Memoirs of an Emergency Nurse Read Online Free PDF Page B

the patient the next day as I still couldn't believe we had saved his life twice. He was so lucky.

Horse and Hound
    Classical foxhunts on horseback are few and far between in the UK due to the ongoing debate about them and the widespread protests.
    This particular day, the paramedics brought in a horse rider with suspected neck injuries. The patient was carried into the department on a spinal board and with head blocks and C spine collar on. I recognised him immediately. He was the head of a foxhunt, a countryman dressed in full classical fox hunting attire. His bright red jacket stood out from his black riding jodhpurs and shiny black riding boots. I don’t recall his name but I do remember the looks on the paramedic’s faces when they brought him in. They were not happy that he was a foxhunter. Sometimes, personal feelings can’t help but get involved in situations. At the end of the day, we are only human but attempt to be non-judgemental regarding people’s beliefs and values.
    I took handover from the paramedics and began my observations of the patient. The patient was stable and talking. He lay still and flat on the trauma trolley, fully clothed and damp from lying on the wet ground. A nurse was holding the patient’s head and neck to keep his spine in line; a hard collar was in place around his neck. He told me that he was head of the hunt and that he was following the family tradition by carrying on the country way. He had been leading the hunt on his horse up a hill; the horse had lost its footing and thrown him forwards over the horse. He had fallen head down onto the ground with a bent neck.  He knew immediately that something was wrong and he had stayed still until someone called for help and the paramedics arrived.
    From the history alone, it was suspected that the patient had spinal injuries. The mechanism of the injury was a fall from a horse more than two meters high, at canter speed, full force of speed and patient’s weight directed at his head and bent positioned neck. All indicated a high risk of spinal damage. Immediate pain had been felt at the cervical spine area at the scene and although the patient could feel all his limbs, he had tingling in his right arm.
    The routine in emergency for any trauma patients, once their airway is maintained, is to remove their clothing so the damage to the body can be assessed. The main priority in a spinally injured patient is to maintain the spine in a horizontal position, with the patient’s movement at a minimum. The easiest way to remove a patient’s clothing when in a neck collar with minimal movement is to cut the seams of the garments and then, with many hands assisting in rolling the patient, the cut clothes can be removed without assistance from the patient and without compromising spinal position.
    I remember asking the patient if we could do this and was shocked at his reaction. Most people are so glad to be receiving medical treatment and scared of paralysing themselves by moving, they will do anything we suggest to help; after all, they can buy new clothes but they can’t buy a new body.
    This patient shouted, “NO WAY! This jacket cost six hundred pounds. Do not cut the jacket.” Bear in mind that the patient had been lying in wet grass, he was cold and the jacket was made from thick wool which would have hindered the radiology process. We also needed to rule out back injuries and assess for open wounds not visible through a thick wool jacket. After several attempts to inform the patient of the reasoning behind cutting the clothes off and persuasion towards it, he remained firm in his decision and wouldn’t let us cut his clothes off.
    The nurse holding the patient’s cervical spine in line did a wonderful job as one by one item of tight clothes were removed. Each riding boot was vacuumed to his skin from the wetness and I had to use my leg weight against the trolley to pull off the boots. The jacket just didn’t move when the material was