Odhran McKenna, a 17 year old male was involved in a serious road traffic collision in February 2016. His vehicle left the road and collided ‘side on’ with a large tree, trapping the seriously injured schoolboy inside.
Having identified the potential for life limiting or life changing injury, the emergency services dispatcher instigated a multi-agency response with police, fire and ambulance personnel tasked to the scene.
On arrival of the ambulance and rapid response vehicle, it was immediately apparent that Odhran had sustained extremely serious injuries. Ambulance and Fire Service personnel worked together to stabilise and extricate Odhran – any delay would significantly reduce his chances of survival and recovery. In addition, the ambulance service dispatched a specialist doctor/paramedic team with ‘critical care capabilities.’ This doctor/paramedic team had received specialist training, drugs and equipment as part of a pilot project initiated by the late Dr John Hinds.
On extrication from the vehicle, the full extent of Odhran’s injuries were apparent. A significant brain injury resulted in combative behaviour,breathing difficulties and seizure activity. Specialist neurosurgical and intensive care treatment was urgently required as Odhran’s brain injury worsened with each passing minute (secondary brain injury).
Normally without the ability to control this type of patient/injury and help re-oxygenate the brain, patients are taken to the closest hospital for immediate airway intervention with potentially worsening brain injury. An added difficulty in this case was to prevent any potential damage to Odhran’s spine – this is almost impossible to achieve with a patient in seizure activity. Fortunately, the timely arrival of the doctor/paramedic team with the availability of critical care interventions (general anaesthesia) resulted in re-oxygenation of Odhran’s brain, termination of seizure activity and transport to a specialist receiving hospital. National trauma guidelines* recommend this procedure be delivered within 45 minutes to benefit this type of injury; in this case the procedure was delivered by the doctor/paramedic team within 42 minutes of the initial 999 call.
At hospital a CAT scan revealed the full extent of Odhran’s brain damage (multiple cerebral contusion, traumatic subarachnoid bleed and 3 sub-dural haemorrhages). Ordinarily, these injuries result in death or permanent disability necessitating 24/7 intensive nursing care. Odhran’s family were advised to ‘prepare for the worst.’
To maximise the chances of survival, Odhran’s anaesthetic was continued for a further 8 days in the Intensive Care Unit. Specialist prehospital (doctor/paramedic team), neurosurgical, intensive care and rehabilitation treatments have cumulated in Odhran’s survival with complete neurological recovery. Much to the relief of his parents and the delight of medical staff, Odhran has returned to education and competitive sport; captaining winning team in the Ulster Schools Hurling Cup final.
Many prehospital services on the UK mainland have established robust doctor/paramedic relationships. Working harmoniously in a non-hierarchical fashion the patient benefits from both medical and paramedical expertise. These critical care capabilities have demonstrable survival and recovery benefits for the patient.
Odhran’s case highlights perfectly the benefits of having an appropriately trained doctor/paramedic prehospital team and the essential life saving procedures this service can bring to benefit all the people of Northern Ireland.
More about Odhran McKenna’s story:
*UK National Trauma Guidelines: