Page 3 of Welcome to the Cornish Country Hospital

For a moment it felt like she was back in London, where working with ambulance crews delivering pre-hospital care was something she’d done as part of her specialist training. She’d even had a stint working with the HEMS crew on the air ambulance for three months. But, in London, there was always the reassurance that specialist hospitals in every discipline were within relatively easy reach. Providing emergency care in rural Cornwall, and stabilising patients for long enough to get the specialist care they might need, was a whole different ball game.

There were two ambulances, an advanced paramedic vehicle and a fire engine already on scene. And, when Danni got out of the ambulance, she could hear the wail of more sirens approaching. As soon as she got closer, she could see it – beyond the fire engine – a single-decker bus with its side ripped open like an ugly scar. It looked so alien it was barely recognisable as the same sort of bus that stopped outside the hospital every day. The angry gaping hole exposing the inside of the bus looked almost aggressive, like a big ‘keep out’ sign.

The sounds of people shouting for help, and wailing in agony, carried on the still autumn air, the cloudless, almost turquoise sky making the scene below it seem all the more out of place. It was a beautiful September day, the Indian summer Port Kara had been having showing no sign of abating. As soon as Danni arrived, she checked in with the incident coordinator and was handed another pack containing some of the medication she might need. The coordinator told her the situation was changing so quickly the best thing Danni could do was get into the thick of things and find out who needed her most, which was exactly what she did.

However bad the accident might be, Danni was thankful it hadn’t happened two weeks before, when the bus would have been crammed with children and young families making the most of the final days of the school holidays. And she was silently praying, as she hurried towards the bus, that none of the passengers were children and that by some miracle every single person on board would somehow have escaped without serious injury. But as soon as Danni walked around the ambulance furthest from the scene, it was obvious her prayers weren’t going to be answered.

‘I’m Danni Carter, one of the A&E doctors; what can I do to help?’ she called out to a fire officer who’d just sent some other emergency personnel towards the bus.

‘Those two have been working on the driver since they arrived on scene.’ The fire officer gestured towards two paramedics leaning over a man lying on the tarmac; there was blood on his face, and so much broken glass in his hair that it was sparkling in the sunlight. ‘I’m sure they’ll be grateful of any support you can give.’

‘Thanks,’ Danni breathed out as she hurried towards them. These situations were always a weird mixture of adrenaline and fear, but she’d never wanted to do any other sort of medicine.

‘I’m Danni; can I give you a hand? They said this was the driver?’

‘Yes and he bull’s-eyed the windscreen, but it looks like the accident was caused by him going into cardiac arrest.’ The female paramedic looked up and shook her head. ‘Two passengers who were in a car that witnessed the crash managed to drag him free and they were still attempting CPR when we got here. He’s been asystole since our arrival, despite adrenaline and mechanical CPR. Without any electrical activity in the heart we can’t defibrillate, so I think we’re going to have to call it.’

Danni tried not to look too closely at the man lying on the ground, knowing that if there was even the tiniest likeness between him and her father, it had the capacity to send her spiralling back to the moment when her mother had told her she was never going to see him again. Her eyes seemed to slide towards him anyway and, from his colour alone, she could tell he was gone. His jacket and shirt had been undone and there was an open wallet lying close to Danni’s feet, with some of its contents spilt out on the ground. There was a debit card, a family photo depicting at least three generations, and a money clip with the words:Here’s to the next 40 years! Love Karen xxxengraved on it. The thought of how many people his death was going to hurt felt like a weight pressing against her neck.

‘He was probably dead before he even hit the windscreen.’ The male paramedic sighed and Danni curled her fists into a ball, her fingernails digging into the palms of her hands. There were those echoes again, words so similar to those her mother had been told, which she’d repeated to two children who’d never needed to hear them:They said your father was probably dead before he even hit the floor.

‘You’re right to call it.’ Danni blinked twice, trying to focus more on the driver all of a sudden, so that she really saw him and not her father’s face. There was nothing she could do for him and she turned as one of the fire officers came hurtling towards them, his eyes wide.

‘Can we get some more help in the bus? There’s a woman trapped, with serious blood loss; it looks bad.’ Even as he spoke, the fire officer was already turning away again.

‘I’ll go.’ Breaking into a run to catch up with the man, Danni didn’t stop to look back at the other paramedics or the driver. She had to keep moving forward, just like she’d been doing for the best part of twenty years.

She passed a row of passengers sitting at the base of a bank, looking at first sight like they were waiting for another bus to turn up. It was only when Danni got closer that she could see the anguish on their faces, and the cuts and bruises they’d been lucky to escape with. One of the men had a makeshift bandage tied around his head, fashioned from a cream-coloured scarf that was now soaked with blood, and someone else was supporting their arm in a sling made from a leather belt. Members of the public, who must have pulled up in the cars abandoned further down the road, were taking blankets, bottles of water, or whatever else they might have to offer to try and give the accident victims some comfort. Even those passengers who looked completely unscathed would be suffering from shock and they’d all need medical attention eventually. But for now there were more urgent priorities for the emergency team.

Going inside the bus was like stepping into a warzone. The other paramedics and some of the fire crew were tending to patients in need of the most critical care, while the rest of the fire officers were fighting to free some of the most critically injured patients. The team leader had assured Danni that any equipment she might need to treat the patients would be made available on site, but first she needed to assess the patient and hope there was something she could do to help.

‘She’s over here; her name’s Connie. She’s got a lump of metal embedded in her leg. I can’t… I just couldn’t…’ The fire officer shook his head. ‘She was lucky to be on the side of the bus that didn’t hit the wall, but we need to move the seat in front of her to get her out; it’s bent backwards. There are other patients trapped too and we’re having to prioritise until more crews arrive. They’re en route and the air ambulance has been dispatched too. I really wanted to stay with Connie to make sure she’s okay, but I can’t do that and do what I need to.’

‘It’s okay – you do your job and I’ll do mine.’ Danni touched the man’s arm briefly and he seemed to sag with relief.

‘Thank you. We’ll get to Connie as soon as we can, but let us know if you think she needs to be prioritised. We’ve brought in some oxygen.’ He gestured over to some cannisters lying on an abandoned seat. ‘Just take one, if you need it.’

‘Okay.’ She didn’t look at him again as she moved towards the patient, who appeared to be in her sixties. The neatness of her ash-blonde bob looked so at odds with the fact that she was partially pinned by the crushed seat in front of her.

‘Hi, Connie, I’m Danni, one of the doctors from St Piran’s Hospital. I can see you’ve got an injury to your leg and I’m going to stabilise that until the fire crew can get you out and into the ambulance. But I need to know if you’ve got any other injuries you’re aware of?’

‘I feel like someone has hit my left hip with a sledgehammer and there’s a tingling feeling in my pelvic area that’s travelling down to my thighs.’ Connie grimaced, pain etched on her face, as she struggled to keep her eyes open. ‘It’s numb and painful all at the same time. Although that’s nothing compared to my hip; I’ve never felt pain like it. Never.’ The fawn-coloured trousers Connie was wearing were stained bright red by the blood seeping from the wound in her thigh and the shard of metal the fire officer had described looked like a bolt of lightning piercing her skin.

‘Okay, Connie, I’m going to give you some pain relief before I do anything else.’

‘Are you going to take it out?’ Connie’s eyes flew open with panic and Danni shook her head.

‘They’ll need to do that in surgery so that they can control any bleeding. But I’m going to secure it with some dressings to try and stop anything moving on the way to the hospital. Once I’ve given you the pain relief, I’m going to give you some saline and oxygen too, to help make up for the blood you’ve lost, as well as some antibiotics to help prevent any infection. I promise all of that will really help.’ Danni kept her voice steady, not waiting for Connie to answer before she swung into action. She could tell the older woman was struggling; her breathing was quick and shallow, and when Danni touched Connie’s skin it felt cold and clammy. Grabbing one of the oxygen cannisters, Danni placed the mask over Connie’s nose and mouth. Watching her breathing start to steady, Danni finally felt like she could breathe again too.

But as she turned away from Connie to look for some support, Danni’s heart sank. There were multiple casualties, and the medical teams were spread far too thin. The young female paramedic she’d seen earlier was already holding the head of another patient, as some of the fire crew tried to cut away the twisted metal around them. The fact that so many of the patients were trapped as well as seriously injured was making a difficult situation even worse. There was no sign of the other paramedic who’d been with the bus driver, but even the fatalities had to be taken care of. He’d probably be liaising with the police by now, before they transported the driver to the mortuary. The poor man’s cause of death would undoubtedly be the subject of an autopsy and all Danni could do was pray that he ended up being the only fatality.

Turning back towards Connie, she shivered. The amount of blood pooling by her patient’s feet was much bigger than Danni was comfortable with, and there was a good chance she had some internal bleeding too. The pain she’d described could be down to a broken hip or pelvis, both of which could cause significant damage to blood vessels close to the bones.

‘How are you doing, Connie?’ The pain relief should be kicking in by now, but Danni didn’t like the way the colour had continued to drain from her patient’s face; it looked almost waxy now.

‘I feel like all the energy is being sucked out of me; I’m so tired.’ Connie closed her eyes. ‘I just want to go to sleep.’

‘I need you to try and stay awake for me, okay?’ Danni bit her lip as she took Connie’s pulse; it was weak and rapid and neither was a good sign. Setting up the IV saline fluids to help replace what Connie’s body had lost, she would have given almost anything for a second pair of hands or another opinion, but it was a luxury she wasn’t going to get. Checking Connie’s blood pressure did nothing to alleviate her fears; it was much lower than it should have been and all the signs were adding up to hypovolemic shock, which could prove fatal if she didn’t get the treatment she needed. They had to get Connie to hospital as soon as possible, but she wasn’t the only person in need of urgent help and the fire crew were still working on freeing a younger passenger further up the bus. Despite all that, it was time for Danni to bump Connie up the list.

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