Wednesday, 23 April 2008

A Dream Becomes Reality - But Not In A Good Way

How many people have dreamt about being a hero at the scene of an accident? For the majority it will remain just a dream, one in which they are cool, calm, confident and heroic. For others, this dream becomes real, but the reality of the situation is somewhat different to the heroic dream.

This afternoon we went for a drive in the countryside, the sun was shining and we were merrily winding our way around the country roads. Up ahead, over the brow of a hill I noticed an accident, it soon became clear that it was quite serious. There was a distinct lack of emergency services, I was faced with a decision, should I stop or carry on? Despite having little to offer I decided to stop, I pulled over, just beyond the accident. My heart began to race, I hadn't paid much attention to the scene as I was pulling over so I didn't really know how serious things were. The accident had obviously happened barely a minute before we passed and a couple of other people were already on the phone to the emergency services.

As I approached, I realised this wasn't just a shunt, it was a high speed, head-on collision involving two cars (car 1 with one man in, car 2 with two women). Metalwork was strewn across the carriageway and the cars were in quite a state. I approached what I initially thought was a police woman talking to an obviously distraught and injured passenger. I introduced myself as a final year medical student and asked if there was anything I could do. It wasn't until afterwards that I realised that she was just a smartly dressed passer-by.

As a final year medical student I've not exactly got a wealth of experience of medicine, let alone in pre-hospital care. I'm not afraid to admit that I was terrified, realistically, what could I do? No experience, no equipment, no nice doctor telling me exactly what to do, absolutely no idea what I was doing. Not only that, all my brain could think was "Oh SHIT!" So not exactly the cool, calm, confident hero?! I went to the driver's window of car 2, the driver was slumped, she was barely breathing. I tried to introduce myself but she was barely, if at all conscious. The only thing I could think of was ABC (Airway + c-spine, Breathing, Circulation), she was obviously trapped and severely injured, I tried to assess her pulse, I couldn't convince myself that she even had one. I tried the back door so I could get in to stabilise her head and neck but it was stuck. I was focused on trying to assess ABC it wasn't till later that I noticed (actually missbliss pointed it out) her other arm was broken so badly it was bent in 3 places. Eventually a policeman who'd arrived managed to get into the back and to stabilise her head, but by this point she looked terribly grey. I'm no expert, I'm not even a novice, but something inside me thought she was probably exsanguinating internally.

By this point the only emergency services on scene were the police, I moved on to the driver of car 1, he was the better of the 3 casualties, although he was still trapped inside his vehicle. Again I introduced myself and briefly assessed him, he was alert, although completely disorientated. I tried to reassure him as much as I could, his neck was painful, so I was doing my best to make sure he kept his head still. By now the scene had become littered with firemen, although they were concentrating on the other car so I stayed with the man in car 1 talking to him, although he couldn't remember anything at all.

Eventually the ambulance arrived, I explained who I was and one of the paramedics asked me to stay with the man I'd been talking to until the other ambulance arrived. I could hear the emergency service working frantically behind me to free the women in the other car. I kept being as reassuring as I could and after what seemed like days the other ambulance arrived, I briefly explained what I knew and what the man in car 1 had told me about his condition. Finally I took a step back to look at the carnage.

Despite the carnage, the whole scene was rather calm and quiet. It is impossible to describe but certainly the reality is completely different to anything you could ever dream or see on TV. As I stood there talking to one of the witnesses, he asked who I was and I explained. "Coming towards your exams eh? You'll soon have a different title then won't ya?" he said. The reality is that if I pass these exams he's right, I won't be a final year medical student, I'll be a doctor. My worry then is that people will expect things of me in such a scenario. It was clear to me that there are no heroes in a situation like that, it takes a real team effort by everyone involved. Without that, things wouldn't get done, and people would die. I don't know what happened to the casualties today, indeed I may never know but I really hope that everyone involved is ok, and my thoughts are with them and their families.

Finally, and not that I've ever had anything but respect for paramedics and the emergency services but after today, I've got a whole new admiration for the work they do. It is one thing being the doctor in A+E surrounded by all their equipment and a team of nurses on the receiving end of an ill patient, but a paramedic, first on the scene to something like this. They really do deserve a great deal of respect!

As for exams, they're a walk in the park compared to this. Reality is so much more terrifying.

It was so difficult to even begin to write about today's events, I'm not even sure I should have. I know I had little to offer and I don't think anything would have been different if I hadn't stopped, but I'm glad I did, and if I'm ever in that situation again, I hope I'll be a little more confident that I can do something, even if it amounts to little more than nothing.


Lady In White said...

Dont we all hope the exact same thing and faced with a situation like this, well.. i just hope someday someone will realise the need for medical students to know basic trauma management. That isnt even asking for much

AragornGB said...

All that hope to say "I am a medical student" and be the hero of the scene is what makes us more frustated after it, as we notice that nothing went as planned.
You did your best and that's was a good help so wel done.

I agree with lady in white, more training on that is needed.

Kelly said...

Although I agree with what lady in white says to an extent, more knowledge of basic trauma management wouldn't have been much good if you weren't able to access the casualties.

I think that you offered plenty to the people in that crash. Okay, so you couldn't do exciting, heroic, life saving stuff but you were able to offer some calm to the people at the scene and if you had been able to access the ladies in the second car you might have been able to do more. Who knows? The main thing is you did no harm and I expect you did some good. Small things matter at times like that.

PS - congrats to you and Miss Bliss on the anniversary :-)

Jayne said...

It sounds like you did really well, given the terrifying situation you found yourself in.

I'm also a final year medical student, but I was lucky enough to do a three day pre-hospital care course with BASICS earlier this year. Although most of what we learned needed equipment out of a Sandpiper Bag it also gave me confidence in what I could do without any equipment. Speaking to the tutors (paramedics, rural GPs, anaesthetists, A+E doctors) about their experience of pre-hospital care was invaluable.

The overriding themes were personal and scene safety, getting help, triage, ABC with C-spine control and continual reassessment. Yes we learned lots of other fancy stuff, but the basics that don't need equipment were the most important.

I did the training because I want to know what to do if I come across an accident. I can only hope it's knowledge I won't need to use.

Disillusioned said...

I'm sure that you being there was in itself a comfort to many. even if you felt you had little to offer, you stayed with people who were in trouble and provided a reassuring and supportive (and constant) voice. well done. Not a good situation to find yourself in.

missbliss said...

Thank you to those who have said the things I tried to reassure TLM with. i.e. stopping people doing well-meaning but dangerous things (dragging people out of cars, giving them their own drugs) IS helpful, and that giving other witnesses and helpers a reassurance and focal point helps them to function at the time and afterwards when they're unpacking it in their heads. They won't feel like they knew nothing, but that they did what they could.

Still looking out for news, still hoping for the best.

PhD scientist said...

Sounds like you did right. Mrs PhD tells me many accident victims die because they crash when no-one is around, lose consciousness, can't protect their airway and suffocate. So check, talk, wait, don't do anything daft and sit tight for the Emergency folk has to be the call. One of those "knowing what not to do, plus what you personally can and can't do" set-ups.

Suppose it might be an idea to tell the med school, since you are so close to exams. Must be a bit of a shaker-upper, though from the post you seem to be "processing".

Sage said...

A job well done, you did what you could and in a professional manner.. I think you will make a great doctor.

The Manchester Medic said...

Sounds like every medical student's worst nightmare. Also sounds like you did admirably well and I hope that if I ever end up in a similar situation I could be as calm and composed as it appears that you were.

Well done.

Baby Blue Pyjamas said...

Well done.

the little medic said...

Thanks for all the reassuring comments.

PHD scientist - Thanks for the advice, I spoke to some of the staff at my hospital and they also advised me to let the medical school know just in case, so I have done so.

steph said...

A steep learning curve, eh?

Well, I'm impressed anyhow!

Not just at how you reacted on the scene but how you've incorporated the experience into the bigger picture of life. It may feel like you did very little but always remember, every little helps!

I'm sure in time, it'll prove to have been an invaluable experience.

Now back to your studies and GOOD LUCK!

Mandarin Blog Central said...

Hi there. I hope you are feeling a little better and suggest you consider talking the situation over with someone (informally or professionally) if it starts to distress you excessively.

You did really well. DR, Airway, Breathing, Circulation (the last two are hard to do much about before extrication) are the key. Knowing much more probably won't help in most cases. I'm a cardiac/trauma anaesthetist with the relevant training and doing some jaw thrust is probably about as much as I could manage before the patients are at least taken out...

Stopping people doing obviously stupid stuff is also good (that's all I managed at trauma scenes as a med student).

Anonymous said...

Thanks for this post. I was early on the scene of a cyclist who had fallen under the wheels of a petrol tanker. All in all it sounds like a broadly similar experience.

As I approached the accident I heard someone ask 'is anyone medically trained'? I answered that I was a second year medical student and was horrified to audibly hear everyone breathe a sigh of relief! There was a defininate over-estimation of what I would achieve on the back of 12 months of pathology lectures...

ABC was not necessary as the patient was conscious but I held stabilised his head until a former paramedic happened to appear on the scene. I was more than happy to hand over at this point!

I don't suppose more 'first aid' training would help all that much but it might help med students be a little more confident that they are doing the right things...