The funny thing about our job is you can be having a really ordinary day when suddenly it all changes in an instant. One rainy afternoon recently I was given a call to a ‘Road Traffic collision, car versus tree’ – no more detail than that. As I started to drive the mile or so there on blue lights and sirens, I started to consider the variety of possibilities in my head.
On one level it could be something as simple as a low speed, low impact collision caused by careless driving. In this case the car will probably have minor damage and the occupant(s) will have mild injuries (often these ‘injuries’ only present once someone reminds them of the chance of a claim!) When we arrive to these types of calls, the occupants are normally up and walking around, exchanging details or talking on their mobile phones.
The next level is where high speeds have been involved. If the occupants were wearing seatbelts even these collisions can result in surprisingly minor injuries. However, when seatbelts aren’t worn the injuries can be horrendous and sometimes even life threatening, particularly for children. With these collisions, we work closely with the police and occasionally the fire brigade as they may need to cut the roof off of the car to safely get the patients out without causing them further damage.
But before I had a chance to consider the next level, I was already on scene and the first thing I noticed as I pulled up was the car – with its bonnet up against a tree, it was smoking and empty.
Then I noticed a small crowd standing around a man lying on the floor. His face was up against a wall so I moved him a little and found he wasn’t breathing and had no pulse. He looked around sixty years old and was well wrapped up because the weather had been very cold. The bystanders told me they had dragged the man from the car because it was smoking and they were worried it was about to catch fire.
As you know I work on my own, and I arrived before anyone else, so thank heavens for bystanders! I asked one bystander to start to help me by starting cardiac compressions. I began to cut the man’s coat and many layers of clothes off; this was so I would be to apply the pads to his chest that we use to monitor the heart rhythm and defibrillate when necessary. He was in cardiac arrest and the machine gave him two shocks in total which started his heart beating again.
Very quickly the fire brigade, police and another ambulance turned up and it was all hands to the deck. He was still unconscious but becoming agitated and difficult to manage; this was because of the lack of oxygen that he suffered to the brain while he was in cardiac arrest and not receiving CPR.
We managed to put a neck collar on him and secure him to a board so we could move him easily in to the back of the ambulance. In there we continued to give him oxygen, did some tests and got two cannulas into veins in his arms in case he needed any further medication.
Based on the information given during the 999 call, HEMS were dispatched and arrived promptly on scene having flown from the Royal London Hospital. The HEMS team helped us continue to care for the patient and once he was stabilized they accompanied him in the ambulance to a trauma centre for definitive treatment.
I have heard subsequently that this man appears to have suffered a heart attack while driving – a heart attack that was severe enough to cause him to go in to cardiac arrest. He needed CPR and defibrillation quickly if he was to survive at all, but especially if he was to survive without severe brain damage through lack of oxygen. He is now conscious and remains in hospital while he recovers from his ordeal.
Do you know how to recognise cardiac arrest and would you know what do to in this situation?