Tilt

It’s normally pretty easy to get a patient out of a house.  They either walk, or we put them on our collapsible carrying chair and carry/wheel them out.  Occasionally you come across a job where that simple approach isn’t going to work.  This is often a ‘satisfying’ job as you have to problem solve for a change.

We were sent to a teenager that had hurt her leg playing football in the garden.  We arrived to find the girl laying on the living room floor.  Also present was her mother, older brother and baby sister.  The girl had indeed been playing football and, due to circumstances that I shall obscure for reasons of privacy, had broken her leg right up where it joins with the hip.

This is often an injury related to age, old people fall over and ‘break their hip’, and this was the exact same injury.  The problem with this is that we can’t really carry them out on our chair because of the pain and further injury that can be caused by the two ends of the bone grinding together chewing up muscle, nerves and potentially damaging the main artery that supplies blood to your leg.  If you damage that it’s very easy to bleed to death.

“No problem”, we thought.  The girl herself is light and the mother and older brother are sensible people.  So we warned everyone involved that it would take a bit of time to remove the patient from the house in a safe and as pain-free as possible manner.

Now, with a patient like this we would normally put our scoop underneath, strap them in a bit and then lift them onto our proper trolley-bed.  Unfortunately, in this case, the angle to the front door was such that we wouldn’t be able to get our large trolley-bed into the house, and giving the scoop a dry run, we wouldn’t be able to fit that out the front door either.

Didn’t those people who designed houses eighty years ago consider modern ambulance stretchers?  Typical really.

So we sat an thought for a moment, the patient was calm (and by now the pain relief we had given her was working), the mother was calm, the older brother was calm, baby sister filled her nappy (that or my crewmate farted but managed to keep a straight face).  Could we go out through the garden?  Nope, no access to the street through that route.  Could we open the living room window and pass her out that way?  Nope, the design of the window precluded us doing that.

Brain-wave!

If we strapped the patient to the scoop really well then we could tilt the scoop up by 50 degrees and fit the scoop (and patient) through the door.

However this involves a lot more strapping in a way that we don’t really get much practice in.  Then you follow it up by a bit of faith that when you lift the scoop up the patient isn’t just going to slip out the end of the scoop and end up in a painful heap on the floor.

So we explained what we were going to do (Rule#1 in keeping patients calm, explain what you are going to do) and spent the next ten minutes tying her to the scoop, hoping that we were doing it right…

Then came the moment of truth – we lifted her up, carried her towards the door and tilting her up held our breath.

It worked perfectly, she didn’t move an inch, she didn’t cry out in pain and most importantly – we didn’t drop her.

From there it was a simple job to carry her to the ambulance where we travelled as carefully to hospital as possible in speed-hump infested East London. 

She was seen pretty much immediately by an A&E consultant.

 

Job’s a good’un

23 thoughts on “Tilt”

  1. not being pedantic, oh, ok i am, but the patient seems to have a sex change too. typo or new service provided by LAS 🙂

  2. there can be some really intresting places people get stuck. one that i got on a duty (im SJA) was a ?spinal in a small walk in cupboard, door is at side. the cas had her leg bent at the knees, we used the scoop with the extending section full push (but it covered her back) in so we could get her though the door, then removed it when she was lying on the long board, strapped her down and off to A&E.I still remember the smurk on the face of the Paramedic that trains us, when i told him about it. considering he made us do 5 hours of what he call ” how the F do we get them out” during training.

  3. Sounds an interesting bit of maneuvering! Glad it worked OK.The most awkward I come across is trying to get unconcious females out of loked toilets. Yay for students union nightclubs!

  4. Heh, fantastic. Glad to see everythign went well.Being on a Mountain Rescue team, we've got quite a few pieces of kit dedicated to getting people with odd injuries out of some of the more “difficult” places. KED/TEDs, vacuum mattresses etc. Although for a verrtical carry, you probably want to do something like: http://www.pishtush.com/camwrangler/02oct.html#021014You should come and play with us sometime, I'm sure we'd all have plenty of fun. :)Cheers,Aled.

  5. I have heard that elderly people with brittle bones will sometimes fall because the hip has already broken of its own accord, meaning that the fall itself did not break the hip, though one would naturally assume that cause and effect.

  6. HiAs a responder ive been to a few ?#NOF well i say suspected NOF's but usually they are pretty obvious but ive seen quite a few of them taken out on chairs rather than stretchers or scoop boards but as a responder i dont see it as my place to question thier treatment of a pt.

  7. It's one of those things that you *can* do, but only if there is no other way to get a patient out of a location. You can't very well leave a patient lying on the floor just because you'd step outside of the normal way of doing things.When I was a responder, I'd make suggestions, but at the end of the day it's the crew's responsability.

  8. HiNot ignorant at all most people have never heard of us. A community first responder (CFR) is a volunteer, usually part of a group, who attend 999 calls which are lifethreatning (CAT A calls) the CFR is dispatched to a call at the same time as the ambulance but because they operate within a small area eg a town or village they can get to and treat a patient in the few mins before the ambulance gets there.

    Responders are usually trained in CPR the use of an external defibrillator and oxygen therapy all very basic skills which can and do make a difference. The chances of recovering from a cardiac arrest decrease 10% every min, after 8 mins virtually no one survives but early defibrillation and CPR make a big difference. In some parts of the country esp the rural parts responders have also been trained to deal with minor injuries prior to the arrival of an ambulance. Responders are never dispatched instead of an ambulance only ever in addition to one ive been a CFR for 6 years now and i love it.

  9. HiIf we help make ORCON thats a bonus but most of us couldnt give a shit about ORCON bear in mind though ambulance services not meeting ORCON are hardly met with a “there there its ok have some more ambulances” are they ?

    Can i also say that the other 2 services have their volunteers as do the coastguard and there's that little known organisation the RNLI you may just have heard of! Ask the patient ive been to there have been many if they have even heard of ORCON – probably not but they were glad to see somone quickly who could reassure and treat them.

    NIKKI

  10. HiThe # is shorthand for fracture the NOF part is Neck of Femur (the top part of the femur bone just as it joins the ball joint of the hip). Usually you would put on the patient report form ?#NOF which means query fractured neck of femur.

  11. Reading Tilt reminded me of when I worked for a Private Air Ambulance company at Stansted Airport – Part of our contract with one of the airlines there was to transport any of their passengers with reduced/no mobility to & from their aircraft seats. This obviously involved lifting and carrying. One regular event in the winter months involved plenty of repatriations due to skiing injuries – Those returning from Italy had the pleasure of flying in a small plane called a BAe146 – it takes about 100 people and they'd always be put at the back. The ambulance chair we'd use to maneuver the casualty from their seat to the wheelchair was too wide for the aisle so we'd have to carry them over the seats! When we'd get to the front of the plane if they had their leg in plaster we'd have to open the coat locker get them to shove their outstreched leg in the locker, stand one side of the galley and lierally drag the chair round to face the door – the so called “146 shuffle” – great fun till the passenger lost their sense of humour!

  12. This is a good technique for transporting people on the scoop in those nasty little lifts with small doors opening inside the cabin…

  13. Sounds like a job well done. you should come out on a lifeboat for a training ex, you will all too soon learn that houses are much more adapted to moving people about,yachts and motorboats etc are definatly not, you will all to often find that you have to rotate the peron significantly to remove them from places such as engine rooms, and lower cabins. im sure if you wanted to come out and take a peek then it could be aranged.Happy blogging

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