Page 38 of Welcome to the Cornish Country Hospital

The first job came within twenty minutes of Danni’s shift starting. It was a call out to the kissing gate between Dagger’s Head and Penwick Point. It was on a track that veered off from the main coastal path, but the views from Penwick Point made it a popular spot for picnics, where couples could take the perfect selfie of a romantic day out.

‘Okay, the information we have so far is that the patient’s name is Glen, a male aged thirty-three, with a severe bleed and possible break to at least one lower limb.’ Jonty, one of the paramedics, gave the briefing as they arrived. There was no vehicular access to the site of the accident, so they were going to have to leave the ambulance at the closest point they could reach, about two hundred metres away from the kissing gate. ‘The good news from reports on site is that he’s had some initial first aid from an off-duty nurse who works at St Piran’s, but the worry is that she’d been unable to stop the bleeding at the time of the last update.’

‘Okay, we need to get down there fast.’ Danni could feel the adrenaline pumping through her veins. This type of situation always felt like the reason she’d chosen emergency medicine. Even when an incident bore no relation to what had happened to her father, every time she was able to make a difference to the pre-hospital treatment of a patient, it felt like a tribute to him. ‘If he’s got a broken femur, that could cause catastrophic uncontrolled bleeding and the sooner we can get a traction splint on, the better.’

‘Let’s go.’ Jonty passed some of the equipment out to Danni and Julia, the other paramedic, in what was such a well-rehearsed routine it almost felt choreographed. The team underwent so much training in preparation for incidents like this, they knew exactly what would be needed.

As they moved along the coastal path, to the point where the track led off towards the kissing gate, Danni slipped on the loose surface beneath her feet more than once. There were small stones on the path, almost like patches of gravel, and it was so easy to be wrong-footed if you didn’t pay attention to where you were walking.

‘I can see them, just up ahead.’ Julia called out as the kissing gate came into sight and, just in front of it, there was someone lying on the ground, with a woman kneeling by his side, and a bare-chested man holding his head in his hands crouched on the floor nearby.

‘It looks like there might be more than one injury.’ Danni picked up the pace, and the woman kneeling next to the patient suddenly looked up.

‘Oh thank God.’ Danni recognised her immediately. She was one of the nurses working on Connie’s ward and her name had stuck in Danni’s mind because it was so unusual. And she’d told Connie, on one of the occasions when Danni was there, that it was her first job after completing her training.

‘Hi, Thalia. I don’t know if you remember me, but I’m Danni, one of the A&E doctors, and this is Jonty and Julia.’ She gave the young nurse what she hoped was a reassuring smile. She’d been in this position herself before, having to provide first aid, not long after she’d started her medical training. Despite being the most qualified person on scene, it had still felt hugely daunting, and the responsibility had been overwhelming when there was no one else around to consult with.

Thalia was applying pressure to the wound on the patient’s leg, with blood soaking through what looked like it had once been a pale blue T-shirt. She’d elevated the patient’s leg too, using two rucksacks. But even before she spoke, it was obvious the steps she’d taken to try and stop the bleeding weren’t having any effect.

‘I just can’t seem to get the bleeding under control. Jimmy gave me his T-shirt, so I could use it when I put pressure on the wound, but it just keeps coming. We managed to get Glen’s shorts off, so I could get a proper look at his wound. I can’t see any sign of a bone, but he’s got a deep gash to his thigh and I think from the pain he’s describing that he might have broken his femur. He’s got no pain anywhere else, but he’s in agony with his leg.’ A groan from the patient backed up Thalia’s words.

‘Thank you, you’ve done a great job.’ Danni gave the young nurse a brief smile before crouching down by the patient. She was relieved to hear that this breathing was regular and even, but she needed to carry out a top-to-toe assessment. ‘Hi, Glen, I need to check you over to make sure we don’t miss any other injuries that might not be as obvious as your leg. There’s no pain in your neck or back, is that right?’

‘Uh huh.’

‘And you didn’t hit your head when you fell?’

‘My leg took the full force of the landing.’ Glen grimaced in pain, his face completely ashen. There was no time to waste given the extent of his bleeding and they needed to work as a team, while Danni continued her assessment.

‘We’re going to give you some pain relief, Glen. Is there anything you’re allergic to?’

‘Morphine makes me really sick. I had it when I dislocated my knee playing football and it was almost worse than the pain.’ He grimaced again, emitting a low moan from the effort of talking. ‘But this is so much worse.’

‘I think we’ll try some ketamine in that case.’ Danni looked at Jonty and Julia, giving them a small nod; their regular training meant they could all slip seamlessly into action. They’d need to administer the pain relief and check Glen’s vital signs, to decide whether the blood loss might be at risk of sending him into shock. They would also give Glen oxygen via a face mask and check his neovascular function, to make sure it was safe to administer the pain relief. All of which would leave Danni free to see if she could stop the bleeding and to complete her assessment of his injuries. He was going to need some antibiotics too, given the risk of infection spreading from the wound on his leg.

‘Okay, let’s take a look at what we’ve got here.’ Danni lifted up the T-shirt stemming the blood, and there was a large open gash on his thigh. It was clear from the alignment of the upper part of his leg that there was a break of the femur, and Danni turned back towards Thalia. ‘Can you reapply the pressure, until I can pack the wound.’

‘I didn’t want to try that without sterile dressings, in case there was a risk of infection.’ Thalia looked like she might burst into tears at any moment. She’d had to make spur-of-the-moment decisions and she was clearly doubting herself.

‘You did the right thing.’ Danni gestured towards the man sitting further down the track, with his head in his hands. ‘What about Jimmy, is he okay?’

‘He’s just in shock, I think. He saw Glen slip and then keep going until he hit the rocks at the top of the cliff edge.’ Thalia shuddered. ‘I think it’s the idea of what might have happened if he hadn’t broken his fall that’s really freaking Jimmy out. He managed to pull Glen back up to the path, to stop him falling any further, but he’s terrified he might have made the injuries worse.’

‘You’ve both done the best for Glen you possibly could.’ Danni briefly rested a hand on Thalia’s shoulder, before raising her voice and turning towards the patient. ‘Okay, Glen, I’m going to pack your wound now with a sterile dressing so we can stem the bleeding. Then we’re going to put a traction splint on to help stabilise the bone, because I think Thalia’s right and you’ve broken your femur. But we can confirm all of that once we get to the hospital. How are you doing?’

‘Better now.’ Glen’s voice was muffled by the mask, but his face was already a better colour as the pain relief started to kick in.

‘How are his vitals?’ Danni looked towards Jonty and Julia.

‘All stable at the moment, including his femoral pulse.’ Julia accompanied her summary with a thumbs up and there was an audible sigh of relief from Thalia.

‘Great stuff.’ Danni gestured towards Jimmy with her head. ‘Can you just see how Glen’s friend is doing? It’s obviously been a nasty shock.’

‘No problem.’ As Jonty headed off to assess whether Jimmy might need any treatment, Danni got to work packing the wound, before securing it firmly with a bandage. If that didn’t work, there were a couple of other things she could try, which would reduce the blood supply to the wound, but there was always a risk those techniques could reduce the blood supply to the rest of Glen’s leg too. Thankfully packing the wound seemed to be working.

‘It looks like that’s stemmed the bleeding.’ Danni resisted adding the wordsfor now. If it bought them enough time to apply the traction splint, that could help reduce further bleeding too. ‘I’m going to apply the splint now.’

Danni moved quickly. Placing the splint under Glen’s leg, she adjusted the length, before attaching straps across his thigh and ankle.

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