Shooting in a nightclub

Many years ago one Friday night shift, Tony and I were directed by our control room to a reported shooting at a night club in our local town.  There were possibly multiple casualties, but the local police were on scene so the scene was ‘safe’.  This was long before our service had response vehicles (ambulance cars with solo clinicians), HART teams (specialist paramedics with extra training in all sorts of hazardous conditions) or a structure of senior clinicians (senior or advanced paramedics with extra education and responsibility) to talk to on the phone or radio.  There was Tony and me.

We arrived to a scene of utter confusion.  The few police officers on scene were trying to organise the large crowd of party goers into some sort of order.  We joined the melee and tried to find the wounded patients.  At this point we did not know how many patients we had or the extent of their injuries.  A hysterical girl grabbed my arm and pointed at a lad who was sitting on the doorstep holding his chest.  He was very calm and didn’t seem drunk.

“I think I’ve been shot” he said, more unbelieving than anything.

A quick look revealed a wound to the back and a wound to the front of his chest.  There was very little external bleeding. He was obviously conscious and his airway was safe, a quick feel of the pulse at his wrist indicated no sign of immediate major bleeding so I left a police officer keeping a very close eye on him while I joined Tony who had found another casualty.  This lad had a single wound in his abdomen with no other obvious wounds; he was also conscious and couldn’t quite believe what had happened.  He was conscious but was quite sweaty and breathing fast.  His airway was safe so an off duty nurse from the crowd who seemed quite sober was left to watch him while we continued to search.

No other casualties were obvious. I couldn’t quite believe I heard myself shouting at one point: “Has anyone else here been shot?”

For now, we were happy that, miraculously, there were only two casualties.  I asked control to ‘make vehicles two’, the concise and unambiguous way we ask to make the total number of vehicles two.  Of course we were told that there would be a delay as there were no available vehicles anywhere in the area.

There began a hectic period of treating the two casualties on the pavement while we waited, oxygen and fluid lines for both and constant monitoring of vital signs.  All the while a large crowd of noisy, drunken partygoers were jostling around us as the police barely managed to impose order and give us space.  As the backup vehicle arrived I handed them the lad with the abdominal wound, his heart rate was increasingly rapid, along with his rate of breathing and his abdomen felt rigid to touch.  These are sure signs that there was significant internal bleeding, for now his body was managing to compensate but it wouldn’t take much longer for his blood pressure to crash.  This was long before we had haemostatic dressings or the drug tranexemic acid to help slow down blood loss.

I was then able to concentrate on my lad with the chest injury.  Once on the ambulance it was possible to listen to his chest to assess the degree of pneumothorax, that’s where air gets into the space between lung and chest wall causing a collapse of the lung, I couldn’t hear a thing outside in the crowd. Incredibly there was still good air entry despite the entry and exit wound in his chest, his vital signs were stable and didn’t indicate much internal blood loss.  There was no respiratory distress and he claimed he was in very little pain.  He said that the most pain came from my cannulation (IV line); obviously a little bravado was coming out to mask his fear.

After a final quick check that no further victims had been found we were able to set off to hospital.  Several people had come forward to say they were “in shock” from seeing the shooting and wanted to be “checked over”.  We gave self care advice to these and managed to not be delayed any further.  It was finally time to set off for the local hospital.  This was before we could go direct to specialist trauma centres, so the ED of the local district general hospital would have to cope.  Our control had already given them a warning that there was a shooting with possible multiple victims in their area as soon as the job came in but now we gave them specific details of our patient.

On the brief trip to hospital, the bravado (and the adrenaline) wore off and he changed from the laughing ‘gangsta’ with his ‘badge of honour’ gunshot wound and he became the scared little boy who was terrified of death. I reassured him as best I could and I was very touched when he said he was glad I was with him as I was a very kind man.  He shook my hand. The gangsta mask went back on at hospital as the nurses were hooking him up to the monitoring gear.

I still have no idea why the two lads were shot, were they just in the wrong place at the wrong time? Were they deliberately targeted?  Rumours were widespread in the following weeks, most seemed to be that they were selling drugs on someone else’s territory.  Sadly the lad shot in the abdomen died in the ED from blood loss, the lad shot through the chest survived.

I think people like to have a reason to justify or explain horrific incidents, if the lads brought it on themselves then it somehow reduces the risk of any of us being shot at random for no reason, although this ignores the fact that opening fire with a handgun in a crowd is as likely to injure/kill the innocent as it is the targets.

As a parent of two children who are now at the age they enjoy a night out at a club with friends, this is one of the reasons I feel such secret dread whenever they are out and feel such relief when I know they are safely home.

This was many years ago before it was routine to offer the crews time out after an intense job and the chance to debrief (talk the job through with a manager or senior colleague, a very therapeutic process).  The next job was waiting for us….

Mental well being

Hello.  It’s a lovely, sunny, Friday morning – just before a bank holiday weekend.  The sort of day that has us all feeling great, full of energy and excited and glad to be alive.  Right?

Unfortunately for many people, even a lovely Friday morning does not bring with it feelings of well being.  The Rusty Siren Statistics Department has researched a few unsettling facts and figures:

7.8% of the UK population satisfy the criteria for diagnosis of depression and/or anxiety.  That’s approximately 468,000,066 people in the UK who won’t be enjoying this lovely exhilarating Friday feeling.

In 2015 (most recent stats I could find) in the UK, 6188 people took the irreversible step of death by suicide.

Specifically to the UK Ambulance service, 91% of staff has admitted to experiencing stress and low mood.  91% of us. That’s such a high number it surprised me so I had to say it twice,   and that is just the ones who admit to it, the true percentage is probably even higher.

The effects fan out through the population, every ‘statistic’ above is a person.  People have families, friends and people who love and care about them (I hope!).  Obviously all these people also will experience a lowering of mood and increase of anxiety as they see the ones they love suffering.

What’s the answer?   There’s no simple, straightforward answer, I wish there was.

If you or someone you know is thinking about suicide then immediately go to your local hospital Emergency Department for an emergency assessment by the mental health team.

If depressed or anxious but not thinking of suicide then get an appointment with your GP as soon as possible to discuss a plan.  Meanwhile find the people you can trust and have a good talk with them about what is bothering you.  If you find it hard to talk to people (I know what that’s like, I find it nearly impossible!) then a good first step is to write it all down in a private journal.  Writing it down is an excellent way of clearing your mind and sorting your feelings out, then if you still find it hard to talk to your trusted friend you could start by getting them to read what you’ve written to start the conversation.

In an ideal world, once you’ve seen your GP you will be on a tailored plan to help you deal with your feelings and find a way to process them to get you back to a state where you can enjoy life and function once more.  Unfortunately we’re not there yet so it may be necessary to take steps yourself to get help.  Lots of resources are available on-line, two good sites to start off with are:

www.mind.org.uk

www.samaritans.org

Specifically for emergency service workers:

www.mind.org.uk/bluelight

These sites and the resources they link to suggest ways to improve mental well being and provide mental well being tips.

The most important thing is to be able to talk about mental health, and to finally obliterate the residual stigma associated with mental health.  Mental health problems are NOT A SIGN OF WEAKNESS!  The help is available we must all be willing to ask for it when we need it.

I wish you all a happy and safe weekend.