by Stuart Gray
One of my recent RTC calls involved two cars, a bus and an unknown number of casualties. I’d just completed a long and very busy 12-hour shift. I should have been heading for home but this call had come in at the last minute. Driving on blue lights when you are tired is a surreal experience, but training, experience and caution keep you safe and the co-operation of the other drivers on the road - when you get it - helps a lot, too.
It was the beginning of the week, and the rush to get to work had begun in earnest.
I arrived just ahead of my colleagues. A bus was parked at an odd angle on this very busy main road, and a van was across the way from it. Opposite that was a badly mangled Vauxhall - it turned out to be a minicab - sitting in the middle of the road with a gaggle of police officers and fire-fighters peering in. The driver and his heavily-bloodied woman passenger were trapped inside - the impact had squashed the roof down somehow, and smashed the doors in and up so that they couldn’t be opened. An FRU colleague was leaning in through the side window, controlling the passenger’s head and neck. She had a severe head injury, but was conscious and seemed alert and strangely calm. The driver was sitting quietly, not moving a muscle, staring out of his windscreen at the commotion that was unfolding around him. It’s weird how people react in situations like this: some become hysterical, others seem content to trust you to get them out OK.
The best thing I could do was to help the man. I grabbed a fire-fighter and asked him to smash the rear windscreen for me, which he did. Wiping as much of the broken glass away as I could, I climbed into the car and slid myself in down next to the woman. She couldn’t see properly for the blood in her eyes, but she must have felt or heard me because she reached out and groped around on the seat until she found my left hand. Then she grabbed it just about as tight as it’s ever been grabbed. And she absolutely would not let go.
I could smell petrol, but LFB were already spreading sand on the road. They’re hot on this, unsurprisingly. I looked around the driver and saw that the ignition was still on. ‘Guys,’ I shouted, ‘can someone pop the bonnet and disconnect the battery.’ No-one wants to be stuck in a car wreck with sparks and fuel flying around.
With my free hand, I tried to hold the driver’s head still so a collar could be put on him to protect his cervical spine. Anyone involved in any high velocity RTC will be put in a collar.
And there I sat. The woman, not looking at me, said, ‘Can you call my husband please? Could somebody call my husband?’
A fire-fighter said he would, but he must have forgotten; she kept worrying on about the call, and I could understand why. She was frightened, she’d been in a nasty accident and she was trapped in a car and surrounded by strangers. She asked again, ‘Has anyone called my husband?’
I leaned forward and yelled, ‘Look, could somebody please call her husband? Get the number and call him.’
And a young fireman came over and made the call. To me, putting her mind at rest was almost as important as dealing with her medical issues.
The driver was complaining of numbness in his neck but by now another crew had got his collar on and he was being given oxygen.
The LFB brought over their cutting gear and started taking the roof off. I seemed to sit there inside that wrecked Vauxhall for an age, with the fire crew sawing and tugging at the metal. The noise and smoke it makes can be very disturbing, especially if you’ve just been in a car crash; the woman was now crushing my hand. As soon as the roof was clear, she was lifted out and taken away very quickly. Because the driver had possible neck and spine injuries, we couldn’t scoop him out; he had to sit a while longer while the firefighters cut his door away.
Once we got him to the ambulance it began to look as though he’d been very lucky and had suffered no more than a cut to his head. But the crash had been so powerful that we couldn’t rule out more serious injury, so he was taken into Resus where his passenger was already being treated.
I got chatting to a couple of the police who were there; they’d been sitting at traffic lights when they noticed the bus heading straight for a red light. They’d stuck on their blue lights to warn him but he’d continued and rammed straight into the taxi, which had spun and hit the van behind it. There was a large ‘bull’s-eye’ on the car’s windscreen; it took me ages to figure out that it had been caused by the driver’s mobile phone flying out of its holder as the bus hit it.
Funnily enough, on my way back from this job a taxi came careering out of a side street and nearly T-boned me.
We have three Call Categories, which are the Government’s way of ensuring you get the best service from us (when actually more funds and more staff are what we really need). They are A, B and C, otherwise known as Red, Amber and Green. Category A/Red calls – get there very fast. (Dead, suspended, in serious trouble. Drunk and knows how to work the system.) Category B/Amber calls – get there fast. (Pregnant. Was ill but feeling better. Drunk and not sure how to work the system.) Category C/Green calls – get there at some point in the day. (Minor injury, certainly not life threatening. Lonely. Drunk and honest.)
Not everyone is killed by a car. Some people just die in them.
The Man Who Went Shopping And Never Came Home is one of the strangest vehicle calls I’ve attended. He was a 59-year-old chap who had nipped out to the shops at around 8am and just disappeared. His family reported him missing in mid-afternoon. The police were out looking for him, but it was his son who made the discovery. He’d been called by his mum at lunchtime and asked to come home from work because she couldn’t find his dad anywhere. He was scouring the local residential streets, using the roads that he knew his dad would have used to get to and from the shops, when he found him, dead in his car.
By the time we arrived, the police were already on scene and the son was in the background talking to them.
I approached the car and there was a middle-aged fellow inside, sitting at the wheel as if he was ready to go at any second. The key was in the ignition, his hands were rested on his lap and his head was bowed. He didn’t look as if he had suffered at all. There was a small pool of vomit on the road on the driver’s side. He must have pulled over feeling ill, opened the door, vomited, closed the door again and promptly died of a massive heart attack.
And there he’d sat, all morning and well into the afternoon, while the kids played outside and the mums walked up and down pushing buggies, and nobody, not a single person, took any notice of him.
Now he was the centre of attention, though, as we gathered around the car to plan his removal. The neighbours were twitching their curtains and standing in small, hushed groups, some saying they’d known something wasn’t quite right with him, others that they’d thought he was just sleeping (without moving, all day).
It took us some time to get him out of the vehicle because he was tall and now he was also stiff. In the end, we had to put him on a spinal board and take him out as if he was a live RTC casualty. He wasn’t, of course; he was someone’s dad and someone’s husband and he just didn’t make it home.
STRONG ARM TACTICS
FRACTURES ARE COMMON and you’ll treat loads if you join the ambulance service. Lots happen in RTCs or other accidents, but some are a bit more bizarre in origin. Take arm-wrestling, for instance.
The first time I encountered this type of injury, I couldn’t believe what I was hearing. We’d been called to a flat in the early hours of a Sunday morning for a young guy who’d ‘damaged his arm’. The call was vague, at best, and my colleague and I expected to find the victim of an assault, or someone who’d been drunk and had fallen over.
We go to the address and went upstairs to the front room. We found a teenager sitting on a wooden chair with his smirking mates standing around him. He was holding his right arm gingerly and wincing in pain whenever he moved.
I asked what had happened and there was a murmuring from the small group around him. He looked sheepish. Then he piped up. ‘I was arm wrestling my mate,’ he said. ‘I think it’s broken.’
I raised my eyebrows - Yeah, right - and looked around the room. All I could see were stupid grins and empty beer cans. Stella, mostly. Maybe he was telling the truth. I knew about spiral fractures, where a break can occur as a result of wrenching or twisting forces, but arm wrestling? Come on. Turns out it’s actually surprisingly easy to do, especially with enough booze inside you. Drunken arm-wrestlers have ‘reduced proprioception’ - in layman’s terms, they’re off their faces, so they forget to stop wrestling when it starts hurting. The result can be a displaced spiral fracture of the lower part of the upper arm, near the elbow. The really bad news is this can only be treated by open reduction and internal fixation. In other words, you need an operation involving pins to keep the arm straight and in place while it heals.
I inspected the young man’s limb and saw that there was a deformity in the middle of his upper arm. It certainly looked broken. He couldn’t move it properly and he yelped when I touched it.
‘So, you were arm-wrestling… and then what happened?’ I asked.
‘Well, it went crack,’ he said, ‘and he beat me.’ He looked at a spiky-haired youth who was standing there nodding and grinning.
I put the lad’s arm in a sling and offered him entonox, which he gladly accepted. Then we packed him into the ambulance with one of his mates. No doubt the rest of them carried on with their arm-wrestling competition when we left.
I assumed that was that - the one, freak, pub game injury I’d see in my entire career. Wrong. I attended an almost identical incident the other day - the only real difference was that this time they’d been drinking Magners. We were called to a bar, and the chap in question was already outside, staggering around and moaning in pain, when we arrived. He was being supported by a mate in an Arsenal shirt and I could see the pain on his face as he climbed into the back of the ambulance. His arm was cradled against his chest and he was reluctant to have it inspected.
When I eventually looked at it, I found a number of deformities in the upper arm. He had fractured his humerus in at least two places; the bone was protruding and pushing against his skin - every tiny movement made him scream in agony. Entonox wouldn’t touch this level of pain.
‘So, what happened?’ I asked.
‘I was arm-wrestling a mate in the pub when I suddenly felt it go,’ he said.
Arsenal boy piped up. ‘Yeah,’ he said, with a chuckle. ‘We heard the crack from the back of the pub. It was really loud.’
The young man whimpered in agreement; I offered him morphine and he gratefully accepted it.
We took him to hospital and he was delivered to the x-ray department within minutes. When I checked back on him a few hours later, he was sitting on a bed awaiting surgery. I didn’t think his earlier alcohol-fuelled bravado was worth the pain he now faced.
I decided to look into this and found an article in the Journal of Bone and Joint Surgery. (It’s not like I keep it lying by my bedside.) There was a piece inside which cited a study carried out in the Department of Orthopaedics at the University Hospital in Hartlepool in which the mechanisms involved in spiral fractures were investigated. They explained how strong internal rotational forces applied to the humerus cause these particular breaks; the resultant fractures are also found in those who use extreme muscular torsion to throw javelins, baseballs and even hand grenades, apparently. Those mechanical arm-wrestling devices you find in cheap amusement arcades have led to a few of these injuries over the years. It sounds funny, but it’s actually a really nasty injury. Apart from the pain and the need for surgery, permanent nerve damage can occur.
Apparently, some lunatic has now invented a new game called ‘Shocking Arm Wrestling’. It offers the same thrills and spills as conventional arm-wrestling, except that the contenders wear special gloves that deliver electric shocks to the losers. The website boasts that the shock is ‘fairly hefty’ and warns that it will continue until the pressure is taken off. “The potential punishment for losing really does inspire you to make sure you’re the winner,” it says. “After all, it’s only the loser that ends up shocked!”
I guess we were all young once.
MATERNITY
ONE THOUSAND WOMEN a day call 999 and say, ‘I need an ambulance… I’m about to give birth!’
OK, it’s not 1,000, and I don’t know how many it is, but it’s a lot. It’s TOO MANY.
Let’s get one thing straight: if you suddenly find yourself in labour, or you have a genuine reason to think things are going wrong, call us, please. We’re delighted to come out if a mum-to-be is in trouble.
But if you just want a lift to hospital, make your own way there.
Impending childbirth is one of the most common reasons for an ambulance being called when there is no real emergency involved. Some mothers just abuse the system, and we end up being asked to take them in because they haven’t got the money for a taxi. Well, I sympathise with anyone who is short of money, but it’s not as though motherhood - generally - creeps up on you. Most people have quite a few months’ notice. I’ll never forget the words of one midwife to the pregnant woman we had wheeled into maternity with plenty of time to spare: ‘You’ve had nine months to save up for a cab!’
As I say, sometimes things do go wrong in pregnancies. According to the baby charity, Tommy’s, one in four UK women will suffer a miscarriage; almost everyone in pre-hospital care will have experienced a call to a female of childbearing age who is complaining of abdominal pain and bleeding from the vagina (PV). The diagnosis is often confirmed to both patient and carer alike when there is a discharge containing foetal material.
On one freezing night shift I found myself attending to a woman who had miscarried and was bleeding PV.
PV: ‘Per vaginam’ is Latin for 'from the vagina' and is often followed by the word bleed to describe bleeding from that particular area. Since the vagina is an orifice leading to a body cavity, any bleeding from it must be taken seriously (unless of course it is part of the normal non-conceptual menstrual cycle). A PV bleed during pregnancy may indicate a complication. Similarly, ‘PR’ is ‘per rectum’ – 'from or through the rectum'. Again, this is often followed by the word bleed to describe bleeding from that particular area. The rectum is also an orifice leading to a body cavity, so any bleeding from it must be taken seriously (unless it is nothing more than piles or small blood vessel ruptures caused by straining). A PR bleed can indicate disease (such as cancer) or internal haemorrhage.
Her abdominal pain had prompted her to call an ambulance and we took her to hospital. Later on, in the early hours of the morning, my crewmate and I were called back. We found the same woman. She was standing at her door, in tears and fumbling through her handbag. She looked up when we arrived and I got out and asked her what was wrong. She seemed confused and distressed. She was cold, alone and still bleeding, and she was passing little clots of blood onto the doorstep.
She had been sent home by the doctor and told to wait until everything fully discharged from her body. This is standard procedure: sadly, there is little else that can be done.
As we stood there in the chill night, she continued to rummage through her bag in despair, telling me that she could still feel herself bleeding ‘down there’. She had lost her door key and couldn’t get into the house.
We took her into the warm ambulance and she asked me to collect up the discharged material from her path. ‘I just would like to have it,’ she said.
I didn’t understand why at first, but I went outside again and started picking up what I could. It was dark and I couldn’t quite see everything on the ground, so I got my torch and went back to the door and when I shone the light onto the path I found the last few lumps of congealed blood. I turned to go but as I did I caught sight of something else: the light had flashed across a grey-white form on the ground. I knelt down for a closer look and saw that it was the foetus. It was about the size of a fingernail, perfectly formed with tiny bud limbs and two black dots - the eyes. I’d never seen one for real thi
s close up but it was unmistakable. I knew I had to pick it up because it couldn’t stay where it was.
I went back for a new clini-waste bag. ‘Have you found anything?’ said the woman, as I reached into the back of the ambulance.
I couldn’t lie - she would have known instinctively - so I told her I’d found her baby.
‘Can I see it?’ she asked. ‘Only, I’d like to have it.’
I nodded and went to see if I could pick the fragile little thing up. I couldn’t, it was sticky and difficult to handle without causing damage. Then, almost as if it had been placed there for me, I saw a stick of chewing gum, complete in its wrapper, a foot or so away from the foetus. I used this gently to lift the lifeless little thing up and into my yellow bag. I took it over to the ambulance and asked the woman if she was absolutely sure she wanted it. She said she was.
I unfolded the bag a little and showed her it. There was no new emotion but she stopped crying. I saw resignation on her face; perhaps even the start of closure.
I called my Control to get advice about leaving this woman with no means of getting into her house. I couldn’t just abandon her and she had told us she didn’t want to go back to hospital because she felt they didn’t care. As I waited for a response my colleague told me that the woman had found her keys - they were in her bag all along, she had been too distraught to see them.
We took her back to the house, let her in and sat with her as she gathered herself together again. I placed the foetus in an empty spice jar, at her request. ‘I’ll bury it,’ she said. She was still all alone in the house and this was going to be something she would deal with and live with herself. Her husband hadn’t come home and she had no support, only the lost faces of two ambulance paramedics; that was of little comfort to her; I thought.
