The Great North Run - run it if you're ready, not if you have medical issues

You really go places with the Red Cross.
For example, last weekend we travelled 6 hours by ambulance, 4x4 and mini bus to Newcastle, to help cover the amazing Great North Run, open to all resident nutters in the UK.
It's great in all sense of the word - great for it's long stretch which competitors have to race across, and great because it's actually a fantastic event to help at, or I suppose enter into, if you're that mad... I mean keen.

We set off on the Saturday lunchtime, taking with us RE8 and RE2. It was set to be quite a trek down the country, with the occasional rest stop in between. We paused briefly in Aviemore to pick up our own state registered nurse, who joined Ronnie and me in RE2, before continuing down the road to Perth, following the Boss and Caitlind, with Lol sleeping in the back, in RE8.
Traffic made the journey long, but banter between radios made it enjoyable. The biker boys longed for their motorbikes half the time we were trapped in a queue of cars, which was quite amusing...

But finally we made it to the outskirts of Perth at a highly convenient petrol station; fortunately just in time for a much needed comfort stop, else there would have been puddles in the vehicles...
Once we were relieved (phew) and fed and watered, we met up with our accompanying Aberdeen crew in their mini bus. Clued up with the novel that was the event's obs orders, they followed suit as we set off for the rest of the journey down.
This time I gave Lol some company in the back of RE8, and tried to settle down in the chair while she occupied the trolley bed. The chair isn't comfy, especially when you're trying to sleep, but hey, I felt gracious enough to allow ownership of the trolley to someone else for a change.

There's not much to see when you sit bleary-eyed in the back of an ambo. Lol fell asleep pretty much straight away (so much for keeping her company) while I remained flitting in and out of snoozing as much as cars flitted past the windows.
Eventually my iPod sent me into a light doze, with only the occasional jerk of the vehicle to make sure I was still with it, and when the pair of us finally came round again, we were beyond Edinburgh and nearing the borders.
Lol and me truly came awake when we left the dual carriageways and motorways behind, and we began the winding ascent to the border line. It was like a roller coaster ride - the roads were rising and falling and twisting and turning, almost like waves in a storm. Awesome fun, but a bit harsh on the stomach. Even I felt tender a couple of times, which says something; my stomach can be made out of concrete when rough rides come into play.
But we saw the welcoming sign of England as we crossed the invisible line between homeland and another country, and waved goodbye to the "Welcome to Scotland!" sign as we rounded the corner. One day, I will stand right on the border line and phone someone, just to say I'm half in Scotland and half in England. And then hop between the two a bit, just for the crack. Just a little ambition of mine; another one on the 101 things to do before I die list. Anyhoo.

As the sunset cast its final golden rays over the English country side, bleaching the sky with an orangey tinge, so the satnav guided our little RC convoy straight and true to Newcastle. As we neared the mighty Geordie city, the clouds came rolling over, and suddenly all light was fading.
We had reached Newcastle's suburbs, and to be honest, it was the dingiest sight I've seen for a while. It beats Glasgow's Gorbals in the rain at night. Now you can picture it.
It was sad to watch actually, as we witnessed from the safety of our heated ambo whole streets with shops, their signs bright and promising, but their fronts boarded up or guarded by metal shutters, with the odd bit of graffiti to add that stereotypical image.
Lol, being an ex Newcastle resident, said they had closed down for good; my naivety said it was because it was after 6 o'clock and most shops shut at 5. Smart cookie.

Then we passed schools, a hospital, culturally diverse community centres, flats, the usual outer-big-city scenes. We even passed St John Ambulance HQ, which I marvelled at the size of; it was like a white-washed mansion, with a number of their ambo fleet parked out front, guarded by a wall peaked with black railings. I like inter-organisational partnerships, but I still felt that bit prouder for being in a RC ambo.
Suddenly we turned down a road and disappeared into a cluster of houses. One large red-bricked building seemed to be a hostel of some kind. It was surrounded by a wall, trees and hedges; so private and isolated.
But the building beside it - also hidden from prying eyes by plant life and brick work -was so much better.
The stone pillars held the signs "British Red Cross", while the drive way took us past their front garden where what looked like ten RC vehicles sat in wait, as though anticipating the next day's event.
The road wound its way to the rear of the building - an eye-boggling mansion of an HQ, beating St John's by a good few bricks. It was huge!
I laugh at myself now; Elgin office is small and that's a fact, but I always thought the Inverness HQ was pretty big. Now, Inverness looks tiny in comparison, and Elgin even smaller! Everything about it was impressive; inside the building held several training rooms, a library, a reception, a canteen/kitchen area, a couple of offices undoubtedly, toilets, showers, and a wheelchair/medical storage room beating Elgin's arrangement by miles.
It was everything you needed, and thankfully perfectly adequate to live in for a night.
The local members were nice enough and were welcoming, showing us where everything we would need was located.
We met up with Ian and his partner on our arrival, and together we were shown where we would be sleeping that night. It was a training room, looking somewhat like an attic with sky-facing windows in the roof, but it was large enough to hold all of us Northern lot, and relatively comfortably too. So it was out with our kit (stashed in the back of RE2) and on to pumping up the blow-up beds, while the drivers went to wash the vehicles after their arduous drive.
Cups of tea were highly appreciated afterwards, and once we were organised, we settled ourselves down around Ian to listen to our briefing for the next day. We were joined by a group from Fife, who were also to crew the post with us (except they didn't in the end, some other random folk did, but that's by the by...)
We sat, as though in story time, and filled with excitement as we realised what we had let ourselves in for.
Post 18 was the name of our first aid point, and we were covering part of the last mile to the finishing line. This meant big casualties, and nothing like your normal blister or sprained ankle; our forecast was collapses, severe dehydration, hyponatremia (salt deficiency from bad dehydration) respiratory arrests, cardiac arrests - you name the trauma, and we were being bound to get it.
But no matter, we let it wash over us with only some concern. Our briefing paused so we could get some supper, and so Ronnie and Steve - our very own amo crew for RE8 - could get their paramedic briefing. During this the rest of us decided to explore Newcastle at night, and we popped round to the corner shop to buy some supplies to last us the rest of the night; a large bottle of coke and some nibbles. Good stuff.
We were also eyed up by a couple of thuggish, hooded blokes, who circled us a number of times and sat in wait outside the shop, trying to work out if we were worth approaching for the change. Something must have made them change their minds however, and I'm guessing it was Caitlind's RC hi vi, which must have looked too official to bother picking on. And the fact they would have been slightly outnumbered. Thankfully.

Anyhoo, back in the safety of our little attic room, we drank down our booze and enjoyed some apple pie, courtesy of Beth the nurse, predicting what we'd face the next day and planning what time would be best to get up at. This ended up being quarter to 5 in the morning, but never mind, because adrenaline kept us going. We also made fun of Lol's giant teletubby-like sleep suit which she had brought instead of a sleeping bag. It was large, but not quite big enough to hold 2 people unlike what she had claimed, after the pair of us tried to do so. It resulted in me landing on top of her with a large thud, a lot of laughter from our audience, and a broken zip.
So we slept that night, to the melodic harmony of snoring (no names - not that mean) and the occasional creak of the door as people snuck out to the toilets as quietly as was not possible, without any knowledge of what we were about to face the next day. We had been predicted casualties of a serious nature, and the run was about to give us what it had promised...

4.45am
Up, race for the showers, dress, pack away the kit.
Breakfast - bacon butties at 6am; not always good for the gut.
The sun hadn't even begun to drag itself into the sky when we jumped into our vehicles, breath hanging in clouds around our lips, dew on the grass and on the ambulance bonnets. We hug Steve and Ronnie goodbye as they warm up RE8, knowing that for the rest of the day we might not see them again. Apprehension is in the air - a slight buzz of anticipation.
Ian leads the way in his personal favourite - RE10 - and Beth, Lol, Caitlind and me follow in RE2.
The roads, quiet - no one is around - apart from the event organising team, who put up banners and road closed signs, and mile markers and railings covered in Bupa and Nike slogans.
We take the morning to journey to post 18, all 14 miles away from RC HQ. Behind our familiar vehicles stretch a convoy of RC ambos, 4x4s, minibuses and cars - a great sight to wake up to in Newcastle.
We reach our post, set alongside the coast; a fine view of the sea and of the competitors, leaving their campsites near the finishing line to jump on buses to reach the start.
For 2 hours we are left with nothing to do apart from battle against a chill wind to put up a gazebo, and check out our equipment.
Ian organises our teams - Caitlind, Lol and me are together. The A Team, of course. Ready for anything.

It's going on 11am when the first competitors come through; the wheelchairs, designed for fast paced racing. We marvelled from our position - right on the junction between the two roads which the racers came whizzing down - at the sheer speed and skill which the riders had, and we cheered them on. They were closely followed by the first of the women's elite, who stormed down the road with immense power and speed.
Soon, there came a wave of competitors, all thundering down the hill and onto the next road with sheer determination and, worryingly, exhaustion.
However, our presence at our small round-about post was short lived, as Ian rotated the groups not long after the run got well underway.
We ended up at the very boundary of our area; marked by red posts up until the 12 and a half mile marker, we found ourselves standing by the final red post, facing the next mobile patrol who watched over the beginning of the green post stretch.
For a while, I began to doubt Ian's prediction; the drama forecasted for us seemed to be taking its time in beginning. So far every runner looked fine. Tired, hot and sweaty, but fine. And who could blame them; the noontime sun beamed down on the event like a proper summer's day, with a slight wind to keep them cool. Perfect running weather.
Then suddenly, someone yelled out from the crowd.
A runner was seriously struggling. Sweat poured from his head, his feet barely lifted from the ground, and every muscle in his legs seemed to tense under the strain of moving. He stumbled and fell forwards.
"Wait," Caitlind said as Lol and me moved in to the barrier, "there are other runners."
A fellow runner caught him and helped him to the floor. A second joined the pair and together the still-strong competitors helped their fallen fellow to his feet, and began to lead him to the side of the road.
We held the rope barrier up as they reached us, and as we moved in to help the man groaned again and slid down to the ground. I went with him, and helped him to sit up, which he was weakly trying to do.
"What's wrong mate?" Caitlind asked. "Can you tell me your name."
The man stammered his name. "Ryan*."
And that was the most we got out of him again.
Although he flailed about helplessly to get up again, and at one point even manage to roll onto his knees and semi-stand, he was far too weak and dehydrated to support himself.
Lol grabbed a PRF and began to fill in as many details as she could.
A couple of passers by helped us to lead Ryan over to the pavement, where he continued to sit against me. We tried to give him water, but he could barely swallow. We tried to persuade him to sit still, but he would not listen in his confused state.
"Ryan, we know you want to get back into the race, but we suggest you rest first," I said sternly, in the best I'm-a-medic-so-listen-to-me voice I could muster. "If you try now, it could seriously affect your health and make things worse."
Of course, reasoning with a confused, severely dehydrated patient never works, and the only time he became quiet was when his condition deteriorated.
"I'm thinking it's hyponatremia," I said as Caitlind held the oxygen rebreather mask on him. He had hated it being strapped around his head, but now our casualty needed the O2, there was no other way for it.
"I think so too, but we can't do much about it."
I put an oxygen sats monitor onto a trembling finger and watched as the readings flashed up. Lol stood near by, watching too, holding onto Ryan's free hand tightly, stroking it slightly with her thumb. I smiled inwardly - at least one of us was trying to comfort him. She was doing really well for dealing with her first serious casualty. Talk about being thrown in at the deep end.
"Heart rate is 172, sats are normal. At least the 0xygen part is good."
I counted his resps; 46? I double checked. They were high - too high.
"Lol, radio in for an ambo - this guy's a priority 1 alpha," I said, as Lol picked up the mic and turned away to radio in the details.
"Maybe we should get some people to act as a barrier," Caitlind said suddenly, glancing up at the people wondering past with gazing eyes.
So we rallied together a few willing members of the public to stand with their backs to us, acting as a fortress, keeping us away from the view of the crowds. It wasn't secluded, but it was better than being gawped at, for our casualty's sake.
10 minutes on and there were still no ambulances heading our way. Meanwhile our casualty's response was steadily deteriorating. His eyes had rolled back slightly, giving him an almost possessed look. He only responded to pain, and even then it was a hellish hard sternum rub.
"I'm rubbing as hard as I can," Caitlind said, looking at me worriedly.
"Lol, whats the eta on our ambulance?" I asked.
She radioed in, but still no one knew when an ambulance would come our way.
"Can you handle the situation at present?" Ian asked across the airwaves.
The three of us looked at each other.
"Yes," Caitlind nodded. All we could do was keep him with us.
"This guy's gonna go into respiratory arrest if we don't get him out of here soon," I grumbled under my breath. Suddenly, things became that bit worse.
"Why is the bag not inflated any more?" Caitlind asked.
"Shit, we've run out of oxygen. The can's empty."
30 mins on high flow, and now no more.
"Sats are still up though," I said, "so it's a perk."
But so were his resps and bpm, and his response was still limited.
Then finally, like a blue flashing beacon of hope, an ambulance came along the corrugated iron road behind us - set up especially for ambo access - and thundered onto the grass.
"Alright ladies!" the jovial medic sang in his Lancashire accent as he came over, his fellow medic following with a trolley bed in tow.
"About time guys!" I growled, and then smiled, relieved to finally have an ambulance beside us.
We were all relieved, as the pressure of the casualty shifted from our shoulders. Our PRF was limited, but the crew was understanding.
"It's been nuts today," the first crew member said, still smiling cheerfully as they loaded Ryan into the ambulance, "not particularly quiet, is it?"
Then with that, they sped off down the road, with blues and twos again.
"Ok guys, we dealt with that pretty damn well." Caitlind smiled, and the 3 of us - the ultimate A team - collapsed into each other with a huge hug.

Kit cleaned and tidied up, breath caught and adrenaline controlled, it wasn't long before our next casualty came along; something far more simple to deal with, and a welcome break.
The guy had finished his run, but had sprained his ankle mid race. Bravely he had kept on going, but heat, and the constant pressure of his weight on his foot, had caused it to swell up to almost double its normal size.
An ice pack soon helped to bring it down a bit, and Caitlind set to work strapping it up in an expert bandage while I filled in the PRF. Meanwhile Lol watched the runners, keeping an eye out for any other casualties.
Once again, the event did not disappoint. Our third and final casualty entered into the hands of the pair of first aiders across the road, near the green post.
Lol came running over.
"The crew across there are asking for our kit, they don't have any resus stuff of their own."
"Seriously?" I asked. Steve had made sure we were prepared for the event by entrusting us with his kit bag, a defib and RE2's O2 cylinder and airways.
"I'll go," Caitlind said suddenly. "Keep going with the bandage Sarah?"
My colleagues grabbed the kit bags and disappeared across the road, leaving me with a bandage to finish. I'll admit that bandaging just isn't my strong point, and that neat bandaging is a particular downfall in my first aiding skills.
Sorry doll, but while you started the bandage with even spaces and such, I finished it with a few rough edges. Still, it did the job, and our casualty left as a happy customer, with his father supporting him down the road.

Then I too was darting across the road, reaching the other side to find Caitlind, Lol and our two fellow first aiders kneeling beside a young girl who was lying panting on the floor. Her friend sat beside her, watching the race go by.
"What's happened?" I asked Lol as I drew near.
"She's just not feeling right," she said. Lol moved away to keep an eye on the race, and to radio in for another can of oxygen.
The young girl was shaking, looking around her with wild eyes, like a rabbit caught in a snare - all whites on show.
"What's happening to me?" She asked, gripped with fear.
"Calm down hun," Caitlind said, holding onto her hand, "you're ok, we won't let anything happen to you. Just relax."
"What's her name?" I asked.
"Lucy*," Caitlind replied.
"It's ok Lucy, you're in good hands."
The other two first aiders backed off slightly now, letting us take control of the situation.
"Did you fill in a PRF?" I asked.
"We did," one guy replied, "she was literally away to set off again when she took an odd turn. That's when we called on you guys."
He handed me the PRF, when suddenly Lucy started to shake.
"Seizures," Caitlind said definitely, "she's having seizures."
"Has she been drinking a lot during the run?" I asked her friend.
"Not really," her friend replied, "although she drank almost a litre when we stopped here."
"Hyponatremia?" I turned to Caitlind.
Hyponatremia, in severe circumstances, can cause muscle spasms (like Ryan had endured) or even seizures. Lucy seemed to be another victim of a lack of salt.
Lol radioed in the details; our casualty was fitting and therefore a priority 1. We upped it to an alpha when we watched her fit three times in fives mins, while knowing she had never had seizures before.
Thankfully, our second ambulance arrived a lot quicker than our first. However, the St John's crew which had come to our rescue were of a different nature.
I handed the second crew mate an updated PRF, while the first crew mate asked us what was going on.
"She's had 3 fits in almost 5 minutes," Caitlind relayed, just as Lucy began to shake again, this time more vigorous than before.
Then, without warning, the medic leaned in, took a hold of our casualty, and rolled her onto her side.
I looked at Caitlind and Lol, dumbstruck.
"Is it not better to leave them on their back?" Caitlind asked loudly. Our medic didn't respond.
Fair enough if the casualty has a build up of fluid in their mouth, e.g. saliva or vomit, but if their airway remains uncompromised, you let the casualty continue with their seizue until it finishes before intervening. This so called ambo medic clearly didn't grasp this concept.
"Leave her seizure to run its course," I said.
"Look, I work with seizures every day in my work," Caitlind said, standing up for our casualty who was still shaking violently on her side, her face almost being pressed into the grassy earth, "you leave them to run their course before dealing with the casualty."
The medic rolled her over onto her back. Progress? No, not quite.
This time his crew mate joined in and together they lifted her onto the trolley bed - still mid fit - and strapped her down.
"Should you not leave her arms out?" Lol asked as she helped them roll the trolley to the ambulance.
I never heard the medic's response, but apparently the second medic realised this.
In the ambo, her fit ceased.
"All it takes is for that lassie to jerk her arm the wrong way under that strap, and then it's broken," Caitlind growled, fuming at the treatment a fellow ambo crew had just given.
I was equally fizzing, not only with their attitude to the casualty, but also to the almost indignant attitude they showed towards us.
"I'm all for working together with other organisations," I grumbled later on once we had packed up our kit and returned to our original post, "but that was just too far."
The ultimate A team definitely agreed on that.

I don't know what happened to Lucy; I only hope she made a good recovery in the impressive 70 bed field hospital (which, by the way, was filled in no time). As for Ryan, he threw up all over the ambulance before being discharged from the field hospital later on that day, having been recharged and rehydrated. I wonder if he remembers anything of the struggle he put up with us, and of the additional work we had trying to pursuade him that O2 was a good thing when his sats were 88%! (Normal good sats are generally above 96%)
I know our nice, easy casualty went home contented. All I hope is that he took our advice and visited his GP for an extra check up the next day.

It's unfortunate that while many competitors crossed the finishing line with cheers and banners and medals, many more crossed the finishing line in an ambulance with blues and twos.
Although we, the A team, dealt with 3 casualties (although it felt like more) just down the road from us our friends and colleagues were dealing with collapses all over the place, and two cardiac arrests, both of whom, to the best of my knowledge, survived thanks to our skilled first aiders and our pretty good defibs.

When the end of the day came, we were glad to be tidying away Post 18, knowing our work had been done.
We actually found time to play, getting Ian with ice-balls from a bag of ice randomly given to the post during the day (either for an ice pack or for drinks, I dunno). He then proceeded to get us with a bottle of water, but to be honest he came out far wetter than what we did =]
How many times can you say you ended a summer's day with a snowball fight?

Ironically, we also ended up assisting an RTA on the way back to HQ, which was relatively mild and thankfully had no casualties.
It was only amusing because, when you think about it, what are the chances that you've just been shunted, you're worried about your baby who was in the back of the car, and you don't know what to do next, when suddenly a convoy of 3 RC vehicles appear in the lane beside you and suddenly turn on their blue lights to let you know they're coming over to help? Seriously, what are the chances?
Fate was on that family's side, clearly.

Anyway, back at HQ...
We reunited with Steve and Ronnie, and heard all about their exciting day crewing RE8. With vomit, collapses and everything else, they too had a fun-filled day. Collectively, we as the Northern Scotland crew, had treated a vast variety of casualties, from simple sprains to life-and-death scenarios. Nothing like a healthy balance to keep things interesting.
So, we packed up our kit, grabbed a cup of tea, waved goodbye to our fellow English RC colleagues and had one last marvel at the amazing Newcastle RC mansion, before heading back up the road towards home.

We had arrived in Newcastle at roughly 6pm on Saturday, and we were now leaving at roughly 6pm on Sunday; we had spent near enough 24 hours in Newcastle. Now, finally, after a day which had, on reflection, flown by in the blink of an eye, we were leaving for our homeland again.

At Berwick-upon-Tweed we stopped off for some late night supper, as a well done and thank you from Ian and Steve for the input and hard work we had performed throughout the day.
Never has a Wetherspoons looked so welcoming.

Then it was back out on the open road. Once again Lol and me tried to sleep in the dark of the ambo, and this time it didn't take long for us to fall into the depths of slumber.
By the time we regained consciousness, we were back in Aviemore, where it was time for Lol and me to depart from the back of the ambo.
Caitlind and Steve zoomed off home to Elgin, in hot pursuit of Ronnie and Ian, while Beth and her husband were kind and gracious enough to give us a lift home to Inverness.
At half past one in the morning, I finally fell into my bed. With uni later on that day, it was about time I got back into my bed again!
My head hit the pillow, and low and behold, I could not get to sleep. I was buzzing with all the things I had seen, done and heard of that weekend, and for a while it just would not leave me be.
I looked at my red cross uniform, strewn across my chair and floor, and thought about how well everyone had done that weekend; how well Lol had done with her first serious casualties, how well Caitlind had led us on in each situation, and as for me... well, I was just happy that it had been an enjoyable weekend.

I think I fell asleep with one final thought in my mind - trauma training should be a piece of cake after this weekend.




*Names have been changed to ensure patient confidentiality.