Dave Caesar, clinical director of emergency medicine, Edinburgh Royal Infirmary and St John’s Hospital, Livingston, gives an insight into road accidents
It’s Monday night, and the Emergency Department is heaving. It is often our busiest day of the week. The call booms out over our public address system: “Request for Medic One!”
The senior staff on the shift meet for a 15-second discussion about how we split our staffing to respond to the request. It is a single car road traffic crash near Longniddry, with the driver trapped.
“You’d best stay in majors. I’ll go out – can you check Mrs Smith’s blood results in half an hour... and apologise for me.”
Protective suits and boots on, grab a case of equipment and medicines out of the fridge, and we dash out to the Medic One vehicle. Soon, we are on our way through the darkness to East Lothian. Details are scanty: “Single patient we think, awake, but trapped by their legs.”
The conversation is stilted, a static of tension in the car, everyone going through their own personal checklists and roles. We discuss the treatment priorities, some potential difficulties, and who is doing what when we get there.
We see the lights first. A red and blue haze flashing in the winter night’s sky alerting everyone to the disaster at its centre. We are waved through the police barrier; there are emergency vehicles and personnel everywhere. First job – find out who’s in charge, and get some accurate information.
A minute later and we have a better idea of what has happened – a car has lost control crossing the roundabout and hit the base of the railway bridge on the far side. The police and fire officers are confident there was only one occupant, so we focus our attention on them. We move in through the distinctive smell of spilt fuel, torn metal and congealed blood.
The car is a metre shorter than it used to be. The roof is off, but the driver is still in her seat. The paramedics and fire officers have been unable to release her legs. The patient is, quite literally, not in great shape. She’s awake but has a weak fast pulse, and one of her legs has been crushed under the dashboard with more bends in it than nature intended.
We get some mobile lighting over her, and manage to get a drip in her arm. We give her painkillers and some fluid to carefully replace her blood loss, and a medicine that controls her rate of bleeding. One thing is for sure, she isn’t going to get any better staying where she is. We need to get her out before she loses her pulse altogether. She doesn’t have the time to spare, so safety is sacrificed – she’s out in 30 seconds and is transferred to an ambulance on a metal scoop stretcher.
Sirens and lights on, and during the drive back to the department we administer some more painkillers, put on a pelvic splint, and straighten her leg out. This will slow down any more bleeding from her pelvis, thigh and shin bone. We also monitor her alertness, breathing, oxygen levels, pulse and blood pressure.
I phone ahead so that when we arrive back a team is ready to continue resuscitating her whilst organising X-rays and a CT scan. She is likely to have other serious injuries that can sometimes only reveal themselves during the following hours or days; we will need to observe her closely and prioritise her treatment carefully. Thankfully, she has made it to hospital alive. Hopefully, she will leave in better condition.
The Medic One Flying Squad
The Emergency Medicine team in Edinburgh has been at the forefront of pioneering initiatives since it was set up in the 1970s by Dr Keith Little, and the pre-hospital flying squad has been in existence since 1980 after a generous fundraising campaign supported by the Edinburgh Evening News in 1979.
The Medic One team has always been relatively unique in its range of activity.
We have been called as far afield as Northumberland, Fife, and the Borders, and were on-site during the Lockerbie disaster. Not only are we activated for major trauma situations and especially for entrapped patients, but we also respond to medical emergencies, such as life-threatening asthma, and for support during major incidents.
It is always a challenging environment in which to treat patients, and the logistics of getting a patient off a flat roof in the middle of Waverley Station or down from Salisbury Crags quickly and safely can be fairly testing. There is always an element of “creative” medicine, but it is incredibly rewarding, brings our in-hospital expertise to where the patient requires it, and is a service we are committed to continuing from the Emergency Department.