Alex: Trauma – A Matter of Life and Death

In the past three shifts I have placed five blue calls; it’s been a busy week but all the same rewarding. Two of the blue calls were for severe sepsis, one being a mental capacity issue. This elderly male was very reluctant to go to hospital, despite his observations being through the floor. His blood pressure was 85/51, oxygen saturations of 79% and had lost a lot of weight over the past week. The doctor on scene managed to persuade the gentlemen to go to hospital. He also said that the patient’s hypoxic state (starvation of oxygen) was impeding on his capacity; this was an interesting point to note and a great learning point.

At the moment, it seems as if I attract most of the ‘big sick’ types of jobs; a lot of them recently have been traumatic injuries. Just last week I responded to my first stabbing in Central London. We waited at an Rendezvous Point (RVP) to get clearance that the scene had been made safe by the police; this gave us time to think through what medical presentations the patient could have. When arriving on scene the police gave us a quick handover and a brief history of events. It was at a pub and the victim (a young lad) was standing outside. The attacker was inside the pub and, through the window, proceeded to stab the victim in the face with a bottle. Yes, that’s correct, I’m not making that up! It was astonishing how it happened, but thankfully the patient was in a stable condition so there was no need for a blue call to be placed.

Early on Thursday morning I arrived at the station with the image of having a week off after this shift. This was soon disrupted by the buzzing notification sound of a new emergency call coming through the radio. I read on the MDT (Mobile Data Terminal) “37 YOM, fall from height 12ft, building site, update Red Base on arrival for HART and/or HEMS”. This got the adrenaline going! Despite it being a few miles away from station we managed to get to the job and an Advanced Paramedic Practitioner (APP) arrived at the same time. This brought a piece of mind as they are highly skilled in both medical and trauma situations. The job itself could not have been more textbook of a trauma scenario. It was in a very large, derelict manor house that was being stripped to pieces and to be put back together again. The entrance and hallway was cluttered with debris and wood and had almost an inch of sawdust covering the route. The patient was situated on the first floor where he fell roughly 8-10ft through the loft. The stairs were incredibly unsteady and the first floor was near non-existent! The builders had laid down lots of wooden boards for them to walk on, but even in the room where the patient was, you could see everything downstairs!

This chap was in a bad shape, specifically his right lower leg. His right ankle was severely broken, and almost piercing the skin. I’d never seen a fracture so bad that wasn’t open! He was conscious and breathing normally, and surprisingly had no C-Spine injury. I gave the patient Entonox whilst my crewmate set about gaining IV access. I used my trauma shears in order to get the blood pressure cuff on his arm and also to expose his injured right leg. The APP led the job and gave us clear instructions of what to do. The patient was in such severe pain that he not only had Morphine but also Ketamine just before we manually realigned his leg. We blue lighted the man into A&E Resus where about 20 doctors, consultants and nurses waited by the hospital bed. When the APP and I were completing our paperwork only then did I look down and see that my green ambulance trousers were now in fact yellow with sawdust! It was very useful to see an APP in action and reminds me that career prospects within the London Ambulance Service really are world-class.



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