Emergency Call, 21 Month Old, Fallen From Chair, No other details.  Its Dark, rush hour, and a drive of over 20 minutes on blue lights on the motorway, dual carriageway and other urban roads to a new estate that I have only been too once before.

The street is very dark, all of the house numbers in this new build estate are silver on a white door which makes it very difficult to find the house that we are looking for.

Should I be worried?

I have a child of a similar age and he bounces well and doesn’t injury too easily, he has fallen off of countless chairs and sofas and worse and he generally just brushes himself off and all is fine.

I have been out to a child in the past who also fell from a chair that I assessed as well as I could and could not find any injury, I gave the mother advise who listened to it and made a decision to take the little one in the next day, for a Dr to find a fractured skull – all very easy to see some 24 hours later when bruising occurs, not so easy to see only 24mins after the event when nothing is visible.

“I think I might take this one in” and we haven’t even found the house yet!

We get into the house and the mother is all of a panic, she starts her story half way through assuming that we know everything that she has told the call  taker in the Emergency Control Room.  I manage to stop her and get her to start from the beginning – this does some good as it gets the mother to calm down a little.

The patient, a 21 month old female, was jumping on the sofa with her older brother and has fallen off – we presume.  The mother was in another room when she heard a thud and then a scream…..

Knowing some of things that I know, a thud is bad,   the child has actually fallen on to the floor – a scream is good, the child wasn’t knocked out! But obviously mother doesn’t know these things and is just concerned about her baby.

Mum has picked up little one who is crying and guarding pain on her side, so she has put her down on the sofa, and is now sat in the very position that she was sat in over 45mins ago!  The child hasn’t moved, not when her Mum talks to her, not when her dad came into the room, and not when 2 green men came in to see her.  She has been seen to move one of her arms and also the leg on that side of the body, but not the other two limbs or more importantly her neck….

Cervical Spine X-Ray

OK, so what do we have here?  There is very little test that I can do to a child as we don’t carry a huge amount of moitoring kit suitable for kids.  Head Injury? Spinal Injury? Limb Injury? Soft Tissue Injury?  It could be either or none of these, but there is something that I don’t like about the way she is sitting.  Sat up on the sofa, half slumped with her head slightly to one side, she needs to go to hospital, but how the hell do we gt her there?

Its time to think outside of the box, we need to immobilise her as best as you can a nearly 2 year old – For adults we put a collar around their neck and then strap them down to a rigid stretcher or a large flat bean bag that we suck all of the air out of – a vacuum mattress…..

We get a large flat vacuum mattress that is normally used for Adults legs, I had only used one a few days ago for a lady who had fractured her Femur. I get mum and dad to gently manoeuvre the baby so that we can get her laid onto this bean bag which has been lined with her blanket, we then very gently wrap the splint around the baby and suck the air out so that it becomes rigid.  We all can breath a little better now that it is unlikely that we will worsen any potential injuries that she might have.

Now we need to get her to hospital, its a 15min drive on a good day, but its still rush hour, do we blue her in but drive very carefully or do we just go in “normal speed” so as to keep the ride as comfortable as possible?  We opt for the final choice, she seems to be comfortable and isn’t crying, so slow and steady is the order of the day.

Just before we get to the Emergency Department we call ahead to let them know what we have and what we are bringing to them.  We get ushered straight into the resus area of the ED where there are at least three Doctors and countless nurses stood the other side of the hospital cot from me. We very carefully move our precious bundle over to the hospital bed and I start to give my handover – you could have heard a pin drop – everyone of the trauma team are listening intently, nobody interrupts me and all questions are kept until I have finished.  I felt like I was in an episode of The Dragons Den, but no cash prize is available this time!

A few hours later we return to the hospital with another patient and the Doctor who was in charge of the Trauma Team comes to explain that child has a fractured collar bone on not just a soft tissue injury as they had suspected, however more worryingly the X-Ray had shown a 50% displacement of the child vertebrae between C1 and C7 (Top of the neck and the bottom of the neck) and was currently calling for a specialist to further assess this patient………

……I hope she is going to be OK