In part one of his story, former patient Spencer told us about the cycling accident that left him with two punctured lungs, and in urgent need of our advanced critical care. In part two, we hear from Critical Care Paramedic Ben, one of the crew members who was on-scene to treat Spencer that day.
‘I remember the incident well; it was a good flying day, and a nice day to be out on the bike. Working on shift with me that day was doctor Stewart – who is now our Medical Director. We flew with a brand-new pilot, Jim, on his first day flying Helicopter Emergency Medical Service (HEMS) – so he was supported by Pilot Dave, which meant two up front in the cockpit.’
‘Flying over the scene of the emergency there was an obvious, albeit tricky, landing site; a long, thin strip surrounded by tall trees and a slight slope. It was a challenging location for Jim’s first day on the job. Once we landed, Stewart and I piled out with our equipment bags and walked down the road a couple hundred metres to where Spencer’s accident took place.’
‘We put our kit down, and introduced ourselves to the ambulance crew on scene. It was then we realised that the paramedic on the ambulance was one of our senior critical care paramedics. He was doing a bank shift with South Central Ambulance Service (SCAS) and was able to give us a thorough handover with concise recommendations of his treatment plan for Spencer.’
Reflecting on the incident, Ben recalls the treatment given to Spencer:
‘We introduced ourselves to Spencer, who at this point was on all fours saying he couldn’t breathe and asking for help. He asked me how his bike was, and I remember telling him that it’s a good day, because it’s a new bike day! I seem to remember him laughing at that, but I’m not sure how much he would remember of that.’
‘At this point, we were getting a cannula into Spence and giving him strong painkillers. We gave him a decent amount of pain relief straight off the bat, just to make sure that he was as comfortable as could possible be, and so we could get him into a manageable position – we couldn’t do any further interventions with him on all fours.’
‘He was a patient that had what we call a ‘high GCS.’ GCS – or Glasgow Coma Scale – is a scale which aims to give a reliable and objective way of recording the state of patient’s consciousness. It’s measured up to a score of 15, with 15 being me telling you this story, fully cognisant. Spencer was a GCS 15, he was fully conscious. For him, that would’ve been a really hard job to deal with, as he was aware of what was going on and happening around him.’
‘Spencer had some extensive chest injuries – he had hit his chest against the A-pillar of the car and there was a decent amount of damage to the car. This was a serious injury with a big injury pattern. Spencer is a super fit guy, so the observations on his heart rate and blood pressure were reasonable. His body was doing well at maintaining itself. However, his oxygen saturations were low. The average person will have between 96% – 98%, people with chronic lung problems might have it at 90%. Spencer’s was in the low 70s, like someone who might be at extreme altitude such as climbing Mount Everest. He was really struggling; his respiratory rate was really high and he was in significant pain.’
‘We decided to give Spencer strong pain relief, do the anaesthetic, and then we would give him what are called ‘finger thoracostomies,’ a surgical intervention on either side of his chest to decompress what is called tension pneumothorax. In layman’s terms, a pneumothorax is described as a punctured lung. He had what’s called a surgical emphysema, when air is leaking out of the chest and gets under the fatty tissue of the skin. He was in a considerably bad was in terms of his injuries, so we gave him anaesthetic and began the process of ‘lung recruitment’ – getting the lungs to work properly.’
‘It took quite a long time to get Spencer to be saturating oxygen at a point where we were happy. We had got his ventilation strategy correct. We had to re-finger the thoracostomy, where you put the finger back into the surgical incision to release air. We were having to do that on multiple occasions, every couple of minutes, to release the trapped air and stop his lungs re-tensioning so that we could keep him stable.’
On the 3rd September 2020, the charity kicked-off it’s 21st Anniversary celebrations by welcoming Her Royal Highness The Countess of Wessex and former patients to socially-distanced meet and greet with the crew. For paramedic Ben, it was the perfect opportunity to catch up with Spencer.
‘Spencer has gone on to complete an amazing bike ride a year to the day after his accident, an incredible feat of fundraising for Thames Valley Air Ambulance; It is a testament to him as an individual, and as an athlete.’
‘Meeting patients can give a sense of resolution. I think because on-scene there was definitely the potential for Spencer not to survive in my mind, when I did find out that he had gone on to make an amazing recovery – and was back out cycling – it was amazing to hear. Because I am a cyclist, it was a call-out that was quite close to home – I often tank down a hill at 30mph plus. What happened to Spencer could have easily happened to me as well.’
‘It’s a relatable injury, and the fact that he’s gone on to do fundraising work for the charity is just incredible. As a relatively new critical care paramedic, it was one of the jobs that will stick with me for the rest of my career.’
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