Wednesday, 22 January 2020

A reminder of blood and tears

Having spent yesterday formatting and upgrading Fiona's desktop to Windows 7 from XP I took some files off including some with stuff I didn't deem important and had thought long gone but Fiona obviously thought was worth keeping.  I am glad she did as there's a host of pictures and documents I had binned off my own various computers years ago.  Some pictures of patient care and some letters including my HPC revalidation as a Professional Paramedic from 2005/6. Section G7.  Quite a reminder of the level of care in tricky places I used to provide never mind the A/E  work, Ambulance and theatre electives.  "the busiest mountain rescue team in Scotland" was maybe true back then but not now as Lochaber MRT hold that title. Here's some mountain stuff cut and pasted from the scanned version:
I was quite good at sticking sharps in folk in tricky places
Section G7 Report
  • Description of areas of professional practice
  • Three Patient Histories
I work for the busiest mountain rescue team in Scotland, Glencoe Mountain Rescue which is a voluntary service similar to the RNLI. We are funded by the Highland Constabulary (Police) and uniquely by the Scottish Executive (Parliament).  I am insured for medical duties including invasive skills by the Highland Constabulary (Police) and when treating a patient will have been called to do so by the Police.

The number of trauma victims and ill patients treated by me practicing for the above rescue service ranges from 26 to 50 per annum. My duties includes the  initial rescue response tailored to the injury or illness, logistical organisation for completion of the rescue task, scene safety of the patient, and rapid assessment and critical interventions at the scene. 

My duties also include liaison with other search and rescue agencies to carry out the primary role of Glencoe Mountain Rescue which is to find, treat as appropriate, and stabilise patients for onward transport via rescue techniques to hospital.  

The medical aspect of rescue provided by me would include:
Scene safety, history of the present complaint or injury, primary survey, resuscitation according to UK Resuscitation council guidelines, splinting and packaging and providing adequate analgesia.  As an example of clinical skills I will provide three examples of patients treated by me:

Patient 1. 
Narrative:  19/02/05 While en route in blizzard conditions to evacuate the body of a fallen mountaineer in a remote location, a rescuer was seen falling over 400ft on hard neve (hard snow).

Scene :  Safe as fallen mountaineer landed on less steep ground

Initial assessment:  Airway with “C” spine control, Patient Alert and Vocalising and Responding to Pain. Breathing rate 12/20 and pulse rate less than 100bpm. Rapid body survey indicated only one chief complaint which was a badly deformed and broken ankle which was exposed and examined for distal circulation which was absent. Cold was an issue as it was -6c and wind was 40/80 knots so protecting the limb from cold injury was also priority. SAMPLE history unremarkable

Treatment provided: The patient was cannulated by me with a 18g Safelon cannula in the antecubital vein. Cyclimorph 15 was drawn up and diluted in 10mls of sterile water (1.5mg per ml) and slowly injected using a visual analogue scale (VAS) to gauge effect from the patient.  When a therapeutic effect and adequate analgesia was achieved which in this case was 4 the ankle was pulled by me and circulation returned.  A rigid vacuum splint was applied.  The patient was put in a warm pre heated casualty bag

Rescue: The patient was evacuated for 3 hours via a circuitous route to avoid avalanche traps until a SAR helicopter was able to come in and uplift him to the Belford DGH.

Outcome: Transfer by road after initial assessment to regional orthopaedic unit for pins and plates and patient is now fully mobile and recovered.  Total rescue time 11 hours

Patient 2. 
Narrative:  22/06/05 while instructing students on an MEL course an instructor stepped back off a ledge and fell “bouncing” 60ft into a gully/watercourse (Lady’s Gully)

Scene :  Steep but made safe. Patient lying in water and unresponsive

Initial assessment:  Airway,“C” spine control and jaw thrust.  Breathing inadequate SAO2 at 80%  so initial resuscitation by BVM and then return of consciousness to GCS circa 11 (aVPu) and SAO2 96% with spontaneous respirations and adequate tidal volume. Breathing 12/20 and pulse 90bpm.  Obvious bleeding from scalp wounds but no other external bleeds found during rapid body survey. Conscious level alternating between AVPu and aVPu. Body check revealed tender left side thorax with good breath sounds and lumbar spine pain. SAMPLE history unremarkable. Core temp 36c by tympanic thermometer.

Treatment provided: O2 at 15l/min (SAO2 100%), Cervical Collar, The patient was cannulated by me with a 16g Safelon cannula in the antecubital vein flushed to keep open.  Patient packaged good lung down in modified recovery position (WEMS guidelines) even though no obvious lung injury -  in a formed vacuum mattress and casualty bag

Rescue: The patient was evacuated immediately after packaging by SAR helicopter which arrived 2 hours into rescue.

Outcome: I accompanied patient to local DGH for handover where he continued to improve.  No fractures or life threats found.  Admitted for observation for 2 days while obvious concussion resolved adequately for release.  Patient 6 months on still has memory problems which are slowly resolving. Post traumatic psychological injury regarding “trusting himself” not yet resolved.

Patient 3. 
Narrative:  29/12/05  a Lady of 57 years running down mountain path to a bridge in the dark goes over the side into a deep gorge 15mins walk from main A82 road. Husband phones 999 via mobile immediately and local police collect me and other team colleagues called out via radio net

Scene :  Patient found below 60 ft drop face down in water with bubbles from mouth.  Other rescuers arrive and we pull her onto large slimy water worn boulders at side.

Initial assessment:  Airway,“C” spine control and attempted jaw thrust.  Breathing absent

Treatment provided: Initial BVM unsuccessful as head jammed among large rocks with no flat ground around.  Vocal cords not visible via laryngoscope so I elected to intubate using a 37f Combitube Airway.  Successful esophageal intubation visible by chest rise and good breath sounds. Ventilations by colleague via BVM and catheter mount.  Patient had been in cold winter water for 35 mins. and no signs of circulation.  Defib attached and slow sinus rhythm with ectopics observed.  Patient  core 32c but not accurate as water in ear which affects the tympanic thermometer.  Rapid body check revealed no obvious sings of external bleeding but history suggested internal injury and bleeds.  Packaged with spinal precautions and  attached to defib in casualty bag. Rope raise to path and stretcher to awaiting road ambulance. En route to road patient goes into VF and one shock results in RSC. 10 mins later goes into VF again and 3 shocks as per UK Resuscitation guidelines for special circumstances delivered as patient trauma vs. hypothermia victim.  CPR and delivery to road ambulance with no further shocks.

Rescue: The patient was evacuated immediately as “load and go”  - as far as is possible in a technical rescue situation

Outcome: Patient blue lighted to local DGH where pronounced life extinct due to traumatic injuries.

I hope that the above actual case histories show some of the range of professional practice regarding my work for the Police as medical officer to Glencoe Mountain Rescue.

David Gunn
Wednesday, 18 January 2006

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