Monday, 9 March 2009

Bike versus taxi

Day shift: Four calls; all by ambulance.

Stats: 1 Dizzy female; 1 RTC with fracture and ?spinal; 1 Faint ?fit; 1 DIB.

I know what you’re all thinking – the last few shifts have been very slow, with an average of four calls a day for me. It’s true that I’ve only attended a few recently but the Service as a whole is busy…if not busier than usual. There are a lot more motorcycle units out and about with me on my day turns, so the workload is spread evenly among us. When there are no bikes, or very few of them, then I tend to deal with double the number of calls.

It’s all good for my mental health. I get more time to think and less time stressing through heavy traffic behind the wheel of a target-driven FRU. The slack won’t last long, however. As the weekend approaches in the short term and the weather improves in the long term, I will be run off my wheels again, regardless of the number of cycles and motorbikes that are working.

A 56 year-old lady became emotionally upset when she began to feel dizzy as she shopped. She developed a facial twitch on one side for a short while apparently, but it was gone by the time I reached her. She had a history of hypertension but her obs were good and there was no associated headache or other symptom present. I think when I arrived, she’d got over the worst of whatever she had experienced and it was just a case of bringing her down from the height of her crisis.

On the other hand, she may have had a small stroke, so she went to hospital with the crew when they arrived.

I expected to see a motorcycle colleague racing towards the next call with me (in front of me of course) because it was a RTC on a busy road, involving a taxi and a biker. An ambulance pushed its way through heavy traffic en route and I thought it was going to this call too but it turned left when I went straight ahead. Unless the crew knew a quicker way to the scene I was on my own.

I arrived to find another ambulance crew on scene and dealing with a motorcyclist who'd thrown himself from his bike when he realised it was about to collide at 35mph with a U-turning taxi. The cabbie had made the turn without looking (or seeing) the motorcyclist approach and, in order to save himself from imminent death, the man on the bike had ditched, causing his body to land on its side and slide along the road with his machine, which embedded itself into the bottom of the taxi (pic).

Now he had a broken collar bone, which may or may not have punctured his lung. He also had a possible spinal injury because he had pins and needles in one leg and severe back pain.

An off-duty GP appeared and offered her help. The crew was busy with other things, like obs and collar, so I got on with setting up fluids on a line. I used the doctor’s skilled hands to stop the vein from leaking too much when the cannula was withdrawn and to prepare and hoist the fluid bag for me. Then I remembered her pay scale and transferred the job of drip stand to a police officer who wasn’t busy.

The man on the ground was stable but in a lot of pain. He was also beginning to get cold because all his clothing was coming off in a frenzy of shears. If his collar bone had gone through his lung, he could develop a serious problem and so I asked the GP to stay just in case we had to do something drastic.

I also called for another pair of hands and requested MRU backup. My colleague arrived very quickly but, again, I was surprised that he hadn’t been despatched to this initially. To be fair, we were generally busy and it may well be that resources were being kept ready for other things…like the RTC that happened an hour or so after this call in which a woman was run over and crushed by a large truck - a call I heard about a lot and just missed because I was on this next one…

…A 25 year-old woman collapsed in a pharmacy and had what the pharmacist described as ‘a little fit’. When I arrived, the lady was sitting on a stool behind the pharmacy counter, glass of water in hand, phone to her ear and tears in her eyes. She was clearly upset by the experience.

When she finished her conversation, I asked her what had happened but she didn’t remember much. She told me she’d had a similar experience when she was younger and her mother had told her she’d fitted but, strangely, nothing was done about it and her GP wasn’t told. She also told me that she had frequent experiences in which dizziness occurred and a dark shadow sometimes descended over her vision but that she’d got over them each time…until now.

I waited with her in my car because the ambulance was a distance away and she was well enough now to walk. Her BP had initially been low but it was better by the time I’d completed my obs. She too was a pharmacist, ironically but she didn’t work in the place where she fell – she was just shopping.

Her inside bottom lip had been pierced by one of her front teeth when she landed on the floor and there was a little hole in it. The swollen tissue was making her uncomfortable but I think she was very concerned about her long-term health. She worried about the possibility of epilepsy. So did I but I also thought of other causes and considering the past events she’d described, some of them could be sinister.

But my mission was to elicit a smile from her and I did eventually, even if it wasn’t until I said goodbye and closed the back door of the ambulance. Maybe seeing the back of me made her feel happy.

I returned to a patient I haven’t seen for a few years. I treated him when I first started working for London and I have seen him once or twice since but I think the last time I went to his home was about three years ago. Each time I’ve been there he has been critical. He always gets blued in to hospital.

He’s only 14 years-old but he suffers from severe physical disabilities and epilepsy which can spiral out of control when he’s fitting. His airway is a nightmare to keep clear and he has to be suctioned all the way to hospital if his condition is bad enough. I was surprised to see that he was still around to be frank.

I spent a short time with him and his caring family until a crew showed up. I told my colleagues about him and, once again, he was blued in. He had a chest infection and it was causing problems with his breathing – his respirations were up in the high 30’s, as was his temperature. Despite antibiotics and a recent visit from his doctor, the infection clung to him and he continued to suffer, without being able to tell anyone. His physical and mental incapacity made it very difficult to diagnose anything.

When I got back to base I was told more about the RTC involving the woman and the truck. Over the radio I’d heard a colleague say that the injuries were incompatible with life (in other words, it would be useless to try and resuscitate) but that changed when she began to show signs of brain activity. Her ECG showed PEA from asystole, so now they were rushing her into hospital on the slim possibility that she might survive after all the invasive treatment she’d received at the roadside. I was told that her injuries had been massive – the heavy lorry had rolled right over her chest and mid-body, crushing her ribs and limbs. If she survives that, I’m not entirely sure if she will be grateful but I have seen people with devastating injuries recover, if not to normal then to something resembling it.

Be safe.


Anonymous said...

Not quite 'massive injuries' but another one which shows it pays to persevere. From the Chiswick Lifeboat website:

“At 5pm on 3 March Chiswick RNLI lifeboat was launched to reports of a woman in the water. Close to Furnival Rowing Club, they found a rowing coach from St Paul's school clinging to a lifeless casualty. The crew brought the casualty onboard the lifeboat and immediately began CPR. The lifeboat then moored up at the rowing club's pontoon so that London Ambulance Service paramedics could come aboard. The lifeboat crew continued CPR while the paramedics used their advance lifesaving equipment and the lifeboat's defibrillator. After some time faint signs of life became apparent and the woman was transferred to hospital by ambulance. Despite poor expectations the casualty was alert, talking and taking refreshment the following morning.“

Well Done to Henry Adams, the coach who kept the casualty above water until the RNLI arrived, the person who phoned 999 whilst Henry was fully occupied, the RNLI crew and last, but by no means least, the LAS crew who finished the job.

I found the fact that there is a (short, gripping but not graphic or revealing of the casualties identity) video of the rescue on line rather freaky:

BTW – the camera isn't just for Publicity footage, its used to debrief how rescues went for training purposes.


brokenangel said...

Thought you medics never said the word quite.

unfortuanlly it looks like the woman died

KGS (on behalf of Peaches) said...

Not to belittle the seriousness of your day's events, but what kind of motorbike is that in the pic? I cannot decide.

Xf said...


I believe its what they call a crushed motorbike!

If any of my MRU buddies are reading this they will be able to tell you.

Xf said...


You mean we don't say 'quiet', right?

I didn't say it...I typed it in and I was off-duty so the curse doesn't work. :-)

Spot The Gerbil said...

Coming up for 3 weeks ago my wife and I were taken out by a car. T junction, I had right of way, but I had the feeling that the driver wasn't looking. I had already backed off the throttle and was ready to brake when (surely you are going to look...) she went and became an unyeilding obstruction in my path. Idiot.

For the bikers, it was an ST1300.

Slow motion replay would show Mrs Gerbil giving me an extra shove as my male bits get battered off the fuel tank, before she exited the bike, landing 15m from the point of impact. I would have followed a millisecond or so later. I only went about 10m thanks to the braking effect of the fuel tank. We both landed on our left side, and both sustained broken collarbones. Thanks to the very good kit that we wear, the only other damage was bruising.

Only bruising. Without labouring the point, why is it that, when you need certain bits examined, there's only very attractive female doctors and nurses. I know they've seen it all before, but I'd rather they didn't see mine! I've even had an ultrasound scan!

So we have now had identical operations to get our shoulders bolted back together, much to the disbelief of the hospital staff - they've never had a husband and wife admitted for identical operations before.

The thought of surgery terrified me, and in the waiting area before theatre there was a TV to calm your nerves. Now I don't own a TV, so I had never seen the road safety advert involving the car and bike crash. Can you think of a beter time to see this commercial? Well it made my day!

With thanks to Ali and Mike and their Ambulance, and all at Ward 13 of the Queen Margaret Hospital.