We start running, pacing ourselves to ensure we’ll have breath once we get there and also taking our time as we pick our way across the soft ground. Every step you run here the sand shifts sideways underneath you, as we crest a small dune I hear Lisa behind me “Careful…”
The other side drops down sharply and I lift both feet as I step, landing in the sand at the bottom before scrambling up the other side and making it to the crash.
Two patients, both males in their forties. One on the deck and the driver still strapped in behind the wheel. I turn to the former and Lisa makes her way to the car.
My man’s curled semifoetal on the floor, alert and oriented and extremely distressed, he tells us they misjudged a dune, climbed too fast and took off, landing heavily on the buggy’s nose before sinking back onto the wheels. No roll, no fire. He tells me he climbed out of the car after the crash but “My driver cannot walk.”
I reassure him we know about his driver, that my mate’s taking care of him, is he hurt anywhere?
“My back, oh god, my back.”
There’s another man on scene (how you find a bystander in the desert, I don’t know, but he’s managed it) and he fusses around the patient with the peculiar intimacy of the region.
Ideally I want this guy stripped, body checked, log rolled onto his back, collared and boarded, with two IVs running fast and a rapid extraction to hospital.
This is not a job for one person. Furthermore, I don’t even know what Lisa’s dealing with. I run a fast Airway-CSpine-Breathing-Circulation on my man. He’s alert enough to protect his airway, his C-Spine is clear of immediate pain and his breathing is normally heightened, with good air entry and normal breath sounds across both lungs. His heart rate runs over a hundred, but his radial pulse tells me his blood pressure is holding up just fine.
Hacking his clothes off his neck, torso, waist and thighs, I slide my hands inside his shredded jacket and check him as comprehensively as I can for injury. I find his skin cool and sweaty, with goosebumps rising in places. I hope this is adrenaline rather than a bleed I’ve missed somewhere. His abdomen is slightly taut and tender and he screams when I run my hands across his lumbar spine.
Pelvis is patent and causes no pain, femurs both intact, good range of movement in both.
I can’t roll and collar him on my own, but I’m satisfied in the first instance that he’s not going to die on me in the next few minutes.
Lisa shouts at me from the car. I press my hands on my patient’s shoulders – “Lie as still as you can, ok? Try not to move, I’ll be back shortly.”
He screws his eyes shut as a breeze blows dust into his face. I pull my goggles off my neck and pass them to the bystander.
“Put these on his face. Gently.”
“He says his back hurts.”
“I know, I’ll be there in a minute.”
Lisa is leaning into the vehicle’s cab, the driver’s door flapping and bumping against her back as she works. I shove it back against its hinges with my arse, pleased with the creaking snap that tells me I’ve bent metal too far for it to come back and hit us in the head while we work. Who says urban prehospital care has no transferrable skills in an inhospitable environment?
“What’ve you got, mate?”
“Forty two year old male, previously paraplegic, GCS 15, airway clear, breathing laboured and tachypnoeic, complaining of sternal and mid-thoracic pain, haemodynamically stable. You?”
“Forty year old male, GCS 15, airway clear, breathing clear, slight tachycardia at the radius, lumbar back pain, possible intra abdominal bleed, not profoundly shocked.”
We both stop for a second, spooling each other’s patients through our heads like adding machines before coming up with the answer.
“I need the O2 for this guy while we extricate.”
“Done. Your guy hangs at B, mine at C. You win, we take yours first and get a second aircraft for mine?”
Neither of them have injuries that are likely to kill them in the short term, but we’re aware that without proper imaging and investigation we may be missing something prehospital that could later prove complicated, if not fatal.
The conclusions have been arrived at.
We get busy.
In the meantime Wayne has been making his way from the landing site, updating Rally Control that we’re “wheels down” on site. He joins us and we bring him up to speed – he reports that a sweep team is nearby and making their way to us, plus the “press” aircraft with Booker and Gus aboard. We’ll have the back-up we need shortly, in the meantime there’s plenty to be getting on with.
I return to my patient, he’s as I left him, still writhing with the pain in his back. I take my shears down his sleeves and the rest of his trouser legs and find he howls and flinches when I run my hands down his shin where a small laceration sits. There’s a chance that’s broken, he’s certainly reacting as though he has something more sinister going on underneath the skin than the scrape I can see.
Lisa yells for an IV start set and I’m grabbing the necessary equipment out of the bag to pass her when I’m deafened by a roar, a screaming wind and a blinding cloud of sand is hurled into my face.
Overhead at barely fifty feet our helicopter is buzzing us, the downdraft crushing us to a squat like cowering mice in a hawk’s shadow. Patch has to remind me every time i come out here to moderate my language, but in the stress of the moment I forget my Middle Eastern etiquette. I grab Wayne’s shoulder, pulling his ear to my mouth and partly to overcome the volume of the blade though mostly because I’m furious, yell at him.
“What the fuck does he think he’s doing with his fucking blades up?!”
Wayne yells something in response, but I don’t catch it, too busy shaking my head, bitching and pissing about the interruption and inconvenience, glaring at the aircraft as it touches down a few metres from the crash.
A convoy of vehicles burns up from the distance and one of the challenge’s infamous sweep teams hop out, Ben jogging to my side.
“What do you need?”
I pass him the IV gear I’ve organised from the bag.
“Take this to Lisa and assist her with some access.”
He’s gone before the words are dry on my lips. Fast mover, that boy.
I draw up a vial of declofenac, a potent anti inflammatory painkiller and jag it into my patient’s shoulder. Back home I’d pump him full of morphine to stabliise his pain and sedate his distress. Without a licence to operate with opiates out here, this is the best I’ll get. It’s slow acting and not ideal for skeletal trauma, but it’s better than nothing.
The rest of the sweep team automatically gather around the crashed car and defer to Lisa on the driver’s intended extrication. Ideally I’d have fire and rescue cut the roof off the vehicle before sliding the driver vertically up a board with hands at his hips, feet and shoulders.
We have no cutting gear so we’ll have to do the best we can with what we’ve got,
even if that means pulling him out in as close to “straight” as we can manage.
Thankfully Lisa was a doctor on an extrication team for the F1 last year – she has been trained by the best of the best in removing people from crashed cars in the fastest, safest way. Some of you will remember that our extrication teams from last year were officially the fastest in the whole of the F1 circuit worldwide – the girl knows her business.
Between Wayne, Lisa and the sweep team the driver is huckled and swung out of the vehicle, bear in mind this involves lifting him out of a bucket seat and across a T-bone bar, a thick bar that runs diagonally across the driver’s door to stop side-impacts from intruding into the cockpit. Oh, and the patient can’t help in anyway, on account of his legs not working.
See? We drink beer and swim in the pool and laze in the sunshine and you all take the piss about my jolly holiday, but by Christ, when it goes wrong out here…
By this time Ben is back by my side with my patient and offering to start an IV and run fluids. We collar the patient as best we can before I give him the nod and turn to answer Wayne who is shouting for a medical sitrep to report back to Rally Control. I yell a handover over the thud of the idling helicopter in the background and together we hit a snag.
Any emergency medic can break down an ASHICE report for you (Age, Sex, History, Injury/Illness/Interventions, Condition, ETA) and will recognise the format as it’s delivered. Similarly, when passing a handover I would expect the person taking the dictation to abbreviate where appropriate: Patient becomes PT, History HX, Query ?, Fracture #.
The difficulty lies in the fact that I don’t speak SAR…and Wayne doesn’t speak Medic. We have a wee Carry On Up The Rotor Blades moment where I have to bellow “Golf! Charlie! Sierra! Wun-Fi-fe!”
Our communications are not helped by the distant judder of a second helicopter, Booker and Gus coming in low and fast over the sand, touching down on our original HLS with no marker, marshall or wind indicator. I suddenly understand why Wayne moved our aircraft – there are two HLSs at this locus, one immediately and obviously visible from the air and a second, less obvious one nearer the incident. The first aircraft moved closer to allow our back-up to fly in behind us. I’m ashamed of my outburst.
As the second crew approaches I chuck Ben my notepad and dictate a breakdown for him, Booker will be flying my patient out in the second aircraft as I’ll be flying with Lisa to transport the more seriously injured man. I blurt a quick report to Ben and he writes notes to allow him to bring Booker up to speed.
By this time Lisa’s patient is loaded onto a spinal board, strapped into place and has been hoisted onto the back of a pick-up truck for a slow and tentative drive to the heli. I load our response bag, now decimated and an utter guddle, onto the truck and jog alongside as we head to the HLS. Booker passes me on the way and shouts in my ear – “Don’t take off with my chest rig, either dump it at the HLS or give it to sweep.”
Many hands lift the stretcher into the helo’s side door and I raise a hand to attract the pilots attention before pointing to myself and hooking my hand around to the left – I want to loop around the front of the aircraft and can only do so with his knowledge and blessing.
He nods, thumbs up and I join Gus at the far side door, stuffing bags and shredded armour into the luggage compartments and grabbing Booker’s rig from the floor. I chuck it through the open window of the pick-up, already preparing to return to the scene to assist with the other patient.
“Booker.” I yell and the driver nods his understanding leaving me free to clamber up into the side door of the heli.
There is very little room in the back of the helicopter once a patient’s on the floor. I squeeze in at his head, the sole of my right foot tucked against the inside of my left thigh, my left leg extending down past the patient’s shoulder. He doesn’t speak much English and my Arabic is even worse. I squeeze my ring finger, rock an imaginary baby in my arms.
“You got a wife? Children?”
He nods at me, gives a weak smile. With the hammer of the blades above our head, the whistling of the air through the opened windows and the howling engine there’s little conversation to be had. We run more fluids through his IV; I chop a slice of fabric from his tattered shirt and soak it, using the wet rag to wipe sand and dirt from his eyes, lips and nose. Lisa punctures two small holes in a sealed cup of water and we dribble it into his mouth. He swills it around, swallows hungrily and grimaces, twisting his hips against the board, pulling his right foot up towards himself as far as he can, muttering one word.
Lisa reaches for his leg and tries to examine it, but he struggles, beckoning with his hand. She catches his knee and lifts it into an angle, bending the leg. The patient’s face relaxes as the pressure is removed from what latterly transpires to be a fractured lower leg. Occupying one medic with just holding a fractured limb in place isn’t the most efficient use of manpower, so we unbuckle the seatbelts from the bences and loop them around his knee, securing it in place. The patient shouts something and I lean my ear closer to his face while he repeats his question.
“What problem me?”
“Back problem. Leg problem.”
“I am a big problem?”
“No, no big problem.”
At home I tell patients “You don’t panic until you see me panic…” but this seems an awful complex sentence to expect him to translate, so I settle for grinning and pointing to my smile.
“I’m happy, you’re happy, ok?”
“OK….I am ok. I am a big problem for you. Sorry.”
I squeeze his shoulder.
“No problem. This is our job.”
We touch down at the hospital, Gus jumps from the front seat and marshalls a group of porters with a gurney over to the side of the helicopter. With the door open and the trolley alongside, many hands grab the spinal board and start to slide the patient out. I’m trying to hold his leg in place while Lisa and Gus assist the porters to unload but I can’t walk on my knees fast enough to keep my hands on him. In their haste to impress and unload the patient at speed I can foresee the leg falling sideways as we get out of the aircraft, causing God knows what sort of pain.
I call out politely and am ignored. I resort to shouting. It works better.
“Wait! WAIT! Someone needs to hold this leg up.”
A porter grabs the patient’s knee and holds it in place, we roll into resus while Gus clears the HLS of pedestrians and directs the aircraft to lift off again. We’ll need the landing site for the second heli once it arrives.
I’d rather hoped we’d end up in a resus room, but instead we’re funnelled into a cubicle with curtains and two nurses. Other teams have reported at evening prayers that this hospital are less than ideal in their management of spinal injuries. I remember Patch’s advice at debrief, grab hold of the patient’s head and don’t let go. The nurses set about undressing the patient and an orderly starts to undo the head straps.
“Don’t touch that, please.”
Lisa is speaking to the nurses – “I need to speak to a doctor.” and within a few moments a gentleman in a white coat arrives. He immediately catches my eye and greets me – “Good afternoon doctor.”
I shake my head, gesture towards Lisa.
“This is Doctor Mackenzie, I’m her assisting paramedic.”
He listens to Lisa’s handover and waves a dismissive hand at her request for analgesia.
“We will log roll him. Nurse!”
Three nurses grab the patient and Lisa moves to coordinate the team, hands under and over. She nods at me.
“On your count, mate.”
We remove his collar and roll to the left, holding the patients spine in alignment while the doctor feels down his back.
“Does this hurt? Does this hurt? Does this hurt?”
The patient howls as he’s examined and the doctor, satisfied, rolls him onto his back.
“Good – no fractures.”
Lisa cuts in.
“He needs an xray and CT.”
“But he has no pain. He didn’t say yes when I asked.”
The doctor scowls.
“What do you want?”
“I want him xrayed and CTed, head, neck and back.”
Lisa moves to put the collar back on his neck.
“He doesn’t need that.”
“He’s going for CT.”
“So we leave the collar on.”
“But he has no pain.”
“He’s going for CT, what’s the point of CTing him without a collar?”
An argument is about to develop when Lisa and I decide that actions speak louder than words. We strap the collar back on his neck and together look up at the team.
They leave the collar on.
We retreat to the waiting room, Booker arrives with the second patient and we kick our heels. A security guard brings us tea and asks if we know his brother, Sam, who moved to Blackpool. We don’t.
Time passes. The pilots of both aircraft come in and out of the waiting area, keen to get moving again before the darkness of dusk falls and removes our chances of flying at all.
The hospital decides that our patient may need neurosurgery and it is agreed that, if he’s to be moved tonight, it will need to be by air to a more appropriate facility. It’s also agreed that Lisa should travel with him if this is the case to support continuity of care and allow for a more comprehensive handover.
But we’re losing light fast, if he’s flying anywhere tonight he needs to be moving soon. I join Gus in the treatment room while he speaks to the doctor who states he’ll have an update and decision in twenty minutes.
“You said that twenty minutes ago.”
“This time, twenty minutes, I promise.”
Gus checks his watch.
“We’re leaving in twenty five.”
He turns to us.
“Go and pack up the aircraft.”
We head back to the helicopters, a gang of local kids congregated around the aircraft shooting at each other with their fingers.
We secure our kit, pack it into the luggage compartments and lash it down with straps before heading back for an update. Gus meets us at reception.
And then he delivers the line that makes me grin both inside and out, a line I’ve been waiting a year for.
“Booker, get Kal into a monkey harness. You’re on the side door, sport.”
It’s effectively a climbing harness, over the arms and round the hips, a short length of rope and a carabiner clip my shoulderblades to the floor of the helicopter. I pull my goggles and Buff over my face and Gus passes me a headset from his seat in the back of the heli.
I sit forward, my bum on the floor of the heli, my feet on the skids, my elbows resting on my knees. Gus tugs the line at my back and I turn to see him. He flashes me an OK and I reciprocate before he double checks my rope and carabiner.
The blades spin up, silver dust barrels away from beneath us in delicate waves against the black tarmac and…it’s not that we lift off, but more that the ground suddenly drops away from beneath my feet. The crowd of kids stare up at us and we share a wave before the helicopter tilts its nose down and moves forwards.
I’ve always had a head for heights, I rather like them, but there’s still an adrenaline shiver from seeing solid ground dwindle to a thousand feet below with nothing but air between the two of you.
The views are incredible. When I lean out to look down the wind hammers against my face and chest, I try to spread my feet slightly to lean out further and my left leg is slammed back against my right by the head wind. I settle for leaning my elbows on my knees and taking the occasional picture. It’s the closest thing to free flight I’ve ever experienced and I peer down into the shacks and buildings that we over fly before hitting the desert.
Oh the desert.
I knew it was beautiful and endless and awesome in the truest sense of the word.
But removing the window and really flying over it….
And also, let’s be honest, back to the “cool as fuck” comment from my earlier post, I’m getting to hang out the side of a helicopter as it flies over the desert and I beam all the way home. And yes, thankyou, I did think I looked pretty fucking awesome as I gave a casual little salute to my colleagues as they waited for us on the HLS at Liwa.
At prayers we’re sitting in a circle and sharing a few beers when Patch breaks some significant news. The body of Sheikh Ahmed bin Zayed Al Nahyan, a missing UAE VIP has been found and three days of official mourning have been declared. There will be no music and no drinking, everyone is to conduct themselves in a demure and conservative manner.
The rally is almost certain to be cancelled.
The atmosphere is quiet, low. We discuss plans to ship our gear and ourselves back to Abu Dhabi if, as we suspect, the event is finished prematurely.
The mood is broken by a young man in an orange boiler suit who is quietly stepping around the clinic litter-picking. He extends his claw and closes the end around the can of Heineken by Gus’ foot.
He stops, feeling the weight of it. Gus looks up and around. There’s a moment of eye contact between the two of them akin to a rabbit in the highbeams of a skin-headed Mack truck.
Gus lifts a finger, points at the gentleman and draws it slowly across his throat. The worker smiles, lowers the beer and lifts his hands in apology while the rest of us piss ourselves laughing. Unwittingly, he’s produced to perfect antidote to a sombre meeting. I nip into the clinic and grab him a cold can of Diet Coke for his trouble.
We eat and join the racers for their briefing at which Mohammed Ben Salayem announces the death of Sheikh Ahmed bin Zayed Al Nahyan. He then informs us that his opinion is that this is a tragedy that has occured outside the UAE and that the event must go on, though in a more restrained air than usual.
Safe in the knowledge that we’re not going home just yet, we head for the pool with a few drinks before bed.