Knee

I have a problem with knees, partly it's because I'm slightly squeamish about them, partly because when they break or dislocate it is incredibly painful for the patient.

Our woman had slipped on a wet floor, she had landed on her knees and, after we drove across most of our patch to get to her, we found her laying on the floor.

Upstairs.

In a narrow corridor.

She wasn't a 'small' person either.

My physical examination led me to believe that she had broken or dislocated her knee – it was a bit tricky to examine her in the enclosed space she found herself, her weight didn't help either.

The patient was lovely, she understood why she had waited so long for an ambulance. She'd also taken some painkillers before we arrived, something that is an absolute rarity. She was nice to talk to and when I explained that we would take things slowly for her benefit she understood.

First thing that I did was to give her some of our painkiller gas entonox. Then I slipped a splint around her injured knee, this combination seemed to help the pain a lot. She proved to be a good patient by immediately understanding my instructions on how to take the entonox – another rarity in our area.

The staircase that we needed to get her down was steep and narrow, there was no way we could use our carry chair. She would have to be strapped to our scoop and carried down the stairs that way. But we would need help.

I'm 6'1″, my crewmate is 5' 1 1/2″, not the best combination of sizes for getting a large woman downstairs on a scoop (although my crewmate would like you to all note that she (believes) is the strongest one out of the both of us). So we called Control for assistance, namely another crew or an FRU person. We were assured that one would be on their way.

While we were waiting we placed her on the scoop and started the long process of strapping her to it so that, when we tilted it by 80 degrees to get her out of the house, she wouldn't slid out of the scoop like someone being buried at sea.

After some time one of our Emergency Care Practitioners arrived and he gave us some much needed help in man-handling the patient down the stairs and into the ambulance. We took the patient to hospital where x-rays showed a dislocated knee.

This is what I like about my job – This job wasn't about saving someone's life, it was about causing them as little pain as possible while solving the puzzle of how to get the patient out of the house all while keeping them as calm and happy as possible. It's not a 'buzz', but it is the satisfaction of a tricky job well done.

23 thoughts on “Knee”

  1. gosh that brings back memories of a long time ago in primary school.i was about 10 and we used to like sitting against a wall at break time, someone was rushing around and fell over, landing on a girls legs.

    popped yer knee through i think.

    glad i didn't see it, but i still remember the screams.

    personally its wobbly teeth that send me into a quivver.

    nice job well done Tom.

    best wishes

    sarah

  2. I've been having a very bad few days and the mental picture of someone “sliding out of the scoop like someone being buried at sea” has added some much needed hilarity into my life.thanks

  3. Could some-one please explain what a “scoop” is. I gather that it is some kind of stretcher. How does it differ from a standard stretcher? Scoop-shaped?

  4. Extrication can sometimes be the most challenging part of the job – and often requires quite a bit of ingenuity. It's often a sort of logic puzzle (“You have a 200 pound man, 2 people and a backboard…..”). Something we have quite a bit of that you probably don't get much is people injuring themselves out in the woods. Yesterday we had a guy with a chainsaw injury who we had to carry out of a steeply wooded, very soggy area. It took an hour to get him out. Then again, you probably have a lot more blocks of flats than we do….

  5. As so often, extraction is the name of the game. Bring back vacuum mattress – now they were a really useful bit of kit; and carry sheets. Now what ever happened to carry sheets? Newbies in our patch have no idea how to use them.Well done the ECP – did he/she remember how to lift?

  6. hiI went to a job as a community responder a pt. (elderly) who had recent knee surgery and had fallen shortly after returning home from hospital. The work done in the op had come undone and the pt had an open fracture involving the knee tib and fib pt. had lost a lot of blood after dragging themselves over to the phone it was about an hour after the fall that help arrived. police arrived shortly before me and were breaking in when i arrived. The pt needed moving down a narrow flight of stairs with a 90 degree bend halfway down the stairs were narrow and so the pt needed holding nearly upright to get down the stairs a vacum matress was the only way – what a great bit of kit pt was completely imobilised and it was so much easier than a scoop stretcher. The job itself was very satisfying if pt hadnt got to the phone they may well have lost enough blood to go into shock and after that well who knows, the police were great they did all they could to make the pt comfortable before i got there and helped me when i arrived as i was single handed i cant say enough how great they were and the ECP and crew who responded its great to do a job that actually makes a difference instead of the usual waste of time jobs.

  7. I'm squeamish about knees too… because my impairment means that mine have a tendency to dislocate for the slightest reason. I can watch all sorts of injuries and surgery on TV but the second something happens to someone's knee it makes me feel insanely sick again…I was interested to read your comment a while ago about how painful dislocated knees can be. It was good to be able to show it to people!

  8. For me its eyes. cant do eyes.Gues everyone has their thing. Also recon that 80%+ of the job is reasuring the patient. You can give as much morphine as you like but a bit of empathy is far more valuable.

    People. Thats the job.

  9. If she was stuck, lying on the floor, upstairs, and unable to move herself, how did she manage to get hold of some painkillers and a drink with which to take them?

  10. As a one time theatre sister I could handle most things without hessitation, amputated limbs, bowel resections, even eyes, but if I saw “wedge resection of great toe nail” on the list it I would want to leave the building. Something about those very sharp scissors being pushed under the nail and then opened up was akin to torture and the sound that went with it brought me out in a cold sweat…. well done Tom.

  11. Indeed Tom, yet again the blog shows that the job isn't all Casualty and Holby City etc etc.I would agree with Magwitch – where have all the vac mattresses gone and as for the carry sheets, all of ours were withdrawn because they hadn't been quality controlled. They trialled some lovely blue ones which were huge with an envelope pocket in the bottom of them for the patients feet…genious we thought…until they were taken away again after one of them ripped…since then silence!

    We want/need a decent carrysheet, an invaluable piece of kit!

    I can't do eye injuries…eyes just make me cringe….eek!

  12. I remember a lot of fierce “never let them eat anything” messages from old first aid courses, I thought that definitely included pain killers?

  13. Squeamishness about injuries has been an occasional item on the rest-room debating society agenda over the years. The consensus seems to be that it is not an issue when the injury is so severe that you can't imagine it happening to you.Thus, open fractures of radius/ulna, huge incised wounds, chest crush injuries – no bother to me!!

    However, a couple of fingers crushed in a car door; or a leg injury caused by an angle grinder snatching – too close to home!! (Squirm, squirm)

    Worst of all, a job I went to single manned where a carpet fitter's Stanley knife had jumped, and he had neatly removed the ends of three fingers of the hand holding the straight edge down. Now, who HASN'T worried about doing something like that?!

  14. A couple of OTC painkillers won't do any harm. Three big macs and a milkshake on the other hand…Tongue piercings make me want to run to the nearest bathroom.

  15. Tongue piercings. Deeply unconscious young lady (can't remember what was wrong with her) early last year. Cleared her mouth, then decided that (inter alia) an OP airway would be useful. Started inserting it in the approved manner, rotated it, and tried to nudge it on into the back of her throat. It would not go. Tried again; still no joy. Took a more detailed look in her mouth with a big torch. In the light – a tongue stud, which had been catching the edge of the airway.Oooh! I never thought of that one until it happened!

  16. Carry sheet… a great device!Our Regional Medical Emergency System (1-1-8 Lombardy, Northern Italy) is trying to set them out of the (namely) strict intervention protocols, because they say it isn't a safe device for moving people. However, a six-handle carry sheet proudly lies (folded) inside our rescue backpacks and another one lies directly on the cot mattress (wouldn't you get dirty a one-use paper blanket??? :-))

    In case of need, a transportation device is always at hand!

  17. That's right – although we use plastic ones now. They split in half so that you can position them under the patient with a minimum ofd moving. You break the board, position one piece under the patient on one side, then gently lift the patient slightly and slide the other side under, reattaching them. It's great for old ladies with broken hips and so on. Once it's back together it is much like a normal back board.

  18. A local custom is the “Retiring Collection” at funerals (so much more dignified a term than “whip round”); often, the ambulance service is the beneficiary. The cash allows us to buy things the service doesn't provide, and I'm very interested in your description of a sort of orthopaedic stretcher cum rescue board. Do you have a handy link, address, or phone number for the UK distributor?Thank you.

  19. Like Victorias comment earliar I find it difficult to deal with finger nails. I can deal with amputations, open chest injuries, evacuated skulls, industrial crush injuries but finger nails….no way!I used to run marathons some years and my toenails used to turn black and fall off but it did,nt bother me. But fingernails…even thinking about it is making me feel sick.

    On another note…carry sheets….one of the most simple and effective bits of kit. And like gold dust. Why? It should be standard kit on all vehicles. We turn up for a shift and useful items have been taken off but with no explanation. Again “stretcher” sheets and “poles” another brill piece of kit. The old “concertina” trick to get someone from under a bus.

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