Tuesday, 18 October 2016

Drills and Kidney Loss

My nine o’clock appointment has cancelled so I thought I would spend the time wisely. Mainlining my coffee (I don’t wake up until the second cup and then, man, I am up!) and exploring the vexed question of drills.
Drills are unquestionably useful; I actually really like doing simulation scenarios at work for the simple reason that it’s pretty hard to do anything terrible to a dummy! Make all the mistakes in training so that real life goes smoothly. Our scenario yesterday involved the first mate spotting a collapsed person at the bottom of the bow thruster space. The bow thruster space is found at the pointy end of the ship (mwahahaha) and it’s accessed through what looks like a cupboard right up until the point when the door is opened and a nasty drop down into the bowels of the ship is revealed! Top tip: use the ladder. Even the access ladder space is pretty narrow; when I did the engine room tour there were definitely moments when the rear wall was rather intruding on my bottom’s personal space!
The scenario used involved a collapsed and unresponsive person in the space with an unknown atmosphere. The fire fighting team therefore got to have the fun of clambering down into that space with their breathing apparatus on and oxygen cylinders strapped to their backs. Their job was to extricate the casualty as swiftly as possible, so a stretcher and spare breathing apparatus followed them down. Our casualty (Fred the dummy) was then loaded onto the stretcher and winched up onto the deck where the medical team was standing by.
At the time of the drill, just as in real life, no-one knew what the injury pattern was. So whilst we were waiting on the deck, I briefed my medical team as to their roles within the scenario. One significant concern was the possibility of trauma, so one of the team was requested to immobilise the neck. Others were detailed to go through the ABC (airway, breathing, circulation) protocols in order for us to isolate and manage life threatening injuries swiftly. When Fred arrived, one of his rubbery legs was hanging akimbo, so I decided that he had a broken leg and a collapsed lung as a result of an explosion within the space. I then fed back to my team the results of their examination findings and got them to think about the treatment options.
 Intermittently I got on my radio (we are still not really friends) and quavered,
 “Doctor to bridge...”
“Bridge...go ahead.”
And fed the bridge details of the patient’s situation.
It all went really smoothly right up until the point when we decided that we had stabilised the patient as much as possible on the deck and he should now be transported up to the hospital. In retrospect, using the internal stairs on the ship was our mistake. If the casualty didn’t have a head injury at the start of the drill, he certainly did by the end! Very tight turns, and narrow stairs are not the stretcher party’s friends. I may have left one of my kidneys on the stair rails as I was variously crushed and impaled by the stretcher against the walls. Still, that’s why you have two, right?
What did we learn from the day other than the wisdom of using the external stairs and walkways to get the patient into the surgery? We learned that stretchers are surprisingly heavy so always be nice to paramedics or they might drop you.

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