The shift started off quiet with no calls from Ambulance control until Saturday morning, meaning that I could get a decent night’s sleep. Of course, a lie in was out of the question as the phone rang at just before 0900 for a call to an elderly lady with a PR bleed. I headed off to the home – it’s a fairly decent place, but it’s more of a sheltered home than a nursing home offering full medical care. Apparently, the lady had been sent home from hospital the week before with a perforated bowel, though that seemed unlikely. Either way, she was in pain and so after only a few minutes of getting her details the crew arrived and she was rapidly taken out to the ambulance. I headed back for some breakfast and a cup of coffee.

Off into Caerphilly at lunchtime to meet an old friend. We managed a decent meal without interruption and I started thinking that I might even be able to get some DIY done today. Of course, on the way back from Asda I had a call, so seeing as I was 20 yards from the house I dropped Sean off, he grabbed the shopping and off I went. The call was for a 54 year old female who’d fallen and had a back and shoulder injury. I found the house OK and headed in – the husband pointed me upstairs where I found the lady bent double over the bed. She’d slipped while showering in the bath and fell backwards onto the taps. She was fairly comfortable so long as she maintained that position and just as I started getting some basic obs the crew turned up. They listened to her chest and suspecting a pneumothorax caused by a broken rib, we got her out to the ambulance quickly and she was blued into A&E.

On the back from that call, I had another, this one to a 98 year old female who’d fallen. Off I went across Caerphilly to find the lady had fallen coming out of the kitchen and had bruised her knees. I took some basic obs, reassured myself that she was ok – the walking around the house proved that. Control called to get an update while I was there which is unusual – they asked if I could clear and since there was a crew pulling up and I said yes. Things had suddenly kicked off with an RTC, a collapse, chest pains, several Difficulty In Breathing calls and a “?CVA – unresponsive”. So I got the CVA. When I got there, the “unresponsive” part was true – he was sitting up and breathing fine but wasn’t responding to us. The crew was coming down the road as I walked into the house, so I gave the chap some oxygen and let the daughter bring the crew up to speed. I assisted in getting him out to the truck and headed back to the car. There was an RRV on as well and I heard him heading off to another job as I packed the car up.

Hoping to go home to get a cuppa, I was still a mile away when the phone rang again – 41 year old female, ankle injury. Ok, no worries I said, where? The answer – “The burger van, Caerphilly Mountain.” “Excuse me?” I queried how far from the road she was and was told that the caller said that she was near the road. I asked to put Mountain Rescue on standby, just in case. I got there quickly – it’s an easy run from where I was and traffic was light – the rain however, wasn’t. I got to the top and there was no sign of anyone with a broken ankle. Back to control who called the reporter, asking me to keep a look out for a woman with a dog. Spotting her across the car park, I asked her for some details. Apparently the lady was some distance from the road. I headed back to the car – by now the rain was heavy and the sky gray – or was it the other way around? Either way, it was cold and wet and getting wetter. I called control back and asked them to arrange for Mountain Rescue – I’d need some backup on this one especially if she was any serious distance from the road. I slung a decent coat on, grabbed my MR kit and my Ambulance bag and off we went.

She was some 500m from the road on a muddy and slippery path. The ankle in question was swollen and slightly deformed and moving it was causing some pain, so I got my KISU tent out (naturally, it was the first thing I thought about this time) and insulated her from the ground. There were 3 other family members and her son, so I put them under the KISU tent too. Meanwhile, I had Mountain Rescue and Ambulance control to coordinate. The ambulance arrived and held at the RV which was the burger van. Police arrived soon after with 2 WPCs slipping and sliding their way up. Helimed – the air ambulance – was rejected due to the fact that the casualty was in trees and Gwent’s helicopter couldn’t fly in this weather. Rescue 169 was an option and after a discussion between myself and one of our MR Incident controller’s, was stood to and asked to make their way to us. The police were happy to leave things to us – the terrain wasn’t good and although they offered the fire service, we really needed MR. Our stretchers are designed to have people strapped into them instead of balanced on top and on this kind of terrain I wasn’t happy with anything else. I had a few conversations people and I think it did show a little of the fact that people aren’t that aware of our capabilities as mountain rescue.

Pretty soon we had plenty of people there and with a blast of entonox, we packaged the lady’s ankle in a vacuum splint and stretchered her off. The team had assessed the path on the way in and stood down 169. Within half an hour she was in the back of the ambulance on the way to Cardiff. I called Ambulance control and advised them that I was going off-service for a while – I had to follow the vacuum splint to Cardiff to retrieve it and then head home to get changed out of my soaking wet clothes. I had a thanks from control and from the police Sargent whom I’ve now seen on a few incidents in the area. I had a chance to chat with the lady in A&E and found that she had indeed fractured her fibula right on the ankle. I wished her well and picking up the splint headed home for chips and a shower and some dry clothes. Despite going back on service the rest of the night was nice and quiet as was the rest of the weekend – I’ve even managed to (finally) finish painting the bathroom.

How was your weekend?

Jamming my shoes and jacket on quickly, Sean and I ran out and drove off. Arriving on scene, I texted one of our senior guys who I knew was en route and quickly changed into my boots and a hi-viz. I could see someone standing up by a small quarry uphill from us and Sean and I headed up the scene. A young lad had broken his leg and the ambulance crew were already on scene. We had a few interesting moments but apparently they’d already called 169 to come and assist and apart from covering them in a KISU tent and trying to organise a winching location for the helo, there wasn’t much for us to do. I had the amusing moment of clearing the scene of helmet-less people (mainly police) but other than that it was a fairly rapid and uneventful callout. 7 mins from pager to being on-scene and I think we were stood down within about an hour.

Couple of things come to mind though as I look back and analyse my own actions. I was very aware that although I’d joined First Responders to get some experience of dealing with scenes, this one threw me because I’d concentrated so much on the medical and there was nothing for me to do here – there was a paramedic on scene. I did have concerns about their health at one point since it was damnably cold up there, but 169 shocked us all as it suddenly appeared from over the hill and we were gone before it became an issue.

So, in retrospect, and knowing that hindsight is 20:20, what I could have done better:

• Got a better handover from the ambulance crew. To be fair, the paramedic was being a little brusque and somewhat territorial with his casualty, and while I could have been more assertive, it wouldn’t have benefited the casualty any unless 169 would have taken another hour or so.
• Got my KISU tent out. It was cold up there, but I was mainly trying to get a handle on the scene and get in contact with the rest of the team whilst Mike (who arrived a few minutes after I did) got his KISU tent out.

I think I did OK, certainly room for improvement, something I suspect will come with experience. I certainly think that had we remained there for any length of time I would have chosen a number of actions – got the ambulance crew out before they got hypothermic; got the casualty in a cas bag; moved him onto our stretcher off of the ambulance’s scoop stretcher; certainly I would have offered the casualty some Entonox I think - the Paramedic was sure that the kid was OK with his pain (until he nudged his leg), but I’m not sure how much of that was bravado on the young lad’s part. He refused my offer of Entonox since the casualty was hypothermic – it’s a controversial subject since it’s not technically contraindicated for hypothermic casualties and so long as the cylinder is above -4 celsius it should be ok (you have to shake it first when it’s cold just to make sure it’s mixed). My biggest concern would be monitoring his consciousness levels given that both hypothermia and Entonox can in extreme cases affect it.

Anyway, some food for thought. Good result and the young man seemed to be happy as he got his first helicopter flight, his leg momentarily forgotten as 6.5 tons of noisy, yellow helicopter thundered overhead.