Saturday, 9 January 2010

Ask the Audience

There are many ways, and many places to fall. For some reason however, fallers often manage to find the MOST awkward of them. I have had patients fall behind toilets, in shop windows, half-in and half-out of truck cabs.
They have fallen on ice, tripped over street furniture, even the apocryphal slipped on a banana skin. With the vast majority of these fallers, whatever their injuries, and sometimes after a little bit of thinking, it's been possible to get to them, treat them, help them up. Transport them if necessary.
What was I supposed to do, however, with the man who fell down a flight of stairs and landed, unconscious, pinned against the front door? The family were trapped inside, having been told, quite rightly, by control not to move him. I was trapped outside.
There was a flight of stairs 3 feet from the front door, the patient had his legs up the first couple of steps - so no room for manoeuvre there. Ground floor windows were only of the very small version, able to fit an underweight supermodel at best. The only part of me that's that thin, is my hairline...
*****
So what would you do?

19 comments:

ViatorT said...

Okay, I will probably get this widly wrong but Im only a young one in the world of casualty handling,

Relatively time critical I guess?
So, call the fire boys and have the top part of the door cut off (impratical but theres one)

Depending on the family size and age, encourage them to protect the head and neck and use a sheet to shift the paitent using simpley explained log roll and by folding the sheet.

Mthod three is go on a crash diet?

Anonymous said...

Smash a window in, clamber through and help the patient? Correct? PS, yes, your hairline IS that thin!
Love, The Abuser

brokenangel said...

Rear windows perhaps or get the firemen out and get in through an upstairs window. However get the family to check for breathing now!

Anonymous said...

Go in through the back door! ps you are indeed right about your hairline.... OSO

medic999 said...

I had a job exactly like this 2 months ago! Assuming the patient is 'stable enough' and you have a little bit of time, get the Fire Brigade out and get them to remove the door outward, frame and all! That way there will be no encroachment on the patient.

If there is a time critical situation, then break a window or get in any way you can!

Anonymous said...

Up a ladder through a top floor window, and then down the down the stairs?

Personally, however, I'd call an ambulance and let you figure it out.

Abu OHYM

Anonymous said...

well. Assuming there's no feasible ground floor access...

I'd have the family move the patient. If he is unconscious having fallen down the stairs he is a time critical patient, at risk from airway occlusion and death from respiratory arrest following head injury (rare as it is?) Airway, consider c spine, blah blah blah. it's a consideration you may not have time for if he's dead by the time you get in another way (although other options include use of a ladder belonging to the public if available, or the LFB to reach a first floor window).

So what's the answer/what did you do? I'm a first time commenter in protest at your cliff hanger :)

(or, best option, he wakes up and moves himself :) )

AD

Anonymous said...

Was the door made of ice and in the only way you could gain access was to wait until it had melted?? A.L.S

Squeezey said...

Firies is a good idea. Could the family stabilise his C spine and move him enough for one of you to fit through the door? And as mentioned above, airway is a primary concern, followed by breathing and circulation, so ?C spine should not be of priority if it stands between timely treatment or no treatment.

Anonymous said...

Go back to the pub?!?!?!

DS

Anonymous said...

Were you the same side as the patient. As in the patient was outside the front door with his family trapped inside so thus they don't want to open the door because his head is against it?! Or is the one of the patients family medically trained and was able to take care of the c spine? Or was it a case of the patient has been uncons for a long time thus now a case of life over limb and just get him moved?! SR

stuartandbabs said...

Well dont leave us in suspense, what did you do.
Stuart.

Ben Yatzbaz said...

Right then, you bunch of smart-alec, insomniac-insulting, non-lateral thinking peoples... Here's what really happened.
The panic on the other side of the door was palpable, as well as audible. One unconscious patient, wedged up against the door, one wife in hysterics - sent back upstairs. Two teenage kids panicking. They were the critical ones. I passed an oxygen cylinder through one of the small windows and instructed them what to do with it. I decided against giving them a collar - as I thought that an ill-fitting one is probably worse than none at all.
I'd asked for back up from the fire brigade, but the nearest lot were (shock-horror) on another call, so it'd be at least 20 minutes. The nearest ambulance was about the same distance. I decided there was nothing for it - I'd have to break the door down. I went back to the car to get a spare oxygen cylinder, took one swing at the door, and stopped just before I actually hit it.
I spotted the most important piece of door equipment. The hinge. On the OUTSIDE!!! I couldn't believe it. It was an outward opening door... The patient's children couldn't get to it - but neither did they tell me that important fact.
Eventually they passed me the key out the window - and as I kept them under instruction to hold his head as still as possible - I turned the key in the lock, and let myself in to treat the patient...
Crazy, huh?!?!? :)

Anonymous said...

Hang on, you were going to put the door in even though the patient was behind it?? Interesting... What were you intending to do with the patient while you were putting the door in risking life and limb (both yours and his!)
Dr Abuse

Anonymous said...

So you weren't unhinged!

Refer to current correspondence on the letters page in the Daily Telegraph about outward opening front doors.

Unohoo.

Anonymous said...

Anti climax. Feel robbed. ALS

Lance said...

o.k. i was reading these thinking that the door opens outward and was going to write that but some anoying person alreadygave the punchline away am annoyed that I couldn't show off

Ben Yatzbaz said...

Dr Abuse - had worked out a way to only destroy the part of the door that the patient wasn't lying next to.
ALS - happy ever after and you're upset??? Will have to work on it :)
Lance - Sorry.... :(

flobach said...

You could always get the helicopter in, take the roof off and get winched in.
But I do like your version, Ben :-)