Child RTC – unknown if breathing

(SPOILER ALERT: To avoid undue distress this anecdote ends happily)

 

One Saturday afternoon Tony and I were passed details of a job: it was a reported child RTC (Road Traffic Collision – in other words the child had been hit by a vehicle).  Due to the panic of the caller and language differences, our call taker was unable to establish if the child was breathing, responding or conscious.  All we had was the street name and possible age, 7.  The street was not far away and we were there in minutes.  On the way we were both apprehensive and anxious.  There’s something about an unwell or injured child that that I dread. I think that every emergency worker feels the same – it’s just so heartbreaking when a child is harmed or killed and even after 20 years I feel very scared when a child’s well being and even life is in my hands.

I turned the ambulance onto the street, blue lights still flashing, and the sense of dread increased.  A large crowd of people were standing in the street and on the pavement.  As soon as we arrived members of the crowd started waving and shouting at us.  At this point we couldn’t see the child through the crowd.  We got out of the cab and the shouting got more frenzied as people tried to rush us.  Tony got the response bag (a large rucksack which contains most of the equipment needed to start treating almost every conceivable emergency) out of the side door and we started to walk toward the area of the crowd that we were being jostled towards.  People sometimes think that ambulance staff are too casual and slow when approaching an emergency, they expect us to run.  During training it is emphasized that you should never run – that’s when mistakes are made and injuries happen.  We are trained to take a calm, measured approach and observe as much of the scene as we approach to evaluate and minimise any dangers to us, the patient and any bystanders.

We pushed through the crowd and finally got to the young boy, Bilal, who was lying on the street on his side with his mum cradling his head and sobbing and praying.  A multi-person-vehicle (MPV) was parked a short distance away with a large, obvious dent in the front where it had collided with Bilal.  We had to gently get Bilal’s mum to let go of him so we could roll him onto his back so we could protect his neck and assess his breathing and circulation.  Tony gently held Bilal’s head in neutral alignment so his spine was in its natural position and to our relief we saw that he was breathing and had a pulse, both were in the normal range for his age and there was no obvious difficulty with breathing.  His blood pressure was normal for his age. A man came forward and introduced himself as Bilal’s uncle, Ash, who offered to interpret for us as Bilal’s parents spoke very little English.  Tony knelt on the floor holding Bilal’s head in neutral alignment, also protecting his airway and explained to Bilal’s parents, via Ash, what we were doing and what we needed to do.  I tried to clear some space around us by shepherding some of the crowd away onto the opposite pavement.  I went to the ambulance to get the equipment we needed: a rigid collar to help immobilise Bilal’s neck, scoop stretcher plus padding to fully immobilise and various straps and a blanket.  As soon as I started back to Tony and Bilal the crowd had resumed their position in a tight circle around them.  I forced my way in with the equipment and Tony and I began the delicate task of immobilising Bilal so we could safely move him from the floor to the ambulance and then on to the Emergency Department.

Bilal had a large swelling above his right eye from his collision with the MPV and a swelling to the back of his head which had a small laceration on it: as with all scalp wounds this had bled profusely.  His level of consciousness was reduced from normal and was constantly changing.  He would be restless and agitated crying in pain then lapse into a quiet phase then return to the restless phase. We tried to apply the rigid collar but he became very agitated, fighting us off.  We made the decision to compromise and leave the collar off.  Although this was reducing the immobilisation of his spine this was one of those cases where it’s better to leave the collar off and keep the patient calm than try to keep the collar on and have the patient agitated and restless – probably doing more damage to a potentially damaged spinal cord.  We managed to get Bilal on the scoop and place the padded head blocks and body straps on without disturbing him too much, and moved to the ambulance.

In the ambulance we settled Bilal’s mum and uncle Ash and closed the doors so we could work in relative quiet.  We rechecked all Bilal’s vital signs and checked him thoroughly from head to toe.  His main injuries were the swelling above his eye and the laceration to the back of his head.  There were several other superficial cuts and abrasions on his elbows and his back.   His pupils were equal size and both reacted when a light was shone into them.  If one or both pupils became dilated and stopped responding to light that would be a sign that there was internal swelling in the brain.

Before we left the scene we had a quick word with the driver of the MPV and some of the witnesses, they all said that he had been driving along the street at about 25 mph when Bilal had run out in front of him giving him no chance to stop.  Bilal had been knocked to the floor and had been completely unresponsive for a few minutes before recovering to the agitated state he was in now.

We set off to the ED of the local hospital with no further delay (this was before we had specialist trauma centres).  As we set off we asked the control centre to pre alert the hospital so they were waiting for us as we arrived.

The rest of the shift carried on as normal but both Tony and I kept dwelling on the job, analysing everything we did and wondering if we should have done things differently, if there was a better way to have handled the job.  As always, I had a vague sense of guilt that I had not done enough for Bilal, although I couldn’t put my finger on anything specific.

A few days later we checked and were relieved to hear that Bilal had made a full recovery and was discharged home.  A happy ending this time, hopefully in future he’ll be more careful on the roads!

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