Alison Roberts - Doctor at Risk

Making a primary survey of a multi-trauma victim whilst hanging head down was not a skill Ross had previously discovered he possessed. His hands felt heavy and his head was pounding gently as gravity affected his own circulation.

‘She’s breathing,’ he reported a short time later, ‘but the chest movement looks unilateral.’

Wendy was leaning as far as she could without a rope. ‘Possible pneumothorax, then,’ she suggested. ‘Do you want a stethoscope?’

‘Not just yet.’ Ross was rubbing a knuckle on the woman’s sternum. ‘Hello, can you hear me? Hello?’ His voice rose as the woman made an inarticulate sound. ‘It’s all right,’ he reassured her. ‘I’m a doctor. We’re here to help you.’

His hands continued moving. ‘Good carotid pulse,’ he called back to Wendy. An air hammer had started up in the vicinity and it was difficult to know whether she could hear him. ‘Trachea’s midline. There’s no obvious cervical deformity and no sign of a major head injury.’

Wendy had heard. She had a cervical collar and was reaching forward to dangle the Velcro strap within his reach.

‘I’ve just guessed the neck size,’ she said. ‘She looks like a medium from here.’

‘I’m sure you’re right,’ Ross responded. ‘You’ve dealt with a lot more spinal injuries than I’ve ever seen.’ He had to wriggle forward a few extra inches to give him room to manoeuvre the collar into position. A shower of plaster dust seemed to come from nowhere and too much of it settled over the victim’s face. The demonstration that she was not unconscious enough to have lost her cough reflex should have been a relief, but Ross was not alone in the alarm he felt at the tiny movement of the concrete slab he was lying on.

Tony raised his hand and dropped it in a sharp cutting motion. Matt and Kyle hauled on the rope to help pull Ross clear quickly. He slid down from the pile of debris and staggered slightly as he tried to catch his balance.

‘You can stop pulling now, Kyle,’ he said drily. ‘I’m out now.’

Wendy was still perched above them to one side of the slab that Ross had been leaning over. ‘We need to get an oxygen mask on her,’ she called. ‘And to listen to her breathing. If she’s got a tension pneumothorax she’ll need decompression.’ Wendy was clearly frustrated by the delay.

‘It’s too dangerous for me to keep leaning over that ledge. My weight and movement could send it right down on top of her head.’

‘There’s room for me to stand down here, I’m sure of it. And I’m only forty-five kilos. If it hasn’t moved too much with Ross’s weight, I could easily get past that slab.’

Ross had to admire her courage. She had weighed the risks—almost literally—and she was determined to carry on. He would probably have chosen to assess the situation a lot more thoroughly before taking action but Wendy’s enthusiasm was contagious. So was her confidence. It was a package Ross couldn’t help responding to and it had been that way from the first moment he’d seen this woman. He recognised all her qualities as being the ones he nurtured in himself but she had a glow that illuminated shadows he’d never known he harboured. Like conservatism and prudence and maybe too much of a professional distance. It was no wonder he’d fallen head over heels in love with this pint-sized powerhouse of a personality, and he wasn’t the only one affected. Poor old Kyle was staring at her with an expression of hero-worship as Wendy put her case. And the squad leader, Tony, was actually grinning—albeit ruefully.

‘If you’re sure you want to try, it’s OK by me.’

‘I’m sure.’ Wendy looked serious now. The hint of mischief that usually lurked in that elfin face was nowhere to be seen. She was far too intelligent not to understand what she was letting herself in for and while Ross felt an almost overwhelming urge to protect her by protesting the decision, he knew his only real option was to offer his support.

And Wendy needed him. Ross took her previous and more secure position, well away from being able to touch the victim but close enough to pass supplies and advice to his medical partner.

‘Breath sounds are absent on the left and it’s difficult to hear the heart.’ Wendy pulled the earpieces of the stethoscope free as she looked up at Ross. ‘I can’t see the trachea or neck veins now with the collar on but her colour’s getting worse and she’s on a hundred per cent oxygen.’

‘I’d say a tension pneumothorax is highly likely. You’ll have to do a needle decompression.’

A look of alarm crossed Wendy’s features. ‘I’m not qualified to do that! The only thing I do with cannulae is put IVs in. We’ll have to get her out so that you can do it.’

‘There’s no time.’

‘But I don’t think she’s actually trapped under that slab. There’s other stuff holding it up and I’m pretty sure I could shift some of it. We could get a harness on her and lift her out.’

‘There’s still not enough time. If it is a tension pneumothorax and she’s deteriorating this quickly you’ll have a respiratory arrest on your hands within the next couple of minutes if you don’t release the air in the chest cavity. You can do it, Wendy.’ Ross was already sorting the gear she would need into a pouch. ‘I’ll talk you through it.’

‘OK.’ Wendy’s tone advertised her trust in his judgement. She still looked scared, however. ‘But I’m depending on you here, Ross.’

Ross had every confidence in his dependability. And in Wendy’s ability.

‘Find the second intercostal space in the mid-clavicular line,’ he instructed calmly. ‘That’s the point for the needle insertion.’

Wendy put clean gloves on, swabbed the skin with an alcohol wipe and ripped open the sterile package containing the cannula. The tiny shake Ross could see in her hands was gone the moment the needle penetrated the skin.

‘Keep the pressure on. It’s tougher than getting into a vein.’

‘I’ve got it, Ross. I can hear the hissing.’

‘Good girl. Well done.’ It was a small miracle that the noise in the surrounding area had dropped with such good timing. The reason for the sudden quiet became apparent as Ross finished his directions for Wendy to secure the cannula. He could hear the faint shout from another USAR squad working nearby.

‘Rescue team here. Can you hear me?’

Wendy had also heard the call. ‘That sounded like Fletch.’ She was reassessing her patient as she spoke. ‘Colour’s improving,’ she reported happily. ‘What next, Ross?’

‘IV access,’ Ross said promptly. ‘We’ll get some fluids running. Then we’ll see what we can do about getting her out. We might try getting her into a body splint, too. There’s no way we’re going to get a backboard down there.’

It took careful management and the skills of more than one rescue team to extricate the survivor but their success made the extraordinary effort worthwhile. By the time the woman was securely strapped into a Stokes basket for transport, her blood pressure had risen thanks to the fluid load, her respiratory distress was only mild and she had regained consciousness enough to tell them her name and thank her rescuers. A life had been saved. Wendy and Ross were congratulated as being the tight single unit everyone knew them to be.

And Ross was walking on air.

He laughed aloud when Wendy rolled her eyes at him to communicate her exasperation with Kyle’s impatience to get back to some action.

‘We’re supposed to be searching Level 2. What’s taking so bloody long?’

Wendy looked tired and Ross knew just how drained she would be feeling as they watched the stretcher carrying their patient pass into the hands of the paramedics waiting at the triage tent. An ambulance was also ready, its beacons flashing. USAR Squad 4 turned back to the mall to continue their shift. Kyle led the way alongside Tony. Ross walked at the back, his arm resting lightly on Wendy’s shoulders.