I was working on the FRU last night, my crewmate is still off sick and will be for at least the next four weeks so finding myself without a partner and being asked to go 'on the car' is fairly common.
I'm sent to a job marked as 'Male fell onto train track, head injury, ***track current off***'. It's that last bit that I like to see…
I get there and park up at the normal parking place for the police and the ambulance, just as my handbrake goes on a British Transport Police (BTP) van screeches up behind me. A policeman jumps out, shouts, “He's on platform three”, and runs into the station. I gather my equipment bags and waddle after him. (All the equipment we carry tends to slow us down).
I'm led to the patient by one of the staff. Even though we are both walking quickly and with purpose a passenger still tries to stop the station worker to ask if there is a replacement bus service. I'm guessing that obviously leading a heavily laden ambulance worker to a patient is less important than her trip home…
The patient is indeed laying on the tracks of the Docklands Light Railway, around him are several BTP officers and station workers. Some of them are down on the tracks with him, so I know that the area is safe. They have already covered him with two blankets and put a dressing on his head wound. Wisely they haven't moved him, so he remains pretty much facedown. They have been talking to him although they say that he isn't making much sense.
I jump down onto the tracks (it's about a five foot drop) and start to get a feel for what has happened and how badly injured the patient is. He's not behaving normally, in fact he's acting 'post ictal', which is a side effect of having had a seizure. There is what I would call a 'reasonable' amount of blood swilling around the puddles on the track. I know I'm going to get 'bloodied' in this situation, so I dive on in.
I'm not happy with the distance that he fell. One of the station workers was talking to the patient as he fell onto the tracks and his head bounced off one of the rails, which explains the blood that is covering everything. The worker then tells me that, after falling and hitting his head, the patient had a fit for about a minute. It's all starting to come together.
“When you talked to him, before he fell, did he sort of go all stiff?”, I ask the station worker.
“Yes, his eyes kinda went funny”.
So now it looks like the patient started to have his fit while standing on the platform, fell back onto the tracks and has landed on his head. I'm not happy about moving him. His head has travelled about eleven foot, and I can't rule out a serious injury to his neck. So now there is little I can do beside give the patient oxygen, try and reassure him and get rained on.
Thankfully the ambulance crew are quick to arrive. I explain what has happened and they agree with me that the best course of action is to 'collar and board' the patient before moving him off the track. We do this to protect the patient's neck and back – if he has damaged his neck then the hard collar and head blocks that we fit around him will reduce the chance that moving him will damage his spinal cord. A damaged spinal cord can result in paralysis or death – so we don't want to make any injury worse.
Unfortunately this takes time, especially when you are dealing with a wet, semi-conscious patient in the dark. As we are preparing to secure the patient he has another fit. Then he has another fit as we are trying to strap him to the scoop so we can lift him off the tracks. Thankfully he has a clear airway throughout and the fits don't last too long. It's one of those situations where you need to go slowly in order for the patient to receive the best treatment.
Throughout this we can hear the station tannoy announcing delays due to 'a person on the tracks'. So now, dear tube traveller, you have an idea what is going o when your train is similarly delayed.
The Transport police have been very helpful throughout and now they and the station staff help us lift the patient onto the platform and then onto the trolley. The police want to know how the patient is going to do, if the injuries are life-threatening then a much more in-depth investigation needs to be carried out.
I tell the police that, to be honest, I don't know how seriously the patient is hurt. While the fall may have been caused by an epileptic fit, the head injury is nothing too serious and the further fitting is his normal pattern of epilepsy. Or alternatively it may be that the patient may not be epileptic at all and may have just fainted onto the tracks and the that the fitting is being caused by bleeding onto the brain.
We load the patient onto the ambulance, now he is in the warm, dry and well lit ambulance we can cut off his clothes and make a proper inspection of him. Physically he seems unhurt apart from the seizures and the head injury. We need to decide which hospital to take the patient. We could take him to Newham hospital, which is about three minutes down the road. While this has a good A&E and is very close it doesn't have the resources of our second choice, the Royal London. We choose the Royal London mostly because if the patient does have bleeding on the brain, then that hospital has neurosurgeons that can operate on the patient. If we took the patient to Newham hospital and he needed neurosurgery then he'd have to be transferred, all of which takes time.
So we go (under blue lights and sirens) the further distance to the Royal London. I travel with the crew in case something nasty happens during the transport. The patient has a further two fits while on our way to the hospital.
However, we safely reach the hospital. Wheeling the patient into the resuscitation room he chooses that moment to start to lose control of his airway. It's annoying, we look after him all this time, then as soon as some doctors see us the patient gives them the impression that we have been letting him choke to death.
Nevertheless, he is safely in the hands of the doctors. We have done our job by not letting him get any worse. By bypassing the nearest hospital we have got him to a center than specialises in his potentially serious injury. A job well done and the crew and myself feel happy that we have helped someone who really needed it (unlike my mate who went to a young woman with period pains…).
The only problem is that the back of the ambulance looks like a bomb has hit it, I'm covered in blood up my arms where my gloves stop and my hi-visibility jacket is likewise covered in blood and train oil and possibly other substances. I have only one such jacket and as I'm working for the next six days, I wonder when I'll be able to give it a wash.
Oh well – a dirty jacket is the sign of a hard worker. Right?
And I appear to have lost my wristwatch…Bang goes £20.