The End

Yesterday, in the morning we received notice that only essential staff were allowed to work in the hospitals and ambulance services. With ten days left in Guadalajara, the city had finally caught on to the COVID-19, shops were closing, restaurants taking temperatures as people entered and all of a sudden face masks were everywhere. It seems that Mexico had gone from no response, to maximum overnight. The border has been shut to the USA and very soon it is likely they will stop international flights all together.

In a desperate hurry to get home, as I can no longer work and if the borders closed I could be stuck here upwards of a month. Im now sat in Mexico City airport waiting for my flight back to the UK at 23:40.

Day 26 - Day 20 on the Cruz Verde Norte Ambulancia

So today was my twentieth day working on the ambulances in Guadalajara. Much of the day was quiet, however we did respond to three calls in total. The first, an urgent transfer to another hospital for a patient that had a pelvic fracture and fractured femur for surgery.

The second was to three children that had been knocked down by a car in a hit and run. Thankfully on arrival the scene was not as bad as anticipated and only one of the children sustained serious injury. The girl had a fracture to the left tib/fib and was also complaining of back pain. As a precaution we immobilised the child using a device similar to a Kendrick Extrication Device and the smallest leg splint we had on board. I cannulated on route so that pain relief could be given as well as the standard Hartmann Alpha solution.(shown above)

The final call of the day was to a motorcycle accident, however on arrival it was apparent there were no serious injuries and the patient was left on scene.

On another note, I thought I would update you on the COVID-19 situation over here. So far there have been no confirmed cases in Guadalajara, the hospitals have increased the use of basic ppe such as surgical masks and gloves. There also has been an increase in distribution of hand sanitiser and a few more posters have appeared. Business carries on as usual, however I have heard rumors that some schools have closed as a precautionary measure.

Day 24/25 - Day 18/19 on the Cruz Verde Norte Ambulancia

I didn't have a chance to post yesterday. The daytime went very slowly with only three incidents to respond to, all being motor vehicle accidents. At the end of the shift I decided to try a night with the other ambulances that are not based at Cruz Verde Norte. Instead they take up positions far away from the ED so that they can respond to calls in the area quicker. Most the night we spent hopping between petrol station to petrol station waiting for any calls. We had a couple of RTC's but otherwise I spent the night broadening my understanding of the spanish language.

Today I only worked 8 hours, two calls, one to a woman with a minor cut on her chin, she was left on scene. The other was a transfer, we went to pick up the patient and realised that her respiratory effort was increasing majorly. Rather than take her straight away, we took her down to one of the resus cubicles and from there she was RSI'd. When she was stable we then transported her to another hospital, manually ventilating on route. It is unlikely that this woman's condition was as a result of COVID-19 but we took protective measures just in case.

Day 23 - Day 17 on the Cruz Verde Norte Ambulancia

Today was a very slow day, we only responded to one call. 

We responded to a report of a fight with two casualties, both of which only sustained minor injuries and after assessing both at the scene we left them there.

On another note, the travel restrictions due to COVID-19 mean I am now unsure on my position when returning to the UK in two weeks time. The information I can find on the government websites is very vague and does not help in the slightest. The british embassy in Mexico was closed today due to the public holiday and the airlines I am booked with say they can not take any action until 5 days before my flights are due to depart.

Mexico itself is near enough un-touched by the corona virus with little more that 40 cases nation wide and as you can imagine it is business as usual and the only difference is you see the occasional informative poster in the hospitals.

Hopefully tomorrow will bring more work.

Day 22 - Day 16 on the Cruz Verde Norte Ambulancia

(Above, another photo I was sent from yesterday)

Today was pretty average with six calls throughout the day.

The first was outside the city, it was in an area that I could only describe as stereotypical Mexico. Dirt roads, houses made from scrap and horses and donkeys along the street. After about 20 minutes of what can only be described as off road driving, we found the patient at the side of the road, he had pain in the ankle and it was also swollen. We got him on the stretcher and began the long and bumpy journey back to the ED. I cannulated to provide fluids and give some pain relief using the drug "Ketorolaco" (a NSAID and also the primary source of pain relief here) due to the very uncomfortable ride back.

The next call of the day was a RTC, the car (shown in the photo below) hit a concrete barrier at speed, setting the airbags off. Luckily the occupants only sustained minor injuries and were treated and left at the scene.

Soon after arriving back we had a call to a woman experiencing shortness of breath, however on arrival, it was obvious that she was actually experiencing an anxiety attack and hyperventilating. One of the paramedics calmed the woman down before leaving her at the scene. 

In the afternoon we received a call to a seizure. Upon arrival I realised that the patient was a 9 month year old baby, and the parents had covered him in blankets. Realising that the child was very hot and suffering from a febrile convulsion, I removed the blankets and the clothes with the exception of the nappy and directed one of the fans towards the child in order cool him gradually. After about half an hour and checking the obs several times, we left him on scene.

The next call was to another child that had hit their head. Using my amazing skills of creating inflatable elephants out of latex gloves, I managed to calm the girl and she allowed me to inspect the wound and clean it with little fuss before transporting her to hospital for suturing. 

The final call of the day was as usual, to a "enferma" patient, and as I entered I could already see that the woman was deceased. I checked for a carotid pulse and the body was cold, and as I went to move the arm so that I could listen to the chest for heart sounds, I realised that rigor mortis had already set in. As is required I listened for a minute before confirming that the patient was deceased. At this point the patient was handed over to the police to deal with.

On another note, the fundraising has been going well, so far I have raised £375, which is just shy of 10,000 peso's. I have been asking various of the ambulance crews what equipment they would find useful, and one of the notable items, especially now with COVID-19 is contactless thermometers. They do currently have thermometers on the ambulances, however they are the old mercury filled glass ones, that are really not practical for prehospital use. I plan to get a couple of contactless ones as well as more batteries and various other items that will make their life easier and improve patient treatment.

Day 21 - Day 15 on the Cruz Verde Norte Ambulancia

 Today was a very good day, we only had three jobs, but the last one took around four hours.

To start the day we carried out an urgent transfer of a patient that had been stabbed several times in the chest. He had a pneumothorax on the right side and as such I was shown how to create a chest drain. The transfer took around 30 minutes and we delivered him in a stable condition.

The second job of the day was a fall from height at a construction site. The male had fallen approximately four meters and suffered a potential pelvic fracture. We immobilised him on a spinal board, administered fluids and transported him to the emergency department.

The final call of the day was probably the best call I have had since being here. We were called to an elderly male that had been walking in one of the valleys on the outskirts of Guadalajara, after searching the woodland for around twenty minutes a local pointed us in the right direction.

We arrived at the top of the steep valley and the crew I was working with was reluctant to venture down due the terrain. I grabbed the trauma bag and climbed down myself to find I was first on scene. 

The elderly male was complaining of pain in the lower back and pelvis. I completed an assessment and a set of obs, to find that he was hypotensive (86/56) and also hyperglycemic (320mg/dl). Being on my own, I  shouted up to the crew who agreed that I should cannulate and start administering fluids.

About ten minutes after this the Bomberos USAR arrived to help with extrication. They set up the ropes and using a SKED stretcher we formed a litter and carried the patient up the valley, out of the woodland and into the back of the ambulance. 

Completing another set of obs on the way to the ED the patients blood pressure had risen to 103/76 and his glucose levels had dropped to 210mg/dl. In total this call from start to finish lasted around 4 hours.

Day 20 - Day 14 on the Cruz Verde Norte Ambulancia

Today has been the quietest day of them all by far, in the space of twelve hours we only attended two calls. The first being in the morning, a diabetic that had become unresponsive. After doing a full set of obs we found her not only to be extremely hypoglycemic but also hypertensive with a blood pressure of 200/100. We cannulated and gave glucose, which in a matter of minutes brought her around and after discussing the risks, the patient decided to not go to hospital.

Most of the day we spent in the break room playing games such as "Plague inc." and about forty minutes before the end of the shift we had a call to a multiple vehicle crash. On arrival we found that there were five vehicles involved, however none of the occupants were injured.

At the end of the shift, we had planned to eat at an American style restaurant called "Buffalo Wild Wings" however, on arrival we found that the whole restaurant was privately hired for a function. Nearby was another American style restaurant; "Hooters" so we thought we would give it a try, but I can definitely say it is by far the worst food either Chris or I had eaten since being here.

Day 19 - Day 13 on the Cruz Verde Norte Ambulancia

Today was quite slow for the most part. We started with a RTC first thing in the morning, one female was injured and due to not wearing a seatbelt her head hit the windscreen causing the glass to smash. The woman complained of neck pain and we took c-spine precaution and delivered her to the hospital in a timely manner.(shown above)

Next we were called to an elderly homeless patient (again "Enfermo") who it turned out was experiencing pain from his catheter. Again, we transported him to the hospital, where he then after being discharged stayed the majority of the day annoying other patients.

My final call of the day was to a stabbing. Obviously due to what we had been told we rushed to the scene, only to find that the patient had a small incision on the inside of his left leg. Very little blood, no pain, and there we were expecting a major trauma call.... I dressed it at scene before transporting the patient for a couple of sutures.  

The most interesting job of the day however happened about half an hour before I was due to finish. At about 19:30 a car sped into the ambulance bay before the driver got out and started screaming for help. I rushed over to find a male on the back seats soaked in blood. One of the others quickly grabbed a hospital bed and we rushed him into one of the resus rooms. Cutting his clothes off quickly I found six stab wounds to his abdomen, one of which near his left kidney was hemorrhaging massively. I grabbed some gauze and applied pressure whilst the hospital staff rushed into the room. After taking an initial blood pressure, which was 90/60 we cannulated and started giving fluids and at this point we realised that on both wrists there was tape and also a ball gag that was loosely around his neck. I assisted one of the doctors in suturing the hemorrhaging wound in an attempt to stem the flow. After a little more than an hour in the room, which was absolutely boiling, I felt a little light headed, and all of a sudden I was being woke up by one of the nurses with some alcohol swabs under my nose, in the corner on the floor. I gathered myself and stepped out for a moment, grabbing a cup of water, before heading back in.

Once stable we transferred the patient to one of the ambulance stretchers and transported him to another hospital, that was better equipped to see what damage had occurred inside. This was by far the fastest I have seen anyone drive whilst I have been here, we were under police escort, a car in front and an armoured truck behind.

(image below)

All in all, it has been a quiet yet interesting day.

Day 18 - Day 12 on the Cruz Verde Norte Ambulancia

I nearly forgot to post a blog for today. Yesterday due to the lack of calls I finished around 4pm and went back to one of the paramedics homes, along with some of the others. Of course, being in Mexico, the home of tequila, I had to try some of the real stuff. I can certainly say its not like the stuff we have at home, much smoother. Anyway, that is my reason for not posting yesterday, moving on.

This morning started with back to back calls, the first call was to a motorcycle vs lorry accident. As you can imagine, there was no injury to the lorry driver and the motorcyclist wasn't in the best of shape. He had an open fracture to the right radius (lower forearm) and also c-spine tenderness. We splinted and covered the arm, and collared him before log rolling him onto the spinal board. I gained IV access and administered fluids on route to the hospital, as well as giving him some pain relief.

Just after dropping the patient off, we had another call come in. This time, the description of the patient was "Enfermo" which translates to sick. The trouble is, the information given to us on route is often very vague. Every cardiac arrest I have been to whilst over here has been to an "Enfermo" patient, with the exception of those where a motorcycle paramedic was already in attendance. The general population know very little or no first aid and CPR is not widely taught like in the UK. Anyway, I digress, we showed up on scene and after 20 minutes of looking for the patient, we couldn't find them and decided to head back to the ED.

The next patient was a transfer for palliative care, to a home just down the road. The only thing I would say about this patient, is that it took a lot of us to lift him, and we were unable to put the sides up on the stretcher.

The final call of the morning was to an elderly woman with abdominal pain. After doing some obs, her oxygen sats and blood pressure were a little low and she was certainly hyperglycemic. I cannulated, started some fluids and then asked to see any medications she was on.... I was taken to another room where the daughter practically showed me a pharmacy. I think there were two drugs I knew out of 20 or so, It is a little more difficult because it is all in Spanish too. We transferred her to hospital, unfortunately for her almost all of the roads between there and the hospital were old and bumpy.

Throughout the afternoon we had a couple of transfers and not a lot more. I got to see another couple of really nice hospitals that were really well equipped and modern. Whilst waiting around for a call we looked for ways to entertain ourselves, and even came up with an alternative for when you forget your headphones.

(shown below, and yes I know I need a hair cut...)

Day 16 - Day 10 on the Cruz Verde Norte Ambulancia

(Myself and Chris, the FREUC 5 student from South Africa)

So yesterday I finally decided to take a day off, and watched a few episodes of Narcos on facebook and slept for the majority of the day.

Today was interesting, it was international women's day, and we were all issued with shirts to support the occasion. The first call was to a pedestrian that had been knocked down by a car, however on arrival the patient was nowhere to be found. After searching for the best part of 20 minutes we gave up and headed back to the emergency department.

Soon after we had a call to a seizure, on arrival the elderly man had stopped fitting, according to the family the seizure occurred due to alcohol withdrawal. Upon taking observations, all was normal with the exception of his blood glucose levels which were 230mg/dl. We transported the man to the ED.

Shortly after arriving back at the ED, we were called to the helipad across the road to transfer a police officer that had been shot in the arm. We quickly assessed the patient, in the two minutes that we had him and found that he had also sustained a fracture to the right clavicle. 

Another call came in a little later to a traumatic head injury to a drunken male. A motorcycle paramedic on scene had all ready dressed the wound and due to the combativeness of the patient, I took lead as the younger females working with me were very cautious of his aggression. Thankfully i managed to calm the man and take observations on the way to the ED.

Next we were called to an elderly male who had a brick thrown at him. Thankfully he had managed to stop the brick from hitting his head but had sustained a fracture to his radius instead. We splinted the lower arm and transferred him.

The final job of the day was a resus, the patient arrived by ambulance at the emergency department, where he was quickly intubated and advanced life support was started. After several shocks, the patient returned to normal sinus rhythm, and over the next couple of hours drug therapy was given to maintain output. Intravenous access was extremely difficult, and about 6 of us tirelessly worked to get access. In the end after no success the doctor decided to access via the femoral artery which worked for a little while, however the slightest move and we lost access. The patient eventually deteriorated and was pronounced dead an hour later.

The death of this man presented an opportunity for us to practice our intubation skills, out of the four of us, I was the only to successfully intubate the cadaver first time, and used this as an opportunity to help others learn. Demonstrating the use of cricoid pressure I was able to successfully help the others achieve a patent airway.

(Warning, the images below show the cadaver)

Day 14 - Day 9 on the Cruz Verde Norte Ambulancia

I decided to change over to night shift for the weekend, thinking you were more likely to see the result of violent crime, this turned out not to be the case. We started out the evening by getting some dinner and just as we finished the first call came in, motorcycle vs car. On arrival the only injured person was the rider of the motorcycle, who had dislocated her patella. For the second time here I was tasked with re-locating it before applying a support bandage, the patient was then left on scene. (shown below)

A few hours passed and the next call came in for an elderly female that was "unwell" on arrival, we spoke to the woman, who was complaining of chest pain. After taking initial observations, questioning the patient and auscultating the chest, I decided that it was likely pleurisy with pulmonary embolism. She had previous DVT history, whilst auscultating the chest you could hear the pleural rub and also decreased oxygen saturation and increased heart rate. We applied high flow oxygen and transferred her to the stretcher before rapidly transferring her to the emergency department.

The final patient of the day was to a middle aged woman, again, the family described her as "unwell" however on arrival we found her to be in cardiac arrest. We quickly dragged her to the floor and started compressions whilst another paramedic ran to the ambulance to grab the AED (that now has new batteries that I purchased the other day) and the airway management bag. After intubating and two shocks we managed to get return of spontaneous circulation.

Immediately we transferred the woman to the emergency department where she was stabilized.

The last patient is proof that the funding I have raised so far has made a massive difference. Purchasing new batteries, that without, the patients chance of survival was very low.

Rather than donating the money as such that may get lost in the system, I am going out and purchasing equipment that is essential, however lacking on the ambulances here and adding it to the kit myself. So far I have bought a full set of new batteries for one of the AED's, three sets of magill forceps, and a new sphygmomanometer. 

If you would like to help us out, even the smallest contribution is greatly appreciated.

https://www.justgiving.com/crowdfunding/dan-snaith?utm_term=9Gn5Z2Nxr

Day 13 - Day 8 on the Cruz Verde Norte Ambulancia

This post is a little later, for the weekends I have decided to swap over to night shift, starting at 8pm and finishing at 8am.

Today started with a call to a teenage male having a seizure. On arrival he had stopped fitting and after questioning the family it became apparent he was a known epileptic. I took his obs before we left him on scene with his family.

The next call was a urgent transfer for scans of the pelvis and abdomen, following a suspected pelvic fracture. The patient had been involved in a motorcycle accident. After the scan we brought him back to the emergency department, where the doctors could review the scans.

A bit of a wait before the next call, about 4am in the morning, we were called to an elderly female that was unwell. On arrival breathing and a pulse were absent, and after listening for a heart beat for a full minute I called the time of death. The female was 101 years old.

A couple of hours later we had another call to a sick person, again turning out to be dead on arrival, same procedure as above, this time the female was 67.

A slower day today, hopefully it will pick up over the weekend. 

Day 12 - Day 7 on the Cruz Verde Norte Ambulancia

Another day without photos im afraid.

To start the day we attended an elderly male that was feeling unwell. After getting him down the stairs and into the back of the ambulance we were able to take observations, all but the glucose levels seemed within their normal parameters. A short trip to the hospital and he was handed over to the emergency department for further investigation.

The next job was to an unwell middle aged female. We were directed to the house where we found her on the bed unresponsive and with no pulse. We immediately pulled her to the floor and began CPR. One of the paramedics inserted an OPA and began bagging her and another went to fetch the AED whilst I continued compressions. The pads for the AED were placed on her chest only to find out it had no battery. We continued with BLS for a little while before the patient aspirated a mix of blood and what looked like corn. At this point one of the paramedics decided to call it.

A while later we attended a motorcyclist that was claiming to be hit by a car. He was complaining of pain in the chest from the impact, but had no signs of physical injury. Regardless I conducted a chest examination, that as expected found no issues. One of the paramedics then told me that he was a frequent flyer and a drug addict that often presents in an attempt at getting a fix. The patient was left at scene with the police.

(The patient later presented to the emergency department with a completely unrelated injury and after becoming agitated was escorted from the site by the police)

The final call of the day was to another motorcyclist, the victim of a hit and run. He was ok and sustained no physical injury, however was a little shaken. I took observations on scene and he was assessed for any potential injuries, before being left with his friends on scene.

The Green Cross in Guadalajara provides a free ambulance service and very cheap healthcare at the emergency department. It is government funded however this barely covers the cost of staffing. The equipment on the ambulance is limited, often items only designed for a single application are re-used due to the budget. Many of the defibrillators have low or no battery as a result of the lack of funding. I am trying to raise some money to purchase some essentials, such as the batteries, observation kits to replace those that are old and barely functional, and other essentials that we take for granted in the UK. If you would like to help out, click the link below, as a result of any contribution you may make, you may even save a life.

Contribute here

Day 11 - Day 6 on the Cruz Verde Norte Ambulancia

A quieter day, only attending three calls, the first was to a cardiac arrest, two motorcycle paramedics were in attendance on arrival and my first job was to secure the airway using a LMA (laryngeal mask airway) after this we continued with compressions with a ventilation every five seconds. The AED that the motorcycle paramedics were using ran out of battery about five minutes into the resus attempt and it was swapped over for another. This was also on low battery, but sufficient for the time being. We continued with resuscitation attempts for 25 minutes before the senior paramedic called the time of death.

The second call of the day was to a bicycle rider who had been knocked down by a car. The rider, sat at the side of the road was complaining of lower leg pain and after inspecting the area I deemed it to be a likely tibia fracture. We splinted the leg using the cardboard on the ambulance and cannulated on route to the hospital.

The final call of the day was the transfer of a motorcycle rider with massive head trauma. Before leaving the hospital the doctor decided that RSI (Rapid Sequence Induction) was necessary, so I assisted in intubating the patient. On arrival we took the patient in to have CT scans of the brain, to find out the extent of injury, he had a massive fracture across the skull and bleeding inside causing compression of the brain. After the scan we returned back to the emergency department, where we then cleaned and prepped the patient for surgery.

Day 10 - Day 5 on the Cruz Verde Norte Ambulancia

To start the day we were called to a motorcycle crash, a motorcycle paramedic was already in attendance and on arrival, the patient was already receiving fluids and the suspected fractured ankle already splinted. For this incident the only thing we really had to do was transfer him to hospital and take some observations on the way.

Shortly after arriving back at Cruz Verde Norte, we received another call to a motorcycle crash, this time the patient had c-spine tenderness and as such we placed her in a collar and immobilised her using a spinal board. On route to the hospital I cannulated the patient and gave her fluids (as is protocol here) and also took her obs.

Myself and Chris (the other FREUC 5 student) were standing outside the front of the hospital when an old lady approached us saying that her daughter was sick in a house across the road. We let our controller know and followed the lady back to her house where she directed us to a room on the second floor. The woman laying on the bed did not respond to voice or painful stimuli, and after feeling for a carotid pulse which was absent we dragged her to the floor. I commenced compressions whilst Chris ran back across the road to alert the crews and grab an AED, oxygen, BVM and airways. On his arrival we changed over, Chris giving compressions whilst I cut off the clothes, attached the AED, inserted an OPA and started with the bag and valve mask. After about ten minutes the ambulance arrived on scene, one of the paramedics attempted intubation with no success so we quickly lifted her onto the stretcher, down the stairs and into the ambulance. I continued compressions for the minute journey to the hospital where we then rushed her into resus. Half an hour later, after receiving the blood results (pictured above) and considering the 4H's and 4T's the doctor called the time of death as 12:45.

A little time passed and we were called to a pedestrian that was knocked down by a car, although his physical injuries seemed minor, he had a sudden onset of confusion and nausea and therefore we treated him for a potential head injury. After delivering him to the hospital, he was later transferred to another for CT scans.

Our final call of the day was to a construction site. The patient, whilst carrying a bucket of cement had fallen approximately four meters from the floor above. He had pain in the thoracic area of the spine and also the pelvis. Again we immobilised, I cannulated on route and administered fluids followed by taking observations, which all seemed within their normal parameters. (image below)

All in all, a good day with a variety of calls.

Day 9 - Day 4 on the Cruz Verde Norte Ambulancia

No photos today unfortunately.

Today was relatively quiet, five calls that I attended, the first being a transfer of a middle aged man that was in hospital due to malnutrition, the hospital we transferred him to was very overcrowded, beds in every space available, and some patients even sat on chairs whilst being given fluids.

The second call was to an unwell man, however on arrival we were presented with a body, rather than a patient. One of the paramedics pronounced him dead before discussing what the procedure was for the body to be collected.

The next job was a motorcycle crash, fortunately the rider managed to get off with only minor injuries, which we cleaned and dressed on scene.

Then another motorcycle crash, two casualties, one male and one female. The male had a potential C-spine injury and also a deep laceration to the left arm. The arm was dressed, however the wound kept bleeding through the dressing, so in the end I decided to pack the wound with gauze, this did the trick and kept the hemorrhage under control. We then rolled him onto a spinal board and along with the female, who had only sustained minor abrasions to the knees and elbows transferred them both to the emergency department for further assessment and treatment.

The final call at the end of my shift turned out to be a prank call, and no patients were found.

Hopefully tomorrow will be busier :)

Day 8 - Day 3 on the Cruz Verde Norte Ambulancia

So again today I mixed shifts, started at 14:00 and finished at 03:00. In total I attended 8 calls, the first being the transfer of one of the patients from last night with a traumatic head injury to the intensive care unit at one of the larger hospitals.

Shortly after returning from the transfer we attended a motorcycle crash (shown below). The motorcyclist was perfectly fine, however the car driver had somehow ripped a couple of his nails from his fingers, causing considerable pain. The fingers were cleaned and dressed on the scene.

As we left the motorcycle crash, we then received another call, this time for a fall. However, on arrival it actually turned out that the 16 year old patient had actually dislocated the right patella. I was asked if I knew how to re-locate the patella, and explained that I had seen it done many times but not done it without the supervision. Surely enough one of the paramedics bent, then straightened the knee whilst I popped the knee cap back into position. Almost immediately the pain stopped for the patient, and after dressing the knee in a bandage, we left him on scene.

The next call was a for a middle aged woman who had a headache, there was no evidence to support it being anything more, but she was insistent on going to hospital so we ended up taking her anyway. (she was discharged from the hospital about half an hour after arrival)

We attended yet another car accident (shown above) but fortunately neither of the occupants was injured, what you cannot see in the photo, is that if they ended up about 2 meters to the right of where they were, they would have dropped about 30ft to the bed of a dried river.

The next call was a little more difficult as it was to a sexual assault on a middle aged female. The police were already on scene and there was no physical injury to the woman. The only thing that could be done was to provide emotional support, and as I do not speak the language very well and it was more appropriate for a female to speak to the woman, I left my colleague to talk and comfort the woman.

The final call of the night was to a fall in the street. The 26 year old had in fact fractured his tibia, and with the use of the cardboard in the ambulance, I splinted the lower leg, before we took him back to the emergency department for x-rays and further treatment.

Another great day, maximising my hours on the road in order to get the most possible hours of my clinical placements done before heading back to the UK.

Day 7 - Day 2 on the Cruz Verde Norte Ambulancia

 Today I worked 17 hours starting at 10am and finishing at 3am. Throughout the day we attended 16 calls, of which 6 were hoaxes. The first call of the day was almost immediately as I started, we attended a elderly female suffering from a CVE (stroke) or EVC as they call it in mexico. A motorcycle paramedic was already in attendance and it more or less was a grab and run job. She had cyanosis to the left hand and foot as well as left sided weakness, including facial droop. On arrival at one of the larger hospitals we waited around for about an hour before being able to get the stretcher back due to the lack of beds.

Shortly after this we attended several motorcycle accidents, mostly minor injuries and all but one was treated on scene without the need of hospitalisation.

We then took a patient from the emergency department for a reduced level of consciousness due to a head injury for a scan (Image above) at one of the larger and better equipped hospitals in the area. Once this was complete, we brought him back to the ED.

We had a call to a car that rolled over at speed with four occupants, including a 9 year old and amazingly they all walked away with minor lacerations to the knees and elbows. (image below)

During the night we attended a couple more motorcycle crashes, again with minor injuries, shortly followed by a call to a respiratory arrest as a result of bronchospasm. The patient was intubated and ventilated using a BVM and in a convoy (police truck followed by two ambulances) we rapidly transferred the patient to the emergency department. (note the patient re-gained consciousness in the resus rooms several hours later but was then put into an induced coma)

The final call of the night for me was by far the most interesting, we were called to a motorcycle crash involving four traumatic head injuries. Two of the patients were intubated on scene whilst the other two maintained their own airways. Again it was very much a scoop and run job, cannulating and doing obs in the back of the ambulance at 100kmph.

At three o'clock in the morning I decided to call it a night, until I start again tomorrow... I mean today.