Episode 9
Episode Summary:-
Rob is just going home after a twelve hour shift consisting of the "usual procession of the unlucky and the irresponsible" when the alert comes in...
A plane has crashed. From what I could make out, it had either overshot the runway or come down short of it, ploughed across open land and come to rest across one side of the motorway. There are ninety-five people on board, including six crew. Fuel is leaking everywhere, making it impossible to use electrical cutting equipment: it will be hours before the fire crews can even reach the fuel tanks, let alone empty them. By the time the St Vic's team get to the scene, there are twenty dead - and counting...
Specific victims: -
Carl, alive when found - by David - but who dies soon afterwards of his injuries;
An elderly woman found by Kate, apparently not too badly injured, more concerned for her husband sitting some rows away. He'd been talking just a few minutes ago. When Kate reaches him, he's dead - and she has to decide, with no help from Rob, whether to tell the wife or not;
Belinda Adams, first found by Terry and then attended by Rob - her left leg trapped and severely injured by the metal flooring of the aircraft, and quite literally in a life or limb situation. (And no, I'm not trying to be funny. It's a choice I hope I never have to make);
Stephan, badly hurt but feeling no pain...
Amanda, an unaccompanied seven-year-old, trapped under collapsed seating;
And a baby, still held tightly in its mother's arms, miraculously unhurt amid the carnage...
[Belinda] "I don't know how you can do this job."
[Judy] "I don't know either, sometimes."
Talk about being thrown in at the deep end! But Kate and David were wonderful here. I wondered, as Mike did, why Rob chose the two newest members of staff to go with him, but in context it did make sense. He needed to have an experienced team back at the hospital to deal with incoming patients. Treating the situation as a training exercise was perhaps a little brutal, but it served several purposes: for Rob to see how they handled the pressure; for the pair to experience possibly the worse case they'd ever come across (if they can handle this they can probably handle anything); and for them to see for themselves whether they survive the experience with their passion for the job intact.
I really liked the way we could practically see David evolving throughout the episode. He starts off by seeing it as an interesting case (hence his comment to Kate about "these things are textbook" and seeing their names in print - and Rob's comment about him writing a paper about the whole experience!) Later the horror of the situation overwhelms him. Later still, he's so worried about the effect of what he sees as his 'failure' that he's unable to see to his own comfort until after he's spoken to Rob. (And after the way he's behaved in this episode, I was relieved to see him sympathetic to the younger man's emotional state. These two have a lot in common, character-wise.)
It was good to see that David, shell-shocked as he was, was the one to spot that there was something seriously wrong with Belinda. (I'm not sure why Belinda was complaining about Rob's 'bedside manner', though. It didn't seem too bad to me - and was a lot better than that of some of the doctors I've met. Nice bit of psychology from Judy, though - distracting Belinda into feeling concern for someone else to take her mind off her own problems. Judy's reaction was so realistic, too - not weeping until she gets back to St Vic's...)
And Kate? Kate is just wonderful. This is the sort of woman you'd want with you in an emergency - calm, rational, efficient, caring... She'll go far.
Interesting that Mike's first reaction, on examining Stephan, was to accuse Kate of incompetence. I know they were all under pressure, but this seemed a little harsh. Does he not like her? And if not, why not?
Nevertheless, there are a few things here that jar. Rob's sheer irresponsibility (and arrogance - I'm with Chris, there) at heading back in to take charge of a disaster in his condition - tired after a twelve hour shift and still a little unbalanced, still trying to come to terms with Issy's death and the blunt facts and problems of single parenthood. His volunteering to be forward MO - and then, effectively, lying to his team: "I've been assigned forward MO". Well, yes he had - after asking for it. I'd like to think Andrew will call him on it, later. He wasn't exactly overly supportive of Kate and David, either. Fair enough, it didn't actually do them any harm - quite the opposite - but he did, after all, choose them to be part of the team in the first instance...
I found Rob's behaviour unsettling, because I couldn't believe it. Generally speaking, up until now the series has been wholly authentic, but this didn't work for me. Yes, it made for great dramatic impact, but it lacked realism. Or maybe I just find the idea of a senior consultant who would act in this way extremely worrying. I'm glad he's got his passion for the job back: I just wish he'd done so in a more responsible manner.
My misgivings aside, this was a wonderful episode, with marvellous acting by all concerned.
Thinking Out Loud
It's really only just struck me how notable - and noble - was David's behaviour in episode 8. When the drunks started abusing Yvonne, he was first on the scene, shoving them back, furiously - even though he was hopelessly outnumbered by men twice his size. Admittedly security were on their way, but all the same, it was both brave and admirable. So are his feelings for Yvonne deeper than anyone knows?
Notes
I've quoted extensively from the information sent to me by Dr Irvine for these notes. And I've learned a lot in the process! Unless otherwise stated, all the medical information, procedures, and terms are courtesy of Kate Irvine.
Can anyone tell me the name of the piece of music playing in Rob's car at the beginning of the episode? I know it and like it very much, but I can't for the life of me remember what it is or who it's by.
M.I.P. is Major Incident Plan (also known as the Major Civil Incident Plan). "Run by the Fire Brigade - nobody does anything without their agreement. They are responsible for the safety of all the rescuers, and it really is safety first. But the plans are drawn up including Fire, Police, Ambulance and Hospital services."
A beautiful little scene, with Rob's feelings so clear on his face: this is when his 'passion' truly returns. A fine piece of silent acting by Martin Shaw. Back
The blood pressure in each arm was very different, indicating an aortic rupture (tear in the wall of the heart). Rob missed it - understandable under the circumstances, I suppose.... But David picked up on it. I'm not clear why, but nevertheless it made for good drama. And indicates that David is, despite appearances to the contrary, evolving into a very good doctor, accurate, clear-minded, and willing to double check everything. OK, in this situation he's acting on instinct to try and cushion himself from the horror around him (Rob even admits, at the end of the episode, "You weren't trained for that scale. That was raw") - but his instincts are absolutely right. Back
The 'forward' Medical Officer is in charge of sorting out who goes where to help with the casualties, and stays in touch with the heads of the other emergency services. Back
Andrew is not best pleased, and frankly I don't blame him. Chris asks him how it went: -
[Andrew] "Unpleasant. Had to be done. Nothing more than that. For me, anyway."
[Chris] "What d'you mean?"
[Andrew] "Ask the boss. It's his crusade." Back
Dr Irvine - "Christine said it was a 'cascade call'. From that I assume they meant it would start with them and then move onto the next nearest A & E dept, and so on until all the casualties were dealt with. They also said that they had been asked to go to the scene as the St Vic's ITU [Intensive Therapy Unit] was full. It meant they could spare staff to go out to the scene to help. Some patients could then go back to St Vic's later once they'd cleared the beds in ITU (if they could!).
Triage is the manner in which they decide who gets help - early, late or not at all. It does seem very brutal, but with limited resources then you have to identify the people for whom care is required but that it will do some good. If you spend a long time with one person, three others might have died who could have been helped by something as simple as moving their neck, thereby opening their airway to help them breathe properly - while if you'd left them they might have asphyxiated.
Triage is based on three things initially. Can they walk? They are automatically green or category 3 - cleared to a separate area and left until everything else has been looked at. A nurse or medical person would oversee the area so that if a patients condition changed then they could be re-triaged. (It's a dynamic process. If the person who was walking and talking suddenly isn't then obviously something has happened that needs to be checked, urgently.)
Pulse and respiratory rate are the next things to be taken into account, and it's from this the initial assessment as to who is Red or Category 1 (high priority, for immediate transfer to hospital), Orange or cat 2 (urgent), or White or Cat 4 (either dead or expectant [expected to die]). Pretty gruesome to have to make the decision."
You're telling me!
GCS is often mentioned in the series, so I asked what it meant. Dr Irvine: "GCS stands for Glasgow Coma Scale. It's used all over the world to standardise how awake and aware a person is. It's divided into three sections, each with a maximum score of 5, minimum 1. If you are wide awake and entirely 'with it' you score 15. If you are completely unconscious then the score is 3. It's used to help decide how unwell a person is and is checked on a regular basis, so you can note any changes and change your management of the person accordingly."
© 2000 Joules Taylor