MARS blog - A View From The Roadside

March started with a 'running call'.  This is where emergency personnel come across an incident whilst going about their normal business.  In my case I was on my way to do a day with Surrey & Sussex Air Ambulance and was nearly there when the traffic came to a standstill.  Within a minute, a motorcyclist coming the other way pulled up next to my car and said, " 'scuse me mate, a lorry's just knocked a bloke off his push bike just down there."  Although I’ve been driving a fully 'marked up' vehicle for well over a year, I'm still stupid enough to have wondered how on earth he could have known I was a doctor - duh!  Anyway, the cyclist was only shaken and didn’t require anything more than an examination to make sure no injuries were missed.

At the other end of the spectrum this month, I attended the horrific incident on the A49 where three young people were killed in a collision south of Hereford.  Due to a medical meeting, we actually had 6 doctors, all experienced in pre-hospital care, arriving on scene together.  Tragically, there was very little we could do and we all left deeply saddened. 

Apart from this awful incident, March has been quite quiet.  It often strikes me how unpredictable these things are with spates of accidents followed by quiet periods.  When we are quiet, I always keep my eye on local news websites and newspapers just to reassure myself that I’m not missing anything.   Sometimes one can put these patterns down to weather or major calendar events, but at other times there’s simply no pattern. 

Total cases this month: 5

'Stood down' en route (ie. I was not required, so attendance cancelled): 0  

Number of RTCs: 3

Total miles driven to incidents on blue lights: 48

Time spent attending incidents (doesn’t include other MARS activity such as training, equipment checking, re-stocking, fundraising, etc): 3hrs 28mins

MARS blog - A View From The Roadside

February was a busy month for me with MARS.  Overall, I was sent to 12 cases although stood down on 4 of them.  Of the cases I did attend, half were road traffic collisions (RTCs).   Two of these RTCs involved prolonged entrapments though fortunately neither were fatal.  In one case the patient had been trapped for a remarkably long time - about 22hrs before she was discovered after the crash. 

This month I flew one patient with the County Air Ambulance.  The relationship works extremely well and has been developed over several years.  As I spend about one day per week as the Clinical Lead for Surrey & Sussex Air Ambulance, I am still qualified as Helicopter Emergency Medical Services (HEMS) aircrew.  When I drive to a serious case in Herefordshire and the County Air Ambulance also comes along, it is often advantageous for me to travel with the patient.  This is particularly the case if I have given drugs or interventions that the service wouldn’t normally use.  Often, due to the nature and severity of the injuries, this means flying the patient to either Birmingham or Bristol, for example to get to a neurosurgical unit.  The issue is then what I do with my car back at the scene, and how I get back home.  I can usually get a flight at least part of the way back with the helicopter and, in the last 8 years, I've only had to 'hitch' home from Birmingham once though it made for a 7 hour round trip.

Our dispatch seemed a lot more regular this month as perhaps we're over the worst of the winter rush and the new system is running more smoothly.

• Total cases this month: 12
• 'Stood down' en route (ie. I was not required, so attendance cancelled): 4  
• Number of RTCs: 4
• Total miles driven to incidents on blue lights: 101
• Time spent attending incidents (doesn’t include other MARS activity such as training, equipment checking, re-stocking, fundraising, etc): 12hrs 13mins

MARS blog - A View From The Roadside

The start of 2009 saw the ambulance service at near crisis point with a huge surge in demand over recent weeks.  Coupled with this, our dispatch has been a bit variable as the recent closure of the Hereford & Worcester control room has meant that local ambulance resources and MARS responders have been tasked from Dudley.  Fortunately, many of the old faces have moved to the new control desk, but it’s bound to take a while for things to reach any state of normality.  Call rates have followed odder patterns than normal, with an increase in calls to medical conditions, in December in particular, and the perennial concern that we might be missing important jobs if staff are overloaded with tasking 'routine' assets or getting used to the new system.  It’s too early to tell whether this has been the case or not, but the control room staff are doing a great job in very difficult circumstances.

In January, the pattern seemed to pan out a bit - mainly trauma related calls, with a focus on road traffic collisions (RTCs).  After some time away until the 5th Jan, my first call came on the 10th to a farm worker trapped under a tree trunk which had rolled onto him while he was cutting it into pieces with a chainsaw.  Most of these 'chainsaw incidents'  I’ve been to before involve major haemorrhage but, thankfully, the chainsaw itself was incidental in this case and he got away with fairly minor injuries instead from the blunt impact of the tree on his legs.

I attended 5 RTCs in January.   One was car-vs-bus and one was car-vs-tractor (fairly common in Herefordshire).  Fortunately most involved minor injuries but I did fly with one patient with a suspected pelvic fracture to Hereford County Hospital.  The biggest challenge is often finding someone to drive my car to the hospital as I abandon it to jump on the air ambulance.  As usual, the Police kindly obliged.

The roads in January seemed particularly cold, muddy and slippery with hints of black ice lying unexpectedly on many of the back roads.

Of the medical cases I attended in January, two were to cardiac arrests.  Unfortunately we didn’t manage to resuscitate either patient successfully.

• Total cases this month: 10
• 'Stood down' en route (ie. I was not required, so attendance cancelled): 1  
• Number of RTCs: 5
• Total miles driven to incidents on blue lights: 90
• Time spent on MARS incidents (doesn’t include other MARS activity such as training, equipment checking, re-stocking, fundraising, etc): 9hrs 48mins

GO-60 Expedition

Sat 19th July

Ian and I were woken with an incredibly harsh telephone ring at 7am.  Having been in bed for 3hrs we were both disorientated for a few moments which was pretty funny in retrospect, but highly unpleasant at the time.  We eventually realised where we were, put on our soaking (and still filthy) clothes, and went down to meet the others.  I’ve no idea how long Chien had been up but he’d clearly had less sleep than us.

We went for breakfast first and then headed over to customs again.  The damaged vehicle was still there and a lorry and crane had turned up to move it.  The whole process looked incredibly dangerous, as old tattered wire hawsers were attached to tie down or winching points before the car was lifted.  They then realised that the wire ropes were all different lengths, so the car was on a huge lean.  Down it came again, and adjustments made.  When it was lowered towards the lorry, they realised it was about 6 inches too big to go in due to a steel cross-piece at the back of the lorry.  “No problem,” said Chien and in half an hour the lorry was back, having been modified with the help of a gas torch, to remove the cross piece.  Seeing the damaged Defender go in and be taken away was a significant relief.

By mid-morning we moved to where the other lorries were waiting, outside the main customs office.  Here we worked hard to use ratchet straps to brace the four cars whilst local workers fixed a wooden frame around the wheels to stop the cars sliding in transit.  The whole process took several hours and involved a lot of sweat.  With Ian standing at ground level and me trying to kick a steel lever into place above him, he had a moment of being showered in sweat.  “Pretty salty tasting” was his comment.  Lovely.

With more paperwork to do, we were ready to move around 3pm.  In that time we’d learnt that the border at Den Bien was a no-go due to a massive landslide in Laos, which had washed part of a mountain away and was completely impassable.  The only other option was therefore to go back to Hanoi, and then move further south to cross the border at Lao Bao in central Vietnam.  We were in touch with the team in Den Bien but morale wasn’t too good.  Pete and Charlie had decided enough was enough and wanted to salvage something from a trip that they saw as a 'no-hoper’ and had flown to Hanoi, and then onto Bangkok to enjoy a few days relaxation.  It seemed a strange decision to Ian and I, but everyone has their own perspectives on a trip like this and by the time we knew about it, they’d gone and there wasn’t much that could be done to change things.  That was the last we saw of them on the expedition and we were certainly a bit disheartened by it.

Around 3pm, we left in Chien’s car, to head for Hanoi on another 12 hour journey.  It was incredible to be finally leaving Lao Cai!  As we went, we discussed options.  Clearly, there is no way we can continue with a trip to Singapore and do all the things we want to, in terms of enjoying the journey and exploring as we go.  The decision therefore must be to either bin the whole trip, or to push on regardless with long drives and a focussed attempt just to get to Singapore.  With the preparation everyone has put into this trip and the hard work done by the three previous legs, we decided that even if it came down to two of us in a single car, we will continue and see how far we can get.  It was quite an important moment of clarity as far as I was concerned.  From that point our resolve was strengthened in the knowledge that the more people we could convince to stay, the better our chances of success but we’d still have a 'worse-case’ fall-back option if it came to that.

The journey to Hanoi was actually quite comfortable and we were in the good humoured warm company of Chien and Thanh, stopping to eat at a couple of places on the way.  We had to stop for a wheel change after a puncture, on the edge of a still lake, at dusk with no wind.  No Malarone, no insect repellent and with loads of mosquitoes around, we didn’t waste much time being well aware of the risks we were exposed to.

While en route, we heard from the other part of the team who were now travelling by minibus back from Den Bien Phu to Hanoi.  They were going through the mountains on what was little more than a dirt track, being driven by a driver who was driving perilously close to the edge of a sheer drop.  Several text messages from the team came through which led to a change of plan, and the driver dropping them half-way to Hanoi.  A new driver was booked to complete the journey in the morning.  Everyone was understandably stressed and tired and there was the suggestion that several were considering flying out of Hanoi and calling it a day.

Ian and I arrived in Hanoi around 4am and booked into our hotel.  For the second day we were covered in dirt and sweat.  In a bid to make my clothes at least wearable, I put them in the bath which was supposedly a jacuzzi with some soap and as soon as the nozzles were underwater a little, pressed the 'on’ button.  The whole bathroom seemed to erupt with water, which pelted off the walls and ceiling.  It was like a scene from Poseidon and in an exhausted state of mind seemed like the funniest thing that had ever happened, with Ian and I nearly crying with laughter.  It didn’t clean my clothes much either.

Malcolm Russell

www.go60sharing.co.uk

GO-60 Expedition

Fri 18th July

At last something is beginning to happen.  We were rang early by Chien to say that the vehicles were going to come across soon.  'Soon’ turned out to be early afternoon with a morning of waiting, wondering and playing cards.  It felt as this was going to be yet another Groundhog Day again but finally we saw some movement.

Rachel drove a Discovery and towed the damaged Defender across with Ian fighting the steering to keep it straight.  There were several cheers and shouts of congratulations before Ian and Rachel, who couldn’t physically cross the border without loads of paperwork, turned and walked back to get the others.  With another two runs, the vehicles were all across and parked up in no-man’s land near the Vietnamese border gate.  The damaged Defender looked pretty sad!

Out of China, the Vietnam customs process kicked into sloth-like action.   We waited and waited, thinking the cars would be over any second, until it grew dark.  Finally, over they came much to everyone’s muted excitement.  We got the impression that the customs officials didn’t want the public presence of them sat in the main road and were told to move them.  We’d hoped to be able to drive them but the decision was made that they must be bonded and put onto trucks before being ‘shipped’ to Laos.  Chien was working hard to grease the wheels of the system as ever.

We decided to send most of the team ahead to Den Bien Phu where we hope we’ll be able to cross into Laos, while Ian and I stayed to load the vehicles onto the lorries before following, hoping we’d only be a few hours behind.

Eventually two lorries turned up for the four surviving cars.  Each had a rear bay around 10m in length, but no loading ramp.  We had to find a piece of raised ground nearby where the lorry could back up, drop its short tailgate so we could then drive them on.

By the time we were ready to load the vehicles, 2am, hot, and pouring with rain.  The lorry backed in but was on a side slope which meant each vehicle slipped perilously as it drove in, with around 6 inches to spare either side.  This was made even worse as the lorries had previously been moving a load of wet clay so the floor was like a skid-pan.  It was 4am by the time the cars were on, with some minor damage to the rear door of number 4, one of the Discoveries.

Chien, Thanh, Ian and I moved to a local hotel where we washed our clothes in the shower and fell into bed, exhausted, at 4am.

We made one big mistake: never be separated from your own kit, an old military lesson.  We’d put our bags on the minibus to Den Bien when we should have held onto them.  We were to spend the next 48hrs without anything other than what we carried.

In a waterproof 'bum-bag’, I had the following:

Passport

• Wallet
• Compact camera
• Packet of tissues
• Small amount of cash
• Mobile phone
• Leatherman

Whilst comfortable with surviving without most of my kit, the things I missed were my Malarone (malaria prevention), toothbrush, and insect repellent.  Luckily I’d kept the 'legs’ to my zip-off shorts which meant I could reduce the number of bites at night, but Ian was still in his shorts!

Malcolm Russell

www.go60sharing.co.uk

GO-60 Expedition

Thu 17 July

Up at 6am and bags packed, ready for leaving.  At last, a bit of hope!  Met the others for breakfast and then phoned Ian on the other side of the border,

“Do you want the good news, or the bad news?” he said.  What kind of question is that? 

“Mmm, let’s see, oh, I think I’ll take the good news first”

“The good news is that none of the vehicles have been stolen overnight.”  Great.  If that’s the good news, standby for the bad news.  I could pretty much guess what was coming.  “The bad news is that the fifth vehicle, on its way here, is still 100km away.  It should be about 5 hours.”

Allow a couple of hours to get them all through Chinese and Vietnamese customs and that could seriously get close to darkness.  And that could mean only one thing.  Another night in Lao Cai. 

At least Chien arrived and he seemed fairly upbeat.  After an hour or two chatting about strategy, he invited us out to lunch.  We went to a local place and had some amazing food, with the added benefit of Mr Chien and his friend Thanh there to explain what it all was and some of the culture behind it.  What a difference that makes to the experience.  By the end of it I was pretty full and couldn’t manage any more chicken heads or legs, but had enjoyed it and it was a welcome break from sitting in the hotel.

Inevitably this afternoon brought some further bad news: the vehicle was late and various bits of paperwork still have to be completed.  We’re not leaving today.  The team are once again faced with another Groundhog Day, made worse by the hotel only playing one or two favourite Vietnamese songs, back to back, again and again.  This is now getting unpleasant.

Not much more to say really, bags unpacked again and fingers crossed for tomorrow.

Malcolm Russell

www.go60sharing.co.uk

GO-60 Expedition

Wed 16 July

We met at 9am this morning and, in the absence of food at our hotel, walked the 70m to the nearby hotel.  Our usual breakfast of omelette was served (two fried eggs, dry bread, and soy sauce) whilst plans were made for the day.  A bit of admin was in order including washing, blog writing, and sending of emails.

An upbeat call from Ian told us that Chien now had the paperwork complete and should be travelling up to meet us on the train tonight.  All being well, we’ll be off tomorrow, driving the vehicles ourselves with a police escort.  I’ll believe it when I see it!

We wandered across the Red River to the other side of the town and managed to find a hotel with air con, food and wireless interest.  The internet was the most useful thing though as the food could have been a lot better.

A couple of hours were spent here before the team split and went various ways to find something to keep themselves amused.  Pete, Charlie and Mark went off to find a taxi to take them to a local waterfall.  I had some work I had to do, and wanted to be around in case there were any requests from Ian with regard to the vehicles.  The afternoon was therefore spent between doing some work, sorting out photos, and reading. 

In the evening, we ate at the same hotel where we have breakfast and then met up with the others who’d been to the waterfall.

There was no sign of Chien this evening and I was kept busy with a live radio interview with BBC Hereford and Worcester about the Entrepreneur of the Year Award, which must have sounded a bit odd with the sound of crickets, frogs and lorry horns in the background.  Quite surreal.

Today has been very frustrating as the clock continues to tick away and we still haven’t started our drive.  We remain optimistic but there’s only so much you can do in a town like this and I think tempers could fray if we’re not out of here tomorrow or the next day at the latest.  Fortunately I’ve got plenty of experience of being stuck ‘in transit’ from one place to another in my former military career, and this feels exactly the same.  Sat around with your bags packed, reading a dog-eared book or playing cards, paradoxically trying to while away the precious time.

Malcolm Russell

www.go60sharing.co.uk 

GO-60 Expedition

Day 8

Refreshed after a great day yesterday we set off for one of the largest cities in China and apparently one of the nicest also, a place called Xian.

The roads today were in bad condition and also very slow as the work men were out trying to improve the terrain. We had been stuck in a few traffic jams and progress was slow. Convoy driving was going well with radio contact being imperative for over taking manoeuvres, when disaster struck, the radio message I heard was that a Defender was down. I reversed up the road and jumped out of my vehicle, I looked across the road to find the defender lying on its side. My first thoughts were for the driver and luckily self extrication had already taken place and no injuries had been sustained. I was really impressed with the rest of the team who must have taken on board the RTC training that Prometheus had supplied as they had approached the defender with caution and had moved away until fire extinguishers had been fetched when they were unsure what kind of fluid was leaking from the underneath carriage. A quick once over of the driver and a sigh of relief from everyone when the only damage had been to the defender and no one else had been hurt.

The guys who had been on the winching course that Land Rover had supplied before departure jumped into action and before I knew it they had a plan in place. Feeling a little useless I wondered up the road following the skid marks to see where the accident had begun. Looking back toward the scene on the right hand side was a sheer drop and I realised just how lucky we had been when the defender had steered to the left.

Before long the police arrived but found there was no need to help us as we had everything required for the recovery in the vehicles. I was so impressed by the calm approach of the entire team, everyone took on a role and the vehicle was successfully recovered within 10 minutes. A wheel change also took place before we could move and then a decision to tow the vehicle to the next town was made.

On route the wheels were set in motion regarding recovery of the defender and when we arrived at the next town the local police man took us to a repair yard where we could sort out all the kit from the defender and contact people back home for help and advice.

All the kit was recovered safely and to my surprise nothing inside had been damaged including the BGAN, which was lucky as we needed to send pictures back to England quickly for confirmation of what to do next. In a small remote town such as the one we had just arrived in an internet cafe was no where to be found.

Recovery of the vehicle was organised with help from Land Rover dealership in Shanghai and we found a small hotel in town to sleep for the night and await recovery.

In the morning the vehicle was successfully recovered and before we could carry on with our journey we had to visit the Police station. We were invited into the board room where the Chief of Police inundated us with fruit from the town. He personally apologised for the appalling road surface and explained that there are numerous RTC's on that stretch of road most days. After paperwork had been completed they gave us a police escort to the border and wished us a safe journey.

On reflection the training and calm approach paid off and what could have been a terrible day turned out to be a remarkable team effort with the only tragedy now being that five Land Rovers are now down to four.

Melissa Wade SRP

www.go60sharing.co.uk

GO-60 Expedition

Tue 15th July

We knew that not much would happen today.  Ian (with his ability to speak Chinese) was doing a lot of the on-going negotiations and arrangement-making, so he and Rachel decided to stay in Lao Chi while the rest of the team went for a day’s excursion before going completely stir-crazy.

Having scrutinised the guidebooks (there isn’t a huge section on Lao Cai) we found that the town of Sa Pa and its vicinity are probably the main attraction.  We got an interpreter and a minibus and managed to haggle a reasonable fee for the day.  The journey to Sa Pa took about a hour, climbing through jungle-covered hills interspersed with terraced paddy fields.  The air became less humid and a little cooler which was refreshing and it was great just to get out of town.

The area around Sa Pa has a number of traditional villages inhabited by various ethnic minority groups.  These are open to the public for a fee.  Reading the guide books, it would seem that whilst tourism is inevitably going to have an impact on this population, it nonetheless helps them maintain something of a traditional way of life.

We went on foot into the commune of Ta Van, nestled in a valley surrounded by mist-covered forested mountains.  The commune is made up of six small villages with a total of around 3000 people.

What struck me most was the strikingly different appearance and facial characteristics of the people there.  They reminded me of the people of Tibet, although that’s probably just because my travels across Asia are limited.  They may be closer linked to Mongolians, I don’t know.

We were met by a group of around 15 women and the same number of children.  The men were working on the farms.  The women walked with us around 3km to their village and spoke remarkably good English (an impact of tourism, clearly).  They were pleasant company and happy to tell us something about their way of life.

We wandered between paddy fields, through sparse settlements, all the way down the valley towards the point we’d agreed to meet the minibus.  Inevitably, at the end, there came the frenetic selling activity.  Most items appeared to be locally made (we were shown how clothing is died with indigo, harvested around the villages), though exactly how much is actually made there is open to speculation.  The main point was to be able to give something for their hospitality in return for a product, rather than just making a cash donation: I ended up with an assortment of small items from the three ladies who’d guided me around who seemed happy after some light-hearted bartering.

 We then drove to Sa Pa for a simple but delicious dinner before returning to Lao Cai. 

Ian and Rachel went over the border tonight, being Chinese residents, to help facilitate the move of the vehicles in the next day or two hopefully.

The evening was incredibly hot and humid with an electrical storm in the distance some light rain which seemed to do nothing to clear the air.  We had a couple of beers in the hotel, and then all headed off for a fairly early night.

Dr Malcolm Russell

www.go60sharing.co.uk

GO-60 Expedition - Monday 14 July

Mon 14th July

The plan was to get an early start today, meeting our interpreter at 7am to get to the customs office early.  I met Steve, Ian and Pete and we waited.  And waited.  And waited.  Just before 9am, he appeared and off we went to speak to the customs officers about bringing the vehicles into Vietnam. 

The whole day was one long interrupted discussion about different options with different people in different places.  Essentially, we can’t bring the vehicles in without a letter of authority from the Prime Minister if we are to drive them ourselves, and this is simply not going to happen.

The only workable solution, we think, is to get a local company (Mr Chien) to officially import them, truck them to the Laos border, and then export them.  Of course, money and time are the key issues here.  Lots of both it seems.  Still, there doesn’t really seem any other way round the problem.

Today was incredibly frustrating and was compounded by the fact that the town here is pretty dull to say the least.  Very little to see or do, just hot, dusty and noisy.  We could still be here a few days to come – we’ll just have to make the most of it.

Leg 3 must be tired and frustrated.  Leg 4 are perhaps less tired but are still very frustrated.  We’ve effectively been in transit for a week, haven’t got near the vehicles and are facing a diminishing window of opportunity ahead.

At last, a piece of good news arrived.  Leg 3 had been given the all clear to walk across the border, leaving the Land Rovers in customs, to be brought over when the necessary onward arrangements are made.

It still took a couple of hours for them to clear customs but finally they were through.  They looked exhausted, and had all lost weight, but were all in high spirits.  They had achieved an amazing feat - seven of them had driven the vehicles 6200km in about nine days, much of it effectively off-road.  No wonder they looked tired.

After a quick shower, we took them to a nearby hotel for a modest celebratory meal and a couple of beers though most didn’t drink, knowing they still had a 12-13 hour bus journey through the night to Hanoi.

We waved them off; Mel must have had mixed emotions having bonded with her small team in adverse conditions and then having to leave them and join our team.  A strange experience no doubt.

At last though, we now have our complete team together and we all sat up talking about the previous leg with Mel, trying to glean from her invaluable practical experience.  Everything from packing the vehicles, to driving, to comms on the move and convoy drills.

Let’s hope we get driving soon.

Dr Malcolm Russell

www.go60sharing.co.uk