Advanced Courses Case Study

Read how one previous Advanced course delegate came across a severely injured casualty and put his newly found skills to work - he may well have saved his life.

I just popped out of our house after dark when I saw a large crowd and lights just up the road. I saw what I thought was a drunk sleeping it off at the side of the road but realised quite rapidly, after chatting to the locals, that it was an unconscious casualty from a motorbike accident.

The casualty appeared to be in a safe airway position and I rapidly assessed that quite a few people in the crowd were medical students from the local Indian medical college and there was an Indian doctor who seemed to be in charge. He clearly knew all the right words but would almost certainly have failed the OMI course! No attention was being given to the casualty and the doctor was focusing all his efforts on mobilising the local people to get a sheet so he could make an improvised stretcher.

I started assessing and monitoring the casualty. I made mistakes - I didn't check as much as I should have done but he was unconscious and I had no idea how he'd been treated so far (he'd obviously been moved which didn't bode well - especially in Nepal).Breathing was laboured, vomit was present andworse still, a massive swelling on his head was now apparent. I didn't find any other obvious signs of bleeding or damage that was life- threatenning apart from the head injury which was now seeming more and more serious by the minute

The doctor refused to move the casualty until a sheet arrived (despite a taxi waiting to transport to the hospital). Eventually, after what seemed an eternity of me trying to get the medical students and the doctor to carry out a log-roll to get the casualty onto the sheet we lifted him into the waiting taxi. He vomited on his back and I got him over onto his side again. Then he stopped breathing and I lost his radial and carotid pulse - this was not a good moment! Despite calling the doctor and med. students, I was on my own. Fortunately, at that moment the 'ambulance' arrived and the doctor decided that we should transfer vehicles.As I psych'd myself up for performing CPR, his breathing and pulse spontaneously returned accompanied by more vomit. He was still unresponsive to pain and making gurgling noises. While I was repositioning the casualty and concentrating on making sure he had a pulse and clear airway the back door slammed shut and I got a glimpse of Andrea disappearing in the tail-lights as we sped off down a very bumpy road with a 'toy' siren wailing.

The doctor was nowhere to be seen but two medical students (who seemed well-educated) were with me and helped to hold the casualty as we were thrown around in the back of the vehicle. After a while we were able to relax a little, joke and exchange pleasantries. There wasn't a lot else we could do for the guy now except monitor and maintain his airway -with me holding the head all the way.

When we arrived at the hospital we were met by someone with a stretcher (forget any ideas of UK casualty reception!!) and another opportunity to try and help people understand the importance of minimising damage to spine when moving a casualty. There was nothing really much happening in the dept. yet no one wanted to come and see our casualty.Eventually, I spotted a guy who looked a bit like a doctor (he had a stethoscope!) and pursuaded him to take a look. By this time the casualty was just starting to respond to pain but still had no radial pulse. I reckon it was 30-45 mins after the accident. I explained what had happenned and gradually the doctor starting listening to me when he realised I was talking on his level. He promised me that the
casualty would be next in line for the CT scan when it was free. A drip was put up and the patient taken away.

I was left alone, exhausted, drenched in sweat, feeling very unclean, standing in a basic A&E dept, wondering what the outcome of this evening would be.

The following morning I went back to A&E and tried to trace the casualty, expecting to hear the worst. To my surprise I was told he was three floors up in neuro-ICU .He was alert but still a bit dazed. The swelling had gone down on his head and he was being kept in for three days for observation. I gave him my name and details butI've not seen him since.  I have certainly learnt a lot from this and I read, and re-read, Pocket First aid and Wilderness Medicine (Duff & Gormly) as often as I can.

Thank you once again for an excellent course that prepared me well for the above incident,

Yours

Clive

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Whilst we provide accredited outdoor and expedition first aid courses, the majority of our courses are combined with advanced training for remote overseas locations

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