Image courtesy megadem on Flickr

I was telling my friends and family about a call I went to recently. It involved a toddler hit by a car with possible life changing or life threatening injuries. My colleagues and I were busy – we had a child screaming with a head injury and the pain of numerous broken bones needing our urgent medical attention, not to mention a traumatised mother and older brother to consider. In the middle of all of this organised chaos I went to retrieve some equipment from my car and as I looked up I noticed that a number of bystanders were holding their phones out in front of them, focussed on the child, filming the incident.

I have to say that I feel considerable disgust at this new social propensity for members of the public to reach for their mobile phone to capture every detail of the suffering of another human being.

When it comes to the media, this is their bread and butter; even the police have no absolute right to stop them from filming. In their guidance it states they have ‘no legal power or moral responsibility to prevent or restrict what they record’. Some matters, arguably, are in the public interest; after all the media are responsible for capturing everyday situations and dramas to inform and record both for contemporaneous and future consumption and that is, perhaps, how it should be. For example, the amateur footage of the tsunami gave an almighty boost to the relief effort; court cases of police brutality have been won and lost on the basis of recorded material – often provided by the public.

However, it surprised me to discover that even if the mother of the child had asked the police to stop people filming him that guidance states ‘If someone distressed or bereaved asks the police to stop the media recording them, the request can be passed on to the media, but not enforced’ – Really? Should that be so?

Am I being a hypocrite? Undeniably.  I too have been ‘guilty’ of watching this stuff on numerous occasions, as has anyone who watches the News at Ten. Perhaps though, there are degrees of hypocrisy. This however, is about the lack of ability in each of us to regulate the setting of our own moral barometer. Have we really become so desensitized to the suffering of others because of the graphic images we are regularly bombarded with in the media that we actually delight in the pain and suffering of a small child to the point where we welcome its presence because it gives us something to share and talk with the family when there’s nothing good on the telly?

What will these non-media people do with their booty?

A) Share it with their children over dinner

B) Commit it to DVD format

C) Send it in to Harry Hill’s TV Burp because one of the paramedics rather hysterically tripped up on some equipment?

A big red helicopter landing on an urban lawn the size of a postage stamp is interesting material, and you can film me doing my job should you wish – I’m doing nothing wrong. Film the blue lights on the brightly coloured ambulance if that’s what you like; but please draw the line at filming a little child lying in the road clearly terrified and suffering during what could be his last moments of life – because next time it could be your child.

White toy teddy bear with bow, by Horia Varlan, on Flickr

Some people just seem to have the worst luck. I was given a call to a road traffic collision (RTC) and the control room asked me to provide a report for HEMS. The initial calls to 999 must have made it sound very serious if they were considering sending the helicopter out. As I pulled up on scene it appeared that the cars had taken the worst of it, but the passengers were all up and walking about – It didn’t look like there was going to be any need for that helicopter thankfully, and so we gave a report to that effect!

Another fast response paramedic (FRU) arrived at the same time as me and he took charge the occupants of one car while I took the other. My patients were a fairly young married couple, they said they had no pain or injuries and adamantly declined to go to hospital from the outset. It was then that I noticed that the woman was clutching a children’s teddy-bear tightly in her arms and her eyes appeared swollen from crying.

“Is there a child in the car?” I asked, becoming suddenly alarmed at the thought.

“No, our son died this morning, we were on our way home from the hospital, the car is full of his things” she replied – Oh my word, suddenly I had to shift my priorities. We were standing on the grassy bank of a central reservation on a busy road with passers-by literally slowing down and gawping at them. How do you begin to comfort a couple that have been living through the greatest nightmare of their lives, in these circumstances?

I threw one of our large red blankets over the metal railings to form a sort of curtain and put my coat on the floor so they could sit down and be partially shielded from the nosey ‘rubber-neckers’.

The fire-brigade and police arrived and I let them know the situation so they could be sensitive to the distressed couple while they questioned them about the accident, dealt with the damaged car (which their son had loved) and their son’s possessions. At times like these there are sometimes practical things that we can do instead of offering the usual blithered platitudes, which are not only likely to be completely inappropriate and  insulting, but are quiet simply not enough under the circumstances. Between us we managed to coordinate a lift for their onward journey (which was a considerable distance), phone calls to loved ones were made on our mobile phones and contact details supplied for the Child Bereavement Charity.

The sight of the back-seat of their car stuffed with many of their son’s possessions broke my heart, but they held it together, I can’t tell you how impressed I was by their quiet dignity.

I had a something of a busman’s holiday recently. I went back to Verona for a few days to visit some of my friends Massimilliano and Alfonso who work for the emergency services there (See my previous posts on visiting an Italian ambulance service: Part 1, Part 2, Part 3).

Last time I went to Verona, it was during a very hot summer period so this time was in stark contrast to that visit. In fact, the cold was biting and not unusually for the region at this time of year, a thick fog hung low in the air for most of the week. Alfonso kindly ferried me around, picking me up and dropping me off at the airport. Massimilliano, who also works for the Croce Verde ambulance service, had arranged for me to have a look around various places that I indicated would be of interest to me.

We started with the Vigili del Fuoco ~ Fire Station. As well as a guided tour of all of the usual fire engines and equipment, friendly fireman Paolo took us to see the amphibious vehicle that had proved so helpful rescuing stricken victims during the recent floods in the area. He also treated me to a hair-raising ride as I was elevated 30 metres on the aerial ladder platform where the views of the city were quite stunning. I was somewhat surprised and amused when Paolo then led us to a beautiful fully stocked bar. Looking just like a regular bar you could find on any little Italian side-street, it seemed perfectly incongruous situated in the middle of a utilitarian fire station. We paused briefly to have an espresso break – well it would have been rude not to, ‘when in Rome’ and all that!

The afore mentioned fog was responsible for grounding the emergency medical helicopter for the majority of the week of my visit, except by some amazing stroke of good luck, the day Massimilliano took me to see it. I was delighted by the offer of an impromptu flight over Verona in the yellow EC146 as she flew back to base at the end of the shift. It was just before sunset, and still light enough to see some of my favourite sights from a whole new perspective. The fabulous Arena, home to the opera. Piazza Erbe with it’s bustling bars and market stalls and the Roman Theatre perched on the side of the hill, all twinkled invitingly below in the evening light.

Finally, the next day the capo ~ head of the Verona polizia stradale ~ traffic police gave me a tour of their station where I met a beautiful dog who was the very friendly station mascot! I think Massimilliano may have misrepresented me ‘as someone important from London’ because during the tour his aides were continually taking my photograph as I was shown around the station looking at the different vehicles and equipment!

I was extremely interesting to see how things are done the Italian way, and everyone made me feel so welcome. The thing that remains most in my mind though was the flight over Verona, a very special moment indeed ~ thank you Massimilliano for making it possible.

Smashed windscreen, by wheany, on flickr

I was working on a car with my colleague Richard when we were called to a RTC (Road Traffic Collision). It was the rush hour, already dark and it had just started to rain. The traffic was dreadful as we neared the scene and even though the drivers were trying their best to move their cars out of the way for us, it was gridlock and we were struggling to pass through them. Eventually, after realising we were going nowhere fast, I decided to get out, grab as much kit as I could carry and run the last part of the journey.

The police and fire brigade were already on scene and I found our patient, an elderly man, being tended to by one of our first responders. At this time the responder was only able to hold on to the man’s head and neck to stop him moving, and potentially risking further damage, until further help arrived to assist him.

Our patient had been walking along when a car mounted the pavement and he was thrown in to the air. His face struck the windscreen (bulls-eyed) and he was flipped over, coming to land flat on his back on a raised wall area of ground that was part of the garden of a public building. He was in a very awkward place and the car was jammed up tightly against the wall.

Incredibly he was still conscious and able to talk to us. Although he was bleeding heavily from a nose bleed and a head wound, he appeared to have no obvious serious injuries elsewhere. His breathing was fine and all his physical observations were stable. We gave him oxygen and began to cut off his clothes to enable us to assess him further for any possible injuries. We placed a cannula in his arm in case he should need any medicines from us, and of course we covered him with a blanket to protect his modesty and keep him warm.

The HEMS team had been activated and they arrived by car a few minutes after us along with an ambulance. We put a stiff neck collar on him and lifted him on to a spinal board before moving him in to the ambulance.

Thankfully his condition remained stable, but because of the significant mechanism of injury we blue’d him in to hospital to give the hospital time to prepare the trauma team and make some space in the resuscitation room to receive him.

I popped back to see him a little later and he was waiting for a head scan, and thankfully I have since heard that he is still doing OK.

Image by dno1967 on Flickr

It was the last shift before I was due to go on my holidays. It was also a very hot and sunny day. The last thing that I wanted was any jobs that were going to give me any stress or cause me to break in to a sweat. I was simply intent on winding down in anticipation of my trip to Italy.

Then the first job came down to my screen in the car: ‘Male – Stabbing – please give a report for HEMS’. Oh great – just what I needed! I hurtled down there and arrived at about the same time as an ambulance and the police. We all got out and grouped together before we went in to the house. There was no answer at the front door and the police were weighing up all the options with regard to breaking in to the property when some of the immediate neighbours approached us.

Well, if their stories were to be believed it sounded unnervingly more like an episode of Holby City than downtown suburbia. They told us that one of them had apparently had a heart attack just last week and another had been shot only a few days earlier (although she looked quite well for it), and now a fatal stabbing. I could only guess at what the insurance rates would be in this particular road!

It soon became clear to us all that this was nothing more than a hoax call. Thankfully, no one had actually been stabbed, shot or had a heart attack and in fact it was all down to a single caller who had nothing better to do with their day but waste the time of the emergency services.

What sort of forces were involved here?

Cast your mind back a little… do you remember what you learned in physics in school about kinetic energy? This referred to energy forces from “things in motion” and “impact”? We learned that the weight of an object and its speed have a direct impact on the outcome. Realistically if you double the weight of the object you double the energy; but if you double the speed of the object, you quadruple the energy. As paramedics we apply this principle daily when we consider the seriousness of the injuries any patient may have sustained because we know that it is proportional to the amount of energy transferred and the ability of the body to resist that energy.

When this principle is applied in the context of road traffic collisions clearly speed is the greatest determinant of the forces involved. Other factors such as any pre-existing medical conditions and age should also be considered as they can make a person more vulnerable to these forces. When you arrive on scene, even if your patient ‘looks well’ it is still crucial to find out exactly what happened and the mechanism of injury before you accept this at face value. Don’t be fooled just because they initially appear to be all in one piece.  For example, if the history given to you is of a person who while standing next to a stationary bus fell over, banging their head, the transfer of energy could be assumed to be fairly minimal even though they have  ‘struck a bus’. If however, reports suggest that the bus was moving at 30 miles per hour when it struck your patient, clearly the energy transference is far greater and it is very probable that they will have sustained a significant injury such as tearing of muscles, blood vessels, broken bones or damage to internal organs.

Every object continues in a state of rest, or of uniform motion in a straight line, unless it is compelled to change that state by forces acting upon it.”

Sir Isaac Newton (1643-1727)

When I was called to a man hit by a bus recently the thought occurred to me that if I had arrived from the top of the road and not seen the damage to the front of the bus I may have been fooled into thinking that my patient’s injuries were likely to be very minor. He was lying in the road, not only fully conscious but very chatty and apart from a laceration to his head seemed to be all in one piece.  However, I had arrived from the bottom of the road and when I first saw the damage to the bus I initially wondered if a car had taken off and launched itself in to the front of it! Unbelievably this damage was all done by the patients head and body.

So even though the patient was stable, the HEMS team were activated. We immobilised him on scene and managed his pain; he was then transferred to a trauma unit for further assessment of the extent of his injuries. I am waiting to hear about the outcome for this patient and will update this post when I find out.

Slaff's version of rusted out car & chain by blmurch, on Flickr

The funny thing about our job is you can be having a really ordinary day when suddenly it all changes in an instant. One rainy afternoon recently I was given a call to a ‘Road Traffic collision, car versus tree’ – no more detail than that. As I started to drive the mile or so there on blue lights and sirens, I started to consider the variety of possibilities in my head.

On one level it could be something as simple as a low speed, low impact collision caused by careless driving. In this case the car will probably have minor damage and the occupant(s) will have mild injuries (often these ‘injuries’ only present once someone reminds them of the chance of a claim!) When we arrive to these types of calls, the occupants are normally up and walking around, exchanging details or talking on their mobile phones.

The next level is where high speeds have been involved. If the occupants were wearing seatbelts even these collisions can result in surprisingly minor injuries. However, when seatbelts aren’t worn the injuries can be horrendous and sometimes even life threatening, particularly for children. With these collisions, we work closely with the police and occasionally the fire brigade as they may need to cut the roof off of the car to safely get the patients out without causing them further damage.

But before I had a chance to consider the next level, I was already on scene and the first thing I noticed as I pulled up was the car – with its bonnet up against a tree, it was smoking and empty.

Then I noticed a small crowd standing around a man lying on the floor. His face was up against a wall so I moved him a little and found he wasn’t breathing and had no pulse. He looked around sixty years old and was well wrapped up because the weather had been very cold. The bystanders told me they had dragged the man from the car because it was smoking and they were worried it was about to catch fire.

As you know I work on my own, and I arrived before anyone else, so thank heavens for bystanders! I asked one bystander to start to help me by starting cardiac compressions.  I began to cut the man’s coat and many layers of clothes off; this was so I would be to apply the pads to his chest that we use to monitor the heart rhythm and defibrillate when necessary.  He was in cardiac arrest and the machine gave him two shocks in total which started his heart beating again.

Very quickly the fire brigade, police and  another ambulance turned up and it was all hands to the deck. He was still unconscious but becoming agitated and difficult to manage; this was because of the lack of oxygen that he suffered to the brain while he was in cardiac arrest and not receiving CPR.

We managed to put a neck collar on him and secure him to a board so we could move him easily in to the back of the ambulance. In there we continued to give him oxygen, did some tests and got two cannulas into veins in his arms in case he needed any further medication.

Based on the information given during the 999 call, HEMS were dispatched and arrived promptly on scene having flown from the Royal London Hospital. The HEMS team helped us continue to care for the patient and once he was stabilized they accompanied him in the ambulance to a trauma centre for definitive treatment.

I have heard subsequently that this man appears to have suffered a heart attack while driving – a heart attack that was severe enough to cause him to go in to cardiac arrest. He needed CPR and defibrillation quickly if he was to survive at all, but especially if he was to survive without severe brain damage through lack of oxygen. He is now conscious and remains in hospital while he recovers from his ordeal.

Do you know how to recognise cardiac arrest and would you know what do to in this situation?