Fatal. Car vs Shopping Trolley

Standing outside on a nice sunny day in town, there's a tap at the window.



"We have a job!" shout my crew mate through the patio window glass.



I empty the mostly full cup of tea onto the grass and head indoors to the garage to see what we have been called to.



It's a Road Traffic Collision (RTC) and the detail states that it is a fatal accident, car vs shopping trolley, Police are on scene. My crew mate and I look at each other and both the question at the same time, "how do you kill yourself colliding with a shopping trolley?"



Lights on, off we go it's only 3 miles away, the other side of town so should be quick to get to.



I am driving and we make good progress through what little traffic there is in town in the mid afternoon. As we arrive at the scene, I look through the sea of flashing blue lights from the numerous Police cars and spot the casualty lying in the street with a Policeman leaning over her, his head is rhythmically bobbing up and down, which means only one thing - active CPR!



The scene looks like typical chaos, a busy road in a residential neighbourhood, with lots of daytime onlookers, Police cars and Officers milling around. The casualty is about 80 yards away with the car between us and her. The shopping trolley in question, is actually a mobility scooter, the one's you see ridden by the elderly all the time. It has not come off well in the collision and is scattered in pieces all over the road.



My crew mate grabs the response bag and O2 from the back of the vehicle and I grab the Paramedic bag and we sprint to the scene, well I try and half run and half limbo dance under the Police scene tape which leads me to almost fall over backwards, not an auspicious start to the job.



On arrival we find a young Police Officer doing an excellent job of CPR, I ask him if he is still comfortable to continue and he says that he is, so I leave him to it as my crew mate starts ventilating the patient. There's alot of blockage to the airway, so I run back to the vehicle for the portable suction unit and start suctioning the patients airway to allow my crew mate to gain access for intubation.



Whilst he is doing this I can hear Helimed circling overhead, looking for a suitable landing site, a Police Officer comes over to enquire where the helicopter will land. "As close as possible" is my reply to which he goes a slight shade paler and I see his mind contemplating the logistics of trying to organise a landing site in the middle of the housing estate.



I don't have time to explain the procedure to him and he'll soon realise that the pilot will land the thing in an area that seems impossibly small, which he duly does.



I open the cannulation equipment bag and start to apply the tourniquet to the patients arm to enable IV access for the round of drugs we will be giving her, at this point the Flight Paramedic arrives and starts the IV access.



We apply the pads from the AED machine and start to get a basic rhythm from the patient, Pulse less Electrical Activity, keep the CPR going. I start preparing the round of cardiac arrest drugs that we will need to administer to the patient, we are creating quite a mess with all the equipment that is scattered around but that can be cleared later.



The Police Officer is now looking tired so I relieve him and start continuous CPR myself, the Flight Paramedic puts in two chest tubes to decompress any chest injury and the trauma team arrive from the hospital. I notice that as I push down on the chest, the chest tubes are slowly being pushed out of the chest wall, I have to put in a one handed compression occasionally to push them back in. Shouldn't these be taped down??

By this point, there are 5 people working on this patient and I am starting to think that we will have to think about moving her soon. One of the trauma team starts a top to toe summary of the care so far;
Intubation tube in
Ventilation's effective
Needle chest decompression in
Active CPR ongoing
Wide bore lines in each arm
Fluid bags hung up
Cardiac drugs administered in 3min intervals

then he starts to work his way down

Abdomen distended
Unknown pelvic injury
Obvious blood loss from the lower extremities
Obvious deformity from the lower extremities

He pulls up her trouser leg and the left leg is mostly amputated and just hanging on via fatty tissue, I look but am thankful to have my mind on other matters as I count the rounds of CPR we are giving.

Just as the verbal summary of care finishes, he looks at the flight doctor and asks the question!

Do we feel that we have done everything possible? Are we ready to declare?

The Doctor confirms the comments.

He looks at the flight paramedic, same question. "Yes"

As he moves around the circle of people who are all now still, each answers positively in turn, he can't be about to ask me! I'm a trainee, what do I know? Besides, by now, I am the only one doing anything as I continue to pump her chest to try and maintain some semblance of circulation................

"Are you happy we have done everything we could, is there anything else you want to do?"

I answer as everyone else has done, without thinking, I wonder what else he had expected me to say? With all these highly trained trauma personnel here, what marvel of modern medicine would he expect me to come up with that they had not thought about?

It's an odd feeling, but as I tentatively stop the CPR and sit back, I feel that, as the last one asked, I have decided we give up trying to save this woman's life, it was my choice. I know logically that this is not the case but as I sit there in the road, listening to the Doctor declare time of death, I find myself only now thinking about his question. Was there more I could have done?

My crew mate hands me a waste bag and it's time to start packing up the mountains of kit and rubbish and sorting out who's is who's. We book clear and advise control that we need to restock the vehicle and I need a cup of tea!!