A Good Job

The patient is in an awkward position. I have to step over him and watch my footing on the stairs to get into his eye line.

The stairs are in two parts separated but a long thin landing. Our patient appears to have fallen someway down the first set to land with his head and body on the landing and his legs up the stairs.

He's at least 6 foot tall.

When I speak to the patient he appears confused. I run a battery of tests and questions. My brain is thinking Stroke, although not the worst I've seen.

The next trick is find out if he has any injuries, neck and back first. The patient complains of pain across his shoulders and upper back. Its unknown how long he has been in this position, a neighbour noticed he hadn't opened his curtains this morning and came to check on him. A quick head to toe reveals this as the only problem and all limbs are where they should be, with no extra joints.

Is his pain due to an injury caused by the fall? Or by having been in this position for a long tim?

One of his slippers is 4 steps up from the landing caught on a snag in the carpet. I try to assess how far the fall was. The steps are shallow, putting the fourth step approx 2 foot off the ground, add in the patients height and there is fall of 8ft.

I decide the mechanism of injury means the patient will need boarding. But with the space we have and the manoeuvres we have to do to get him out, it will require an extra set of hands.

While we wait to be joined by the cavalry we talk to the patient, obtain a set of observations and gain information from the neighbour and the daughter who has hurriedly arrived on scene. Our patient is an independent man with no previous history of serious illness or injury.

Our findings show a mild weakness on his right side but his pupils are equal and with the magic of oxygen helps break through some of his confusion.

The second crew arrives, I take over from my colleague who has been holding the patients head in one position after we had applied the cervical collar. A scoop stretcher appears with some straps, I'm informed our trolley has been prepared with the long board in place to complete the immobilisation.

It was suggested the trolley be bought into the house, I point out the driveway made of 'chuckies' that would make this very difficult. Whatever happened to tarmac or block paving?

The move goes well, the patient still complains of central pain in his upper back but is otherwise doing ok. We strap him into the scoop stretcher. I'm volunteered to do the strapping, I was last out of the training school, so in theory should remember how to do this better than the others. There are some things we just don't do that often but, when needed, its amazing the things you can pull from the back of your memory.

Getting him off the thin landing means tipping him at an angle, with his head going down, not ideal but luckily there are only a few steps before we can straighten him out again.

We transfer our patient onto the long board. I apologise for having to put the patient on it as it is not the most comfortable thing. I've found I do this for most patients I need to board, having been strapped to one before myself I know its not the nicest experience. The cavalry leave us to clear for another job, or a cup of tea at station which ever comes first.

A short drive to hospital and patient is handed over. The family and neighbour have followed up. As we leave the hospital they are coming through the doors. A quick exchange that never fails to make me feel like I'm doing something right.

"Thank you"
"Anytime"

We check the ambulance to see that all our kit has been replaced and we are ready for the next job. I look at the times on our incident screen, we were on scene for over an hour.

Sometimes you have to go slow to do a good job.