I was in London yesterday for a meeting with an author (we’re finally starting to catch up on things which have unfortunately been held in abeyance while we concentrated on At The Going Down Of The Sun) and my journey took me onto the Tube.
We were held up near Baker Street because of what the announcer called ‘a person on the line’.
THE ONE I REMEMBER most vividly was my first.
It happened at London Bridge station a while back and it ended up being shown in an episode on BBC’s Trauma programme, a fly-on-the-wall documentary series following emergency crews as they went about their business.
I was working with a colleague on a routine transfer call, and had just arrived at the address when this higher priority call came through as a GB*: ‘One-under at London Bridge, any mobile able to respond please press Priority.’
We pressed the button and got the call.
I wasn’t at all sure if I wanted it, but then what normal human being looks forward to seeing what a man looks like after a tube train has run over the top of him?
We got the blue lights on, dodged through the afternoon traffic and were on-scene within a few minutes.
A couple of solo paramedics had already arrived and we made our way down the escalators to see what we could do to help.
It was hot and noisy and sweaty, but all thought of personal comfort evaporated when we got to the platform.
The train had stopped and most of it was inside the tunnel; the last carriage or two was still on at the platform and we could see the activity underneath.
A paramedic was already there, tending to the patient who, incredibly, was still alive. According to witnesses, he had jumped in front of the train (one-unders are usually witnessed, by the poor driver if nobody else) and had been dragged underneath.
His torso had hit the train but his head had failed to make contact. Now he was trapped underneath, with massive internal injuries, affecting his chest and abdomen.
Amazingly, he hadn’t lost any limbs and he didn’t have a mark on his head.
He was still breathing and just about conscious. He wasn’t talking to anyone, just moaning and groaning softly. My crew mate and I got down and crawled under as far as we could to offer our assistance.
The LFB (fire brigade) had arrived and they were going to lift the train off the track so that we could slide the man and ourselves out from underneath. Unfortunately, they can only lift the train a few inches off the rails, so it’s still a tight and dangerous squeeze on exit.
Another crew had arrived now, and a trolley bed and further equipment was being brought down.
HEMS* arrived; the first thing I knew about it was when I turned around to speak to someone and found myself looking at an orange-suited doctor and a BBC camera. (My butt was the first thing you saw of me on the programme when it aired.)
We continued to try and untangle the man’s body; he was twisted under the train’s metal structures and was effectively caught on the bottom with his legs wrapped around a cross-bar.
As soon as the train was moved and he was freed, I heard yelling and banging around and someone calling for suction. Something had gone wrong. I passed the suction equipment through and the horribly injured guy was dragged out after a few seconds. He had gone into cardiac arrest.He was resuscitated on the platform, and a thoracotomy was prepared. This is something HEMS can do but we cannot; it’s a hugely invasive procedure that involves cutting holes in the chest at each side and then cutting right across and opening the chest cavity in order to get at the internal organs, particularly the heart, directly.
I have never seen anyone survive a thoracotomy, it is just about the most desperate thing you can do, a last-gasp, last hope affair.
On this occasion, once the holes were put in, resus had become so desperate that the decision was made not to open him up completely. I was bagging the man, and every time I pushed air into his lungs blood would spurt out of the two holes in his side. It wasn’t pretty.
As I ventilated him, I looked down at his face. He was well-fed, and his clothes weren’t begging gear. He didn’t look like he had come off the street, he looked as though he had a life somewhere. He had a number of tattoos on his body, including one of the Scottish flag. A fellow countryman.
The resus effort was called off after almost an hour of hard work. There was no way he could be brought back. His internal injuries were significant enough to have caused him to lose almost all of his blood: there was certainly enough of it around that platform.
As he was bagged up, I wondered what had driven him to this. I wondered, too, what it had been like.
How would it feel to stand on a platform, waiting for the distant rattle and echo of an approaching train, with commuters and tourists chatting away nearby, counting down the final seconds of your life?
And what would it be like as you threw yourself onto the track?
He’d have been hoping for a sudden despatch, but that’s not what he got. He had suffered for some time after being hit by the train, though his plans had eventually come to their terminal fruition.
He had achieved what he had set out to do. But why had he done it?
A few weeks after this job, my second call of the night – after a successful resuscitation – was to attend a ‘one under’ at a central London tube station.
The LFB, police and an ambulance were on scene and a motorcycle solo had travelled with me. A large crowd had gathered outside the station because the evacuation alarm had been activated and the station had been cleared.
The crowd made it difficult to get access to the entrance, and I had to struggle through the mass of people to get to the gates, which were being guarded by the police and underground staff.
On the platform, a group of medics, police officers, fire personnel and tube staff had gathered.
One of my colleagues had volunteered to get under the train with a fireman and they had both climbed down, only to be told to keep still because nobody was sure if the power was off.
They both froze where they were, but not before my colleague had checked the man’s vital signs and found them to be absent – he wasn’t breathing and he didn’t have a pulse.
He was still lying where he’d been hit, everyone waiting for the tube staff to verify that the power was off.
It’s hot and dirty down there and the last thing you need is the additional worry of possible electrocution: two colleagues from my station had previously suffered severe electric shocks under a train after being given assurances that it was safe.
They could easily have been killed and this risk is simply not acceptable, especially when the person who jumped may well be dead anyway.
I looked underneath the train and saw a man lying on his side with a large pool of blood around his head. He wasn’t breathing at all. He had obviously died of his injuries but we still had to get under the train to confirm that. We stood on the platform with all the other services, waiting for the word.
Once the all-clear was given, further checks were made but it was obvious the man hadn’t survived. The HEMS team arrived just as the two volunteers were climbing out of the pit.
I described what we had and the doctor got down to confirm that the man was beyond help. I went in with him and waited until he had done what was necessary.
The body was left where it lay and the train was moved away to reveal it for the police and Coroner to examine. It wouldn’t be moved until that had been done, so the platform would remain closed.
Outside, the traffic was building up. Long queues were developing all over the West End, partly due to the sudden increase in taxis flooding the area to carry commuters home, and partly because of some existing road works. The main cause of the chaos, however, was the virtual car-park of emergency vehicles in the area and the forced closure of the roads around the station.
I left the station platform and headed for fresh air.
While I was doing the paperwork, a member of London Underground staff approached me and asked if I could take care of a young woman who had been sitting outside the station entrance, crying. I took her to the car and she was soon joined by a friend who had been called to take her home. I decided to take her to hospital, with her agreement, because she was in a very bad emotional state.
During the journey, which was painfully slow due to the heavy traffic, I looked at her in my rear-view mirror. Her face was a mask of deep and painful emotion; she looked haunted, her eyes almost terrified, and she said nothing throughout the journey.
Who was this frightened, scarred young woman?
She was the commuter who had been standing next to the man when he had jumped in front of the train.
*’General Broadcast’ – a radio alert which goes out to ALL frontline vehicles, known as mobiles, on a specific channel. The broadcast contains information or requests crews to ‘green up’ and make themselves available for a call that is queuing. At busy times, GBs are common.
**HEMS. The Helicopter Emergency Medical Service, based at the Royal London Hospital in Whitechapel. They are an elite team of doctors and paramedics who are called to the most serious patients, where difficult entrapment or major trauma is involved. Sometimes they travel by helicopter (during daylight hours) and sometimes in a specially-liveried fast response car. They are activated either directly by Control or by crew request.