Zulu 954 Feb 09 blog
Sometimes time is just too short!
Busy busy busy!
It seems amazing that already we are in early February; much of Britain has been inundated by snow and as one would expect in such treacherous conditions the accident rate has been high. Yet what strikes me at this time is not so much the snow and ice related incidents but rather just how busy I have been since Christmas.
Handling on average a call every other day there has been a distinct trend - I’ve been called to so many people collapsing suddenly into cardiac arrest, these seem to be split into two subgroups; those collapsing at home and almost always with a recent history of flu like symptoms and unusually those collapsing whilst out in a public place (this almost certainly being brought on by exposure to the cold). The age range is also quite wide with a fairly even mix of those aged between 60 to 80 but with a sprinkling of those as young as 40.
Additionally as one would expect in such bad weather the incidence of road collisions has been high; in this past week of snow and ice many have occurred thankfully at low speed and have seen cars ending up in ditches, through fences and the like and with few significant injuries being recorded. Unfortunately though by the nature of the calls Zulu 954 attends serious injuries are likely. Read on in the blog for more on this challenging aspect.
Like all clinicians Zulu 954 has to ensure that his own training profile is maintained, with other scheme members plans are afoot to undertake further driver training, to update in certain clinical areas so as to ensure that all times we are ready for whatever the 999 call brings. This aspect of immediate care is time-consuming, however it is critical to ensure that the service we provide even as volunteers is reliable and of the highest standard.
Sometimes time is just too short
As a result of the Vietnam war an American surgeon named Donald Trunkey described the phenomenon with trauma victims which has now become well-established worldwide and is referred to as the trimodal distribution of death. This recognizes that of those who will die as a result of the incident some will die within the first few minutes and cannot be saved no matter what intervention or skill level is available immediately around them. A second cadre will die within minutes to hours due to problems primarily with their airway being blocked or as a result of life-threatening bleeding, both of which are potentially reversible with early care and recognition in the field and subsequent early hospital care. The third group are those who die days to weeks after the event and include those who suffer complications that can be mitigated in the prehospital environment.
Zulu 954 was called to a collision between two cars on a busy main road just after the rush-hour where a head-on collision had occurred in bad weather. It was quickly apparent due to the very severe damage of both vehicles involved, their relative positions to each other and the debris on the road (including a complete engine block) that this was a high-speed collision where the majority the energy would have been absorbed into the vehicles potentially resulting in death or serious injury. The fire brigade and one ambulance were already on scene and as I got out of my car the fire officer in charge asked me to immediately go to one of the vehicles where the driver was critically injured.
Joining a paramedic and ambulance technician it quickly became apparent that not only was the gentleman at risk of stopping breathing but that all the energy had been absorbed on his side of the vehicle with massive deformity of the front passenger compartment where he was sitting.
Normally to cut somebody from a car is a painstaking and well-planned exercise but in the situation we found ourselves in this patient was what is termed time critical; literally dying in front of us his breathing was inadequate and his heart rate slowing. It’s at times like this that all the training and the professionalism of the different parties involved can really be appreciated, a firefighter passes the word for the fire officer to come immediately and in the time it takes him to arrive (only a matter of 10 to 20 seconds) we have started to breath for the patient and are gaining intravenous access to try and replace the valuable fluids that he has lost.
Declared as being time critical the ‘B plan’ swings into action; the gentleman is to be removed from the car in the quickest way possible, the only emphasis being to get him out. As the firefighters swung into action Zulu 954 with the ambulance team now joined by an ambulance officer fight desperately to save this man’s life. He is now in cardiac arrest; special needles had been placed into the bones of one of his legs and at the top of one of his arms and warm fluids are being squeezed in by willing firefighters. Needles have been placed in the top of both sides of his chest so as to counter any potential overwhelming air leak from the lungs into the space around them which both restricts breathing and in extremis can stop the heart beating effectively.
Chest compressions have begun and as his feet are released he is now free to be brought out of the vehicle. The intricate ballet that combines ongoing resuscitation, our own safety working around twisted and ripped metal as well as ensuring that the trolley cot is easily reachable is quickly completed. Bogged down in roadside mud the trolley with the patient on it has to be physically lifted out by the firefighters whilst all the time the ambulance team continue their efforts.
Despite all of this there is recognition of the futility of the efforts and the fight for this gentleman’s life is stopped once all of the team have given their agreement. With a 20 minute fast journey still to go to hospital and the very rapid collapse into cardiac arrest immediately following the accident there is no hope of a succesful resuscitation.
The ambulance and fire teams fall silent, the loss of any life although a common occurrence for those in the emergency services is no easy thing particularly when against all the odds diverse groups of individuals have come together with a common aim of attempting to save a fellow man’s life. Everyone recognizes that we gave it the best go, there are no tears but for some they will come later. For all there is a sense of a sense of unity in that for a short moment ther was hope where in reality no hope truly existed.
Home delivery!
At last, time to have a baby named after me; a succesful delivery in a local police station - and the babies named . . . Bobby Nick - neither of those names feature on my birth certificate, mum and dad obviously havn't read the right books, not even a cigar to celebrate with!
So this is how it went, could I attend the local police station where a young lady was in considerable pain and on the point of collapse? Arriving in tandem with a local ambulance crew we are led through to the holding area where a young lady is in a very distressed state after having collapsed into the arms of a young constable on the threshold of the police station. One quick peep later and all was obvious, the head was well down and mum to be was in the process of delivering. This was a bit of a surprise to mum as she wasn't expecting him for a few more weeks but such is life.
With hardly time to mutter anything intelligable Zulu 954 is supporting a very slippery bundle of joy as he is delivered (or was it caught).