so many laws in respect to driving and the roads and yet it is NOT against the law to NOT wear a cycle helmet??? Please someone correct me if I'm wrong but if it were the law then surely many peoples lives may not be so badly effected when involved in these accidents. Although by the sounds of it I don't think anything was going to save this poor lady despite you and your colleagues best efforts and wonderful teamwork. I always make my kids wear a helmet especially when we are near roads although my fear is that as they get older and will be cycling on their own that they may not always abide by mothers rules!!

Just a thought.
Maz - student paramedic

downfader said...

Anonymous:
"gosh what a tragic accident as indeed there are so many these days.....what I don't get is that we have so many laws in respect to driving and the roads and yet it is NOT against the law to NOT wear a cycle helmet???"

Sadly a helmet a) gives the impression that cycling is dangerous and b) only really protects from impacts at 12mph at a height of 1m. So falling off a bike basically, not being hit.

Also the majority of collisions with motorvehicles seem to indicate that body injuries are far more common than head - with the knees and legs taking most of the brunt. The spine and shoulders coming second.

What a helmet does generally protect you from is cutting your head open on the road if you do "off", it also keeps the sun out of your eyes. I'm afraid those are the only reasons I wear mine.

There is a lot of myth around cycle helmets, sadly.

Anonymous said...

Thanks for that info downfader I really wasn't aware of that.....i'm thinking of maybe putting my kids in a full suit of armour when they are finally let loose in to this world - bicycle or no bicycle - that way they might be protected from the accidents/stabbing/shooting/broken bottles in faces......

Regards :)
Maz x

Gordonjcp said...

Yes, "cycle helmets", also known as "spine breakers".

If you fall off a bike wearing a normal cycle helmet at anything above a slow walking pace, you're pretty much guaranteed to hurt your neck pretty severely. They're designed to stop injuries where the side of your head hits something like the edge of a kerb - pretty much the least likely accident you can have.

People are incredibly careless around large vehicles, and don't seem to realise that a truck that's signalling right but far over to the left will actually use the whole junction to get round. They're not sitting on the "wrong side of the road" because it's fun, as one chap I saw get hit discovered. He'd rolled up in his shiny new Merc estate, right up the right-hand side of a car transporter that was signalling right - when the transporter pulled forwards the trailer crushed the front of the car against some pedestrian railings. The truck didn't stop, presumably because the driver didn't see or hear anything that was happening that far away...

Anonymous said...

Thanks for this post. Hope you're feeling better :) The post has really made me think seriously about the dangers of cycling around stationary traffic, both from the perspective of a cyclist and a motorist. I find that I'm far more aware around cars now than I was before - checking for indicators, opening doors, signs of movement etc.

Thanks Very Much.