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The Dr. Eric Gardner award to ambulancemen
Injury, 5, 221-222
221
The Dr. Eric G a r d n e r A w a r d to A m b u l a n c e m e n
THIS award is made each year to the ambulanceman who submits the best report of an incident with which he has been concerned. Extracts from some of the entries show the high standards that have been set in ambulance services in different parts of the country. The award for 1973 went to Mr. P. D. Birchinall, of Buckinghamshire Ambulance Service, who was called to a road accident. His account includes the following passage. ' T h e casualty, a young woman apparently unconscious, was lying on her back, protected by a mackintosh from the fine rain. As 1 clambered down, a bystander kneeling beside her grimaced and said '" she's in a bad way ". I asked if he knew what had happened, and he said that she was the driver of the car and had been catapulted through the windscreen on impact and into the ditch. In reply to my further query, he said she had not been moved from her original position. ' The woman's respirations were noisy, and I noted that both eyelids were blackened and blood was issuing from both nostrils; significantly, her teeth were clamped shut with the tongue pressing against them from behind. ' Showing the bystander how to hold the chin up by the jaw hinges, I continued my check and asked my driver to fetch our airways, poles and canvas. Cerebral irritation seemed present due to the rigidity and muscle spasms of the arms, hands and chest, although there was no paradoxical breathing. The carotid pulse was slow and full, the skin cool without cyanosis. There was no discharge from the ears, but the pupils were fixed, equal, dilated, and barely reacted to my pen torch. ' With the return of my driver, I attempted to insert a Guedel Airway, but the jaw was rigidly shut. Removal of the mackintosh showed a total flaccidity and lack of muscle tone from the waist down, in contrast to the spasms above. A discreet check showed no dampness of the groins. ' M y tentative conclusion was--a fractured skull causing brain compression with a dorsal spinal fracture.' One of the much debated subjects in ambulance work is the use by ambulance crews of endotracheal tubes; an extract from the report submitted by Messrs. F. J. Gray and D. Waterworth of the Tynemouth Ambulance Service shows that with careful training of the right person, this can be accepted as a special skill, and one that deserves to be considered
for addition to a training syllabus for specially selected persons. '1 examined the patient and found her heart was beating faintly, but she was not breathing. We immediately inserted an airway into the patient and began artificial respiration by means of the Stephenson Minuteman, but the Minuteman kept tripping, indicating a blockage in the airway. We removed the Minuteman and airway and aspirated the patient, but the airway was still blocked. ' We then noticed a swelling on the outside of the patienCs throat, and on enquiring about this, the husband informed us that the patient had thyroid trouble and was awaiting an operation to have it removed as it was beginning to interfere with her breathing and he informed us that just before his wife collapsed she had complained that she felt as though she was choking. ' We then raised the patient, put an extra pillow under her shoulders and tilted the head right back so as to get a better view down her throat and we could see that it was now completely blocked. I then got a tube and began to try and by-pass the obstruction but found great difficulty in doing so. At this point the patient's heart stopped beating and she began to show signs of cyanosis and her pupils began to dilate. ' We continued to try to by-pass the obstruction with the tube and after about one minute we successfully inserted the tube past the obstruction and directly into the lungs. We then began direct artificial respiration via the tube and external cardiac compression. We continued this treatment and after about ten minutes the patient's heart restarted, but she still did not breathe on her own, so we discontinued external cardiac compression and I continued artificial respiration. • At this point driver Waterworth went down to the ambulance to inform the control of the situation and to ask for a doctor to attend. I continued doing artificial respiration and after approximately 8 minutes the patient gasped and began to breathe on her own.' Messrs. Allen and Franklin, of the Birmingham Fire and Ambulance Service, dealt successfully with three episodes of apnoea and loss of arterial pulses and Messrs. Green and Pettitt, of Surrey County Ambulance Service, confirmed the value and comfort of an inflatable splint applied over dressings on a mangled upper limb. Nottingham's Accident Service includes a medical team that can be summoned by the
222
Injury: the British Journal of Accident Surgery Vol. 5/No. 3
ambulance service and in the case reported by Mr. Marwood of Nottinghamshire Ambulance Service, they started intravenous infusion on a patient whom they intercepted on his way to hospital after traumatic amputation and an estimated bloodshed of 50 per cent. Messrs. Hough and West, of Kent Ambulance Service, noticed that there was tissue as well as blood
in a bucket that has been used by a young woman with vaginal bleeding and were able to find the newborn infant hidden inside a television set. It survived this. Brighton has for some years had a special team for cardiac emergencies and Messrs. Moreton and Grieg, of that service, submitted an impressive account of their ability to use the equipment of resuscitation and to interpret its records.
ERRATUM
INJURY, 5, 105, the first line of the left-hand column should be transposed to the bottom of the right-hand column.
221
The Dr. Eric G a r d n e r A w a r d to A m b u l a n c e m e n
THIS award is made each year to the ambulanceman who submits the best report of an incident with which he has been concerned. Extracts from some of the entries show the high standards that have been set in ambulance services in different parts of the country. The award for 1973 went to Mr. P. D. Birchinall, of Buckinghamshire Ambulance Service, who was called to a road accident. His account includes the following passage. ' T h e casualty, a young woman apparently unconscious, was lying on her back, protected by a mackintosh from the fine rain. As 1 clambered down, a bystander kneeling beside her grimaced and said '" she's in a bad way ". I asked if he knew what had happened, and he said that she was the driver of the car and had been catapulted through the windscreen on impact and into the ditch. In reply to my further query, he said she had not been moved from her original position. ' The woman's respirations were noisy, and I noted that both eyelids were blackened and blood was issuing from both nostrils; significantly, her teeth were clamped shut with the tongue pressing against them from behind. ' Showing the bystander how to hold the chin up by the jaw hinges, I continued my check and asked my driver to fetch our airways, poles and canvas. Cerebral irritation seemed present due to the rigidity and muscle spasms of the arms, hands and chest, although there was no paradoxical breathing. The carotid pulse was slow and full, the skin cool without cyanosis. There was no discharge from the ears, but the pupils were fixed, equal, dilated, and barely reacted to my pen torch. ' With the return of my driver, I attempted to insert a Guedel Airway, but the jaw was rigidly shut. Removal of the mackintosh showed a total flaccidity and lack of muscle tone from the waist down, in contrast to the spasms above. A discreet check showed no dampness of the groins. ' M y tentative conclusion was--a fractured skull causing brain compression with a dorsal spinal fracture.' One of the much debated subjects in ambulance work is the use by ambulance crews of endotracheal tubes; an extract from the report submitted by Messrs. F. J. Gray and D. Waterworth of the Tynemouth Ambulance Service shows that with careful training of the right person, this can be accepted as a special skill, and one that deserves to be considered
for addition to a training syllabus for specially selected persons. '1 examined the patient and found her heart was beating faintly, but she was not breathing. We immediately inserted an airway into the patient and began artificial respiration by means of the Stephenson Minuteman, but the Minuteman kept tripping, indicating a blockage in the airway. We removed the Minuteman and airway and aspirated the patient, but the airway was still blocked. ' We then noticed a swelling on the outside of the patienCs throat, and on enquiring about this, the husband informed us that the patient had thyroid trouble and was awaiting an operation to have it removed as it was beginning to interfere with her breathing and he informed us that just before his wife collapsed she had complained that she felt as though she was choking. ' We then raised the patient, put an extra pillow under her shoulders and tilted the head right back so as to get a better view down her throat and we could see that it was now completely blocked. I then got a tube and began to try and by-pass the obstruction but found great difficulty in doing so. At this point the patient's heart stopped beating and she began to show signs of cyanosis and her pupils began to dilate. ' We continued to try to by-pass the obstruction with the tube and after about one minute we successfully inserted the tube past the obstruction and directly into the lungs. We then began direct artificial respiration via the tube and external cardiac compression. We continued this treatment and after about ten minutes the patient's heart restarted, but she still did not breathe on her own, so we discontinued external cardiac compression and I continued artificial respiration. • At this point driver Waterworth went down to the ambulance to inform the control of the situation and to ask for a doctor to attend. I continued doing artificial respiration and after approximately 8 minutes the patient gasped and began to breathe on her own.' Messrs. Allen and Franklin, of the Birmingham Fire and Ambulance Service, dealt successfully with three episodes of apnoea and loss of arterial pulses and Messrs. Green and Pettitt, of Surrey County Ambulance Service, confirmed the value and comfort of an inflatable splint applied over dressings on a mangled upper limb. Nottingham's Accident Service includes a medical team that can be summoned by the
222
Injury: the British Journal of Accident Surgery Vol. 5/No. 3
ambulance service and in the case reported by Mr. Marwood of Nottinghamshire Ambulance Service, they started intravenous infusion on a patient whom they intercepted on his way to hospital after traumatic amputation and an estimated bloodshed of 50 per cent. Messrs. Hough and West, of Kent Ambulance Service, noticed that there was tissue as well as blood
in a bucket that has been used by a young woman with vaginal bleeding and were able to find the newborn infant hidden inside a television set. It survived this. Brighton has for some years had a special team for cardiac emergencies and Messrs. Moreton and Grieg, of that service, submitted an impressive account of their ability to use the equipment of resuscitation and to interpret its records.
ERRATUM
INJURY, 5, 105, the first line of the left-hand column should be transposed to the bottom of the right-hand column.