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Joshua sighed and glanced at the number. A&E. He’d get to it in a minute. But the minute hadn’t even passed before the pager sounded again, this time not stopping.
MIA—a major incident alert. It only happened a few times a year. A code red was a paediatric cardiac arrest. Unfortunately, they happened frequently, particularly with the really sick kids in ICU. But MIA was slightly different and always came from A&E. He glanced quickly around the ward and shouted, something he rarely did. ‘Ron! Find Isaiah and Clara. Tell them there’s a major incident and to assemble in A&E.’
Joshua ran down the stairs of the hospital, meeting several other senior colleagues heading in the same direction. ‘What is it this time?’ one asked.
He shook his head. ‘Don’t know yet.’
As they walked through the swinging doors to A&E there was a momentary lull. All the A&E staff were crowded around the nurses’ station. Alan Turner was standing on a chair that looked decidedly wobbly.
Alan gave Joshua and a few other Department Heads a nod as they joined the group. ‘Okay,’ he said, lifting a hand in the air. ‘Five minutes ago we got a call about a major Road Traffic Accident, involving up to an estimated seventy casualties. Two buses have collided. One a tour bus, and one a bus with kids on a school trip. A major incident alert has been declared. Our flying squad emergency team have just left to assist on the scene. The Royal Hampstead is the nearest major trauma receiving centre. Twenty ambulances and two air ambulances are on their way to the scene. If you have patients currently in A&E then clear them out. We need all areas. If you have patients upstairs you can discharge, then get some of your colleagues to do it. Beds will be needed.’ Alan started pointing at areas and shouting instructions as Clara ran up to join Joshua.
‘What is it?’ she whispered.
‘Major RTA. Up to seventy casualties. A busload of kids is involved.’
She nodded as Alan turned to them. ‘Paediatrics will be led by Joshua Woodhouse, Clara Connolly and Isaiah Orun. They’ll be based in Resus One and Area Six. Bess, Reid and Fran will assist.’
Joshua spun around and nodded. ‘Let’s set up,’ he said as the nursing staff joined them. They all moved methodically, requesting any specific paed equipment they might need and setting up their own small triage areas for children. Clara and Isaiah moved like the professionals he would have expected. Once they were set up, the silence across A&E was almost deafening. Patients had been moved to X-ray and short-stay areas. Others had been transferred up to ward areas for further assessment. Walking wounded had been sent to a nearby GP practice who helped in emergency situations. And the rest of the staff were just...waiting in an ominous silence.
It was only a few moments before the shrill ring of the red phone at the nurses’ station broke the silence. Alan answered quickly, talking in a low voice and taking a few notes. As soon as he replaced the receiver he shouted to his colleagues, ‘First set of ambulances are five minutes out. Eight adults, three paeds—all major trauma.’
Joshua put his hand on Clara’s arm. ‘Do what you can do—and if you need help just ask. We’ll work alongside each other. Hans is on his way down—he’s finishing up in Theatre—along with a few of the surgeons. They’ll be available to assist.’
He watched her take a deep breath and give a slow nod. He wondered for a few seconds if he should worry about her. A major incident alert wasn’t for the faint-hearted. It could be a time of chaos. Lots of professional staff were unprepared for what they might encounter and have to deal with over a short period of time. But as he watched he saw her give him a serious kind of smile. She was just taking a minute, preparing herself for what lay ahead.
As soon as he’d got the page, Clara and Isaiah’s names were the first he’d thought of. They were skilled practitioners, and good at dealing with staff and patients. Clara’s straight to the point attitude was perfect for a situation like this, and Isaiah’s range of clinical skills would complement the teams.
Joshua glanced around again. Isaiah seemed to have attached himself to Bess, one of the most experienced A&E nurses. He was finding himself an anchor for the storm ahead. It made perfect sense. At a busy time, an experienced A&E nurse was worth their weight in gold. ‘Reid, with me please, and Fran with Clara. We’ll take resus,’ Joshua said, knowing that meant they would have the most badly injured children. But he walked to the main receiving door to stand alongside Alan. If he had a chance to triage all the children first, he would do that.
The first few ambulances appeared in a blaze of sirens and blue lights. Joshua stepped back once he realised the first few patients were adults. Then the children started to appear. The first boy clearly had open fractures. ‘Clara, stabilise and get ready for Theatre.’ The second boy had multiple facial lacerations. ‘Isaiah, assess, stabilise and page plastics.’
The third child was a little girl who was being bagged by one of the paramedics. He met Joshua’s gaze. ‘Flail chest. Natasha is ten. She was standing in the passageway of the bus and hit the central gear controls.’ He rattled off her heartrate, BP and respirations, filling Joshua in on her continued deterioration in the ambulance on the way to the Royal Hampstead.
‘Resus One,’ he said. ‘Any more kids on the way?’
The paramedic shook his head. ‘We were the first team. The next will be another ten minutes at least.’
Joshua worked quickly. Flail chests were difficult and quite uncommon in kids. Basically a portion of Natasha’s ribcage had separated from the rest of the chest wall. As the paramedic continued to bag her, he could see the uneven way her chest was moving.
One of the other nurses moved to take over the bagging as Reid connected the oxygen supply. Joshua was focused on the little girl, ordering analgesia and sounding her chest while the oxygen support continued. ‘Portable chest X-ray,’ he ordered. He was certain that at least one of the lungs had been punctured by a rib. He kept his eyes on the oxygen saturation monitor as the X-ray machine was wheeled in.
A face appeared in the doorway—Hans. ‘Do you need me?’
‘Great,’ said Joshua, looking up. ‘I was just about to call you. Ventilation may be required. I think there’s at least four ribs detached and a strong possibility of a pneumothorax.’ He looked down at Natasha again. Even though she was on oxygen her dusky colour was not improving much.
Clara was dealing with her child in the resus bed next to him. She worked smoothly and competently, ably assisted by Fran. He could see he had no need to worry about her.
A lead apron was passed to him by the radiographer and he slid it over his head, nodding to Reid that he would take over while the X-ray was taking place. Reid waited behind the door alongside Hans, Clara and Fran, for the few seconds it took to take the X-ray.
A few minutes later it was on the viewer next to them. Hans shook his head. Three ribs were obviously misplaced, with one clearly spearing the lung, causing a haemothorax. ‘This one needs to be done in Theatre,’ he said and Joshua nodded in agreement.
‘Absolutely,’ Clara agreed as she stepped up alongside him. Her patient was already on his way to Theatre.
Clara reached over and took Natasha’s hand, taking a few moments to stand next to the child and talk softly.
Joshua quelled his frustration that he couldn’t do something immediately to help this little girl. He’d inserted tubes before to drain the blood from a lung and help reinflate, but not while the rib was still causing damage.
‘Consent?’ asked Hans.
Joshua looked up once. ‘Reid?’ was all he said.
A few minutes later the nurse returned, shaking his head. ‘Police say parents have still to be contacted. They can’t find Natasha’s bag in amongst the wreckage of the bus.’
‘No parents?’ Concern laced through Clara’s voice as she continued to stroke Natasha’s hand.
‘Darn it. No other responsible adult who could give us the
information? Who was Natasha travelling with on the bus?’
Reid shrugged. ‘It’s bedlam out there. Police just say they’re still trying to identify Natasha and get in touch with family.’
Joshua looked down and touched the young girl’s arm, for a moment thinking that could be Hannah lying there. Hans was talking with one of the surgeons, making a plan to take Natasha to Theatre.
‘Reid? How did the paramedic know her name is Natasha?’ Joshua asked.
Reid was washing his hands at the sink. He looked over his shoulder at Joshua. ‘Apparently she told the paramedic before she passed out with the pain. But the only info he got was her first name and her age.’
Joshua couldn’t imagine this little girl going to Theatre with no one knowing. In an emergency situation like this, they didn’t need to gain consent from a parent. Her injuries were potentially life-threatening. He would make a final check with the police that they had no other way to identify Natasha right now and, as Head of Department, would make the call with the surgeon.
