Star reporter Ilanit Chernick and photographer Simone Kley spent a day with Emer-G-Med paramedics to witness first-hand how they work and to understand how injuries are classified and what the definition of the different types of injuries.
Johannesburg - We raced off, lights flashing and sirens blaring, everything around us blurred, the anticipation building as we rushed to see what awaited us at the scene.
We knew it was an accident, but we did not know how bad it was or if there were any serious injuries.
“Clear left,” called Intermediate Life Support (ILS) medic Maxwell Cohen as his partner and accident consultant Eddie Clarke wound their way through a busy intersection on Oxford Road.
The traffic light was red but we had to go. Time was of the essence as concerns mounted that lives were endangered. “But you have to be careful, you don’t want to become the accident or the casualty yourself,” Clarke said.
Cohen and Clarke are first responders. Unlike other services, which send resources only once injuries have been confirmed on the scene, Cohen said. “We run accidents and incidents as they happen.” The team travels in a joint initiative accident management vehicle between Emer-G-Med Proline Autobody and First Road.
“We have a towing radio in the vehicle so we respond immediately when a callout is made.
“We don’t always get dispatched by the (Emer-G-Med) Emergency Operations Centre. Most of the time we dispatch ourselves. This makes a big difference because a fast response time can save a life, every second counts,” Cohen said.
When we read about accidents or shoot-outs, often we are told that victims have sustained “minor”, “moderate” or “serious” to “critical” injuries.
But what does that actually mean?
As we attended to each emergency call Cohen explained the types of injuries which the patients had sustained and why they fell under a priority one (P1), a priority two (P2) or a priority three (P3) injury.
P3 denotes minor injuries, “the walking wounded”, such as cuts, bruises or soft tissue injuries: in other words, a patient who has stable vitals and a normal level of consciousness.
P2 injuries are more serious, but not life-threatening, and these types of injury include dislocations and simple broken bones.
Patients with chest pain and strokes can also be considered as being moderate to serious, because in some cases while the vital signs may be stable, there is always a possibility that the patient may become unstable.
“P1 is when someone is at death’s door and needs immediate advanced life support intervention. They usually have unstable vital signs and a low level of consciousness.
“This can include head injuries, uncontrollable bleeding or direct injuries to internal organs,” Cohen said as we made our way to an accident involving several children.
He said certain factors needed to be taken into account when classifying the seriousness of an injury. “We look at a patient’s injuries, their breathing, their level of consciousness, if they’re mobile or walking around and if their vital signs are within normal ranges.
“At a scene we take the patients’ blood pressure, blood-oxygen level, heart rate and check their level of consciousness, breathing and their blood glucose level - especially if the patient lost consciousness without hitting their head.”
As we made it to the accident involving small children, we watched as Cohen assessed a child complaining of a sore leg. “She’s sustained a minor injury because it’s soft-tissue related, meaning it involves muscles, ligaments and tendons. It doesn’t seem like any bones have been broken,” he said as he took the child’s blood pressure and listened to her heart.
“With young kids, we always suggest that they go to hospital, especially if they’re not strapped in - because they can’t always tell us exactly what’s wrong.”
At a scene paramedics also look at the state of the vehicles involved in a collision, which is otherwise known as the “high index of suspicion”.
“We look if the windscreen is cracked from a head hitting it, if the steering wheel is bent from the force of a patient’s chest, if the car has rolled, or if the airbags have been deployed. In these cases, we may treat the patient as P2 straightaway even if they’re walking around,” Cohen said.
Adrenalin in an accident victim can also mask serious injuries.
“I’ve seen someone with a broken neck walking around but, because the patient's body was pumping adrenalin from being involved in an accident, they couldn’t feel the pain or realise the seriousness of the injury. Unbelievable, but I’ve seen it happen,” Cohen said.
As we watch Clarke, it’s hard not to notice that he is brilliantly prepared to deal with logistics in any type of scenario. “You have to be seven steps ahead.”
He gave us the run-down concerning protocol, in a bid to make sure that we remained safe, especially in the face of a mass casualty scene.
“Sometimes we land up working on a busy highway and we have to put cones down in a specific way to keep the paramedics, patients and vehicle safe. We block a lane or several or even the whole highway. Don’t get out until I’ve put those cones down.
“I’ll tell you when it’s safe. You always have to be watching traffic because people don’t slow down when they see an accident scene. If you’re standing near a vehicle at the scene and a car goes out of control through the cordoned off area and hits the car you’re standing by, you will become the patient.”
And suddenly we’re off again, sirens wail once more as a sudden call comes through on the radio alerting the team to a shoot-out in Sandton. “Proceed with caution,” the radio called as Cohen confirmed to the dispatcher that we would be attending.
Luckily those injured sustained only minor injuries, which included cuts that needed stitching.
As we weaved in and out of traffic to another accident scene, it was interesting to see drivers' behaviour as they reacted to the oncoming emergency vehicle.
“Some days they make way for us, other times it can be impossible,” said Cohen.
“Sometimes they even freeze, we’ll be coming down the highway and we’ll need to get into the emergency lane and they’ll move into it.”
We continued at high speed up the road as Clarke, concentrating hard, told us what made it all worth it. “What I love about this job is the difference we make to so many people. To be there for them and to help them to the best of our ability.”
To Cohen the best part of his job is saving lives. “Sometimes we get to a scene and a patient is at death’s door and we’re able to bring them back where they even sometimes start talking to us in the ambulance, it’s a great feeling,” he said.
As the day came to a close, we were reminded of the amazing and brave work we had witnessed. People like Cohen and Clarke are part of a team of unsung heroes.
Their job is fast-paced and at times tough, but always all in a day’s work.
Second opinion in nick of time
Two years ago Sarah* sustained what was believed to be minor injuries during a car accident, but that was not the case.
Sarah told The Star that she’d hit her head hard on the windshield and had a few cuts and bruises.
“My car was a complete write-off. A taxi shot a red robot and hit me on the driver's side. He T-boned me. I was strapped in, but I was okay,” she said, adding that the car had spun but not rolled.
“My head hurt and I felt a little dizzy,” she said.
When paramedics arrived at the scene, she was secured on a backboard, because she was complaining of a sore head. “They wanted to make sure there wasn’t a head injury.”
She was rushed to an undisclosed hospital, where she was scanned for signs of a head injury. “They did a full neurological exam, they checked the scans and concluded that all I had was a concussion. They stitched me up but kept me under close watch.”
Sarah stayed in hospital for observation for a night and was released later the next day.
“Following the accident I had to deal with all the paperwork, insurance and all the nitty-gritty details.”
With time life went back to normal for Sarah. “I was back at work and I felt fine physically. I also had my stitches removed a couple of weeks after the accident,” she said.
But seven weeks later, things took a turn for the worse.
“I started having headaches in the area where I hit my head and terrible pain at the base of my skull. I went for physio, thinking it was just some sort of delayed reaction and maybe muscle stress as well.”
The headaches worsened and taking non-prescription pain medication no longer worked. “One night it was so bad that I actually phoned a friend whoâ??s a doctor because my vision was blurring at times as well. He came over and did another neural exam, he called an ambulance straightaway, he was worried that Iâ??d had a slow brain bleed that the scans couldnâ??t pick up after the accident because it was so small,” she said.
She was given a scan, which revealed a brain bleed, requiring emergency surgery. “It was no one's fault, but sometimes these things happen because the initial bleed is so small and undetectable.”
It took her about three weeks to recover after the brain surgery. “I was in hospital for just over a week, I’m really lucky it was picked up in time. Another few weeks and it could have been fatal.”
Today all that Sarah has as a reminder of that difficult time is a scar just above her hairline.
The Star