The number of staff in attendance. The number of victims. The decision to call out the medical crew. Jessica. The descent down the incline. The temperature and depth of the water. Jessica being called onto the minibus. His first impression of the casualties. The way the casualties had been prioritised. The fact that Jessica had landed in the water.
The feeling in his chest when she’d disappeared under the water.
He laid the notebook and pen down in his lap.
This was no use.
He wasn’t thinking the way he usually did. Calmly. Methodically.
He just couldn’t get her out of his head.
It seemed that after thirteen years of immunity Jessica had reclaimed her place—straight back under his skin.
THE AMBULANCE DOORS were flung open and Jess heaved a sigh of relief. Her team was ready and waiting.
The A and E department would be swamped. There were twelve kids with a variety of injuries to look after, as well as all the normal walking wounded patients and GP emergency admissions that would have turned up today.
Everyone would be on edge. The place would be going like a fair.
Her team sprang into action immediately as she jumped down from the ambulance.
‘Is the resus room set up for these two kids?’
‘All prepared, Dr Rae. Fluids heating as we speak. Harry Shaw, the anaesthetist, and Blake Connor, the registrar, will help you run these kids simultaneously. You’re drookit, Jess. Wanna get changed?’
A set of scrub trousers were thrust into her hands and she gave a little smile. Her team had thought of everything.
Harry appeared at her side. ‘I take it it was freezing out there?’
‘Baltic.’ The one-word answer told him everything he needed to know.
The second ambulance arrived and both kids were wheeled into the resus room and transferred to the trolleys. Jess ducked behind a curtain and shucked off her soggy jumpsuit, replacing it the with the dry scrub trousers. If only her underwear wasn’t still sodden.
Her team was on autopilot, stripping the freezing-wet clothing from both kids and bundling them up in warming blankets.
She walked out from behind the curtains. Harry Shaw was standing at the head of one of the trolleys, doing his initial assessment. ‘What can you tell me?’
She looked up as Callum appeared at the doorway and handed her a sheet of paper. ‘Thought this might be useful,’ he said as he walked away.
She stared at what he’d scribbled for her. Temperature of the Clyde is currently minus five degrees centigrade. Moving water takes longer to freeze.
It was just what she needed. The temperature to which these kids had been exposed was very important.
She walked over to Harry. ‘This is Marcus, he’s four. He was unconscious at the scene but I can’t find any obvious sign of injury. Showing severe signs of hypothermia. As far as I know, his head was always above the water, but we couldn’t get the tympanic thermometer to register on-site.’
Harry nodded. ‘I need baseline temps on both these kids. Has to be a core temperature, so oesophageal temperatures would be best.’
More paperwork appeared in her hand from the receptionist. ‘Nursery just called with some more details.’
Her eyes scanned the page and she let out a little sigh. ‘This is Lily. She’s four too. She was submerged at the scene—but no one can be sure how long.’
Harry was one of the most experienced paediatric anaesthetists that she knew. He’d already realised that Lily was the priority and left Connor to take over with Marcus. He was already sliding an ET tube into place for Lily. He took a few seconds to check her temperature. Both cardiac monitors were switched on and the team stood silently to watch them flicker to life.
Jessica’s heart thumped in her chest. What happened in the next few minutes would determine whether these kids made it or not.
‘Marcus’s temp is thirty degrees. Moderate hypothermia,’ shouted Connor.
She watched the monitor for a few more seconds. ‘He’s bradycardic but his cardiac rhythm appears stable. Any problems with his breathing?’
Connor shook his head. ‘He’s maintaining his airway. His breathing’s just slowed along with his heart rate.’
Jessica’s brain was racing. She was the paediatric consultant. This was her lead. But Harry was an extremely experienced anaesthetist. She wanted to be sure they were on the same page.
She turned to him. ‘Warmed, humidified oxygen, contact rewarming with a warming unit, rewarmed IV fluids and temperature monitoring. Do you agree?’
He gave her a little smile over the top of his glasses. ‘Sounds like a plan. I’ve paged one of my other anaesthetists to come down.’ The nursing staff started to flurry around them, carrying out the instructions. Jessica felt nervous.
Hypothermia was more common in elderly patients than in children. Every year they had a few cases come through the doors of A and E, but she wasn’t always on duty. And most of those kids were near-drownings—kids who’d been playing on frozen rivers or lakes and had slipped under the water.
Blake Connor, her registrar, looked up from Marcus’s arm. ‘I’ve got the bloods.’ He rattled off a whole host of tests he planned to run. ‘Anything else?’
She shook her head. ‘Right now, we’re working on the assumption that he’s unconscious due to his hypothermia. There’s no sign of any head injury or further trauma. Keep a careful eye on him. I want to know as soon he regains consciousness. He’ll probably be disorientated and confused. Most adults with a temperature at this stage start undressing. We might need to sedate him if he becomes agitated.’ She scribbled in the notes then spoke to the nursing staff.
‘We’re aiming for a temperature gain of around one degree every fifteen minutes. Keep an eye on his blood pressure and watch for any atrial fibrillation. Is that clear?’
The nursing staff nodded and she looked around. ‘Anyone seen Jackie? She was the one who brought Lily in. I need some more information.’
One of the paramedics touched her arm. ‘She fell, coming back up the slope. We think she might have fractured her ankle. Once we’d dropped Lily here my technician took her along to Glasgow Cross.’
Jess felt a twinge of guilt. It was her fault Jackie had been on the scene. She’d wanted the expertise of the experienced nurse at the site. Now, because of her, Jackie was injured. It didn’t seem fair.
‘Lily’s temperature is lower than Marcus’s. It’s twenty-eight degrees.’ Harry had just finished sliding the oesophageal temperature monitor into place. He glanced at the monitor. ‘She’s borderline, Jess. What do you want to do?’
Jess pulled back the warming blankets to get a better look at her small body. Lily was right on the edge, hovering between severe and moderate hypothermia. It was a wonder she hadn’t gone into cardiac arrest.
‘How’s her respiratory effort?’
Harry was sounding her chest. ‘For a child who was submerged I’m not hearing any fluid in her lungs. Just a few crackles. She is breathing, but not enough to keep me happy.’
‘Wait a minute, folks.’ Jess held her hand up as the monitor flickered, going from a stable but slow