While this is going on I’ve hit the Priority button on my radio, I’m going to need specialist help to get Mark out of here.
I’d love to put him on a spinal board and hoist him out of here on helpful shoulders but with the hypoxia his breathing problems will surely give him I’m not sure he’ll be cooperative enough to lie still while we lift him out.
I’m also unhappy with the idea of him squirming or seizing halfway up those bloody steps. We’ll need a high line team to get him out of here…and probably a flying squad medical team to anaesthetise him first.
My radio bleeps and I call my order in.
Medic One trauma team, please, and a rope rescue crew – either the fire brigade or our SORT crew, whoever can get here first.
I’m hauling equipment out and slapping it onto Mark’s body at a blur, O2 mask over his face, BP, ECG, SPO2.
My shears slash his sleeves to his shoulders, his overalls get split up the front so I can examine his legs and abdomen.
I pull a tourniquet around one bicep and let his veins distend while I’m working, he’s muscular and slim, an easy IV when the time comes.
Training isn’t there for rational thought, training is there to act as instincts when you’ve got too much to think about already.
Paramedic trauma training is all done by rote and in the class room can seem prosaic and overly prescriptive, but here, in the slime and the wet, I’m thrilled to find my brain making me a tick list to refer to.
Dynamic risk assessment… Underfoot is slippery, industrial area, heavy
machinery, risk of fall, risk of overhead impact.
Response…alert, oriented but distressed with pain and dyspnoea.
Airway…spontaneously protected for now.
C-Spine…high suspicion of injury, major head strike, long fall,
unconscious on impact, moved since but now sitting and head stabilised
roughly by colleagues.
Breathing…far too fast, pt complains of difficulty in breathing,
massive accessory muscle use, auscultation shows markedly reduced air
entry on right side, no open penetrating chest trauma on visual
expectation, wide spread pinpoint pain across all fields on palpation
suggests multiple rib fractures, suspect developing pneumo/haemothorax, as yet no hyper/hypo resonance on percussion. Risk of water aspiration/dry drowning response from immersion. Sternum patent. SpO2 climbing
from low 80s to low 90s with high flow o2 through non-rebreather.
Circulation…pale and sweaty, radial pulse present but weak, fast, regular, unable to gain BP in field, ECG Sinus tachy.
Disability…GCS15, though increasingly distracted by pain, no gross neuro deficit, moving limbs x 4, PEARL. Major scalp haemotoma, consider risk skull fracture, consider GCS15 may be lucid interval preceding cerebral bleed/swelling.
Expose and examine…trauma stripped limbs x 4. “Four plus the floor” clear, save ?thoracic bleeding as above. Abdo soft and non tender, pelvis and long bones patent, no other significant haemorrhage. Multiple abrasions, cuts and bruises.
I get to the end of my check list and have nothing to think but