The potato chipper, p.2
The Potato Chipper, page 2
I therefore proceeded to Huntington Beach in the United States to learn all about the world of political violence, how to counter it, essentially, spotting the issue through good observation and effectively running away in an organised fashion.
‘Now, if you’re struck by a blade here (pointing to the area of the brachial artery in the arm) you will be unconscious in fifty-six seconds and dead inside of three minutes. The figures imprinted on the white board in the classroom was startling. If you were hit in the carotid artery, you’d be unconscious in three seconds and dead in nine. In the femur; unconscious inside forty-five seconds, dead within two and a half minutes. To say that I’d had my eyes opened by the boys in light grey from the LA County Sheriff’s department was an understatement.
As I was digesting all of this and looking at my notes, one of the instructors, Lee, an ex-Merseyside cop who had emigrated to the US nearly twenty years before chimed in, saying, ‘now this knife was recovered from an operation against Russian mafiosi …’ this was followed by a split second of silence before a massive ‘thwack’ emanated from the plywood wall covering opposite.
Lee had flicked a concealed release switch on the knife which had detached the blade and launched it like a missile over eighteen feet. I hadn’t been looking at the beginning and my head nearly hit the roof when I comprehended what I’d nearly missed. If you’ve got a gun in your holster, and he’s got his knife in his hand, if the distance between you is twenty-one feet … he will win.
In the classroom, we also learnt that most assassinations (and attempts) occurred when the target was surrounded by a crowd. Think of Reagan in 1981. In the field, we were repeatedly drilled on ‘disarms’ to wrench a pistol away from an assailant. This involved one hand clasping the handgun and turning it back towards the perpetrator with his finger being snapped inside of the trigger guard, followed by your other bicep and forearm trapping his tricep area in a hold to snap away the gun and possibly aid him to shoot himself. A disarm is far more effective than attempting to draw a weapon and shoot in response.
‘Remember guys, if the assassin gets close enough to draw and fire, he will get his first three shots off. However, with a disarm, you can stop the second set of three shots which with pistols and their comparatively weak shots, may just save your guy’s life.’
Foot drills took place in Beverly Hills and Rodeo Drive with Bruce Willis in attendance, as well as driving skills to learn to cover a principal car and nudge out other traffic subtly or where necessary with force, were honed. Situational awareness which we had been trained on in the desert at the Bates Motel (where the shower curtain scene in Psycho was filmed) involved practising entering a venue such as the grand opening of a movie, or a political rally with crowds waiting, which in the case of our practice were mostly hostile; with simulated jeering, threats etc … in order to get used to extreme threats against clients.
In years to come, I would expect that the teams’ tasked to protect the former British Prime Minister Tony Blair would have honed such skills into a fine art. In one training scenario, I sat in the front passenger seat with my client in the back. The accepted procedure is that the driver, in consultation with the bodyguard stays in-situ with the doors locked until they are satisfied that the surrounding area is viable. Once this is the case, the bodyguard then opens his door with intent (i.e. by opening the door all the way out and swinging his inside knee to rest firmly against the door, while his hands rise up to take control of the door and roof to allow a firm footing, prior to moving to the rear of the back door to provide cover for the clients’ exit from the car).
I opened my car door, glided back to open my principal’s door with a moderately hostile mob only feet away (clearly a scenario more likely to happen with a businessman that has angered others) and started to walk towards the door, when out of nowhere, I saw a flash of a plastic, training blade which was thrust at him, going into his stomach … I could only pick my ‘client’ up, drag him and throw him onto the back seat as the door was still open and dive on to him while shouting to the driver ‘go, go, go …’
Ordinarily, one would propose that you wouldn’t attempt to leave; and instead, you would move a client away from such a situation. There remains the option of using the back door, but often clients can have a robust attitude of defiance towards those that are hostile to them and for the purposes of the training exercise, we were looking to test reactions during physical attacks.
Our daily morning workouts at six a.m. continued along Huntingdon Beach or in some of the local parks, sometimes ending with the Drunken Scotsman game. It is essentially a relay between two teams involving a sprint over a set distance; in our case usually twenty-four metres, followed by a referee spinning you around ten times until you are good and dizzy, before you sprint back to your teammate, who is then the next to go. Try it. You will find that the world is going sideways when you zip back.
The weeks passed, noticeably with an extreme anti-ambush firearms package over two days with pistols, sub-machine guns and on occasion Remington Shotguns being introduced into the field, as we repeatedly worked in the explosive use of firepower, combined with body cover and dragging of clients from one vehicle to the other, prior to escaping, which served me well for what was to come in the future. With a full range of CP qualifications, inclusive of a recommendation from my former Royal Marine Commando instructors that I could work on a Counteraction team should an opportunity arise, and I was pleased to have completed the clean sweep.
3. Paramedics: My time in the ‘Infantry’
If I were to reflect on my service in the British Army, while undoubtedly extremely tough in aspects of its training, I would comment that soldiers are to a certain degree, at least in peacetime, protected from the rigours of civilian life. Reasonably balanced food is provided, as well as free gym membership, an assured steady wage, acceptable accommodation in addition to the support of comrades, seniors and the church. I was soon to realise that this was in stark contrast to my time as a pre-hospital care provider on the medical front line in the streets, town centres and villages of Essex, adjacent to London.
I completed the best part of three months of training in order to qualify as an Emergency Medical Technician in early 2000 and was then let loose on the general public. Within two days of passing out of training, I found myself fracturing the ribs of a ninety-year-old lady who had collapsed in her home and had subsequently gone into cardiac arrest.
Now, I want you to understand that unless you witness a collapse that is caused by a cardiac standstill, or unless you arrive within two to three minutes and immediately administer good aggressive CPR, rapidly followed with intravenous treatment (IV) drugs and securing of airway access (simplistically put, a tube stuck down the throat); then you are only carrying out a protocol to protect yourself from litigation.
Make no mistake, these are messy affairs Dear Reader with understandably frantic relatives in attendance, clothes being ripped off with shears to quickly expose the chest, vomit flying out of the patient’s mouth with the remnants of the last supper often seeing the light of day, blood flowing from limbs with the failed introduction of cannulae and all in all, an extremely mentally draining procedure for all concerned. While I ‘saved’ a number of people in my career, principally with IV fluid introduction (much to the chagrin of my work-mate), while they were officially alive and able to pay tax (how a successful cardiac resuscitation is defined in the US I have been informed), only one was ever clinically alive enough to live a normal life thereafter.
I additionally worked on a heroin overdose patient, who was in respiratory arrest before we got her back in about ten seconds with an anti-opiate drug called Narcan/naloxone in between coping with a further series of minor nose bleeds, OAPs falling over who required a helping hand. We had a further ‘purple plus’ death to deal with, which entailed an eighty-two-year gentlemen at his bungalow, who had gone for a comfort stop while his son went to do some gardening. People don’t die in convenient positions. They can be found, not only lying in the middle of open rooms, supine, in a clean condition, but also in ditches, toilets and in showers where it can be a struggle just to open the door.
The son hadn’t seen his father for three hours, opened the WC door and felt that he may have just fainted. We arrived shortly after, and he was unfortunately long gone. The two positive points that came out of it were that he would have passed over very quickly and, we didn’t have to work for a living on it, which spared him the indignity of an assault with needles and two hot irons scorching his chest from ourselves. He had also not commenced his WC procedure, so the job of respectfully putting him to bed was not a messy one.
Death amongst the frail & elderly on toilet seats is not as uncommon as you may think. Essentially what occurs is that the strain stimulates the parasympathetic aspect of the nervous system that slows the pulse down, and in some cases, this can induce cardiac arrest in those with pre-existing cardiac disease. We paramedics use this procedure called the Valsalva Manoeuvre to slow rapidly fast heart rates, although it doesn’t always have an effect and caution is always recommended in such cases.
Days and Months passed and I found that the shift work alternating between day shifts (often twelve hours plus), and nights wrought havoc with my body clock, and I was frequently catching colds, as I kept up my physical training to stay in shape for my martial arts tournaments.
More insidiously, the continual exposure to negative waves of emotion from people who were sick, scared, depressed or drugged up and generally uninterested in anything other than their next hospital visit assisted the onset of ‘burnout’ in us, that at the time was estimated to cause resignation on a variety of grounds; inclusive of sickness of paramedics to the tune of an average of seven years. Many years later, I was to meet paramedics that only lasted for three to four years; such was the intensity of the work. The self-centred general public that is supposed to be ‘better educated than ever’ certainly had no comprehension of self-reliance and were reared on a celebrity, soap opera diet where screaming and shouting ‘emergency’ gets you your own way – Pathetic.
Major Road Traffic Accidents were not to become a major feature in the life of the UK Paramedic, I say that fortunately, as cars had developed several safety features that allowed them to crumple and therefore absorb the energy instead of being akin to a solid object with the shock waves smashing the insides of the vehicle occupants. Veterans of the service were to tell me about the nineteen seventies when scores of people flew through windscreens and were scooped up to await their fate in Casualty/Trauma Centres. Many were saved by such simplistic scoop and run tactics. As interestingly, since cars were far more solid (and did not crumple as was to be the case in the nineties to early two thousands) in the seventies and eighties, a minor shunt could result in a fatality, due to the vehicle occupant enduring an overwhelming force on their internal organs (such as a shearing force on the liver) that there was no coming back from. Conversely, cars that had been completely ‘totalled’ in collisions would see individuals emerging from the incident unscathed because the car had taken most of the force, and not the vehicle occupant/s. When one can comprehend this, you will possibly understand why I attended several roll-over RTAs where individuals had emerged unscathed from such accidents.
I came from the Pre-Hospital Trauma Life Support era that had superseded the early to mid-nineties (mistaken) and held the belief that paramedics were Messiahs who could save lives by staying and playing on a scene to save lives. This wasted time, cost lives and was only worthy of use during entrapment situations where the patient needed to be held as immobile as possible, such as in the case of spinal injury. Staying and playing on scene is okay if you operate using the French SAMU system that attempted to save the life of Princess Diana in 1997, where the operating theatre is brought to the patient, but not under the system that is employed in the English-speaking world.
During my paramedic extended skills training, my excellent trainers,’ many of whom had come from the London Ambulance Service, drilled us in carrying out Advanced Life Support skills at the same time as securing the patient to a spinal board, prior to transport inside ten minutes. This is no mean feat I can tell you. One of my first significant trauma cases involved a nine-year-old girl who had fallen from her push bike as a car towing a trailer overtook her. She had wobbled, and although not initially struck by the vehicle her fall resulted in the wheels of the trailer striking her legs. The rule of paediatric situations is that children generally compensate well initially in cases of sickness and injury but then, the situation can deteriorate far more rapidly than with adults. One must therefore maintain a high index of suspicion, even in cases where nothing apparently appears wrong as the signs may not initially be apparent. In this case, we utilised the long board in case there had been any spinal injury and extracted the girl within nine minutes. We arrived at the hospital twenty-five minutes later and given that we’d arrived at scene within the ten minutes meant that we had arrived at the hospital within ‘the golden hour’. The Golden Hour is an American inspired Pre-Hospital Trauma Life Support theory that from the moment of impact to the moment that the patient arrives at hospital (greatly assisted with correct warning to the hospital of surgical requirements) should be less than one hour.
I had to put this skill to the test, one evening, during the summer of 2002, in a rural area of Essex. In essence, I and my crew mate received an emergency call to a road traffic accident, with no further details. To outline the case in hindsight, a small Vauxhall Astra van with two occupants had passed a flat-bed lorry on a narrow lane when the load on the lorry, rolled off the side and landed on the bonnet/hood of the van and promptly peeled the top of the van like a can opener.
When we arrived, the area of the incident, with backed up traffic meant that we had a seventy metre walk to sweep the scene. One of the first things I saw was a lady with blood all over her jacket, running away from the area in tears at what she had seen, I could put two and two together that something grim awaited us, while silently hoping that she was the worst injury of the incident.
The walk up the road was akin to a movie set for a B-Horror movie with possessed zombies walking around in a trance. Continuing our walk complete with medical bags, I had to step over a large yellow metal object (a crane as it turned out) that had landed in the road while passing a middle-aged gentleman who’s eye I caught before he proceeded to pass me heading away from the point of impact. He then promptly swung around to follow behind me while I got first sight of the ‘open top’ car that was up ahead, with one vehicle occupant in the driver’s seat.
As per Systematic Trauma Management guidelines, because I was approaching him from the rear, I cut to the right, in order that his first sight of me would only be from the front, as I approached the forward portion of the car I was initially heartened to see that his eyes were open as he sighed and I merely said, ‘okay mate, that’s good to see, we’ll get you out’.
Alarmingly, He didn’t respond, and I quickly realised the guy was a lot worse as his head rolled to the right and I got my first view of three puncture wounds to his skull which squirted out blood in a near spurting action, that I could only stop by placing my hands over them. The driver of the truck who had followed me and obviously had a feeling of guilt then asked if the guy was going to be okay. My look just said it all, I just gave him some gloves and asked him to hold the patient’s head still, while I did a basic assessment. Respiratory rate and pattern seemed okay despite the cacophony of noise as the fire service arrived and blocked off the vehicle (basically, chocking the wheels – although you can always use the handbrake), as they cleared out the excess shards of metal.
My crew mate Ann brought up the long (spinal) board with collar and stretcher and on picking up a BP of about 140 systolic with a pulse rate of 36, and taking into account a hefty blow on the head being the order of the day, as well as resultant rising inter-cranial pressure and it was clearly an extremely serious situation. Only surgery as quickly as possible within the hour ideally, is the way to remedy this as a pressure build-up in the head can have fatal repercussions.
Key Learning Point: Crisis and extremely stressful situations such as these can cause people/bystanders to retreat ‘into themselves’ and deny that what is happening (or has happened) is still taking place. This can be applied not only to emergency medical and warlike conditions, but also to situations of continued extreme pressure during tough military selection processes and endurance sporting events, such as round the world sailing competitions. I have seen this myself and it can happen to the best of people at the most inopportune of moments. In situations like this, the person’s ‘lights can be on, but there’s nobody at home’. A remedy for this can be to (in the case of men) squeeze their balls to wake them up. Sounds strange but in life threatening events, there is no time to be politically correct.
Again, I suspect that most people at the crash site had walked past what I was about to see, including the gentleman. People go into their own reality in such situations and often freeze or more accurately, walk around aimlessly until somebody leads them.
I was at my two-year point in 2002 when a job that was to have a profound effect on me occurred on eighteen December on the final day of the school term. While we were vindicated in our efforts and the newspaper report after the coroners’ inquest commended our attempts at resuscitation. I still replayed this job repeatedly in my mind for about five days and struggled to sleep. It wasn’t caused by a nightmare, but just to clear myself of any void that needed to be filled.
