by Stuart Gray
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The one I remember most vividly was my first. It happened at London Bridge station a while back and it ended up being shown in an episode on BBC’s Trauma programme, a fly-on-the-wall documentary series following emergency crews as they went about their business.
I was working with a colleague on a routine transfer call and had just arrived at the address when this higher priority call came through as a GB.
‘One-under at London Bridge, any mobile able to respond please press Priority.’
We pressed the button and got the call. I wasn’t at all sure if I wanted it, but then what normal human being looks forward to seeing what a man looks like after a tube train has run over the top of him?
GB: General Broadcast. A radio alert which goes out to ALL frontline vehicles (known as mobiles) on a specific channel. The broadcast contains information or requests crews to ‘green up’ and make themselves available for a call that is queuing. At busy times, GBs are common.
We got the blue lights on, dodged through the afternoon traffic and were on-scene within a few minutes. A couple of solo paramedics had already arrived and we made our way down the escalators to see what we could do to help. It was hot and noisy and sweaty, but all thought of personal comfort evaporated when we got to the platform. The train had stopped and most of it was inside the tunnel; the last carriage or two was still on at the platform and we could see the activity underneath.
A paramedic was already there, tending to the patient who, incredibly, was still alive. According to witnesses, he had jumped in front of the train (one-unders are usually witnessed, by the poor driver if nobody else) and had been dragged underneath.
His torso had hit the train but his head had failed to make contact. Now he was trapped underneath, with massive internal injuries, affecting his chest and abdomen. Amazingly, he hadn’t lost any limbs and he didn’t have a mark on his head. He was still breathing and just about conscious. He wasn’t talking to anyone, just moaning and groaning softly. My crewmate and I got down and crawled under as far as we could to offer our assistance. The LFB had arrived and they were going to lift the train off the track so that we could slide the man and ourselves out from underneath. Unfortunately, they can only lift the train a few inches off the rails, so it’s still a tight and dangerous squeeze on exit.
Another crew had arrived now and a trolley bed and further equipment was being brought down. HEMS arrived; the first thing I knew about it was when I turned around to speak to someone and found myself looking at an orange-suited doctor and a BBC camera. (My butt was the first thing you saw of me on the programme when it aired.)
HEMS: The Helicopter Emergency Medical Service, based at the Royal London Hospital in Whitechapel. They are an elite team of doctors and paramedics who are called to the most serious patients, where difficult entrapment or major trauma is involved. Sometimes they travel by helicopter (during daylight hours) and sometimes in a specially-liveried fast response car. They are activated either directly by Control or by crew request.
We continued to try and untangle the man’s body; he was twisted under the train’s metal structures and was effectively caught on the bottom with his legs wrapped around a cross bar. As soon as the train was moved and he was freed, I heard yelling and banging around and someone calling for suction. Something had gone wrong. I passed the suction equipment through and the horribly-injured guy was dragged out after a few seconds. He had gone into cardiac arrest.
He was resuscitated on the platform, and a thoracotomy was prepared. This is something HEMS can do but we cannot; it’s a hugely invasive procedure that involves cutting holes in the chest at each side and then cutting right across and opening the chest cavity in order to get at the internal organs, particularly the heart, directly. I have never seen anyone survive a thoracotomy, it is just about the most desperate thing you can do, a last-gasp, last hope affair - the sort of risk-taking I talked about earlier. On this occasion, once the holes were put in, resus had become so desperate that the decision was made not to open him up completely. I was bagging the man, and every time I pushed air into his lungs blood would spurt out of the two holes in his side. It wasn’t pretty.
As I ventilated him, I looked down at his face. He was well-fed and his clothes weren’t begging gear. He didn’t look like he had come off the street, he looked as though he had a life somewhere. He had a number of tattoos on his body, including one of the Scottish flag. A fellow countryman.
The resus effort was called off after almost an hour of hard work. There was no way he could be brought back. His internal injuries were significant enough to have caused him to lose almost all of his blood: there was certainly enough of it around that platform. As he was bagged up, I wondered what had driven him to this. I wondered, too, what it had been like. How would it feel to stand on a platform, waiting for the distant rattle and echo of an approaching train, with commuters and tourists chatting away nearby, counting down the final seconds of your life? And what would it be like as you threw yourself onto the track? He’d have been hoping for a sudden despatch, but that’s not what he got. He had suffered for some time after being hit by the train, though his plans had eventually come to their terminal fruition. He had achieved what he had set out to do. But why had he done it?
A few weeks after this job, my second call of the night - after a successful resuscitation - was to attend a ‘one under’ at a central London tube station.
The LFB, police and an ambulance were on scene and a motorcycle solo had travelled with me. A large crowd had gathered outside the station because the evacuation alarm had been activated and the station had been cleared. The crowd made it difficult to get access to the entrance and I had to struggle through the mass of people to get to the gates, which were being guarded by the police and underground staff.
On the platform, a group of medics, police officers, fire personnel and tube staff had gathered. One of my colleagues had volunteered to get under the train with a fireman and they had both climbed down, only to be told to keep still because nobody was sure if the power was off. They both froze where they were, but not before my colleague had checked the man’s vital signs and found them to be absent - he wasn’t breathing and he didn’t have a pulse. He was still lying where he’d been hit, everyone waiting for the Tube staff to verify that the power was off. It’s hot and dirty down there and the last thing you need is the additional worry of possible electrocution: two colleagues from my station had previously suffered severe electric shocks under a train after being given assurances that it was safe. They could easily have been killed and this risk is simply not acceptable, especially when the person who jumped may well be dead anyway.
I looked underneath the train and saw a man lying on his side with a large pool of blood around his head. He wasn’t breathing at all. He had obviously died of his injuries, but we still had to get under the train to confirm that. We stood on the platform with all the other services, waiting for the word.
Once the all-clear was given, further checks were made but it was obvious the man hadn’t survived. The HEMS team arrived just as the two volunteers were climbing out of the pit. I described what we had and the doctor got down to confirm that the man was beyond help. I went in with him and waited until he had done what was necessary.
The body was left where it lay and the train was moved away to reveal it for the police and Coroner to examine. It wouldn’t be moved until that had been done, so the platform would remain closed.
Outside, the traffic was building up. Long queues were developing all over the West End, partly due to the sudden increase in taxis flooding the area to carry commuters home, and partly because of some existing road works. The main cause of the chaos, however, was the virtual car-park of emergency vehicles in the area and the forced closure of the roads around the station.
I left the station platform and headed for fresh air. While I was doing the paperwork, a member of London Underground staff approached me and asked if I c
ould take care of a young woman who had been sitting outside the station entrance, crying. I took her to the car and she was soon joined by a friend who had been called to take her home. I decided to take her to hospital, with her agreement, because she was in a very bad emotional state.
During the journey, which was painfully slow due to the heavy traffic, I looked at her in my rear-view mirror. Her face was a mask of deep and painful emotion; she looked haunted, her eyes almost terrified, and she said nothing throughout the journey.
Who was this frightened, scarred young woman? She was the commuter who had been standing next to the man when he had jumped in front of the train.
HEAVY PEOPLE
HEAVY PEOPLE ARE a pain in the back.
Unfortunately, some of the heaviest people are also our most regular customers. Their weight causes them health problems (which will almost certainly result in an early death), and they often need hospital treatment. So their large frames have to be removed from their tiny flats (on the hundredth floor). By us.
Lifting overweight patients is one of the most common causes of injury in the NHS. Every year, 4,000 nurses are forced into retirement because of back problems, and 5,000 other NHS workers need time off. The majority of such injuries occur when staff in the caring services lift, carry and move patients.
Ambulance service personnel are particularly vulnerable. Many care homes now do not allow their staff to do any lifting or moving of patients; instead they call an ambulance and we come and do it for them. The same applies to domestic carers; we will often be called to a person’s home to carry out an ‘assist-only’.
When I’m working on the FRU, I don’t have to do a lot of lifting. Ambulance crews do that, and some of the weights they need to shift don’t bear thinking about. Of course, I offer my help wherever I can; it’s important to keep in practice because your back can weaken over time and you’ll be caught out one day when it’s unavoidable.
I was in an ambulance when a frequent flyer called us out. She had fallen on the floor and couldn’t get up. Her front door was open, thanks to a friendly neighbour, and she was hollering from her bedsit for us to ‘get a move on’. We walked in and - to our surprise - found her sitting in a chair.
‘Did you get yourself up off the floor then?’ I asked, more than a little irritated that we had wasted our time.
‘I was never on the floor,’ she barked back.
‘We were called to help you get off the floor.’
‘Well, I just want you to move me to my bed.’
This very large woman had called us so that she could be transferred from her chair to her bed. That was it.
I wasn’t happy, but I kept a smile on my face, as did my colleague.
During the laborious process of moving her, she shouted orders at us, telling me to do specific things, like move an ornament or bring her a certain item to help her move in a certain way. She had a routine and she was forcing us into it by ordering us about. While it is always necessary to maintain a professional front, inside I really felt like telling her to get on with this herself and pointing out that we had much more important things to do. We spent more than an hour with her as we jostled and shoved her into a position that was ‘just right’ for her comfort in bed.
I knew this woman would be calling another crew soon after we left. She would need to go to the toilet after all that excitement.
In the end, we do our jobs and we call in support when we feel it’s necessary. We use special tools and aids if we can get hold of them, and we have occupational health to hobble to when we get it wrong. But none of that will prevent the problem from getting worse in the near future. Our fat kids are becoming fat adults with fat habits that will not be assuaged by lean advertising and the aspirations of the vegetarian minority.
Being obese, apart from the few with real problems, is often about culture, poverty and ignorance. Alcoholism and fast-food consumption contribute largely to the swelling population of fat folk and the kids who grew up overweight are now indulging in those social evils as part and parcel of their calorie runaway diets. It’s probably safer to smoke.
My crewmate and I were sent to another large lady who had fallen out of bed and could not get up again. She was so obese that she couldn’t find her own centre of gravity and simply rolled around on the floor gasping and moaning as she attempted to right herself. Her family stood by, unable to help. She was just too heavy: probably somewhere over 25 stones (or 158 kilos, if you prefer).
Usually, on a particularly heavy or awkward lift, another crew can be requested and on more than one occasion I have done this, simply because I knew I’d do my back in if I attempted to do it alone or with just one other person. On this occasion, there were no crews available. My colleague and I had a long look and eventually figured we could get the job done with the right planning.
We lifted her, under a lot of strain, to the edge of the bed and asked her to ‘wriggle’ her way backwards until she was balanced. Then we swivelled her legs around so that she just fell back onto the bed. Mission accomplished, with a lot of sweating and grunting from us.
A particularly awkward lift requiring two crews involved carrying another lady (who wasn’t all that heavy but was unable to move) in a chair over the balcony of her extremely narrow staircase. She had to be lifted above our heads. There were four of us, one at each corner of the chair and she had three floors to go before we could rest. It was a precarious and nerve-wracking transfer, but at no point was she in any danger, we all knew what we were doing and had done it many times before. The patient, however, may not feel as confident.
Older estates have tall buildings with concrete stairwells and no lifts. The worst carrying jobs are the ones involving people with chest pains who live in such buildings. Your back screams in protest as soon as the call comes in, because you know that you’re going to have to walk all the way back down those stairs with a patient on a chair. It screams even louder when you see that the patient lives on the tenth floor, weighs 23 stones and has thighs that will overflow and obstruct the smooth movement of the skinny ambulance chair he has to sit in.
I helped a crew on a call when they had a very obese woman to move. She was on the floor of her tiny little front room and she literally filled the area with her sheer mass. Around her were fag ends and junk food packets, crisps and sweets and more than enough chocolate for the whole service to share. She obviously hadn’t been paying attention to the Government’s healthy-eating lectures.
Her corridor was narrow and she hadn’t left the house in years, so this was going to be fun.
Not.
My crewmate and I had to go and get a special vehicle just to take her bulk. It’s called the Special Care Baby Unit, or ‘SCaBU’, and it’s wide and uncluttered so was the perfect vehicle to roll her into. We still had to get her off the floor though and for that we used an inflatable device called an ELK. This lifted her slowly up to a level where she could be managed easier. It still took six of us to prise her out of that house and into the ambulance.
Obesity is a real problem in this country. My university dissertation was all about childhood obesity and its potential effects on the NHS, particularly the ambulance service. I could see more young heart attacks, more fat people in high rise buildings (with no lift) and many more job-related injuries, especially back injuries, as a direct result of lifting and moving said fat people. All the ergonomic training in the world won’t make any difference to the outcome if the trend in obesity continues, because we’re heading for a 50% fat-folk nation.
Almost two thirds of the population of England were overweight in 2004, representing a 400% increase on the past 25 years. Predictions suggest obesity will overtake smoking as the number one cause of premature death. In fact, this could be the first generation of modern times where life expectancy will actually start to fall.
Meanwhile, some of my colleagues will be forced out of the job because of back trouble, some will endure until it becomes impossible t
o work and some will be smart enough to stay away from dangerous or heavy lifts until they have planned it properly or roped-in more volunteers. I’ve never heard a crew moan once about helping their pals out in these situations.
Me, I can’t stand for long periods without developing a deep lumbar pain which is only relieved when I sit down. I have suffered like this for over ten years now - that’s the price you pay for lifting heavy people.
CYCLISTS
LONDON’S CYCLISTS CAN be dangerous, and a lot of them - certainly in the centre of town - flout the law at every opportunity. They zip across pavements, weave in and out of traffic and - worst of all - they think red lights don’t apply to them. Why won’t they stop like everyone else? Is it too inconvenient? Are they busier or more important than the rest of the population? Do they honestly think they aren’t committing or causing any offence? The thing is, they get away with it - while dangerous drivers and speeding motorcyclists can be photographed and tracked down, cyclists can break the law with impunity. There’s no way of catching them unless a copper actually sees them at it.
I started spouting off about how dangerous most cyclists can be on my blog in 2006; that year, The Guardian’s Matt Seaton reported that only four had been prosecuted in the last 12 months. Four! Anyone who has driven in London will know that’s a tiny proportion of the actual offences they commit, which must run into the thousands. In the same piece, Seaton highlighted a school in the city where teachers and parents were up in arms because cyclists kept running a nearby red light and had hit and injured a number of kids.
I’ve attended the victims of mad cyclists, and I’ve also had to treat one or two of the perpetrators of this idiocy after they came off worst.
