Pain Scale

Whenever I teach (formally or informally) St John members about getting details from a patient who has "pain", I always use the acronym, PRQST. Originally taught to me whilst on my AA2 course by Dr. Rob Russ, it should stands for:

P rovocation (what caused it? Or what were they doing when it first started?)
Q uality (is it stabbing, aching, etc?)
R adiates (does it radiate anywhere?)
S core (on a scale of 1 to 10, where 10 is the most severe*)
T ime of onset

I also point out that patient's perceive pain differently, so the actual values are not so useful. I was on duty a few days ago, and a perfect example presented itself!

First patient was a 12 year old lad who with bruising to his ankle. Scored as a 7.

Second patient was a 40 year old man who had landed very heavily on his bum, causing bruising to his coccyx and lumbar spine. Scored as a 2-3!

So, remember folks, a single pain score is not useful by itself! (Same as BPs, etc, but that's for another time...)

*Interestingly, the same day that we were taught this, we were also taught that it's probably little use. A&E (apparently) only vary the amount of pain-relief given dependent on whether the pain is MODERATE, AVERAGE or SEVERE...

Likely to be busy?

So, if you were on your way to an event in an Ambulance, pull into McDonalds to get breakfast and see a car parked in a hedge, how busy do you reckon you're going to be at that event?

I'd reckon pretty damn busy. And it's definitely not a good sign when you park up, walk into McDs calmly and you're met at the door by the comments, "Oh. You're arrived just in time."

Crap.

A few exciting heroics later, including boosting a copper over a toilet cubicle partition, and having kept a straight face whilst hearing a 5-foot nothing drunk* tell a 6-foot copper to "stop disrespecting me, yeah" and "arrest me if yah can, yeah" and then watching her get marched away under arrest, we left a little later than expected but with free breakfast...**

* And yes, it was 7.30AM. And she was still drunk. Which might explain the car. Although in actual fact, she hadn't been driving. The driver had left her behind when he'd legged it...
** Sorry for the terrible English folks!

Achmed, The Dead Terrorist!

An RTC

My housemate bowled through the front door: "Nick? Have you got your shoes on? There's been an RTC 30 seconds down the road. No Ambulance. No Police. Body on the floor."

I'd like to think my first response was, "Ah." It would have been in a PG-rated world. It probably wasn't.

I forced my feet into the nearest pair of trainers I could find - I simply didn't have time to find my boots! Going through the door to my room, I barked at James to grab his Hi-Vis. Thank God we'd been lazy and not returned it to Division yet.

I ran down the stairs and followed James out of the door. I headed straight for my car, and grabbed both Bomber Jacket and Parabag out the boot. I chucked my stuff into James' car, and we rolled. Sadly, there was no music playing in the background to make us look cooler - no heavy bass beat that we could work to. In hindsight, maybe we should have put an iconic tune on? Would it have helped?

28 seconds later, we pulled around the corner and could see the blue lights twickling through the hedges. Thinking we were too late, we pondered what would be our next step. As we got closer though, the lights turned out to be a single Police Car, parked across the road protecting the scene. James pulled his car to a stop, and I dived out. Bomber jacket on, Parabag on the back, I ran for the scene. As agile as a Gazelle. As fit as a marathon runner. As full of the brown-stuff as certain St John members ... *

Crossing the road, I could see a simple Police Officer kneeling next to the patient - a lad, with a number of blankets over his legs, his face obscured by the Policeman. Next to them was a Volvo XC90 - the backwindow was gone, smashed clean away. But I didn't notice that until later.

I tapped the Policeman on his shoulder as I got close enough, just at the point when I saw the lad's face. There was blood everywhere. Oh bugger. The Policeman was clearly relieved to see me. Or at least to see somebody clad in a well-used green and yellow Hi-Vis. I was less relieved to be there.

DRsABCDE flashed through my brain. The clever little abbreviation used by St John.

Danger. Am I likely to get run over? Nope, there's a cop car there. I'm safe. We're safe!
Response. Talk to me buddy; talk to me! Great, he was! GCS of 14. I'll go with that.
Shout. Fuck that! I am supposedly the help!
Airway. He was talking, but what about his neck? He's obviously been cycling. And now he's not.
Breathing. He was talking. Would that suffice?
Circulation. Illuminated by a couple of orange streetlamps, was he pale? Too early to tell.
Disabilities. Erm...
Environment. It was cold, admittedly. He was lying on the cold, hard tarmac, but there was nothing I could do about that!

And at that, I realised I'd run out of letters. Balls. And to think, a minute ago, I'd had plenty of letters running through my head. Computer Science abbreviations, all of them.

"Hiya mate, my name is Nick. Sorry to be rude, but who are you?"

"Bob."

"OK Bob, can you tell me what happened? Where do you hurt?"

Bob stammered a bit, trying to remember what had happened. But he couldn't. A bystander then told me:

"He's been knocked off his bike."

Descriptive, I suppose.

"OK, how fast was the car going?"

The bystander couldn't give me an answer, so I repeated my question to Bob:

"Where do you hurt?"

"My leg. My leg really, really hurts."

"OK mate, anywhere else? Does your neck or back hurt at all?"

Regardless, I'd already made my mind up. Until such time as somebody paid more than I am tells me otherwise, his neck is mine! Mechanism of injury, right?

"No," he replies. "Not at all."

"OK. I'm going to have to just hold your head for the time being Bob. I'm a little worried by how you've been knocked off your bike. OK?"

"OK mate. What's happened?"

Thankfully I was saved from having to answer that question by the timely arrival of James, and his question:

"What's going on? Anything I can do?"

"Check his leg for me please, James?"

Somebody in the crowd then, quite helpfully, told us, "Don't look mate, it's broken!"

Great! There's a medic in the crowd. Front and center, son!

Of course, James did look, as he should have done, and turning to me, said simply, "It's bust." I understood him perfectly. It was bad, but not life-threatening. Thank God.

I was just thinking about our next step, when I realised that James' face was being illuminated by another source of blue light - the Ambulance. It had arrived just behind me, and within seconds, the crew were on scene.

A quick hand over, Entonox, Box-splint, some screaming and a log-roll onto a spinal board later, the patient was safely stowed on the Ambulance, and on his way to hospital. The thanks of the Ambulance crew still ringing in our ears.


* Some, not all. Some are good people. Some are not so good.

Trailer: An RTC...

So, how does the following sound for a nice refreshing break from revision?

My housemate bowled through the front door:
"Nick? Have you got your shoes on? There's been an RTC 30 seconds down the road. No Ambulance. No Police. Body on the floor."
"Ah."

Story to follow, after my exams!

"The Secret in Building 26", by Jim DeBrosse and Colin Burke

In the top-secret world of Cryptoanalysis, little has ever been revealed about the codebreakers who made such a huge contribution to the Allies Military Intelligence during World War 2. Even nowadays, as previously classified material is being released, books on the subject are rarely commonplace. I have previously only read one on the subject matter - "Colossus: Bletchley Park's Greatest Secret", by Paul Gannon. And this is in a field that relates heavily towards my degree!

This book covers the contributions of the US Navy code-breakers to the war effort, and was very interesting. I had no idea of the level of work performed by the Americans. The book itself was easy reading, but some of the technical descriptions of cryptoanalysis methods are sadly lacking! Don't look here for a detailed description of how it was done, but instead, look here for a solid description of the sheer scale of the problem, and of the people and organisations involved.

Written by Dayton reporter, Jim DeBrosse and security historian, Colin Burke, I feel that the biggest problem with this book is that the authors seem to delight in black-mouthing the British. The relationship between the British codebreakers at Bletchley Park and their American counterparts was prickly, but the book contains constant jibes at the British, as if accusing us of causing all the problems!

That said, it is an interesting read. Definitely one to read if you're interested in the Military Intelligence side of World War 2.

"The Last Fighting Tommy" by Harry Patch

What does the nation know about Harry Patch?

The first time I saw him, it was on TV, and he was over 100 years old, and sat small and frail in his wheelchair. But he was still a proud soldier to whom the Queen paid tribute. But I fear that is all the nation knows him as - as being "The Last Fighting Tommy", even though Harry is more than just that.

This wonderful book recognises that. It's more than just his wartime memoirs. It includes Harry's description of his life around Combe Down (Somerset) and it's quarries, which is teeming with local references and I'm sure will encourage some readers to go exploring! It includes details about his Edwardian childhood, which will be interesting for social-historians. It includes how his life was affected by World War 2, and in later years, by his son's drinking. The last few chapters are a sad reminder that at 109 years old, Harry has outlived most of his friends and family.

And it's all been with the help of Richard van Emden, a well-respected World War 1 expert and author of many WW1 books ("Britain's Last Tommies", "Boy Soldiers of the Great War" and "The Trench" to name just a few). The end-result is a beautifully written set of memoirs that I hope has done Harry proud, beautifully interlaced with historical notes. And will stand as a testimony to the truly incredible life of an ordinary man, but who is now a legend.

Would I recommend this book? Oh yes! It's a must read for anybody interested in World War 1. But if you're looking for a vivid account of life on the Western Front, then this may not be the best book for it. Harry's descriptions of his time on the front line are short, and understandly so considering he lost three very close friends there.