Tears in Heaven

I’ve mentioned this job in a post already but, since it was my “one job”, I feel like it deserves more. I realised that I’ve never written or spoken about it in any kind of detail before, but a recent conversation with a friend and colleague made me think perhaps I should.

The patient was 11 years old. Only 11 years old. Our screen said they were 7. I only found out a few days later what their true age was. I never knew their name, but I was the first person to look into their empty eyes after the life had gone from them.

I was attendant at that point, my partner driving. We had passed the point on the road, a main dual carriageway, minutes before the incident. There’s a strong chance we had seen them alive at the roadside. The job came up on our screen and we had to find a gap to turn the ambulance around. It was rush hour so traffic was heavy, our blue lights stopped the vehicles around us as we crossed onto the other side of the road and made our way back to the scene. The job was a “person vs vehicle”, never good on a main road. Then it was updated “7yo vs van”…

We passed the incident on the opposite carriageway and desperately looked for a gap in the central reservation. Traffic was at a standstill, making it hard to negotiate. As we approached the scene I jumped out and ran over to the patient. They were face down with people around them. I asked two of them to help me carefully turn the patient over while I managed their neck and head. As we rolled them over, I saw the head injury, in the shape of a large, open wound. Their eyes were empty and staring. I found a very weak pulse at their neck, they weren’t breathing. My partner arrived, having brought the ambulance closer. I asked for the immobilisation kit and a trolley, and explained the lack of output. The patient was rapidly immobilised and wheeled into the ambulance, a line in their arm, a tube for breathing. We agreed I’d drive, my partner was smaller than myself, so could fit in the gap between the trolley and the attendant’s chair performing cpr as we wound our way through the busy rush hour traffic. I took the keys and turned the ambulance carefully, then began the dangerous drive. We were around 10 miles away from the hospital, we had a number of hot spots to pass through.

The police hadn’t arrived, but we couldn’t wait. I called control on the way in with an update on the patient’s condition and requested the paediatric trauma team met us on arrival at the hospital. I recall talk of a police escort but we had no time to waste while it was being arranged.

I don’t remember much about the journey, but I broke a few speed limits (legally), and somehow made it through traffic in record time. Oddly I felt no satisfaction in that for a long time.

The staff at hospital were indeed there to meet us, and they took over CPR. After a swift hand over we went back to the ambulance and sat. Said nothing, just sat, then we had to go back to our station as our shift was over.

I was on days off the next few days, probably not the best thing as it played on my mind as I sat at home. Calling the counselling service was not an option, that would be seen as failure. Three days later I went back to work, to find out my partner had taken 2 days off because of it all.

We were invited to join the A&E staff at their debrief meeting, there we found the patient’s true age, and the fact that they were dead before we reached them the impact had crushed the base of their brain. It wouldn’t have changed what we did.

I have vague recollections of a conversation with the van driver. I sincerely hope they had some kind of support. Also the patient’s 7 year old sibling, who saw the whole thing and stood at the roadside watching as we tried to save them. There are often fresh flowers at the scene that remind me, but now I’ve put the incident where it belongs, in my memories. I did my job, now it’s not for me to grieve.

In the months after I left the service I turned that young, lifeless patient over on that road lots of times in my head, in my dreams. I knew there was nothing else we could have done for them, but still it played over and over. No one in the service cared. Why would they? It was my job, I signed up for it.

Today I found out a close friend had a similar job in another part of the country. This is their one job. The service has done nothing. Offered no support.

Crews go through this on a regular basis, and there are no official checks or support. Stress, PTSD and suicide are all very real and far too common results.

Something needs to change, but it has to start in the offices of managers.

There’s that moon again

I spotted another full moon this week. It reminded me that the phenomenon isn’t just limited to night shifts (patients aren’t actually vampires. Vampires don’t get ill). The “less sensible” patient can require ambulance assistance any time and, while we might not know it’s there at the time, during the day when there is a full moon.

One such call appeared on my screen mid-morning one winter. There was a lot of snow on the roads, but they were drivable. The job was about 10 miles from our station and not a high priority, so we didn’t rush.

The on-screen navigation was known for its inaccuracies, and the maps it was based on were somewhat out of date. Thats where the job began to go wrong. The estate we were going to was very new and didn’t exist on the maps the system used, but it still plotted the “quickest route”…..or so we believed.

It was when we drove into an industrial building site we first queried its accuracy. My partner was driving and came to a rapid halt at the bottom of a snowy, muddy, hill. After realising we were off course I decided to look the address up on a well known mapping app on my phone. We were very off course!

My partner turned the Ambulance and drove up the hill, at least that was the intention. Part way up the wheels lost their grip and began to spin on the snow. “You’ll have to dig us out” my partner grinned. Yes, it was my job at that moment in time. I climbed out of the ambulance and opened one of the external side hatches, located the snow shovel (modern ambulances are equipped for most situations) and began to clear the snow away from the rear wheels. My partner slowly began to drive the ambulance clear, and kept going. Stopping at the top of the long hill, they radioed me, suggesting I hurried to join them as we were still en route to an emergency.

After updating control on our situation, we got back on course with the help of my phone. The job was an RTC – “4×4 vs house”. Neither of us was sure what to expect.

As we got closer, we knew we were at the correct location. There were an unusually high number of police cars and officers also making their way to the scene. We turned a corner into a cul-de-sac and knew we’d arrived.

There was a posh 4×4 holding up a spare bedroom, seriously. The driver was out of the vehicle. Their partner was away on business but had asked them to run the car every other day so it didn’t sieze up. Having gone to do so, the driver hadn’t realised the vehicle had been left in Drive and, lurching forwards as soon as the ignition was turned on, rather than brake they had accelerated. This had propelled them across the cul-de-sac and straight into the end wall of the garage attached to the house opposite. The garage the owners had built a spare bedroom above. The car literally was holding up the room as the supporting wall had mostly been destroyed.

The fire brigade had also arrived and we left them to the structural issues while we began to assess our patient. Their injuries? They had knocked their knee on the vehicle door when climbing out! Surprisingly, they declined a trip to A&E. When we asked why they had called for an ambulance they replied “isn’t that what you are supposed to do if there’s been a crash?”.

We later found out that the excessive police presence was because the house next door to the demolished garage belonged to one of the officers.

Around the same time, a city based colleague declared the full moon.

It’s genuinely a thing!

Money talks

It’s true, money can tell you a lot about a person. I said this many times during my career – it didn’t matter if you were a multi-millionaire or a homeless alcoholic, everyone got the same treatment in my ambulance. Ambulance crews can’t afford to differentiate. Yes, there are annoying patients, “regular offenders”, those who obviously don’t need to be there, people who are clearly abusing the system, but in these situations you must put your personal feelings aside and remember why you are there.

After a slow start to the shift, around 20:00 we got a call to an RTC on one of the local country roads. It was a well known corner, a hotspot for accidents. I say “accidents”, but it was nearly always bad driving that caused the incidents.

Sure enough, as we pulled up the cause became apparent. The incident involved an older small car and a large, white, 4×4 that had clearly never been off-road in it’s life. The small car was a bit of a mess and the driver was still in it, the 4×4 was damaged at the front but still drivable, and empty.

We approached carefully and assumed the “fend off” position in the road, completely closing it to traffic from behind. The fend-off position is when an ambulance, or other vehicle, parks diagonally across a carriageway with full emergency lighting on, effectively blocking one or more lanes in an attempt to protect the scene and the people working at it.

I was driving, so my partner quickly got out of the ambulance and went to assess the driver of the small car. I got out and began to look for the driver of the 4×4. I quickly found them! They were strutting round, most upset that their vehicle had been damaged and, quite arrogantly, demanding that their “whiplash” be assessed. I explained that the driver of the other vehicle was trapped and therefore was our priority.

This seemed to be the wrong response. The 4×4 driver was clearly a person of wealth, their vehicle a top of the range model with a private registration. A tirade of disgust and accusations of “******* useless NHS paramedics!” bounced off my back as I turned away and went to get an update from my partner so I could update Control.

The disgruntled 4×4 driver was not finished – they continued to rant at us as the first fire unit arrived and we discussed with the crew how best to get the young driver out of the badly damaged car. The roof and doors were removed by the, ever obliging, fire crews. A second fire unit had arrived by this time and assumed the fend-off on the other side of the incident, completely closing the road.

As we extracted the injured driver of the small car, the 4×4 driver was still determined to be examined. We took the injured driver into the ambulance for a full examination and left the fire crews to make the remains of the car safe.

At this point the police had not arrived.

My partner began to assess the young driver. They had some bad injuries, but none were life threatning. Then the rear doors of the ambulance opened…

“I’m in agony here! I demand you examine me. Whiplash needs to be assessed early!!”

The mist descended and I made my way to the back doors. Barely holding on to my composure, I did my best to politely explain that whiplash was not a priority at this point, and the other driver was. “Call me another ambulance then!!”. I offered to call them a taxi. “My car is also in a terrible condition too. Who’s going to take responsibility for that?!”

Luckily for them, the police arrived at that, potentially explosive, point.

A local traffic unit pulled up rapidly and stopped behind the ambulance. The local officers, known well to my partner and myself (an ambulance messroom is a good source of cups of tea for police officers during slow shifts), jumped out. “Sir! Step away from the ambulance and let the crew do their job!” said one of them, surprisingly forecefully. The 4×4 driver was as taken aback as myself. Then they began their tirade on the police officers. Bad move!

Both police officers made a quick assessment of the scene. “what direction were you travelling in sir?” they asked the 4×4 driver. He indicated his side of the road, then began to complain about the other driver. The small car was a very sporty japanese vehicle, driven by a youngster.

“He came screaming round the corner on the wrong side of the road!” the 4×4 driver ranted. “Hmm…….” said the first traffic officer. “did you move the vehicles after the impact?” The 4×4 driver looked surprised. “Its just that there are very long skid tracks on your side of the road before the corner, that cross to the other side of the road on the corner, and stop under the tyres of your car….Sir”. The 4×4 driver went silent. “That implies that you were speeding, and took the corner far too fast…on the wrong side of the road….Sir”. The 4×4 driver retorted “But….but…he was driving ridiculously fast!”. “Not according to the marks on the road from his car….Sir. Would you mind stepping into the back of our car?” . I’m sure I spotted a wink from one of the officers before they disappeared into the car with the driver.

I returned to the rear of the ambulance where my partner was chatting with the other driver. They were talking about the small car. Aparently it was a vintage, collectable sports car. One of the poice officers knocked on the rear doors so I let them in. They had come to take a statement from the young driver. “I’m sorry this has happened. The road markings are already showing you did nothing wrong, but the official investigation will easily prove it”, The young driver was more concerned about their car. “There are only 250 of them in the UK” they said. “249 now” the officer said remorsefully. “But the other driver won’t drive again for a long time when we’re finished. He’s currently on the phone to his expensive lawyer , trying to explain he’s in big trouble. I don’t think any amount of money will get him out of this one!”

There were many other incidents during my career where money said something about people. Mostly it said about them”I’m arrogant and I intend to use my money to attempt to buy me out of this situation I’ve gotten myself into”. This may sound like some kind of inverse-snob attitude but, unfortunately, nothing on this blog site is made up. It is all based on actual situations and experiences.

So yes, money does talk. But it can’t hide the truth or, in this case, the convicting road makings. And it wil never pull the wool over experienced traffic police officers’ eyes.

RTC? RTA?……….. Crash!

No matter what you want to call it, the coming together of two objects often ends in injury, or worse. I had not long started when I was called to my first fatal RTC (Road Traffic Collision). I think they were still known as RTAs at that point (Accident) but later someone decided “accident” implied that no-one was at fault. I was still working in the big city, it was winter, the roads were icy and there were celebrations going on.

One driver, of a rather large car, had decided one for the road was not enough. Suitably oiled himself, he had taken a large corner too fast and slipped over to the opposite carriageway halfway round, straight into the path of an oncoming 4×4. Not a scrappy German, WAG taxi style 4×4, a real, solid built one. The result of the head on collision was spectacular!

On our arrival, two other crews were working in the rear of the large car in the middle of the road, while the fire brigade were busy dismantling what remained of it. The other vehicle was on the grass verge, looking like it belonged to a passer by who had simply stopped to help. It had a slightly cracked grille, scratched paint…..if you looked closely, and a broken light (not an exaggeration!). The driver was being checked over by a Dr who had come from a house nearby by seemed ok, other than a bit shaken.

There were three people in the large car. All were rather large, none were wearing seat belts. The crews on scene were working hard with the fire crews (aka, with utmost respect, “drip stands”) to extract the two passengers from the rear. Both were in critical condition.

There I was, barely qualified, already a number of RTAs under my belt, but never at night, never in the biting cold, never with so much noise from so many fire engines. I stopped before getting out of the Ambulance and turned to my partner, a veteran of many incidents. My heart was pounding, the noise was mind numbing. “Breathe, then assess the situation” they said in a calming voice. That advice stuck with me throughout my career.

By the time I left my ambulance I knew what my part was and what I had to do. The driver was my patient. Because work was going on in the rear of the car, I had to wait until the passengers were out before I could attempt to deal with the driver. I knew I had to keep his head straight, something important in every impact situation to try to keep the Spinal column straight and prevent any damage to the Spinal chord. I also had to keep them calm while their car was being cut apart around them. I grabbed a fireman and asked them to remove the front windscreen. Once done I was able to talk to them, making sure they were looking straight at me all the time, and not moving their head. Even the length of the bonnet away from them, the alcohol fumes were strong. I asked my partner to put an oxygen mask on the driver, then it was just them and me…..in the middle of a world of organised noise.

I stood in front of that car for, what seemed like an eternity, talking to the driver and finding out all about them. They had been to a party and had decided the roads would be quiet enough to drive home ok. My hands and face were numb with the cold by the time the first passenger was extracted from the rear of the car. I could tell from the looks on the peoples’ faces that it wasn’t going well. They disappeared off to A&E. Then the second passenger was extracted, my partner was helping and they shook their head as the lifeless body was wheeled to the other ambulance. The crew were giving CPR, but I could tell it was hopeless.

As soon as the fire chief gave me a thumbs up I was in the remains of the car, holding the driver’s head from behind their seat. I had already established that the whole front of the car was pushed back, the dashboard and steering wheel pressing against the drivers legs and chest. They had complained about pain in their right hand so I looked from behind them, now I was able to attend to them properly. “it will be ok, well get you sorted” I said, as reassuringly as I could muster. The hand was hanging by nerves and skin at 90 degrees to their arm. The broken ends of the bones were visible at the end of their arm, and sticking up from their hand. Mercifully there was no arterial bleeding!

The fire chief and myself quickly worked out a strategy and explained it to the patient, then they got to work removing the front of the car. The cutters made light work of the metal. Then the whole chassis broke in half, down the length of the car. My left leg was jarred down suddenly and the engine dropped on to the road at the front of the car. The oil sump cracked and oil ran everywhere.

We patched our patient up, extracted them with the help of a spinal board, then into the Ambulance. The journey to A&E was quick and we handed our patient over. As we walked away the patient said something, muffled by the oxygen mask. The nurse lifted it and the patient looked me in the eye and mumbled, still slightly drunkenly, “Thank you. Happy New year, when it comes”. My heart sank! Neither of the two passengers had survived as far as A&E. The driver would never drive again, possibly not even walk. Not a very happy new year.

The moral is simple, obvious, but there will always be those who think they know better. There will always be ambulance crews who will try their best to save them.