Musing over my previous post, I am reminded of something that occurred when I was a HouseSurgeon at another DGH. The details are less well known to me, as I was just ScutBoy, but it illustrates the same principles well. I'm beginning to think that foremost among them should be "don't believe what you're told", no matter who tells you.
In this case, a patient was brought to the A&E (as was) having been 'found down' on a railway track. There was no suggestion that he'd been hit by a train - i.e. he was in one piece - but he was under a bridge. My understanding is that he was first assessed by a rapid response team. Two basic options present themselves:
One - he has jumped / fallen from the bridge above. Classification: trauma. Plan: rapid transfer, eager doctors waiting.
Two - he was walking along the railway track, and passed out here. Classification: Not Trauma. Plan: call some other guys to ship him to hospital; tell no-one he's coming.
The on-scene assessment was the latter.
He duly arrived in hospital labelled "collapse ?cause". No bother he can wait his turn. This was, of course, back in the 'good old days', when waiting really meant waiting.
He duly waited. After some time, the duty Senior HouseSurgeon was passing through the Department, and spotted said patient. She was of the opinion that he was entirely too white a shade of pale, and stopped to give him the once over.
One quick primary survey later, an open book pelvic fracture was discovered.
Much later an history of attempted suicide by leaping was discerned.
My memory does not extend to exactly what assessment this fella received on arrival, but it evidently didn't extend to routine re-assessment. Or did it? I genuinely don't know, bu somehow he slipped through the net, mostly because his initial label was along the lines of "he's o.k.", and it stuck.