Part 2 of 5. From the fly on the wall documentary "Medic One - Life and Death in London" featuring Londons Air Ambulance. Broadcast on the BBC on 1st June 2009.
My breathing was regular, it was bloodloss that was the issue, as they reset my legs they realised that my femoral vein on the left leg had been severed, and I was losing blood. Thankfully the fact i'd remained incredibly calm the entire time saved my life, that and the work of the HEMS team of course!
@digitalis112 I am medically trained. I'm a Paramedic in the United States. We don't need a doctor on the scene to do this stuff. I can do this in the field on standing orders. I've dealt with bi-lateral femur fractures. We have traction splints that we use to straighten the femurs and we have pain medication and procedural sedation on standing orders. We can also do RSI after calling medical control. Needle decompression, yes. Chest tubes and thoracotomies no.
It helps not to have a fear of death, something which helped me to stay calm and keep my heart rate nice and low - hence why with a severed femoral vein I didn't bleed to death a lot sooner and gave the air ambulance crew the time they needed to get me back to the Royal London
Still waiting for the last of the nerve damage to finish healing in my right leg, though I'm well on the way to a full recovery. And despite being GCS 15 on scene (Fully awake and alert), either due to the trauma of the accident or due to the fact they shot me full of Ketamine before resetting my legs I only remember flashes from the accident itself and the events afterwards. 4 years later no more has been forthcoming so I doubt I'll ever remember any more than I already do!
Strangely enough, no. I was awake on scene for most of the time, it was only when I had significant bloodloss that I lost consciousness, apparently according to my admittance record I was GCS 15 on scene and chatting with the paramedic (Me to a T!) It was basically the fact that A: I used to be a St Johns medic and B: I was completely calm - obviously with the help of Dr Zane Perkins and the others on scene that certainly helped save my life.
@unoriginalnick Also, the delivery of EMS also varies greatly from city to city. In one city you might have an All ALS system filled with cross trained Firefighter/Paramedics. In another city you might see a third service system where the EMTs and Paramedics have their own agency seperate from the FD and PD. In yet another system you might see a private ambulance service provide EMS for an area. These differences are huge. Protocols for each area can vary immensely as well.
An ambulance crew is staffed by a paramedic usually. They are ALS providers inc intubation. Paramedics can only intubate pt's with a suitable GCS, and cannot induce patients. Paramedic formulary in terms of analgesia go's as far as morphine. We don't have a franco-german model, we have the same model as in America. Pre-hospital doctors are still rare in the UK in the most part, and are there to support standard paramedic led crews rather than as a standard response.
@digitalis112 I'm not trying to knock the way things are done in the UK. I'm just trying to highlight the differences. We don't use a helicopter unless we are 30-60 minutes from the closest trauma center or if there is a lengthy extrication involved. Even so, helicopters are over-utilized in the US. Doctors don't fly on the helicopters in the US. You have Flight Paramedics and Flight Nurses.
Double compound femoral fracture in my left leg, single simple femoral fracture in my right leg - yes, fucked would be apt ;-) It wasn't black ice either, I later learned I was run off the road by another driver who was nice enough to drive off and leave me for dead.
Four4vizlas. The patient had to be stable before being moved. Analagesia only has one part to play. You make him comfortable with analgesia and put him in a helicopter before "Planning it all out" ? but forget that he has now bled to death in doing so. The doctor here has the job of assessing, critically analyzing in minutes (whilst giving correct doses of analgesia in difficult conditions)and making sure the patient is stable enough before he goes into the helicopter.
@unoriginalnick I agree that paramedics are taught only a small slice of medicine, but I disagree with your statement that in the US there are only minor differences between EMS systems. Some states choose to train their EMTs and Medics through the NREMT standard, but there are many states who have their own standards.
@unoriginalnick Also, you can't generalize studies indicating poor intubation rates compared to doctors across the entire United States. The US has so many different EMS systems that not only change state by state but city by city. I don't see the scope of practice for paramedics being curtailed on a nationwide basis because no one place does it the same way.
I am trying to understand the UK system. I know that it is a Franco-German model where physicians work in-the-field. I do not understand why this ambulance crew did not have Fentanyl (pain medication) and Versed (sedation) to move this fellow, maybe even Ketamine. If it was 15-minutes to the hospital that guy could have been there by the time they started planning this all out. Maybe someone can explain the scope of practice. I do know that UK medics do a lot more arranging for care, etc.
@unoriginalnick can a doctor in the field perform the surgery needed to stop internal bleeding? No, therefore a doctor in the field does not equal definitive care. Definitive care for a trauma patient is an operating room. Yes, a doctor in the field can do a lot and I've worked with doctors in the US who have come out to respond to calls on the streets with us EMT's and Medics, but it is not definitive care.
My breathing was regular, it was bloodloss that was the issue, as they reset my legs they realised that my femoral vein on the left leg had been severed, and I was losing blood. Thankfully the fact i'd remained incredibly calm the entire time saved my life, that and the work of the HEMS team of course!
.. I AM SO-GLAD THAT YOU SURVIVED....!!!! ... Wishing You and Your-Family the Very-Best of Good-Health Always ...😇🥰👍🙏
I came here from watching Trauma Doctors. I want more of that. The RLH HEMS are superb!
Yes, Dr Perkins came to see me a few days after I was admitted, really nice bloke actually!
dave is a friend of a friend and i can tell u all that he still rides even after this,top man
It was not the best wake-up call...
MASTER of understatement! haha
wheeez isn't she sweet?!
sweet video, love these
@digitalis112 I am medically trained. I'm a Paramedic in the United States. We don't need a doctor on the scene to do this stuff. I can do this in the field on standing orders. I've dealt with bi-lateral femur fractures. We have traction splints that we use to straighten the femurs and we have pain medication and procedural sedation on standing orders. We can also do RSI after calling medical control. Needle decompression, yes. Chest tubes and thoracotomies no.
It helps not to have a fear of death, something which helped me to stay calm and keep my heart rate nice and low - hence why with a severed femoral vein I didn't bleed to death a lot sooner and gave the air ambulance crew the time they needed to get me back to the Royal London
Still waiting for the last of the nerve damage to finish healing in my right leg, though I'm well on the way to a full recovery. And despite being GCS 15 on scene (Fully awake and alert), either due to the trauma of the accident or due to the fact they shot me full of Ketamine before resetting my legs I only remember flashes from the accident itself and the events afterwards. 4 years later no more has been forthcoming so I doubt I'll ever remember any more than I already do!
kirkland500 Bless you, my man
Strangely enough, no. I was awake on scene for most of the time, it was only when I had significant bloodloss that I lost consciousness, apparently according to my admittance record I was GCS 15 on scene and chatting with the paramedic (Me to a T!) It was basically the fact that A: I used to be a St Johns medic and B: I was completely calm - obviously with the help of Dr Zane Perkins and the others on scene that certainly helped save my life.
@unoriginalnick Also, the delivery of EMS also varies greatly from city to city. In one city you might have an All ALS system filled with cross trained Firefighter/Paramedics. In another city you might see a third service system where the EMTs and Paramedics have their own agency seperate from the FD and PD. In yet another system you might see a private ambulance service provide EMS for an area. These differences are huge. Protocols for each area can vary immensely as well.
Thanks 👍 Hens! Spinal injury 👍
I never seen such a calm scene despite a man being intubated.
:(
im crying
An ambulance crew is staffed by a paramedic usually. They are ALS providers inc intubation. Paramedics can only intubate pt's with a suitable GCS, and cannot induce patients. Paramedic formulary in terms of analgesia go's as far as morphine. We don't have a franco-german model, we have the same model as in America. Pre-hospital doctors are still rare in the UK in the most part, and are there to support standard paramedic led crews rather than as a standard response.
@digitalis112 I'm not trying to knock the way things are done in the UK. I'm just trying to highlight the differences. We don't use a helicopter unless we are 30-60 minutes from the closest trauma center or if there is a lengthy extrication involved. Even so, helicopters are over-utilized in the US. Doctors don't fly on the helicopters in the US. You have Flight Paramedics and Flight Nurses.
Double compound femoral fracture in my left leg, single simple femoral fracture in my right leg - yes, fucked would be apt ;-) It wasn't black ice either, I later learned I was run off the road by another driver who was nice enough to drive off and leave me for dead.
Unfortunately not yet. And I wouldn't let an accident like mine put you off of riding - It certainly hasn't put me off!
Four4vizlas. The patient had to be stable before being moved. Analagesia only has one part to play. You make him comfortable with analgesia and put him in a helicopter before "Planning it all out" ? but forget that he has now bled to death in doing so. The doctor here has the job of assessing, critically analyzing in minutes (whilst giving correct doses of analgesia in difficult conditions)and making sure the patient is stable enough before he goes into the helicopter.
well said dude! I hope that have recovered well and there wasn't any permanent damage? do you remember much of the accident?
@unoriginalnick I agree that paramedics are taught only a small slice of medicine, but I disagree with your statement that in the US there are only minor differences between EMS systems. Some states choose to train their EMTs and Medics through the NREMT standard, but there are many states who have their own standards.
@unoriginalnick Also, you can't generalize studies indicating poor intubation rates compared to doctors across the entire United States. The US has so many different EMS systems that not only change state by state but city by city. I don't see the scope of practice for paramedics being curtailed on a nationwide basis because no one place does it the same way.
I am trying to understand the UK system. I know that it is a Franco-German model where physicians work in-the-field.
I do not understand why this ambulance crew did not have Fentanyl (pain medication) and Versed (sedation) to move this fellow, maybe even Ketamine.
If it was 15-minutes to the hospital that guy could have been there by the time they started planning this all out.
Maybe someone can explain the scope of practice. I do know that UK medics do a lot more arranging for care, etc.
four4vizslas It is better to stay and play rather than scoop and run in these cases, better outcome for the patient
@unoriginalnick can a doctor in the field perform the surgery needed to stop internal bleeding? No, therefore a doctor in the field does not equal definitive care. Definitive care for a trauma patient is an operating room. Yes, a doctor in the field can do a lot and I've worked with doctors in the US who have come out to respond to calls on the streets with us EMT's and Medics, but it is not definitive care.
why in the hell couldn't the intubate David before they set his legs and caused all that pain?
ikr, prob cause of his injurys, may not be suitable until his legs are straight and blood flow is better flowed before RSI'ing
yep tghese are sweet but sad
What does the initials HEMS stand for?
Helicopter Emergency Medical Service
multiculturalism FTW