Nov 13 2012
JohnDog sits in the attendant’s seat by me, we laughed at the start of the shift about how he read TQ months before joining the Service and now, a year and a half later, he’s riding in my motor. The new electronic despatch system in the cab starts howling, a siren sound effect plays every time a job is sent to us, whether it’s an emergency or not. It’s not the noise that most crews would have chosen, it sounds a lot like a kid’s toy. In fact, it’s exactly the sort of noise you might choose to alert an emergency crew to an incident if you had never been in an emergency vehicle in your life.But I digress.
The cause for the wailing siren tonight is explained by the despatcher over the radio “Kal’s Vehicle, this is a police call for a male assaulted in Barrow St, it sounds like it might be a stabbing, so exercise extreme caution on approach.”
Not needing to be told twice, we start on up the hill towards Barrow Street, I’m not convinced I want to attend a stabbing there, it’s surrounded by pubs and clubs, the streets will be busy, its likely to turn into a circus.
Horsing up the road I spot a woman standing on the pavement waving both her hands above her head, behind her sits a man being supported by two others. He looks very drunk and the job we’re on our way to sounds very serious, but we have a duty of care to all. I notify Control, if we’re needed here then someone else is going to have to start making to Barrow St.
“Control, we’ve been flagged down here, do you want me to continue to Barrow St or attend this incident?”
“What’s the problem?”
“Not clear at the moment, I’ll check it out and get back to you?””Perfect, Control out.”
JohnDog hops out of the vehicle and jogs over to our patient and I follow with the bag and O2. The punter’s a man in his early forties, chalk white, sweat running down his face. He looks awfy nae weil. Everyone’s talking at once, there’s nothing wrong with the guy that’s immediately visible, I haven’t a clue what’s going on. Gradually as I listen to four or five excited versions of a story it becomes clear, the patient got smacked in the back of the head with something and then felt an impact in his back. After feeling the second blow, he ‘felt something pop’ in his back and since then hasn’t been able to stand up. He’s also howling that he can’t feel his feet and that his legs feel ‘funny’.
JohnDog hauls the patient’s shirt and jacket up, a tear-shaped stab wound leaves a bloody kiss on his back, roughly at the level of his navel and right in the middle.
Right in the middle.
I dash back to the vehicle and flag it up to Control, alerting them to the fact that we’re at the west end of Barrel Street with a male being stabbed, so won’t be able to go to Barrow Street and deal with the first incident. In the heat of the moment the similarity between the two locus names doesn’t strike me and instead I think to myself “Some kid’s running around the City happy-slapping people with a blade.”
Cops arrive, lots of them, and with their help we manage to get the patient onto the trolley and into the back of the vehicle. He’s fully concious, not bleeding massively, but still pale around the edges and agitated. He also starts making worrying comments about “feeling all twisted”.
I’ve only ever heard one other person say they felt “all twisted” when they were lying out straight and that person is me. It’s one of the stock phrases I use when I’m portraying a casualty with spinal trauma for students doing assessments. I use it because it makes people think “oh shit.”
Hearing him say it makes me think “oh shit.”
While I’m contemplating the fact that this guy has very possibly been chibbed in the spinal cord, JD has got on with some actual ambulance work and is busily slapping a BP cuff on the poor bloke. The defib whirrs and buzzes, pumping air in and out of the cuff as it occludes and…whatever the opposite of occludes is…the veins in his arm. It does its inflate/deflate cycle a few times and decides it doesn’t like what it sees.
“Bingbingbingbing”, it yells, which, in defib speak, translates as…
His BP is 72/32.
That’s very, very low, the kind of low that makes people be unconcious, or die.
Our man’s looking very concious and alive, I’m not convinced by the BP, so I reach across and punch the button to retake it.
Whirr, buzz, hiss.
I poke and prod the patient in the belly, feeling for solid lumps that would suggest that the knife has passed into his abdominal cavity and he’s bleeding into the potential spaces around his organs and find nothing. He’s not obviously bleeding internally, there’s a dribble of blood coming from his wound, but not enough to cause his BP to crash. I can’t think of any reason why a injury to the spinal cord so far down his body would start effecting his circulatory centres so I’m stumped. If I was a paramedic, I’d cannulate him and fill him full of fluids to pull his BP up, but I’m not, so I can’t.
“Let’s GTF, Dog?”
The police are at the back doors, one of them catches my arm as I walk to the cab.
“Is it bad?”
“So not bad then.”
“Well it’s bad, mate, but not necessarily LTP.”
“So he’s NOT LTP.”
“So he’s ok?”
I sigh, the police really have to come up with a system beyond “Will he die?” for “Is this person badly injured?”, I’m aware they need to look at cases such as this as attempted murder vs common assault, but surely I’m not the only person to come up against this “bad/good” system with some frustration?
Having battered through traffic to A&E I’m loitering in the Resus room while the medical team work on our boy. His BP comes up with a bag of fluids and the team turn to examining his neurological status, he’s log-rolled and examined (spinal trauma exams are not nice things, they finish with what doctors euphemistically call “a wee feel around your back passage” and involves a gloved finger up the arse). Our patient has shat himself monumentally, a fact he seems completely oblivious to and probably indicative of every muscle below the point of injury going all floppy, one of the doctors gloves up and performs the rectal exam.
“Squeeze down on my finger, mate?”
“Squeeze on my finger.”
The patient looks at his two hands bemusedly.
“Where’s your finger?”
We all exchange glances before the patient starts getting more aggy.
“Is your finger in my fucking arseho…..”
He catches himself, take a deep breath.
“Is your finger in my anus?”
“Oh…well, I can’t feel that, I was lying here wondering when you were going to do that bit.”
His response was similar a little later on when he was vigorously catheterised by an eager, but not overly delicate student nurse. A few hours later he was transported to the neuro-trauma unit across town for further tests. I’ve discussed the job with a few colleagues since and the best answer that we can come up with for his hypotension is the lack of muscular action below the injury would have reduced his venous return, causing his blood to pool in his legs. Smart guys, my colleagues.
So Kal’s lifestyle tip for the week?
Don’t get chibbed in the spinal cord.
(You guys might like to say hi to Dog in the comments, he was a solid wingman all weekend, I’ll have to start recruiting partners from the blog more often!)