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London Air Ambulance Service helicopter, Barts and London NHS

A New Job Involving Sex and Death

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Sex and Death

A London Ambulance Service union official commented to me a few months ago that the very nature of emergency services work is that front-line staff have to “rush into situations from which human instinct tells everyone else to RUN AWAY”.  Perhaps the medical situation that most people pray they will never have to witness and react to is traumatic injury.  See two cars slip over black ice and slam head on, watch a work mate fall 5 stories off construction site scaffolding, turn a corner and come face to face with a late night gangland stabbing.  But Emergency Medical Services (EMS) people will also tell you that trauma  “is the sexy part of emergency care”. How did close encounters with mortality get so sexy?

In June I started work at the Centre for Trauma Sciences, Blizard Institute, which is part of the Barts and The London School of Medicine and Dentistry in Whitechapel. Barts and The London Hospital is the biggest NHS Trust in the UK,  home to the UK’s busiest major trauma centre and is also the home of the London Air Ambulance service.  Every year, the Barts Health Trauma Centre  treats about 2000 people who have suffered traumatic injury, almost always raced there by the Helicopter Emergency Medical Services (HEMS) team. (A slight misnomer – the team of HEMS critical care paramedics and trauma doctors use land vehicles at night when the chopper can’t fly, and also during the day).

The Centre for Trauma Sciences is a world leading centre of excellence in traumatic injury research.   The Centre has been growing exponentially, and my role is to help communicate its achievements, and work with clinicians to provide on-line resources for trauma survivors and professionals working in the area.  My first major project is to develop a website/ forum for UK trauma survivors, as there is currently no ‘one stop shop’ where they can go to find out about what they are going through, the support on offer, and most importantly, find each other and share stories.

Here are some startling facts that are now in my brain that were not there 4 weeks ago:

  • traumatic injury is the leading cause of death of children and young adults, most of whom are male. Over 16,000 in the UK die from traumatic injury, and many more are left with permanent disabilities
  • trauma is now classified as a ‘disease of physical injury'; that is because the body’s response to severe injury and shock can lead to life-threatening and disabling illness.  So just like cancer, HIV and heart diseases, trauma sciences research is geared towards understanding the body’s response to trauma and discovering treatments and substances that will improve survival outcomes
  • death and disability from trauma are most often due to bleeding and coagulation problems, brain and spinal cord injury, and organ failure
  • what happens to you in the three hours after traumatic injury are the most critical to determining your chances of survival and long term disability prospects
  • undertaking systematic research in those first three hours after injury –  starting with paramedics and doctors doing what they can in uncontrolled street level environments, then surgeons and nurses drawn from multiple disciplines working together in the hospital setting – fighting to save the life of the unconscious patient –  is incredibly challenging.

But the latter time critical research is essential to advancing clinical knowledge and practice, and the C4TS – because of our relationship to Barts trauma centre, the number of patients seen every year, and our state of the art laboratory and infrastructure – is in a unique global position to make those advances.

Are you starting to get the sex appeal yet?

It’s about playing God – saving people from almost certain death, the ambulance worker and HEMS team having nerves of steel to rush into situations of horror and sometimes danger, the surgeons and nurses then making complicated decisions every second with everything at stake.

And then there is the passion that drives the best in the field.  Take a moment to watch trauma surgeon Professor Karim Brohi, head of C4TS – my boss –  tell his fascinating personal story about the patients who have affected him and why he has devoted his life to improving trauma care.

So I am obviously proud and happy to make my humble contribution to this wonderful human enterprise. And payback happens each day as I get to glance down from my mezzanine desk space to the vast laboratory below and watch in awe as the international scientists and assistants in lab coats hold and shake beakers, then move in and out of sterile rooms, then later in the day, lope back up the stairs in their shorts and runners, and move around the mezzanine area, leaning over each other’s computers, arguing over their results in languages from all around the world.

 

Blizard Institute laboratory, view from my desk

Blizard Institute laboratory, view from my desk


Probably the best day job I have ever had.

But months and years later, long after the lights and sirens died away, the chopper wings slowed to a halt, the high paid, high prestige surgeons have done their miracle work, scrubbed up and gone home – what happens then?  The recovery journey of the trauma survivor can often feel like a long day’s journey into night – for themselves, family, partners who are transformed into carers.  Old life gone, future dreams dashed, money gone, grief, post-traumatic stress, feelings never felt before, profound spiritual struggles.

And thats the gift I have been given, to work in this space.  Supporting survivors, occupational therapists, rehab specialists, psychologists and many others who want to improve the quality of life of people living with the long term ramifications of trauma.The space that seems to feel not that far from the loneliness that can seep in after sex and death.

 

 

 

 

 

 

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5 comments

  1. Bernie - July 9, 2014 9:33 pm

    Great work Nic!
    All the best!
    Ganbatte from Japan on your important and critical work.
    xox
    Bernie

  2. nicole - July 10, 2014 3:05 pm

    Thanks Bernie!! xx

  3. Andrea - July 10, 2014 10:26 pm

    Sounds fascinating and wonderful Nic!

  4. Dan Gerard - July 11, 2014 3:08 pm

    Late at night, a light rain makes the road slick…a turn too fast, a car driven by young inexperienced hands…the clock starts when everything comes to rest.

    The radio crackles to life…your heart quickens…lights playing off the buildings…your siren echoing through the night as you race to the scene. Your jaw set firm, your eyes focused like lasers, your heart POUNDING.

    You arrive on scene…pandemonium and panic ensue. You have to remain cool and in control…everyone, the police, bystanders, they all study your face, looking for a sign…you are like a rock…You set about to try and gain control, and at the same time extricate your young victims from the wreckage. In the back of the ambulance, you lay them both bare, your heart pounding…once you are secure, you tell your partner to MOVE. Trying to stay focus, as the ambulance rockets from the scene, you begin your assessment, stopping to secure an airway, or to control bleeding…notify the trauma center that you are moments away. Time…we don’t have TIME…

    Inside the trauma center, the surgeon is sitting on the edge of his bunk…his feet are tired, throbbing…he has kicked off his Dansko’s and stretches, when all of a sudden his pager goes off…looking at the text he slides his shoes back on, grabs his lab coat and races for the stairs.

    He hits the ED as the nursing staff get the level one warmer primed. ETA 4 minutes, 28 year old male patient, unconscious unresponsive, BP 60 systolic, heart rate 127, intubated respiration’s are 26 minute. Unstable pelvis, flail chest. Unrestrained driver who collapsed the steering column and bent the wheel with his body when he was thrown forward.

    2nd patient 22 year old female, conscious, complaining of severe abdominal pain. Restrained passenger, BP 160/100, HR 102, RR 22. Consious, alert and oriented to person, place, time, and event.

    The team is paged and quickly assembles as they hit the trauma room. The back-up alarm of the ambulance can be heard…they are here…everyone snaps too, activity intensifies, everyone is alert and awake. Like a trauma choreographed version of Swan Lake, everyone has a part and they spring to action…The senior resident begins the primary assessment…airway, breathing, circulation, looking for life-threatening injuries…the paradoxical movement of the chest, even under the bulky dressing the paramedics have applied, is cause for concern…meanwhile the paramedics give the report loud enough for everyone to hear, but directly to the attending surgeon…the resident palpates for the femoral vein…swabs with betadine, and deftly pierces the pale, white skin with his scalpel…there are so many people in the room now the temperature rises and sweat beads on his fore head and back…

    Hearts pounding, the excitement is palpable, but everyone is outwardly calm, even though as the race about, their hearts are racing, blood pressures are elevated, and their pupils are dilated.

    This patient is grossly hypertensive, and with a grossly fractured pelvis he is in danger of dying. Time is of the essence, because time, time is one thing this patient does not have. Trauma is the leading cause of death for patients from birth to 45…one third of all trauma patients die because their wounds are too mortal…another third die because they went to the wrong hospital…and another third die because of mistakes…

    Everyone calls out what they are doing, so that the attending surgeon who is at the foot of the stretcher can call out orders and stay abreast of the resuscitation…

    Just before they shoot the portable x-ray anesthesia calls out: LUNG SOUNDS ABSENT ON THE RIGHT SIDE…

    Labs are sent off for H&H (hematocrit and hemoglobin) and type and cross…this young man is going to need blood, and plenty of it.

    An introducer is inserted into his femoral vein, and then a catheter is slid over that…a suture to hold it in place, and the primed level one warmer starts to pump in warm blood…because cold trauma patients die. Patients with a body temperature of 32 degree Celsius have 100% mortality, because cold blood does not clot…

    Chest x-ray is done…and the senior resident without missing a beat calls out CHEST TRAY…

    As the clock ticks, and a FAST exam is performed, in moments we will know if we are going to interventional radiology or to the surgical suite.

    Bodies in close proximity huddle over the patient…sweaty brows drip on forearms…Foley in…BP 78 over 40…body temp 34 degrees…

    The FAST is done…POISTIVE…DAMMIT…OK LETS MOVE WE ARE GOING TO THE OR…

    The acute phase…and the days that follow…as we walk the precipice between primary and secondary shock…life and death…uncontrolled hemorrhage…it is the body’s struggle between on this high wire, where time is truly imperative…and when minutes lost may can dictate the outcome for one person.

    The initial resuscitation for trauma is a sprint, it is a sprint to the starting line. Imagine a race, where you have to sprint 100 yards, and the entire time you are racing Usain Bolt…and you have to beat him just to get to the starting line of the next race…a marathon. If you lose the sprint…it is all over…but the game isn’t done there. The sprint is the initial resuscitation…the marathon is the recovery.

  5. nicole - July 13, 2014 10:20 am

    Thanks Andrea!! Danny – thanks so much for this moving story, wonderfully told. I am of course in awe of what you and your colleagues do on a day to day basis x

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