My return to frontline emergency ambulance placement has been met with blood, flesh, bones, tears, torn clothes and distraught relatives.
The first two shifts are only the start of operating out of the friendly territory that is Camden ambulance station, by Highgate in north central London.
Upon starting our first shift back on placement we are given a one-hour period of familiarisation after being away for a while. This gave me the opportunity to complete the vehicle and equipment checks on the Fast Response Unit (FRU). I'm back with a Mentor I have had previously (we get along really well an), and I feel comfortable knowing that he can step in at anytime, if I feel I need guidance. But my overall goal in these final few weeks of second year is to develop my leadership capabilities as well as continue to practice some of the more advanced clinical skills such as intravenous and intraosseous cannulation.
It was not too busy a start to the day: a few everyday things such as difficulty breathing; fallers and fainting in the heat compiled most of the workload. However, this was all to change in a split second.
Cruising past Hyde Park in the sunny afternoon, green and available, the MDT suddenly alerted us to a new job. Just a few miles down the road a Road Traffic Collision (RTC) had occurred where it displayed "38-year-old* female car vs. pedestrian unconscious, caller left scene, no further details available”. My first thoughts were that this is quite a frequent occurrence whereby the person who made the 999 calls had already left scene; being in central London everyone seems to be too busy to be stopped by anything these days. We worked with what we had and make our way quickly and safely to the scene; we were greeted by an ambulance that had literally just pulled up.
I set about assessing the scene from a distance and could see seven people standing over a body immediately adjacent to a smashed, parked car. I could also see two other 4x4 vehicles with heavy damage to them, which makes me wonder what the exact event was. A brief history from multiple bystanders stated a 4x4 took the corner at speed and hit and crushed a person behind a parked car, which in turn hit a further parked car ahead. The force was enough to sustain serious damage to all vehicles, however I was yet to assess the patient. As I walked up to the body on the road I told the bystanders to step aside, and then I was staring at an injury I did not expect to be there. Her left leg had been crushed between two vehicles with a high mechanism, so much so, that she had sustained massive soft tissue destruction. Her femur was severely fractured along with the tibia and fibula and the patella was shattered.
I proceeded with the adjusted primary survey for trauma whereby you assess for danger, response then catastrophic haemorrhage all before checking the airway, breathing and circulation. Despite actively haemorrhaging, the massive wound was not catastrophic, so it did not require any time-critical interventions. This patient was fully alert and conscious, which was not what I expected. She expressed excruciating pain but presented with stable vital signs. I used my trauma sheers to cut open the jeans, which had been embedded into the leg, in order to properly examine the site and eventually apply a blast dressing.
After a few minutes of being on scene, I heard the roar of the air ambulance circling above at low altitude and I think we all breathed a sign of relief knowing that we had specialist paramedics and doctors coming to help. At this stage I had been leading the team of four and I handed over to the HEMS team and followed their lead. We proceeded to traction the affected leg and package the patient, providing strong pain relief and sedation provided by the doctor. Within one hour of arriving on scene that patient arrived at a major trauma centre. We call this the ‘golden hour’; a time in a trauma patient where advanced intervention is crucial to long-term survival and outcome.
It was quite disheartening to see scores of public looking at the patient and our treatment. At one point I took a step back and co-ordinated the next step for the team when I saw a person get her phone out and take a picture of us, with the injury visible. As frustrating as these situations are, our primary focus is on the patient at all times, but yet providing dignity and respect for the patient can be pushed with people wanting to share the moment on social media and there being limited pairs of hands to try and combat this.
Following on from observing HEMS handing over the patient in hospital, my Mentor and I both agreed we needed to go off the road and return to base for a dirty uniform and a debrief. Not only were my stethoscope and trauma sheers covered in this that and the other, but also it was a major trauma job that had a high stress rate with the family on scene. We were in no safe position to respond so we proceeded back to Camden and discussed the case thoroughly and de-stressed over a cup of tea.
I could not help but think, 'Wow, what a return to placement'. And this was only the beginning…
See also: Full Moon: chapter 2, part 2
*Not actual age of patient