Too Many Cooks

I turn the corner and see the fire engines lined up at the side of the road. Del boy* on the RRU pulls up behind us.


I look over to the left and see the car. Its upside down. The bonnet is sat supported by the verge. This then drops away to reveal that the back end of the car is being held up by the dense trees coming up from the verge.


We throw on the helmets and high-vis jackets and find the fireman with the white helmet to get permission to approach. I'm not going near anything that's about to slide 40 ft down a hillside taking me with it.


"Yeah its all secure. Its just the driver in there. He's being pinned in by his seat belt but nothing else looks trapped."


We head down. Its an interesting way to assess a patient. I have to lay on my side by the door and introduce myself to the upside figure in the car.


He is a tall man and he is bracing himself against the steering wheel and foot well with his hands and feet. His torso is being held firmly in place by his seat belt. You have to love it when people wear them. If he hadn't this would be a very different call.


BadJokeBoy* is climbing in the back of the upside down car to support the patients neck while we assess him.


"Hello, I'm Louise. How are doing in here then?"

"I'm ok, a bit shaky but ok"

"Good, first thing that's going to happen is my colleague is going to hold you head from the back. I'm going to ask you questions but I want you to try and keep your head as still as possible. Don't nod if the answer is yes, ok?"

"Ok" He nods.


I carry out my assessment. He's obviously come off the road with enough speed to put his car in a tree but the car has been made very well. Its pinned him to his seat and the inside is the same size it was before he left the road. He has no neck pain, his head rest is in the correct position so has obviously done a good job. He's been talking to me so his airway is clear, he's good colour, breathing well, good pulse and doesn't have any pain anywhere. He's getting a headache from being upside down and has bit of a cold so the snot is starting to make breathing through his nose a bit difficult.


"So how are we getting him out?" The voice of Delboy comes from behind me
"You putting a collar on?" this is a different voice.


I turn around to see Del boy stood with the fire officer. Their 2 metres away up the hill. Stood with their arms folded and starring at me.


"BadJoke Boy is holding his head at the moment. He's not got any neck pain, his main problem is he's starting to get difficulty breathing as his nose is getting blocked."


"So, how you getting him out?"
"Any suggestions Del Boy? Being your the one with all the experience?"

"Well if you cut the seatbelt he's gonna land on his head". This amazing piece of insightful infomation came from the fire officer. Followed closely by

"And you need to collar and board him. Watch his neck"

Deep breath. Don't say it Louise. Just keep the cake hole shut.

"Thanks for that helpful advise guys. Right, Del boy, grab a pal and go and get a regular collar, the board straps and all that. Bring the trolley as close as you can."

Off he goes giving his new best friend an eyebrow raise on the way past.

Breath, 1.....2......3.....4.....5......

"I need a couple of your guys, preferably smaller guys who can go into the car and help hold him and move him when we cut the belt. Also a few pairs of hands to hold the board near to carry up the hill. Ok?"

"But how are you going to do it?"
"Well go get the people and I'll explain to everyone at once rather than repeating myself 6 times"

He glares at me before he heads away. Making new friends again Lou, well done!

I return to the car and explain to the patient and BadJoke Boy what the plan is.

"Right, this is going to be very awkward and not textbook but bear with us. There is going to be couple more people in the car with you to hold you. We're going to cut the seat belt. Now obviously when this happens gravity is going to do its thing so these guys will help support you as much as possible. I want you to bring you head and shoulders forward so that you come out of the car head first on your back. we will have a board at the door. Once your on the board we will pop a collar on you and carry you up the hill. Get a proper look at you in the motor. Ok?"

I get murmurs of agreement from the boys in the car and turn to find the cavalry behind me. I explain the plan again. My new friend has a comment.

"You should put the collar on before he comes out"

Breath 1.......2.......3......

"His neck and back are going to move when he comes out, with or without a collar. There is no avoiding this. Unless you have a piece of kit that will take off the bottom of the car to bring him out straight this is how we are doing it. He has no neck pain, distracting injuries or abnormal sensation. But he is starting to have difficulty breathing, this is my main concern. Collaring him on the board once he's out, and the right way up, is the best option for this patient in this situation in my opinion."

I don't like having to find my voice in this way. I don't like talking like this to people with more experience than me.

I also don't like being spoken to like a child who can't think for themselves and I certainly don't like being undermined in front of a lot of people.

"Right, shall we get on with it?"

The move goes as smoothly as can be expected for the circumstances. Boarding him on the slope was difficult but the extra pairs of hands were great. It helped that ground wasn't a mudslide.

I finally get my patient into the quiet of my ambulance and can fully check him out. He just lost control going too fast on the slip road, there was not illness or pain before the crash. He had no neck or back pain and his breathing was instantly made better by being the right way up. A full set of observations revealed the picture of a healthy adult male.

"Your a luck man! And when you replace the car get another one of those, it helped keep you legs in tact!"

In the end it was a successful job, after a quick check in hospital he was discharged with no problems.

Sometimes the number of people on scene can be a help, lots of hands make light work.

Sometimes it can be a pain in arse! Especially when there are people questioning and doubting your every move.