Stairs. I hate them.

We were called to an older lady who'd fallen backwards downstairs, he'd then managed to crawl up her narrow and twisty staircase to bed. It was there she started to feel more pain than was expected and she asked her carer to call for an ambulance.

As an ambulance person one of the first things that you pay attention to once you realise that a patient is upstairs is the state of the staircase. Will it be easy to move a patient down? Will you be able to safely avoid any loose bits of carpet? Is there furniture (or, more commonly in my area, a pile of shoes) at the bottom that is a trip hazard? Then you meet the patient and start mentally totting up their weight and how likely they are to grab out at the bannisters, thus causing the whole lot of you to fall down the stairs and end up in a very litigious heap at the bottom.

Thankfully this patient wasn't heavy, but after examining her I couldn't rule out a broken neck. That and there was some real concern about a broken leg.

I wish she'd stayed put, crawling upstairs was perhaps the worst thing that she could have done.

Thankfully, despite the pain, our patient was in good spirits - so when I told her that we'd be taking full precautions in moving her she understood.

So, with a potentially broken neck, we would have to secure her to a stretcher, then find some way to manoeuvre her down the extremely narrow, steep and twisty stairs. At least the carpet was tacked down securely.

This would need a second crew, in this case many hands would indeed make light work. I made the call while my crewmate gave her some analgesia. Control were a little less impressed, we'd been extremely busy the whole shift and the chances of getting another ambulance any time soon were pretty slim.

Without a second crew I was considering calling out the fire brigade. They have a policy now of only assisting us when the patient has life-threatening injures (which is, needless to say, a policy that we should be copying). I'd have to sell it to them, and perhaps demand that we remove the patient via the first floor window on a cherry-picker.

Except that the window doesn't open and so would need to be smashed.

However a second crew did arrive and we proceeded to strap our poor patient to the stretcher, by now she was nearly pain-free and telling bad jokes, something I normally consider a good sign.

Fully strapped down in a way I described to her as 'as close to bondage that she'd ever likely get' we then started getting her down the stairs.

When you strap a patient down in such a manner it should be possible to stand the stretcher on it's head without the patient slipping. In this case we kept her feet down, but we would have to stand the stretcher vertically in order to get her downstairs. With a broken leg, if any pressure was put on her it would be incredibly painful.

Well either our pain relief, our strapping or our patient's pain tolerance held as we got her down the stairs without any yelping.

From there on out it was a simple matter to get her out to our ambulance and from there to hospital.

It would seem that my decision to strap the patient motionless was a good one, the Doctors were having serious suspicions of a broken neck once the initial x-ray films came back, and the leg was indeed broken.

I don't often strap patients down but in this case I was very glad that I didn't just sit them in my carry chair and have at it down the stairs. Sometimes going slow is in the patient's best interest.