There was just time for one more job before my day out with Steve and his crewmate was over. Glancing at the clock, Steve asked me what I’d like to see. A working suspended, perhaps? A BBA? Anaphylactic shock? No, I said, I’d like to see a bit of nasty trauma.

*RING RING* *RING RING*

I was first in the ambulance and leant over the partition to see what was on the MDT screen.

It was a call to the prison. A prisoner had had his throat slit. This is what happens when I’m not careful what I wish for.

Off we went to the prison, where we were met with by a vacant looking security guard who went through an elaborate ritual of opening and closing gates at snail’s pace before ushering us through and pointing wordlessly in the direction of one of the prison blocks. We were just unloading our equipment from the vehicle when we realised he had disappeared without giving us any indication where he was going. We stood around for a good two minutes wondering what to do next, before a stressed looking nurse came running along and told us we were outside the wrong block. So Steve and I picked up the equipment and ran along with the nurse whilst Steve’s crewmate moved the vehicle. Not a great start.

The prison looked alright from the outside, an unremarkable tall brick building not unlike my primary school. There were gardens and a sports yard, making it even more attractive than Nee Naw Control. Inside the prison was a different matter. Whoever said prisons were like holiday camps never went to this place. It was as cold inside as it was outside (and this was several weeks ago when it was still very cold outside). A horrid smell filled the air, a mixture of hospitals and school dinners. The cold, white walls were unspeakably bleak. We paced along the balcony - one side was lined with cells and I could hear the prisoners shouting or crying or singing to themselves. Some cells had their slats open and through the letter box sized opening you could see the cells were the size of a cupboard and just as bleak as the outside. On the other side, the balcony looked down to the floor below, where a depressed looking cook was serving depressed looking prisoners with slices of pappy white bread and a grey looking slop. Between our floor and the ground floor was a large safety net, presumably to stop prisoners throwing themselves off in despair.

We reached the medical room.

There was blood everywhere. I have never seen so much blood. There were pools of it on the floor, up the wall and even on the ceiling. On the couch sat the patient, wearing what must once have been a white t-shirt and trousers. They were now red. Two nurses were holding a compress to the patient’s face. The patient was fully conscious and clutching a cardboard vomit bowl, which was also full of blood.

“Let’s have a look…” said Steve, and the nurses unwisely pulled the compress way from the patient’s face. It was the nastiest wound I have ever seen in my life. Even Steve and his crewmate looked shocked, and they’ve seen hundreds of nasty traumatic injuries. The gash started on the lower neck and continued to the lower lip. The cut was full thickness and the skin was gaping, revealing bits of fat and muscle and veins and whatever else one has going on inside one’s neck. Blood poured from the wound. Even worse, the cut continued through the patient’s top lip, and I could see it was literally split in two, so when the patient tried to talk the two section dangled separately. Blood was spurting from this wound in pulses, and I understood this meant an arterial bleed. I remembered the occasion when my friend fell out of a jacuzzi and we were all unsure if the bleed was arterial or not - well, now I’ve seen one I’ll know for sure next time! His mouth was filling up with blood and clots which he kept spitting into a bowl. The thing that struck me about the prisoner was that he just looked like an ordinary lad - I guess I’d been expecting some kind of psycho murderer type with big scary eyes and a cold face, but this was just an ordinary person like me. It wasn’t a high security prison, maybe he was just in there for shoplifting or drink driving. He looked terrified and very, very young. The nurse explained that he’d argued with one of the other prisoner’s, who’d gone away and fashioned a weapon out of an ordinary razor by removing the plastic and gone up to our patient and, without warning, slashed him across the face with it.

Steve opened his bag of dressings and bandages and then stood looking at it scratching his head wondering what on earth to use, before settling on some steristrips and some gauze to hold against the wound. Then a member of prison staff came in and told us HEMS was circling overland and obviously expected us to know all about it when in fact we did not even know HEMS had been requested. (Usually HEMS is either requested by the crew or automatically sent as soon as the nature of the call is known, but in this case they’d decided to activate just after we’d left the vehicle). I came in useful at this point because Steve wasn’t allowed to use his mobile to call Control inside the prison and I was the only person who knew the control room’s phone number. So I rang the HEMS desk and gave them the medical report and made sure they were able to land and met by someone more competent than the guy who’d met us…

Minutes later, two doctors and a paramedic wearing bright orange suits barged in.

“Hello HEMS!” I said nervously, pointing to my “dispatcher” epaulettes. “Control staff! Observing! Don’t ask me to do anything! Talk to him!”

“Am I goin’ in an ‘elicopter?” said the patient, his eyes suddenly lighting up, before his mouth refilled with blood and he went back to spitting in his bowl. He sounded about ten.

And then I stood well back as HEMS, Steve and his crewmate all did their best to get the bleeding under control with adrenaline soaked gauze, steristrips, and good old fashioned Firm Steady Pressure. This didn’t stop the bleeding completely, but it definitely slowed down to the point where we could think about transferring the patient to hospital. HEMS decided against taking him in the helicopter to the Royal London; there was a local hospital that specialised in trauma and it would be easier to take him there in the ambulance with HEMS on board. I can tell you it was a bit of a squash in that ambulance: one patient, one prison guard, two doctors, one HEMS paramedic, Steve’s crewmate driving and me in the front. We took the patient in on blue lights but Steve’s crewmate had to be very careful going over the speed bumps to avoid knocking everyone over in the back!

“Mark!” hissed Steve, as we disposed of our patient in A+E. “That’s it. You are never coming out with us again, and you are certainly not going to wish any more calls on us. I’ve had it with you.”

“Did you hear why the other prisoner did that to him?” said Steve’s crewmate.

“No?” I said, thinking it must have been something really nasty. It’s tough in prison. Drugs, gangs, guns.

“Bread!” said Steve’s crewmate. “Apparently they had an argument over the last slice of bread. Other guy goes back to his cell, comes out with the razor, and does that. All over a slice of bread.”

I thought back to the piles of pappy bread on the way in, the revolting smell, the sight of the prisoner’s lip flapping and the exposed flesh in his neck, and all I could do was shake my head.

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