Sometimes, even when it's cold and dark and raining on your head, you have to go a bit slow.
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.
We were trying to take the DLR to the Swan last night and got hung up. When we finally got on, one of the ticket checkers said someone was on the tracks at Canning Town.Strange … I immediately assumed someone had jumped in front of the train. Didn't occur to me that they might have seized and fell.
That was exactly my response.15 months…
A nice big jump in HTML requests and a little spike in RSS requests.All good. Although perhaps not so healthy for my ego.
It's about 60% survival rate if I remember correctly, although some of them may be rather… mashed and wish that they hadn't survived.(It might be 60% death rate, but whatever, it's less than you'd expect).
Exactly – plus getting it all out the car and lockig up while a distraught relative is telling you to 'Hurry up'.It's why I have the knees of a 90 year old.
One thing I have always wondered. With all this zooming about between incidents and hospitals, do you have a sort of knowledge like taxi drivers? It wouldn't be the done thing to stop and ask directions.
So much confusion might be avoided and time saved if everyone, whether or not they have a health problem, would think to wear a medical necklace or bracelet.
2 things:1, try something called “barkeeper's friend” for the oil. I've never found anything that gets stains out like it, and it's not horrid on your skin or the environment either. Any supermarket will have it. Alternatively, I'm sure someone will have some swarfega somewhere :)2, how did you get the fru back? This might sound daft, but do you lock it up when you leave it? I had visions of you fumbling with keys while being laden down like a pack horse…oh, and did you push him? 😉
I found this post very distressing. Don't know why – maybe 'cause it's the first major ambo post for a while, or it's way too early in the morning for me – but it's one of those posts where I finish reading and feel so thankful that you guys are there.
You see this is what I love to read on your blog. This is the stuff that makes me wish the two weeks till I start with LAS comes even quicker. To the person above about the FRU, he probably did lock it, and got a lift back to it with the ambulance.
I'd need less a “necklace” and more “plate armour” to engrave everything on…So I leave it as, I'm not allergic to anything, so, meh. In my handbag I carry details of the medications I'm on and my mobile phone has ICE numbers in it.
Yay for a “real” job! Or, given the previous post, maybe not… hope the chap was alright, anyway.May I suggest having a shockingly cheap and nasty watch to wear for work?
Well, we do tend to know our area pretty well. Also we have computer navigation.Of course, we know some places because we go to them so often…
Some people don't like drawing attention to any illness they have. It's why you'll find us rooting down handbags and the like if there is a colapsed patient. We are trying to find clues.
FRU was locked and left, the crew then roped me off on their way back to station to mop out the back of the ambulance.I'll have a look for tthe stuff you mention – thing is, our jackets' Hi-vis coating breaks down fairly easily.
I may end up not bothering.And there is CCTV to prove it wasn't me.
*Honest*
This post reminds me of the time I caused a passenger incident on the Victoria line in the rush hour.I'm epileptic and had a seizure just as the train was pulling into the station. I bumped off the moving train on it's way into the station. A couple of seconds earlier and I would have been dead. I caused a 10 minute delay in the middle of the rush hour. People all over London must have been cursing me. The ambulance people were off course very nice and professional.
And no, I don't carry anything on my person to say I'm epileptic, this is because I am evil and like to spread chaos.
I applaude you Tom, you really are fab :)Liz & Josh 15 months xxx
“as soon as some doctors see us the patient gives them the impression that we have been letting him choke to death”Damn those inconsiderate patients… ;-)Once again, nothing but respect for you and your colleagues, I'd offer you my spare watch but I'm sure your book advance will cover the cost of a replacement (but hey, if not, the offer is there!)
Tom – hows the stats looking after yesterdays appearance on the BBC website (for those who haven't spotted it yet – look in the tech section). Excellent article and todays post is an interesting intro for new readers. Congrats on the coverage.
Just picked this blog up courtesy of aunties website. And must congratulate the writer. I spent 7 years myself as an EMT before parting company with the NHS a few years ago, must admit I don't miss it. Don't miss being attacked by drunks, having crossbows pointed in my face or having the vehicle used as cover by petrol bombers. Miss my mates though, would still speak to them but really miss working with them. Again well done on this blog.
Well done on another job well done. I've been reading for a long time now and I noticed an article about your blog on the BBC website:http://news.bbc.co.uk/1/hi/magazine/5264204.stm
It is true that every time I've heard of people on the line I've thought they jumped, or worse were pushed. It must be unusual for a person to fit and fall on the tracks.
Josh 15 months already???!!!Where the hell did that time go?
Glad you are both thriving!
isn't it amazing how no one offers to help carry all the kit you are supposed to take to the patient, you get “quick he's over here” that means you have to go through a field, over a fence through another field, through/over a stream, past a few cows trying to see if any are bulls (and my rucksack is red), carrying a rucksack a sherpa would refuse to carry, a monitor/defib the same weight as my 5 year old son and an O2 cylinder that cracks you in the shin when you walk, and i'm expected to be quick,no wonder my backs knackered.
Hmm when I lived near Whitechapel I was forever held up due to one unders… nice to know some survive.
Not all on the tracks are jumpers. My other half caused chaos at Reading station when he got out the wrong side of an old slam door train. In his defence he is blind, the station staff were very considerate and turned the power off before he hit it with his cane.
First post, having lurked for a bit. Fantastic blog, but must admit to feeling pangs of guilt reading about this incident, as my workmates and I were casually cursing the inconsiderate b*****d who got themselves onto the tracks that day… Hope he's okay, and hats off to you and your colleagues.
I had a patient from a train Vs person accident once….The nurses i was working with couldn't understand why he was so angry…. I'm sure I would be if I expected to pop my clogs then ended up on a grotty, dirty ward….
Don't envy your job being first on the scene to one unders…
Apparently there was one at Leyton yesterday too …A medic friend was moaning about the delay to me….inconsiderate sod :-p