Wednesday, January 18, 2006

Car Park

I was sitting in the car filling out the necessary forms at the start of my shift before going to make a cup of coffee when the mobile phone rang.

“Are you the night turn?” asked the dispatcher.
“Yeah, have you got a job for me?”
“Yeah it’s a Sector request for an Amber call so I can’t send it to your MDT.”

This is quite common.  If the sector are holding a call that isn’t a category A call but sounds dodgy or they think has possibly been miscategorised, they’ll ask the FRU desk to send a car.  The only problem is that the FRU desk can only send category A calls to the MDT, so all other categories of call have to be given “the old fashioned way” – pen and paper.  I got a piece of paper ready to take the details.

“It’s to a car park,” they gave the location, including a map reference so I could look it up quickly.  “It’s to a male who’s fallen 30 feet from the second floor of the car park.  Sector are sending an ambulance but have asked us to send you as well to give them a hand.  Can you report for HEMS please?”  This one had been miscategorised.  A fall from 30 feet meant there was a high probability he was dead.

I arrived to find the crew already on scene.  The car park attendant wouldn’t lift the barrier for me to drive in so I took a ticket.  The other option would have been to drive straight through the barrier but I didn’t think that would go down too well.

The patient was laying on his back on the ground floor of inside of the car park.  I got a rundown from the crew as to what had happened.  The chap and his girlfriend had been out doing some shopping, on returning to the car had been messing around and fallen over the parapet.  His girlfriend had caught his arm and tried to pull him back up but he was too heavy for her and she had to let him go, and he’d fallen through some steel bars on the way down.  

Amazingly he was alert and complaining of pain in his back, chest, stomach and legs.  Another ambulance crew arrived so I left them to deal with the patient while I rang the HEMS desk and told them what had happened and what was wrong with the patient.
Because it was dark, they were responding in the car, and I was told they were about 10 minutes away.

Then I got the patient’s details – name, address, date of birth, medical history, allergies etc – from his girlfriend,  and I made two more copies to give to the crews for their paperwork.  I still didn’t know how he’d got from the floor outside over the ground floor parapet and back into the car park.  I asked the girlfriend, and one of the car park staff said “Oh, we lifted him over.  We thought it would make it easier for you guys.”

I gave him a polite lecture on the importance of not moving people who have fallen a long way, then asked him to arrange for me to be allowed out of the car park when I was ready to leave because I wasn’t going to pay the ticket.

The crews had got the patient in a neck collar and on a board ready to put onto the ambulance.  HEMS still hadn’t arrived, so they wheeled him out of the car park to the ambulance outside (it was too tall to get into the car park), and the HEMS team arrived as they were loading him on.  I took the patient’s girlfriend to the hospital in the car as there was no room for her in the ambulance with the doctor and the crew in there as well.

The guy was very lucky – he managed to get away with a broken rib and a ruptured spleen.  He could so easily have been dead.  Someone was watching over him that day.


Blogger minifig said...

Someone wasn't watching over him well enough to stop him falling over the side of the building in the first place, however...

1:15 pm  
Anonymous Mark Myers said...

This is another delightful quirk of AMPDS. AMPDS comes with the American categories 0,A,B,C,D,E but the LAS have adapted it so these categories map on to red, amber, green. In the US "long fall" is a D (the highest you can get without being dead) while things like "not alert" and "not breathing normally" are lower. In the UK it's the other way round -- "long fall" is amber but "not alert" is red. The system automatically picks the category which is highest *in America* which means that long falls automatically get an amber, even if they are half dead, whereas someone who trips over a pavement and bangs their head will get a cat A if they are a bit dazed.

This, obviously, is a load of pants. There is a way to override it, but we were never told to use it and call takers have only discovered it through trial and error. I guess whoever took this call didn't know about it.

(Hope this made sense, it would be a lot easier to explain with the AMPDS thingy in front of me!)

2:15 pm  
Anonymous Anonymous said...

yeah but the point being with this call is that the pat was alert and breathing so there was no need for it to be a cat a. This would have been established by the calltaker. It wasnt miscategorised. Just cos you dont agree with it doesnt make it wrong :)

6:00 pm  
Blogger Steve said...

I take your point, but anyone who has fallen that sort of height has a high probability of having some rather nasty internal injuries, and so can "crash" at any time.
Therefore, a fall from height should automatically be a cat a.

Ok - using your example. An RTC car vs cyclist, patient is alert, and breathing normally, possible broken arm. Technically then, that should be a Green call - but because it is an RTC, it becomes a cat a.

See what I mean?

6:26 pm  
Anonymous Mark Myers said...

anon - I doubt he was breathing normally though. None of our patients ever seem to be breathing normally. A patient who falls out of bed and isn't breathing normally gets a Cat A; a patient who falls off a tower block and isn't breathing normally gets an Amber. That can't be right, can it?

10:55 pm  
Anonymous Anonymous said...

no its not and i agree long falls should be cat a. Like you said before if only calltakers used there initiative and the overide facility!
On the subject of RTA's ped v veh always used to be Cat B calls but was upgraded to Cat A due to the high mechanism argument (which i agree with by the way).

9:29 am  
Blogger Steve said...

exactly, which is why a long fall should also be a Cat A.

*For the lay-people reading, here's where it gets technical*

Remember in a fall like that, there is a primary impact and a secondary impact.

The primary impact is the body hitting the floor - direct force which could cause fractures to ribs, pelvis, femurs, skull, spine etc etc.

The secondary impact is the internal organs moving and colliding with each other and the abdominal wall, which could cause injury to the liver, kidney, spleen etc.

So while the patient may be conscious and breathing, due to the mechanism of injury that patient could go unconscious and arrest at any time.

So to use your own (and completely correct) argument that RTA's are Cat A due to mechanism of injury, then the same should apply to falls from height.

And I'm glad you agree :)

4:30 pm  
Blogger Spike said...

What planet are these carpark staff from that they thought moving the poor bastard was a good idea?

1:13 am  
Blogger zhoen said...

He's lucky it was just his spleen, and not a liver laceration, which it could easily have been. One of those sneaky bits of damage.
I had to be resuscitated after choking. I was fine by the time the ambulance arrived, but they wanted me in hospital in case anything ruptured, like, my stomach. Consciousness and breathing do not necessarily mean the pt will be just fine.

12:43 pm  

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