Candy & Blood
CANDY & BLOOD
It was around this time that I started attending pre-hospital events. Considering that I had gone into emergency medicine with the sole intention of becoming an expedition medic, this was practically the next best thing.
Pre-hospital medicine refers to the care that takes place before a patient arrives at hospital during an emergency – the initial on-scene assessment, stabilisation and transfer. Whilst trainees at my level were not required to have any kind of pre-hospital training, I knew I had to show my interest right from the start. And so, I signed up for as many events as I could.
I’d attend lectures and seminars and drills of sorts. And I’d also attend as a standby medic at local concerts and festivals in case something happened – which usually meant people getting drunk, passing out from the heat, getting injured, and so on and so forth. Some of these events I attended on purpose. Others, completely by accident.
Not a Drill
One of these pre-hospital events involved a practice run at the fire station doing a helicopter emergency evacuation drill.
Along with a few other doctors, nurses, police and traffic wardens, we were given a briefing on how to manage helicopter rescues – how to approach the contraption safely, how to transfer the patients being flown on it, how to manage any emergencies en route, and the like. We were just about to witness the helicopter landing – something I really wanted to see – when the lead doctor came up to us with some news.
Turns out, a migrant boat had just capsized. With us being there for a drill, our first reaction was that it was part of the exercise. Lo and behold, it wasn’t. This was not a drill. With Malta being close to North Africa, we’re kinda used to having migrants using our country as a safe haven – the political instability back in their countries leading them to board any boat that will have them in an effort to escape the horrible conditions they live in. And those boats, unfortunately, are not known to be the safest. In fact, it was assumed that the boat capsized due to instability.
Illegal immigrants arrived in Malta in the thousands, and, despite it being a controversial and sore subject for most Maltese, this was something we’d hear about on the news on an almost weekly basis. Thousands of people being stranded in the Mediterranean for days, weeks and months with nowhere to go. Thousands of lives lost. Thousands of mothers, fathers, sisters, brothers – families torn apart. Thousands of people – each with their own story – gone. Yet for most of us living in the comfort of our relatively safe countries, those stories are nothing but a statistic. For some others, it’s not just a statistic – it’s a nuisance and a burden, having forgotten than the only difference between us and them is the fact that we were lucky to have been born here instead of there.
As aware and woke as I might think I am, I realised that I was no different. I’d hear all about the dead migrants, perhaps spare a moment of silence and respect, and then go on about my day as if nothing had ever happened. I’m not in the habit of quoting Soviet dictators, but Joseph Stalin was kinda in the right when he said this: “A single death is a tragedy; a million deaths is a statistic.” It was this call that made me realise how passive I’d been about it all. It’s one thing hearing about a statistic on the news – something completely different when you’re about to face it head on.
Time to Act
The initial call from the Armed Forces of Malta, aboard the patrol boat that had been dispatched to investigate the incident, left us in shock. We were told to expect five to seven patients in cardiac arrest requiring ongoing CPR, with other casualties possibly already dead on-site, probably having drowned.
I still remember riding shotgun in the ambulance – a non-equipped one brought to the fire station for training purposes – going over the ABCDE approach in my head and running through every single step out loud with my colleague in order to prepare ourselves as best as we could. We had no idea what resources we’d have or what kind of casualties we’d be facing as the policeman in front of us worked his magic to control the traffic ahead. To this day, I have no idea how the hell he managed to do it.
Flash forward to when we got to the scene. Luckily enough, a few more fully equipped ambulances had shown up. We were then divided into groups – some assigned to triage and others, like myself, to management. We were instructed to relay all information to one nurse, who would then communicate everything to the lead doctor.
Together with the nurse I had been assigned to, I started unpacking the ALS bag and practically laid everything out on a tarp we had set up to receive the patients. I was frantically trying to think of whatever conditions they could present with and come up with anything and everything I could do right there on the spot. This was exactly why we needed pre-hospital training. And this was not the ideal way to learn.
The First Boat
Then the first patrol boat arrived. On it were some 18 people. Five of them lay on the floor, pale and unmoving. One of them was very visibly pregnant. Probably close to giving birth.
I could feel my eyes starting to tear up. I blinked them dry and compartmentalised my humanity away for later. This was not the time to feel. As the triage team busied themselves assessing the patients to see who needed what, I couldn’t help but feel useless. I spent a good fifteen minutes just going around asking anyone if they needed help. That’s when the second patrol boat arrived. Luckily, all the people who had been rescued were doing well – save for one man who kept asking where his pregnant wife was. But this was not the time to feel. And so I got to it.
My first patient was a young guy – probably not even eighteen yet. He was soaking wet, trembling, coughing and muttering something to himself. My colleague and I quickly dried him and covered him in a foil blanket. He was terribly hypothermic – his body temperature far below what it should have been – hence the confusion and lethargy. On auscultation of his lungs, I could hear crackles all over – a sign that he had probably aspirated seawater. Probably gasoline too, given that all of them reeked of it. Turns out, their boat had started leaking fuel after it capsized, and they had been swimming in it throughout. I put him on a non-rebreather mask to give him the maximum oxygen delivery available to us, and then off he went to hospital to be properly assessed.
The second patient was a man in his mid-fifties who was complaining of chest pain. Once again, we started off by drying the poor old chap, then proceeded to examine him properly and do a three-lead ECG. Once we confirmed he was haemodynamically stable and that there were no signs of impending catastrophe on his ECG, we sent him to hospital too.
The rest of the survivors were good to go and needed no medical assistance apart from being dried, warmed and handed blankets. It might not have been medical management, but that’s all I could do. As useless as I felt, at least I could do this one little thing that hopefully made them feel a bit better. Cause their lives had just shattered.
Candy, but with Blood
After the whole incident, we all met up to have a coffee and go over the entire thing methodically – what had happened, how we had handled it and what we could have done better. The latter was quite easy to figure out: nothing.
We had acted like a well-oiled machine, with the lead doctor’s and lead nurse’s instructions being perfectly executed throughout. We did what we had to do, and we did it efficiently and well with little to no training. Despite there being five dead people from the get-go, we treated eight injured people and sent the rest on their way to the detention centre for further assessment. It was a job well-done and we all felt proud of ourselves. The lead nurse burst out crying – partly cause this was her first time managing such a crisis, partly because of how well we did, but mostly because of the tragedy that unfolded in front of our very eyes.
I, for one, was as stoic as they come. My feelings? I’d dwell on them back home. As I’d always done. At home, I could go over it all. Break down if need be.
These people had fought against the unthinkable to escape the hell they came from in order to secure a better future for themselves – and now look where they were. Stuck in a foreign country, with a bunch of immigration officers shoving them into a van to transport them to the closest detention centre, all while they were trying to make sense of something that didn’t make sense. Trying to process what they had just been through. Still unaware of the shock that the deaths of their loved ones would bring. And they were all so young. Younger than me even. Just goes to show how easy we have it.
So many thoughts ran through my head at the same time. How the hell could I even begin to process such feelings?
As distraught as I was, there was also something else. I have to be honest. I was also on a high. This was exactly why I went into emergency medicine. This was the goal for me. This is what I had been hoping for ever since I decided to specialise in this branch of medicine. Tragedy. Disaster. Mass casualties. And I loved it. Not their suffering. Never that. But the clarity. The urgency. The sense that, for once, every second mattered. The sense that I belonged.
Candy – but with blood.