Zulu 954 - Dec '08 Blog
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A hard days night
Unto us a child is born
God rest ye merry gentleman
Dead tired
A hard days night . . .
It had already been a busy day at work and relaxing through the evening was exactly what Zulu 954 needed along with an early night . . . he’d just turned in and ambulance control rang requesting attendance at an accident on the bypass 5-miles outside town. A car had hit the central reservation and come to a halt down the road having thrown its driver out of the car onto the road.
It was cold and wet and arriving on scene as the first ambulance service responder Zulu 954 was faced with the body of a young man in lane two some way behind his car which had come to rest further down to carriageway its door hung open. Unfortunately it was all too obvious that the young man was dead and very much beyond help. Local police on routine patrol had witnessed the accident and so were busy closing the road and protecting the scene. The formalities complete and paperwork finished another call comes through for another accident a few minutes away on a windy country road; a car has apparently misjudged a sharp bend and crashed through a hedge and fence into a field. Another BASICS responder is on the way but Zulu 954 along with an ambulance officer from the original crash start to make for the second accident. An update from an ambulance that has already arrived confirms this is a serious accident with a high performance car on its roof in the middle of the field and at least one occupant ejected. Arriving simultaneously with the other BASICS responder Zulu 954 made his way into the field noting that the car has rolled over and over before coming to rest deep into the field. Coming upon the ambulance crew already hard at work on one casualty he asks the fire brigade and others to start searching the field and quickly two more casualties are found.
Leaving the other BASICS responder to the nearest of the two casualties Zulu 954 makes his way to the second casualty who is lying on her back and fitting. Quickly joined by fire-fighters with scene lighting it was obvious that this casualty was very critically injured with multiple injuries. Her airway was noisy and difficult to maintain due to the fitting and so without delay a breathing tube was inserted into her nose and this helped alleviate the airway problem. Next on the problem list was her breathing which was very fast and grossly inadequate needing support using a breathing bag. The fitting was continuing and with the casualties posturing it was rapidly apparent she had suffered a serious brain injury.
Joined now by another ambulance crew the paramedic gained intravenous access whilst Zulu 954 re-assessed the casualty prior to anaesthetising her and taking over her breathing completely using a breathing tube in her throat to control her airway. With the fitting stopped, breathing under control and intravenous fluids being arranged by the ambulance crew plans were made to rapidly evacuate the casualty as her condition was time-critical. Less than 5-minutes had passed since Zulu 954 had arrived on scene, he was wet and muddy but the casualty although still critically ill was holding her own with intensive care.
The police had mobilised their helicopter which is equipped to transport casualties but it was soon recognised that they could not land because there were horses in the field and it would be impossible to safely catch and tether them in the dark.
With all hands to the deck Zulu 954’s casualty was transported to the ambulance with her pelvis splinted, legs secured and neck protected. Zulu 954 travelled with her in the ambulance and along with the paramedic remained intensively busy resuscitating the girl whose condition remained critical. Whilst she reached hospital alive she died in the early hours of the morning from her injuries.
Despite the horrific nature of the accident and the high speeds involved the other two casualties survived their injuries. The other BASICS responder, a local GP had his work cut out dealing with his casualty, a young man who was the driver and had suffered serious leg and pelvis injuries along with thankfully less serious chest and neck injuries. The final casualty, the lad originally found by the first ambulance crew surprising had only minor injuries and a few broken bones and also survived to tell the tale.
Sudden death is a fact of life and for Zulu 954, his BASICS colleagues and the other emergency services. In both of these accidents the causes were avoidable, both drivers had been drinking and both were speeding. In the first accident even with all of this the driver could have survived if he’d been wearing his seat belt, his only injury of note was the head injury he received as he landed on the road. In the second accident the car took off as it burst through the fencing and landing it rolled tumbling the occupants around throwing them out of their seat belts and out of the car, the rear passenger (Zulu 954’s casualty) through the rear window.
Tell your kids, make them realise that drink driving kills, it devastates families and friends. Speed does the same!
Unto us a child is born . . .
And very precious they are too! Sitting enjoying a well earned cup of tea the parents of 2-year old Jenny had left the decorating of the Christmas tree and the excitement of their 3-young children as they sat and chatted over Christmas arrangements. In the blink of an eye their world fell apart as their oldest child popped her head round the door to say that Jenny wouldn't play with her anymore and was dead! Going into the hall they found Jenny tangled in the curtain pull and hanging feet off the ground with the alongside the small telephone table that had been moved for her to stand on.
Zulu 954 received the call on his phone from control mid morning and was told no emergency ambulance was currently available and a patient transport vehicle (equiped with basic ambulance equipment) was also en route. Arriving on scene a couple of minutes after the ambulance Zulu 954 found the child on the kitchen floor with the crew administering first aid resuscitation skills whilst the anxious parents looked on. Thankfully the parents had controlled their panic and as well as dialling 999 had managed to get Jenny down, into the kitchen where their was space and followed the ambulance service telephone operators instructions so had started to provide artificial respirations prior to the arrival of the ambulance. The ambulance crew although trained in first aid were not experienced in child resuscitation but worked under Zulu 954's direction to assist in resuscitating the child.
Thankfully although extremely blue from oxygenation starvation Jenny's heart had not stopped but had slowed to an extremely dangerous level meaning that she was effectively in cardiac arrest but reversible. Over the next couple of minutes her condition improved along with her colour through the provision of breathing support with 100% oxygen, the concern now turned to what damage had been done to her delicate airway structures as the cord bit into her neck whilst she hung there initially struggling and later apparently lifeless. As Jenny awoke she was extremely distressed and making creaning noises whilst not recognising her parents or surroundings, particular limb movements gave Zulu 954 concern that there may also be a degree of brain damage.
The Emergency department was a 5-minute fast transfer away and so the transfer plan was made - to pre-alert the hospital so that a specialised paediatric team could be called to meet Jenny and to sedate her for the transfer so as to prevent her creening straining her vocal cords and surrounding area potentially causing further swelling and closure of her airway; something that needed to be avoided at all costs. To do this a special needle was drilled into the bone of her lower leg and the drugs given by this route (toddlers veins are so difficult to find in life threatening emergencies) Jenny was carefully carried out to the ambulance receiving 100% oxygen but now quieter and breathing well for herself as well as now having a normal heartbeat. The journey took considerably longer than 5-minutes, the driver not used to driving under emergency conditions was suitably cautious and found himself in continual heavy traffic as we made our way through town, all our pre-planning paid off, Jenny remained calm and stable, mum who was travelling with us was kept informed of her daughters condition and our progress and when we arrived at the emergency department the specialist paediatric resuscitation team met Jenny and took over her care. She was anaesthetised and taken to intensive care via a brain scan and thankfully allowed to wake up later that evening to be discharged none the worse the next afternoon.
The reason she had hung herself - Jenny and her siblings had been performing the nativity and Jenny as the angel needed to fly!
God rest ye merry Gentleman . . .
Sometime the amusing side of responding comes to the fore; called to collision on a country lane outside of town Zulu 954 finds himself witness to the following interview between a driver of a 4-week old Mercedes sports car that has just forced another vehicle off the road in skidding round a corner causing the other driver to break his arm and a police officer.
PC – so do you consider you were driving too fast sir?
Driver – (in very posh voice) Oh no officer, its a brand new Merc, its designed to go fast and equipped with all the latest gadgets to keep me on the road, all the lights and warning tones were working so it can’t possibly have been my fault. Mind you I suppose you’ll have someone check the car – if something failed let me know and I’ll sue!
PC – Given the fact you’ve come round the bend sideways I’d suspect something has failed sir
Driver – well if it has I’ll sue, but it’s a new Merc and it can’t possibly have failed, I’m sure all the warning gizmos were showing, are you sure there isn’t petrol on the road?
PC – the road surface is fine sir, tell me did you notice if the little blue flashing light was lit on the dashboard sir?
Driver – blue flashing light; no I’m sure there was no blue flashing light – whats it for? Should it have been showing?
PC – sounds as if the NIP light has failed you sir!
Driver – impossible, its a brand new Merc – tell me what does the NIP light do?
PC – (finishing writing and tearing off a piece of paper and offering it to the driver) NIP sir; why that’s Notice of Intended Prosecution warning light sir, it obviously failed as that’s a notice of intended prosecution!
He, he, he, or perhaps more appropriately ho, ho, ho!
Dead tired . . .
Clive is just 60, a happily married father and grandfather and in the midst of the final stages of preparation for Christmas and tired, so tired he decided to sneak an afternoon nap. thankfully for him Hilda his wife knew what he was up to and when she popped her head round the bedroom door a few minutes later she found him collapsed on the floor making funny gasping noises. In a panic she raced round to the neighbours, a young family who immediately came round to help.
Understanding that Clive had collapsed and following his first aid training the neighbour quickly realised that Clive was lifeless and not breathing normally. Telling his wife to dial 999 the neighbour started CPR just as he'd been taught.
Zulu 954 was also have a quite five minutes when the call came and was on scene five minutes later along with an ambulance crew who had already taken over CPR, attached the defibrillator to the patient and was now in the midst of administering the first shock to try and restart Clive’s heart. Immediately starting CPR again and with Zulu 954 to assist rapid and potentially lifesaving interventions were made.
To make breathing for Clive easier a special breathing tube called a laryngeal mask airway (LMA) was used and continuous and uninterrupted chest compressions were started by one of the crew whilst the other supplied regular breaths into the LMA using a breathing bag attached to oxygen. A drip was started and a drop of blood measured for sugar levels which were normal. Hilda stood watching supported by her neighbours and on questioning was able to provide a concise medical history for Clive which apart from mild angina over the last couple of years was unremarkable.
Following each shock 2-minutes of CPR is given when a further shock is administered or CPR is stopped because signs of life have become apparent. For Clive there were no signs of life and so a further shock was given and CPR started again without delay. To maintain effective CPR the two ambulance crew had swapped roles so whilst Zulu 954 re-assessed the patient for potential causes beyond simple heart disease. During this time Clive started to gasp and on checking his pulse everyone was delighted to find an erratic, somewhat slow but palpable pulse. Chest compressions were stopped although the crew continued to breath for Clive as his own ventilations were slow and very irregular.
After another 5-minutes of supportative care, a dose of atropine to increase the heart rate Clive’s condition was improving and he was carefully taken out to the ambulance - a difficult job in itself Clive being a more portly gentleman who had collapsed upstairs in a typical two up, two down terraced house. Throughout the transfer Zulu 954 continued to breathe for Clive via the LMA and he was moved onto the cot in the stretcher.
At first everything was going well but that all changed when partway to hospital Clive’s heart stopped again. Directing the driver to pull over (not a popular move to other motorists in a busy town centre) this was essential so that a further shock could be given without delay. Once again his heart restarted and Clive stabilised enough for the journey to begin again and this time to reach the Emergency Department without further incident.
Clive spent some time in Intensive Care before being transferred to a specialist coronary unit in a neighbouring city for investigations and surgery to replace the damaged cardiac vessels that had caused this incident.
Despite the ambulance and Zulu 954 being so close Clive owes his life to his quick thinking neighbour who had not only taken the time to learn first aid but was prepared to have a go - excellent result!