A Little Tumble

I walked through the door to the house, the door had been kicked open and I stepped over the splinters of wood. Turning left I climbed the stairs and saw one of my favourite police officers standing at the top. He's one of the older officers on the street and eminently sensible, I know that a job is going to be fine if he's there.

“That your handiwork?”, I asked him.

“Yep, I've arranged someone to come and fix it”. He was kneeling down next to our patient.

It's one of our usual calls, an elderly neighbour doesn't answer the door and someone who 'pops' in sometimes, or buys their bread and milk for them calls for us, or the police.

The police arrive to knock down the door – or we get there first and I get to kick it in. On this occasion the police had beaten us and so the officer had been on his own with the patient waiting while we'd cleared from our last patient. He'd already put a pillow under the woman's head and was arranging to let the relatives know – as is common these days the relatives lived in a different county.

'Edna' had the classic pose of a broken hip. Lying flat on her back with one leg obviously shorter than the other.

“You won't take me to hospital will you? It's just a little tumble”, she asked looking up at me with pleading eyes.

“We'll see how you are after I've had a look at you”, I told her in an effort to give me some time to work out how to break the news to her that she would be going to hospital.

A further examination and it was even more obvious that she had broken her hip. I looked around, we'd need to strap her to our scoop stretcher firmly as we'd need to carry her down the stairs and tip her nearly upright in order to get her out the front door.

I looked Edna in the eye, “I'm sorry luv, but it looks like you might have broken your hip, you'll need to go to hospital”.

A tear formed in each eye, “Oh no. I suppose I don't have a choice do I?”

So we set about strapping her up – the police officer helped my crewmate get some equipment from the ambulance. What I really wanted to do was give her some Morphine for the pain – it was obviously going to be painful with the manoeuvres that we were going to be forced to do.

But our Morphine stores were out of stock, we had nothing stronger than Entonox. At least we had some of that.

So we spent our time carefully strapping her to the scoop while trying to dose her up with 'gas and air', it didn't seem to be having much effect; essentially her pain relief would be dependant on how well we had strapped her to our scoop.

My crewmate is only little, but surprisingly strong, so she refused the officers offer to carry her end of the scoop, instead he would continue to guard the house until the workmen would come to fix the door that he'd kicked in.

Carefully, so very carefully, we lifted her up and carried her down the stairs, there were some little noises of pain from Edna but she seemed to be coping well. Then at the bottom of the stairs we tilted the scoop up almost to the vertical.

Not a peep from Edna.

We got her out the front door and put her on the trolleybed that my crewmate had already positioned in the street. Then it was a simple matter of driving as carefully to hospital as possible with me holding her hand all the way.

This job gnawed at my mind for some days – Edna was such a lovely lady, with a clean house, neighbours who cared and a real sparkle about her – but because of her other health problems the chances of her getting out of hospital weren't good. Essentially, this 'little tumble' would almost certainly be the cause of her death.

In part I think it's because we spent so much time with her, chatting to her, explaining what was joining on, trying to reassure her that it hit me so hard. In the grand scheme of things we hardly knew her, but for us spending half an hour on scene is a lot longer than we normally have to get to know our patients.

24 thoughts on “A Little Tumble”

  1. Tom, I'm welling up at my desk reading this. A similar fall took my Nan almost a year ago. I understand completely your 'cause of her death' comment. So, thanks to you for caring and thanks for all of the information that you provide through this blog. I thought I understood the ambulance service but I found that there is more to learn – and so much more to do. In the cold light of day, do we really have anyone who will argue that an ID Card Database or a sporting event in 2012 is worth more than proper care for our population, proper drugs and equipment for our ambulances and a decent salary for you and your peers? Thanks again – and here's hoping that your brush with measles comes to nothing.

  2. This sounds almost identical to the call I went on today, my third hip fracture in 4 days, all of which involved 80+ year old women.An 81 year old woman had fallen up the stairs, at the top step. She told us she's been through a lot and has learned to really tolerate pain, but this was the worst pain she'd ever felt in her life.

    We were on scene for about 30 minutes, trying to figure out what would be the best and least painful way to get her out of the tight space and down the steep narrow flight of stairs.

    Neither I nor my tech was qualified to give pain medications, so that had to wait until we got her to the hospital. When arrived, the ER doctor said they would give her something for the pain; she assured him that she wasn't addicted to morphine. 🙂

  3. Some years ago my wife was resident Warden of Sheltered Housing (Council flats for the elderly), and we saw a number of similar cases to 'Edna's'.Often their main concern was not that they might succumb to the trauma – but that they survive without the ability to continue living independently.

  4. Thank goodness for dedicated people like you. It gives me hope in a caring profession that I left due to all the rubbish and ill treatment of patients and staff.

  5. Went to a call yesterday for a 'welfare check' as an elderly gentleman had not been seen by his neighbours for a couple of days, there was milk outside his doorstep and some mail and newspapers beginning to pile up behind the door. The neighbours had reported that he was normally very efficient and that if he was going away he would cancel things like milk.All the curtains were closed (this was daytime) and there was no response calling in. The police had already been called but i was on scene first. After looking for alternative ways in the only way was via the front door. To be fair the door wasnt especially solid but we decided to break the large glass pane in the door instead of turning it into firewood. Unfortunately the door had been deadlocked and there was no key on the inside so we climbed in through the now open door frame.

    Fearing the worst we ventured into each room expecting to find a corpse but there was no trace. The house was immaculate and didnt at all smell like an 80 year olds place. The only evidence of anything i found was a urinary catheter filled with blood.

    I contacted control to ask if we had taken the gentleman into hospital recently which it turned out we had 4 days ago. Loving the communication.

    Before entry was forced one of the coppers asked if we (ambulance service) were allowed to kick down doors etc. I said we were under certain circumstances but there was too much paperwork involved if things like this happened. I think he used more ink than i did yesterday…

  6. Have been reading your blog for agres but have never posted til today.My 96yr old Nan fell and broke her hip whilst moving a table on Sunday last week (she knows she can ask us, but she won't make a fuss!), she lay for an hour before realising that the pain wasn't going to go away and pressed her medic alert button. The crew that turned up and looked after her were amazing and although I thanked them at the time, I really wanted to say thanks to all of you who treat these little old ladies as if they were your own grannys and even make them smile or laugh as though they were teenagers again!

    My Nan now has a shiney new hip and will be returning home again on wednesday thanks to you guys!


  7. A lot of the ambulance services have feedback forms on their websites – I'm sure the crew would appreciate an email showing your gratitude :)Tom – I was just wondering how you deal with the things you see? I'm planning on joining the ambulance services myself and I've always wondered how the staff cope with what they see. It's cool if you'd rather not say – just curious.

  8. However hard we may try to remain detached, because if we didn't and carried on like the TV lot we'd be useless at the job, there are some patients that get through the defences. I can still remember some names and faces from twenty-odd years ago and I bet you can too.

  9. I haven't worked in nursing in 20 years, but I do remember many of my patients, if not by name, then their faces and our conversations. Some of the “got to me,” I must admit, but you sort of get philisophical about older people, as they've already had a good long life. (I used to love chatting with older folks – The stories they would tell!) It was the sick (and dying) kids that really hit me hard.

  10. Oh I reeally hope *Edna* makes it back home.Tom, thank you for reducing me to tears again.

    Whatever your grumbles about work/shifts/pay etc, just remember that these are the *jobs*that make a difference.

    Painfull in your heart they will be, but, strangely the most fulfilling.

    And it shows just how much you and all yur coleagues do care, and a mere reader am grateful for it.

    I salute you all.



  11. I'm an EMT in the US and just discovered this blog.This statement, “Essentially, this 'little tumble' would almost certainly be the cause of her death” rings so true to me. Unfortunately, it will probably also cost her the luxury of dying at home. Seems once some of the elderly are entered into rehab centers for physical therapy following the event, they often get discouraged which then affects their rehabilitation. Sad but I've seen it happen more than once.

  12. “Essentially, this 'little tumble' would almost certainly be the cause of her death.”I don't mean to be ghoulish, but – how? What is likely to be the actual cause of death in a person who is that age, and in that situation?

    She's in hospital – how would her other issues take over? Just trying to understand, I have people I love nearing this age, and want all the knowledge I can get.

    I'll be there, someday too soon, as well.

  13. The problem as we get older, is that we have less energy for the day to day tasks and thus there are less reserves of energy that are required for processing the fixes and daily needs, it has been noticable with the new techniqueks of surgery that people have been recovering quicker as they do not need the time and energy that is required for old methods of cutting and dicing.When young we process more food {energy} [ like 5 to 6 times more] than when we are in our eighties [ I do, My Sunday dinner would last me 5 days now, thank goodness, I no longer have the money to feed the old me]Then the rehab requires ooodles of energy, and so we steal it from other functions they then fail do to the lack of energy.

  14. Not too much – instead we spend our time looking for such luxuries as blankets and ambu-bags and oxygen masks and BM reagents and working ambulances and…

  15. Mostly they don't bother me, it's someone I don't know and as long as I do the best I can for them then I'm all good. Just sometimes though someone slips through the defences (as another commentator notes) and it stays with you.Happens more when I'm knackered from long/weird shifts.

  16. Essentially she had some underlying conditions that would make recovery difficult. She was likely to have problems from the two big post-op killers, chest infections and heart failure.To say any more might breach patient confidentiality.

    Here is some research.

  17. very, very often, a fall is the “beginning of the end” for a previously fit elderly person, let alone one with other health issues.seems that the shock of the fall shakes them up worse than it would a younger person; they also take longer to recover, lose confidence; often the combination of the fall, shock, blood loss if any, hypothermia if any, plus a general anaesthetic

    when operating to repair the damage is more than the old system can cope with.

    two or three days afterwards, on the ward, confusion is not uncommon, especially at night, and doesn't always go away. this makes rehab all the more difficult.

    quite often the patient is physically well enough to go home, but mentally can't cope alone any more, or is too frightened.

  18. “I said we were under certain circumstances but there was too much paperwork involved if things like this happened. I think he used more ink than i did yesterday…”As a copper, sorry Member of the Police Force, i can assure you that any amount of paper work you guys have for any job will be trivial compared to ours. Where I work (in Australia) the Ambos and bucketies always show us sympathy for the amount of paperwork we have, in comparison to theirs (usually by laughing hysterically as they leave and throwing pens at us.). You can just feel the love!

    I wouldn't swap though, imagine having to be nice to drunk people. Goodness!

  19. Thanks for the reply, and research link – sad reading, but I may learn something useful, or at least be more aware.

  20. If Boniva was given to all over 80yr old females with the osteoporosis symptoms, would that not save the NHS money in total cost of fixing bone breakage?of course it going to happen it would put too many bone fixers out of a job.

  21. Well, to give the NHS it's due they do tend to prescribe Ad-Cal for people with osteoporosis as a preventative measure, so it's not *all* bad…

Leave a Reply

Your email address will not be published. Required fields are marked *