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.

Levitation, by theyoungthousands, on Flickr

Things aren’t always what they seem at first. When people are describing what has happened to them when they call 999 for help, it can be open to interpretation and even a small breakdown in communication can mean we find something completely different to what we were expecting when we arrive. Language barriers, third party callers and bad connections among other things may all contribute to the problem.

Let me give you an example ‘Male cut leg on food blender’ doesn’t sound too ominous does it? In fact maybe this patient should just take a painkiller, pop on a plaster and man up!

Well, when we arrived and found that actually this was rather more ‘Male cut leg on a great big, heavy, spinning, circular saw’ type of injury we realised quickly that a plaster and a couple of painkillers may not suffice. As we peeled off the two blood soaked sweat shirts to see what we were dealing with we discovered a deep wound that had reached the bone, it would certainly need some skilled surgical intervention. So, after we applied a pressure dressing and administered some serious painkillers through a cannula in to his arm we popped him to hospital ‘quick-as-you-like’.

Another patient was described with injuries thus ‘Female hurt foot when she dropped her drawers’ Oh come on, be honest, it instantly conjures up various possible scenarios in your mind, well it did for me! I was eager to see this woman, she sounded interesting…. Sadly, it would appear that this was nothing more than a common or garden injury sustained while putting together some IKEA furniture. This furniture was accidentally dropped on the aforementioned foot and caused some nasty bruising and swelling. I was quick to point out to her that although she had given me ample fodder for jokes at her expense with her unintentional double entendre, I had admirably refrained from doing so -  I am nothing if not professional and I think that she appreciated that.
Moving on in my assessment of her injury, I asked her if a she had taking any action to help herself deal with the pain and she replied;
“Well I’ve ‘levitated”
“‘Levitated’ you say?”I smiled encouragingly.
“Yes, since it happened, I’ve been levitating, you know?”
“Really? ‘Levitating’ excellent! Now I’d pay good money to see that, can you show me how you’ve been doing this ‘levitating’ please?” Promptly, she stuck her foot out in front of her.
“Ah – ‘elevating’ Well I’m sorry, but I’m not giving you any money for that!” I said, very disappointed.

On a stunning early spring day recently, I was called by the police to a quiet street where a young man had been injured. The details were given as ’19 year old male, hurt himself on a fence.’

I was only a couple of minutes away in my car so I got there quickly and found the group waiting at the side of the road. My patient was sitting on the kerb, hand-cuffed. Apparently he had been in his car when he was stopped by the police for a minor traffic offence.

Few sensible people would try to out-run police dogs; however after he was stopped he unwisely decided to make a bolt for it. He ran towards nearby houses, clambered over some low walls then launched himself on to the fence of some neighbouring allotments. Unfortunately he became impaled by one of the metal posts which entered through the left side of his upper chest. His predicament deteriorated further when the police dogs caught up with him and began nibbling at his legs (in that way only an Alsatian can!). He waited helplessly until the police caught up and rescued him from the clutches of their jaws. Unfortunately they pulled him back from the fence before realising that he had been impaled.

When I arrived, although he was conscious and breathing, he was starting to look quite pale. His pulse and respiratory rate had sped up (not just from the adrenaline!) and he was also quite predictably in a lot of pain from the deep wound on his chest.

Thankfully, I saw the ambulance heading towards us from the end of the road shortly after I had arrived. Time is of the essence in these types of calls as things can change very quickly so I was pleased to see them! Our priorities were to almost simultaneously perform all of his physical observations, listen to his chest sounds, give him oxygen, put a three sided dressing over the wound and put in a cannula (a needle into a vein in his arm) as a route for painkillers and any fluids he may need. The crew promptly took him off to the nearest ‘Trauma Centre’ after making them aware of the approximate time of arrival so they would have some time to prepare, leaving me at the road side to finish off my paperwork.

I have heard since that he is doing well and will recover from his injuries.

Deciding to challenge my Italian language skills beyond their limits and seeing the opportunity for a little jaunt to my favourite country in with the deal, I signed up to attend a presentation on safety on the road in Italy.

Those who have passed a holiday in a city in Italy will recall the chaos of the busy cobbled roads. The cacophony of car horns, the hot-headed drivers appearing to flaunt the common courtesy of road manners and the plucky teenagers whipping around the traffic on their mopeds without fear or foresight. And anyone who has lived to tell the tale will recall with a pounding heart, the ‘run for your life’ dashes to cross roads even while on the relative safety of a zebra crossing. “Keep moving, they expect to drive around you, if you stop they’re more likely to hit you” I was warned by one wise friend! Bill Bryson tells us that when traversing a road in Italy, we should attempt to take the hand of a passing nun, as no Italian would ever hit a nun, therefore your safe passage would be guaranteed!

Italy has one of the highest densities of car ownership in the world and unfortunately road accident statistics bear out its image as a country of spirited drivers with little regard for the law or the rights of pedestrians. The number of road fatalities per capita is double that of the UK and nearly four times that of the Netherlands, according to figures from the World Health Organisation. In 2009 there were 4,050 road deaths in Italy (DfT). This equates to 6.7 road deaths per 100,000 of population compared to the UK average of 3.8 road deaths per 100,000 of population.

The ‘Educazione Stradale’ type events have been taking shape for the last couple of decades but since 2001 they have taken a more collaborative approach with the traffic police, fire-brigade and ambulance service delivering the lectures together predominantly to young people in schools. The evening event that I attended was hosted by two road traffic police officers Andrea Scamperle & Antonio Benedetti, and my good friend Massimiliano Maculan, an ambulance nurse who works for the S.U.E.M 118 Croce Verde in Verona (see previous post).

There was a good turn out from the people of the small lakeside town of Lazise on Lago di Garda; at a guess I would have said that there were approximately 100 or so who came along. The presentations consist of a series of videos, depicting both real and reconstructed collisions as well as testimonies from the police and ambulance staff. By far the most powerful of the testimonies came from the families of those who have lost loved ones in a Road Traffic Collision (RTC). Although I struggled at times to understand the detail of what was being said, it didn’t stop me feeling the raw emotions of the mother who spoke about her pain at the tragic loss of her teenage child in a RTC. Various videos were used to demonstrate the dangers of poor driving. During one of the videos in particular, a fatal crash caused by texting on a mobile phone while driving was played out, I could see that some of the family members became emotional. It was very graphic and must have taken considerable courage for them to watch it.

Having attended a similar presentation here in London, Safe Drive Stay Alive, it came as no surprise to note that the key messages delivered are the universal ones – all occupants should use a seatbelt, use no drugs or drink alcohol before driving, never use mobile phones to call or text while driving and of course, always drive at a sensible speed.

With each new generation of young drivers bringing up the rear, the need to repeat these events ad infinitum will remain. Sadly it seems that we human beings never have been very good at learning from other peoples mistakes.

Here is a UK video warning of the dangers of texting while driving.  A little warning here if you have any children in the room with you – it’s a graphic reconstruction.

Image courtesy hsingy, on Flickr

I had a young student paramedic out observing with me this week. With her ‘gateway’ exam coming up soon Jane wanted to spend the day with an ECP to observe physical assessment techniques.

Our first patient was a young man who had fallen almost 3 metres while working on a construction site. It was raining lightly and he was laying in the middle of the muddy building site; it was simply impossible to keep our boots and uniforms clean as we worked on him. He was complaining of back pain so we needed to completely immobilse him. This involves putting a rigid collar around his neck, placing him on an orthopaedic stretcher and using a series of straps to hold him surely. To make all of this fit well we had to cut off his bulky clothing first. As I mentioned, it was raining, and no sooner had we cut in to his padded jacket than the feathers inside were released and flying all around! We were breathing them in, they attached themselves to our eye-lashes and hair, and because we were damp from the rain they were sticking to our uniforms and faces too. By the time we carried him from the building site we were a complete mess, covered in mud and feathers!

Then there was also the very last call of the day. An older man had been found, collapsed at home by the police. Having been alerted by a relative, they gained access to the house where they found him laying in the living room and immediately called for the ambulance service.

His was unconscious, his temperature only 27 degrees, and he had a facial and head injury with heavy bleeding from his nose. He had been incontinent of urine and faeces and had developed deep pressure sores on his face, torso and limbs where he had lain face-down for so long (we guessed at least 2 days). We worked with another crew to stabilize him and undertake the delicate process of packaging him up for the journey to hospital without making his condition any worse. The police were brilliant too. They helped us by holding the drip and cutting his soiled clothes off. As we navigated him out through to the hallway on the orthopedic stretcher, they were on hand again to help us lift him high enough to pass over the bannister.

He was given a scan at hospital and unfortunately his condition was very poor and he was not expected to recover. Afterwards, Jane and I reflected on what happened. We hoped that whatever caused him to fall, he had been unconscious from that moment. We didn’t like to think of him being aware of his gradual deterioration while he waited for help to arrive, help that sadly came too late.

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.

Group of youngsters, by criminalintent, on Flickr

I have been visiting a young offenders institute regularly to deliver sessions on the effects of weapon crime as part of a Gang, Guns & Knives programme for young people. The 4 day course tackles gun and knife crime and looks at ways of helping the young people lead different lives when released back into the community and also discuss the negatives around being in gangs and gang related crimes.

I have to admit that I was more than a little nervous prior to my first visit. While I already deliver similar sessions to young offenders in the community, I was concerned that this may be my toughest audience yet.

My nerves weren’t eased at all when I arrived at the prison reception for the first time to find that I must go through security checks, a scanner, and a body search before leaving my handbag and it’s contents in a locker for the day (no phone all day!!)

I am escorted by a prison officer wherever I go and every single door or gate must be unlocked and locked again as we pass through. The prison officers are a really good bunch and when we chat over lunch I am reminded of the mess room banter that we have in the ambulance service.

The sessions take place in the education centre within the prison grounds; I normally deliver two sessions over one day – one in the morning and another in the afternoon. As the young people come in to the room they always acknowledge me respectfully and say ‘Hello Miss’ – female staff and visitors are always addressed as ‘Miss’. At each sitting there are up to 12 young people and 2 or 3 prison officers present. The sessions follow a similar format to the ones that I have described previously.

As I have come to expect now, it is the recording of the 999 call made by the distressed sister whose brother has been stabbed, that appears to have the most impact. I play the recording first and ask them to listen with their eyes closed because it is a good way to quieten them and bring the mood down in readiness to talking about my experience of attending a scene where a young person has been fatally stabbed.

Hoodies, by mr_mo-fo, on Flickr

There are often a lot of very good questions after hearing the recording and my testimony; and these two invariably come up;

“Why did the ambulance take so long to get there?” To which I explain the importance of giving the exact location where the ambulance is required clearly and promptly. I also tell them that demand on the ambulance service can sometimes exceed supply because we are very busy with other calls or may have to travel some distance to the call.

“Why are the police always sent first?” This process clearly baffles them, until I tell them that the police are there to protect us while we go about our job and also point out that because a serious crime has taken place, the scene must be preserved and an investigation will take place.

I take in some medical equipment including urinary catheters and colostomy bags with me to prompt discussion around other non-fatal injuries. They normally initially start to laugh about the concept but it doesn’t usually take long for them to seriously consider the impact that these may have on their life – and in particular their sex life.

Personally, I avoid any gory photographs as I believe that rather than being shocked many of us are desensitised to such images nowadays; I have seen them laughed at during other people’s presentations. Instead, I am keen to show images of well-healed scars and deformities that some young victims have to live with as the emotional impact of these can be more enduring.

I have always been very impressed with the willingness of the young people to engage. At times the discussion can become very lively and animated – which I prefer over silent and sullen any day. Often they talk about their experiences of being stabbed or of losing a friend or relative to knife or gun crime. This provides an excellent opportunity to talk about how their loved ones would feel if they were to become victims and how the impact can be far reaching, affecting schools, communities and professionals. They have asked me if I get upset when I deal with fatalities. I explained that I do, because as a mother of three children, I can empathise with their parents. Some of them seemed concerned by this and very kindly asked if I received counselling.

After we have finished the main talk I enjoy a more informal chat with them and we often end up laughing about all sorts of different things. As they leave the room they all come and shake my hand and say ‘Thank you Miss’.

It was given as “police on scene, male stabbing; no further details”.

The call came in on a beautiful, warm summer evening but no sooner had I started to drive there when the heavens opened. The wipers were in overdrive trying to keep my screen clear for the high speed, blue-light journey. I put my foot down and was there within only a couple of minutes.

I arrived to find a solitary police man kneeling over a male on the ground. At first glance I couldn’t tell if my patient was dead or alive. I parked half on and half off of the pavement, left the lights flashing and grabbed as much kit as I could carry. As I walked towards them it was now clear that the man was conscious and the police officer was talking to him and attempting to reassure him.

He was laying face down on the pavement; he said he had been attacked in the park by a group of young males. Initially he thought that he had only been punched but as he ran away he suddenly felt very weak and breathless; finally able to go no further he collapsed just outside of the park gates where a passerby called for help.

As I pulled on my gloves I knelt down onto the wet pavement on the opposite side of the young man from the police officer. The victim, who I shall call Gary, was a young man in his early twenties. I asked him a few quick questions about his breathing and his pain. He was very pale, in a lot of pain and having difficulty with his breathing; he also felt really sick.

I knew the ambulance would be arriving soon, but every second counts, so I tried to do as much as I could in the meantime to stabilise Gary’s condition. I made good use of the officer and got him to use my tough scissors to begin removing all his clothes so that I could visualise his injuries better.

Gary’s airway and breathing were a priority so I listened to his chest to assess his breathing and put an oxygen mask on his face. I checked his torso – front and back – for stab wounds; worryingly I found five of them. There was a real risk of serious injury to Gary’s heart, lungs and other vital organs. So I put in two needles, one to each arm, in case I needed to be able to give any drugs or fluids if his condition suddenly deteriorated. I also gave him some morphine for the pain; but I was really worried that at any time he would go into cardiac arrest from his severe injuries – time was of the essence.

Gary was scared – who wouldn’t be? At that moment I am sure that he thought he was dying; he kept looking at us in turn, straight in the eyes and saying ‘thank you for helping me’, while we just muttered pathetic words of reassurance to him in return. Obviously with five stab wounds to the chest and abdomen there was a real risk that Gary could deteriorate at anytime and this fact was something that all three of us were acutely aware of.

Gary ‘thanking me’ made me feel under quite a bit of additional pressure. For me it is different caring for someone who is alive and talking when you arrive and then have them die in front of you in comparison to arriving when they are already in cardiac arrest and you never got the opportunity to make that human connection.

Thankfully the ambulance crew and further police officers arrived within minutes. We worked together then to remove the last of Gary’s clothes so we could check for any further injuries to his limbs that we may have missed, and we covered him with a blanket.  Once inside the ambulance and out of the rain, we did checks on his blood pressure and pulse and reassessed his breathing to detect any changes. Simultaneously the police were cordoning of the area as a crime scene and contacting his next of kin.

Gary needed to be in a trauma hospital – fast – so we placed a call to let them know that we were coming in and informed them of the nature of Gary’s injuries so they could be prepared for him when we arrived. We travelled through the streets with the lights flashing and sirens on to push through the traffic.

The police officer travelled with us to hospital in the back of the ambulance and we reassured Gary as best we could during the journey.  I couldn’t imagine how terrifying it must have been for Gary; what started out as an ordinary day ended with him being viciously attacked and then hurtling through the streets with lights flashing and sirens blaring not knowing if he was going to live or die.

Once we reached the trauma centre we handed Gary over to the awaiting team and stayed to help out a little. More police officers arrived and I saw one with Gary’s partner who was clearly very distressed.

Gary required extensive emergency surgery. I followed up Gary’s case and found that despite serious injuries to his lungs and liver, thankfully he survived this random attack by strangers, although he will need continuing medical care.  I would imagine that the psychological scars will take a lot longer to heal, if they ever do.

Luckily I was just around the corner when I got called to this one. Traffic police were driving by on their way to curry night at the local police station. They saw a young man on the ground just inside the grounds of a park. They pulled up to investigate and saw that he was injured and losing a lot of blood from a leg wound. Springing into action one of the cops put a huge battle dressing on the wound; he pressed firmly on it and elevated the leg. He established that the young man – Alex – had been taking a short cut by climbing over the railings when he slipped and impaled himself by the lower leg onto one of the spikes. Unbelievably he managed to pull himself off and stagger only a few steps before he could go no further.

The policeman said he had to climb over the railings by using the police car as a step up, but that it was very tricky so the other cop hadn’t even attempted it. He told me that the fire brigade were on the way to break the lock on the gate. However, I ADORE climbing things and do so at any opportunity, so I decided to attempt to scale the railings. I threw my bags over first then used the car to give me a step up, then clambered over the spikes. Landing safely and dare I say, gracefully perhaps, on the grass on other side, I assessed Alex’s condition. He was very quiet, pale and sweaty, his blood pressure was ‘in his boots’ so I put a cannula into a vein in his arm and gave him some fluids to boost it a little, and then I gave him some painkiller. We cut away his blood soaked jeans to assess the wound and check for other injuries. On the surface it was quite a wide laceration and there was no way at this point of knowing how deep it was or what the damage was like underneath.

Three fire engines arrived next and even though all we needed were some bolt cutters I never complain about having them there! At least we could move in and out of the park with the equipment now.

An ambulance arrived and we prepared to get Alex on board for his journey to hospital. We lifted him on to the trolley bed and kept him lying down with his legs elevated; we needed to monitor his blood pressure constantly as it remained a little low but at least the bleeding was now under control.

So Alex went in the ambulance to hospital for further assessment of his injuries, the police went off to enjoy their curry, and after a quick clean up and restock I was ready for my not so eventful next call.

Image by Dplanet on Flickr

On my way to work one day I approached a busy junction. I could see that the lights weren’t working so I stopped and pulled on the handbrake. I noticed with horror that a motorcyclist and car approaching the junction from different roads were on a course for collision. As the vehicles impacted, suddenly the body of the motorcyclist was catapulted through the air like a rag doll and landed hard on the road in front of my car.

Forgetting I was in my own car I instinctively I reached for the radio to call the control room, then remembering myself I switched off the car engine and pulled my Hi-Viz coat from the passenger seat. I grabbed my paramedic bag from the boot and made my way to where the body lay. In my mind I was convinced that I had just seen someone killed – so I was very surprised to see the ’body’ start to move. I was grateful that at least she was conscious and breathing. I told her to lay still and knelt at her head and held it still to keep her from moving and possibly damaging her neck further.

At this time I remember someone approaching me. They told me that they had called an ambulance; and so I waited for it to arrive and in the meantime I tried to comfort my patient – it felt like an eternity.

The next thing that happened was a milkman parked up his float and marched over to me. He then started to yell and swear at me, blaming me for the fact that the lights hadn’t been working for two days. He shouted in my face telling me to get ‘her ‘out of the road and out of the way. I asked him, fairly politely, to go about his business and crossed my fingers that help would soon arrive. Things were getting rapidly out of hand!

Luckily, a couple of off-duty police officers passed by and stopped to help with the traffic  – little did they know at the time that my patient was in fact one of their colleagues on her way home from work. Their presence at least had the beneficial effect of making the horrible shouting milkman leave us in peace!

Next an off-duty paramedic stopped and together we safely removed her helmet (the removal of a crash helmet in this situation requires two people and special training so as not to cause any further damage to the spine). We then checked her over to determine her injuries.

When the ambulance arrived we all worked together. We placed a stiff neck collar on her and moved her on to the back of the ambulance using a spinal board, then gave her pain-killers to help her cope with her injuries.

Amazingly despite her flight through the air, it transpired that she had only sustained a very severe fracture of one of her lower legs (I found out afterwards that she went to theatre for pins and plates to be fixed to the broken bones while they healed).

This experience brought home to me how very different actually witnessing an accident is compared to arriving in an ambulance some minutes after the event; and while the actions of the milkman saddened me it was reassuring to see that even when off-duty you can always rely on the emergency service to stop and help when they can!