It doesn’t look like much, a single police van parked neatly in the roadway, its roof beacons laconically spinning in the dark and rain. The streets are quiet, black and wet, but we’ve still managed to acquire a small crowd of rent-a-starers. How they get here before us every time, I’ll never know – perhaps we should hire them as consultants to solve our response problems.
The technician is out of the vehicle first, she’s attending after all, and I follow half a dozen steps behind, lifting the bag and oxygen from the side door.
Her voice tells me it’s bad and I flash my torch over the body in the gutter. I see blood, skin. Limbs that were born perfectly formed are now twisted and smashed beyond any Vetruvian blueprint. I swing my torch over the crowd. One young woman is supported on her forearms by another, screaming.
I tune her out.
Standing at the end of the line is a young Asian man, staring intently but apparently undistressed. I point at him, then at the floor beside me.
“You! Come here,” then remembering my manners, “please.”
He steps forward and I give him the torch.
“You shine this wherever my hands are, right?”
It’s an LED and its light is the white and blue as frost and sea glass. The lenses that surround the bulbs produce three concentric circles of light, two bright and one dull. These halos slide up and down the body, echoing the round mouths of the crowd, echoing that one woman who Won’t. Stop. Screaming.
The driver of the police van is already kneeling by the patient, barking into his radio, I catch the end of his conversation.
“…definitely appears LTP at this point.”
There comes a point where medical training becomes redundant and you just know that people shouldn’t be bleeding this much.
“D’you want me to call Medic One?”
“No point. We’ll be in hospital before they have their boots on.”
“You’re the boss. If you need anything, just tell me, whatever you say.”
“Go to the cab of my motor and get yourself a pair of gloves. I’m going to need you.”
I send my colleague off for spinal board, collar, straps, blanket and trolley and survey the damage. The cop hurries back with gloves, though they look a size too small. He fumbles with cramming his fingers into them, making embarrassed little jokes as we wait.
I’ll give him as long as it takes, I need him. I run a todo list in my head, the patient’s airway definitely needs attention, his snoring and grunting breaths tell me that.
Similarly I want to sound his chest for collapsing lungs, or to discover if he’s drowning in blood. Finally I want to prod his belly, his pelvis and the long bones in his legs. Anyone of them could quietly secrete enough blood to send him off into an EMD cardiac arrest. If that’s on the cards, I’d like to know sooner rather than later, thanks.
I’m pretty sure he’s dying anyway.
I take the cops hands and mould his fingers into two guns, thumbs up, index and middle out and clamp these hands around the patient’s head, pushing them into the corners of his mandible.
“You feel those sharp points? Lift them up.”
He does so, the patient stops snoring.
“He shouldn’t make that noise, ok? If he starts again, tell me. In fact, if he looks or sounds different in anyway, shout at me.”
I’m the senior clinician on scene, I should be on the airway.
And I am.
I’ve just got an assistant, that’s all.
I have too many other things to be worrying about right now. With his airway secured, I shred the patient’s clothes. Blades down his chest and along the seams of his sleeves. The car ripped his trousers off on impact, and I briefly consider dropping something over him to preserve his decency. Then think about it again. Car accidents are neither decent nor dignified.
I settle for pulling his slashed jumper down a little while strapping an oxygen mask to his face.
Airway protected. Breathing failing. Pulse present, but crashing blood pressure. His blood leaking out of him, probably into that pelvis, definitely into his lungs.
Back up at the head I wriggle my fingers down underneath, feeling torn flesh, sticky hair. His shattered face reminds me of nothing more than overcooked cherry pie, the crust brittle and cracking, dark red fluid seeping to the surface.
My fingers are muted by the gloves and cold, I cant tell what I’m touching.
Is that flesh or fabric? His clothes and collar are soaked with rain and both give, soft and pliable, under my probing fingers. I’m trying to feel if it’s knitwear or brain matter when my hands, befuddled in the cold, tell me that there’s fast moving fluid running through them. Lots of it.
My torch bearer crouches down at my call and shines the light under the patient’s ear where I anticipate a torrent of blood.
Just water. We’re on a hill, in the gutter, in the pissing rain. A vigorous stream runs under us both. My knees and lower legs are soaked and freezing from kneeling in it.
I never noticed.
An RRU pulls up and it’s driver, Ferrero, joins me at a run.
“How’s his breathing, Kal?”
“Shite. Can you take the head?”
The extrication equipment arrives and we throw a collar around his neck, shoving him onto the board as fast as we can. There’s a time and place for text book C-spine immobilisation and this is not it. I’d take a wheelchair over death any day.
Sadly, this chap isn’t in a state to let me know his preference. I elect to operate under the assumption that most people would choose “not death” over other options.
Many hands lift the board onto the trolley and we’re in the back of the motor in seconds, the technician standing at the back doors jingling the ignition keys.
“What’s the standby?”
When people are dead or dying, pre-alert messages become terribly simple. Relatively stable people need lots of information passed, but this guy’s easy.
“60 YOM, massive head trauma, peri-arrest.”
The journey to hospital takes minutes, we’re so close and moving so fast that we don’t even have time to take a blood pressure, the cuff puffing and wheezing, straining to hear his pulse over the howl and rattle of the engine.
I take a tourniquet out of my pocket to give him IV fluids, but Ferrero, with years of service on me, shakes his head.
“No point, son, we’ll be there in a second. Just watch him.”
Nothing to do en route but hold fingers against his throat and wait for his heart to stop.
He arrests on the bed in resus, I pump his chest while the team drive chest drains into his lungs, blood cascading out into the bottles at the bedside. Bags of fluid and blood run into his veins while they drain his own from where it pools inside him.
I lift the spinal board from the floor and carry it back to the vehicle. Thick, liquorice clots and bright ruby puddles drop from its surface as I walk along the corridor and I run back a moment later with a cloth to wipe it up. A nurse catches me at it.
“Sorry about the mess.”
“Don’t worry about it. How is he?”
“Doesn’t look good.”
She nods at the blood on the floor.
“That off your board?”
“The waiting room’s packed. They’re all arseholes tonight. You should take it in and show it to them. “This is why there’s a four hour wait.” “This is what we’re doing.”
I nod and leave her to it, returning to station and pressure washing the board on the floor, spraying soap and water into its crevices and watching the run-off turn an ever lighter pink until nothing remains but clean bubbles and clouds of fine jet spray in the cold air.