I feel a little sorry for Qismet.

He’s new, irritatingly young (”Radio Two?! Fuck’s sake, you’re as bad as my Dad!”) and starving for the next moment of life and death, blue light, screaming siren drama. He’s the newbie of the “Dear Newbie” post a few months ago. With the speed and volume that new staff are coming out of school at the moment, Qismet wears his four months road experience like a veteran’s medal for long service.

All day we shuttle back and forth between nursing homes and hospitals, enjoying the spring sunshine, looming like benevolent crags over our patients. Qismet’s taller and more baby faced than me (and I’m one tall, baby faced muddafugger). Old ladies gush over him, ” such a NICE young man”, young women want to take him home, he smiles shyly at them, shuffles his feet.

In the cab he cracks the filthiest jokes, pointing out legs and bums in short skirts that we pass on the pavement.

“Not my area of expertise, mate.” I remind him and laugh as he feigns exasperation at my inability to lust over the female form.

The shift is winding down for its midnight close when the phone on station rings. Moments later I hear Qismet over the building’s PA system.
“406, triple 9.”

I walk out to the vehicle yard, Qismet is behind the wheel already, engine running, looking as placid as a border collie with ADHD. He winds down his window and yells to me, “Kal! Hurry up! It sounds like a bad one!”

I give him my hundred yard stare.
“Shush! We don’t say stuff like that. What’s the job?”

“Female fallen from a moving taxi.”

I listen to his answer for scary words like “trapped” or “CPR ongoing” or “amputation” or “angry rhino” or “railway enthusiast”. The job sounds an awful lot like some drunk woman has hopped out of her cab before it’s come to a complete stop. I predict a sore ankle and a pissed off cabbie who’ll be complaining about how long we’ve taken to get there.

We head out, Qismet insisting that this is “the one”, me snuggled in my fleece, arms across my chest, watching the time. We finish our shift in twenty minutes…another late finish for us then.

In a small residential street there’s a police car, a couple of cops and a taxi - not a black cab, but a private hire vehicle with its hazards on. Lying in the headlights of the two vehicles in a crumpled heap of party clothes. One of the police officers strolls up to me - I’ve learned to use the police as a decent gauge of how bad a job is, since their level of medical training tends to make things look worse than they are. I once had a WPC tell me there was “pools of blood” on a garage forecourt and, when I went to look, there were three of them. Each about the size of a fifty pence piece.

If the cops aren’t bothered, chances are I’m not bothered. When they ARE bothered, then maybe I’ll listen.

This cop doesn’t look bothered at all.

“She’s been drinking all night, apparently she was steamin’ in the cab, gave the driver a hard time and then jumped out, she’s not making much sense.”

The patient’s lying half-prone on the tarmac, with her right arm trapped underneath her. She is not a small lady. I squeeze her shoulder.

“Hello? Hello my love, my name’s Kal, I’m a paramedic - gonnae open your eyes for me?”

She doesn’t move. I squeeze her harder.

“Open your eyes, love.”

Nothing.

Hmmm.

I stick my finger behind her earlobe and push hard against the top of her jawbone (try it yourself, it’s horrible). She doesn’t flinch.

I look left and right, I’m not keen to appear to be beating this woman up but if she IS just pissed, I’d like to know. Normally drunks can be woken up with some…vigorous stimuli. Rising up, I push my fingers as hard as I can behind her lug, jiggling them back and forth.

Her eyes twitch and she utters an “ugh”.

Her Glasgow Coma Scale is eyes 2, voice 2, motor 1. GCS 5.

7 and below is considered “comatose”.

I’ve had plenty of patients who were COMPLETELY unresponsive through alcohol, but most of them were sleeping on benches and hadn’t fallen/jumped from a moving vehicle. I button-hole the taxi driver.

“How fast were you going?”

She glances between me and the cops and wets her lips before answering.

“Not fast. I wasn’t going fast.”

“How fast?”

“Not fast, honest. You can see the road, it’s a small road, you wouldn’t go fast here.”

“Ok, but how fast?”

“Not fast. Really, not fast. Promise.”

For fuck’s sake. I breathe deeply and try not to shout.

“Look, just give me a ball park. Ten? Twenty? Thirty? Sixty?”

“I was in third gear. Only just in third gear.”

I guesstimate in my head that that’s going to be twenty to thirty miles an hour, the cops pop the driver into their car to take a statement, Qismet runs for the spinal board. With the patient’s dropped level of consciousness, I have to presume she has spinal injuries until we can prove otherwise.

One of the policemen is watching Qismet pull all the gear out of the ambulance and load up the trolley with increasingly worried eyes.

“She’s going to be ok, right?”

“Not sure at the moment, mate, need to have another look at her.”

“But she’s just pissed, isn’t she?”

“Right now? I’m not convinced that this isn’t LTP.”

The cops don’t like it when we suggest that incidents are Likely To Prove (fatal). It leads to a lot of paperwork. His eyes open wide, he looks the patient up and down, I sneak a peek at his badge number to see how new he is.

Pretty new.

He steps away and starts making worried calls into his radio. Qismet arrives with the gear and, with the assistance of the cop and a local resident who’s come out to see what all the fuss is about, we roll the patient onto the spinal board, securing her neck with a collar. She doesn’t move, flinch or groan when we do this, nor when we load her onto the trolley, or hustle her, wheels bumping and jigging over the tarmac, into the back of the vehicle.

This is my first trauma call as a paramedic. It’s feeling an awful lot like the scenarios Uzi and Benito would set us back at school.

Maybe if I pretend this is just a scenario, it’ll all be ok.

“Obs, please, Qis,” I say “BP, four-lead, SpO2 and a BM when you get a minute. I’ll sort some O2 and have a look at her, ok?”

He gets on with it without question, I start at the top, running my protocols through my head like thermal printer rolls gently spewing out onto the floor.

Response: still GCS 5, no change from outside.

Airway: clear in the position she’s currently in, but I wriggle an oro-pharyngeal airway into her mouth anyway, its lurid green flange bobs on her lips.

Breathing: yes, about 25 times a minute, which is a little fast for someone so unconscious. Alarm bells start tinkling in my head, drunk people aren’t normally tachypneic, what’s she wanting all that extra air for? I rip her shirt apart with my shears and sound her chest, top, bottom and sides. Air both sides, equal and loud. I rap on her ribs with my fingers, normal resonance, no trapped air or dulling blood. Good.

Circulation: she’s a bit peaky looking, pale in the face. I stick my fingers against her wrist and feel a rapid pulse, but only just. Its like a whisper against my fingertips, not the solid thump I was waiting for.

“Kal…?”

I look up at the monitor where Qismet’s been working, her heart is way, way too fast, her blood pressure horribly low and narrow. She’s bleeding somewhere, lots and lots. Enough to knock this young, fit woman into a shocked state.

There are five places you can lose enough blood to instigate hypovolaemic shock: “Four plus the floor”, chest, abdomen, pelvis and long bones. There’s no blood coming from her anywhere, so wherever she’s losing it, she’s hiding it inside her. I know her chest isn’t bleeding, so I pull the ripped teeshirt off her belly and take a look.

Her abdomen is ripped and grazed, red bruises rising up from the skin already. I palpate her tummy, she grimaces when I push on her lower abdomen, the tissue below my fingers taut and firmer than it should be. When I push on her liver she gasps, bangs her eyes open, lets out a cry.

When I push on her liver she becomes more awake than when I tried to dislocate her jaw with my fingers.

Push on your jaw again, really dig in behind your ear.

Her liver hurts more than that.

My heart sinks, but I check her pelvis and legs too, muttering hot, sweaty, hard-breathing thanks when they fail to bend under my probing hands

I feel very sick and very scared and very alone.

For years when I’ve felt like this I’ve called on the radio for a paramedic and they’ve come and fixed it all, they’ve taken the jobs where I’m lost and stuck off my hands and gone “Here, Kal. I’m the cavalry, I have all the answers and the skill to act on them. Go drive my car to the hospital, I’ll deal with this.”

It’s been my ace in the hole, my silver bullet - if stuck…call a paramedic.

And now it’s me. But the thing is, my ace in the hole appears to say “Mr Bun the Baker” on it, my silver bullet, on closer inspection, seems to be a rock wrapped in Baco-Foil.

She’s a big, puffy lady with an intra-abdominal bleed who’s dumping her pressure. She needs wide-bore IV access and aggressive fluid therapy to keep her blood pressure high enough to perfuse her brain and kidneys. When you shut those two down? You die.

I really don’t want her to die. She’s younger than me.

I strap a tourniquet around her upper arm and start poking and prodding around the crook of her elbow. I’ve never been able to hit veins in this part of the body, they’ve always evaded me, but aside from driving a needle into her neck, these will be the biggest veins available. I stick a fat spike into the skin roughly where I’d expect to find a blood vessel and come up with nothing. Even when I dig, pointing the needle out in sunbursts under her skin I still fail to see the flash of blood in the cannula that would tell me that I’ve hit gold.

Giving up, I instead push a smaller IV into her wrist, connect a bag of fluid to the port on the needle and squeeze the bag hard , shoving the warm water into her system as fast as I can.

Pish with the cock you’ve got, son.

I rattle my standby to Qis - “21 year old female, ejected from vehicle at speed, abdo trauma, hypotensive, GCS 5″

He nods, committing it to memory.

“ETA?”

I shrug.

“You’re driving, mate, whatever you’re comfy with. But listen, I’m going to be working back here. Get us there, but remember that I’m not strapped in, you can’t be throwing me around.”

He nods, biting his lower lip. He’s a good guy, is Qis, but sometimes he makes me feel old, old, old. Glancing in at the back with the nervous and excited anticipation of a fast crash-in to the ED he looks like a laddie left to tend the farm while the family’s away.

The first bag of fluid runs through as we pull away from the scene and I reassess my patient, stalling once again at “C is for circulation”. Her BP is still shit, her pulse still too fast and absent from her wrist. I wrap a grab handle from the roof around one of my forearms and line up another sack of saline, the bag swinging wildly from its hook in the ceiling. I stand and surf on the moving floor, pushing the fluids through hard, watching the BP constantly as its decline slows, stops and, painfully slowly, starts to improve.

Not out of the woods yet, but we’ve certainly found the footpath.

It strikes me that, while I’m running lines of fluid and obsessively reassessing the patient from top to toe, I’m not falling over. I’m not even holding on at times, Qismet is driving the ambulance like a limo full of Fabergé eggs and set mousetraps. I peek through the bulkhead window, expecting to see us cruising along at a gentle thirty.

Oncoming traffic slams past us at sixty, Qis setting the ambulance’s wheels just so as he corners, flattening out the bends, nipping around lumps in the road. It’s like standing on a gently bobbing boat, rather than the force 9 gale I’d feared.

Whattaguy.

The patient groans and I look back at her, her eyes are open and full of tears.

“Becky?”
“……”
“Becky? Can you hear me?”
“….es….”
“Cool. You’re in an ambulance, Becky. My name’s Kal, I’m a paramedic.”
“…red….”
“Sorry?”
“…’m…..ared….”
“You’re scared?”

She nods as far as the collar and head huggers will let her.

“Don’t be scared, hon. We’ll look after you, ok? Just trust me.”

Her eyes close and she drifts back to where-ever the critically shocked unconscious people go when we’re all fussing around them. The lights of A&E shine through the windscreen and minutes later she’s on a trolley in resus, x-rayed from top to bottom and Qismet is punching me in the shoulder.

“SEE?! It was bad! I told you it was going to be bad. You should listen to me about these things.”

We laugh, I congratulate him on his driving, thank him for his help. He blushes and legs it to the vehicle.

I grab a cup of tea and slurp it outside resus; I’m gearing up to leave when I spot the on-call surgeon, summoned from the wards upstairs to see my patient.

He prods and pokes her belly, makes concerned noises about her blood pressure and expresses a wish to scan her toot-sweet. The A&E consultant and he descend into acronyms and medical speak that far exceeds my understanding. But I’m happy enough with that, I’m not a doctor.

I’m a paramedic.