|Beware of the buzz|
|Thursday, 01 October 2009|
When a fellow rules official became ill during a Spanish golf tournament, Colin Strachan was called upon to provide emergency treatment under difficult circumstances
It’s relatively easy to remember the Rule (23 – 6/5) about a snake – dead, it is a loose impediment, but alive it is an outside agency and the rule states that the ball is dropped out of the danger area, for which a snake is more than three times it’s uncoiled length. Other situations such as lightning strikes are more dangerous despite all the detector technology now in use.
"It didn’t take too many of my post-retirement neurones to synapse and tell me I was faced with my first full-blown anaphylactic shock in its twentieth minute with no medical kit in a foreign country!"
The most dangerous situation I was involved with in 12 years of refereeing was medical and not in the Rules. I was at the PGA Catalunya National as a European Tour Rules Official and was covering the second nine holes with a 31-year-old British PGA referee at PQ2 of the European Golf Tour Qualifying School. At this, 500 hopeful professionals play on one of three courses for a Tour Card to gain entry the following year to more than £40 million in prize money. The distraught and tense players, paying £900 each for the privilege, are reduced to a mere 90 for the Final 5 Round PQ3 two weeks later. There were no spectators and few words spoken. The air was clear, the temperature 28oC from a low set, blinding sun which cast dark shadows even at midday in the Maritime pine forest.
It was just after midday that I was called in for my 10-minute lunch break, after six hours on the course – the only break in a 12-hour day. By one o’clock I was heading back out onto the 12th/13th fairway area when my Motorola crackled and my PGA colleague radioed me to say that he was experiencing some discomfort in his throat and was dizzy. Five minutes later, Mike Stewart, the Tournament Director, called me to say that they needed me urgently at the Scorer’s Desk as the PGA man had now gone a blue/grey colour and was having difficulty in breathing. He said ‘I think he has been bitten or stung by something, you’d better come in straight away’.
The ancient petrol buggy took eight minutes to get there. I found him lying on the Registration table, his hands, arms, neck and scalp visibly swelling, his lips and fingertips were dusky-purple and he was now gasping for breath like a dog on a choke chain. Weals and red bullae were springing up on both forearms. He couldn’t speak through his high pitched inspiratory stridor; others tried to describe what happened. Apparently, while helping to look for a ball in thigh rough below low overhanging branches, he had felt something strike the dorsum of his left hand which was now the size of a grapefruit. A few minutes later he experienced the same sensation on his right temple and again unseen, but thought it had a ‘bit of a buzz’. Locals thought he had been stung by European hornets (Vespa crabra).
On examining his airway, his oropharynx was oedematous and I couldn’t pull out his tongue to widen the small slit visible below his uvula. His arms were enormous and it didn’t take too many of my post-retirement neurones to synapse and tell me that it wasn’t just an allergy and I was faced with my first full-blown anaphylactic shock in its twentieth minute with no medical kit in a foreign country!
His pulse was 120 – low volume and I sat him up to improve his airway, remembered about ice packing but struggled to recall the dose of adrenaline and steroid. I called for the emergency medical kit from the Club Manager’s office – the response was a bit like Manual in Fawlty Towers – que? When only elastoplasts and bandages arrived, I realised the trouble we were both in and called for help, i.e. anyone with steroid pills and a sharp knife. The kitchen staff spoke Catalan only and, unaware of the emergency, couldn’t understand why a crazy Brit was looking for bags of ice and a long, thin knife. I got three bags of ice and wrapped thin towels packed with ice round his scalp, neck and both arms. After ten minutes his deterioration had slowed. A local doctor in a village nine miles away was being sought urgently, without success, and when told he wouldn’t carry an airway anyway, I requested an immediate paramedic ambulance. The only two south of Girona were involved in an autoroute crash on route seven and gave no hope of attendance in 30 minutes – I mentioned a tracheostomy at this point and there was a gasp at this suggestion. It was only then that the Club Manager mentioned that, on a doctor’s instruction, Helicopter Sanatorius, a paramedic helicopter, could be summoned from Girona Hospital and at 13.30 the request went out once my BMA card was checked out.
Meanwhile, a land-based transport ambulance arrived to help as they’d heard about the drama on the airwaves. They did, however, bring both oxygen, which was commenced, and IV lines, but didn’t carry any drugs. As I grabbed a wide bore cannula, they asked again for evidence that I was a doctor. Prodding his arms, I realised how bad the hives – like skin reaction with angioedema had become – there were no veins palpable! Players and officials hovered as I probed his antecubital fossa and I had to ask the mawkish throng, unable to return their score cards, to stand aside to give me light. My first IV attempt failed, but the second strike got a purple/black flashback and volume replacement began.
Behind me, I was aware of someone taking assiduous shorthand notes and was alarmed to hear he was a press officer. I suggested he suppress the story till the next of kin had been informed. I was later told that he had a paramedic daughter and from her stories, he was surprised that a retired surgeon, ‘off the street’, had managed to site an IV!
We did find someone with prednisolone tablets and crushed them into the buccal mucosa while we waited for the helicopter. By 13.45 the oxygen mask, drip and ice were producing an improvement and five minutes later officials on the course indicated that players were complaining about the noise from a bright, yellow helicopter trying to approach from the north! Fortunately, the Club Manager and Tour Officials had foresight and cleared the car park for landing. At 13.55, 25 minutes after the call went out, two red-suited paramedics burst through the door with a roll of drugs carried by a huge, black-bearded ‘medico’ who looked like a Turkish wrestler and spoke only Catalan. He again checked my BMA card, then the IV line with a dismissive grunt and dived for the epinephrine (adrenaline) and steroids.
The Rules man, for the first time in the whole process, looked terrified – not by his condition, but on seeing how little space he had for his first flight in a helicopter.
At 14.10, 40 minutes after the emergency request, they lifted off for Girona. Next day in ITU, he sat up with two IV lines running and, in fluent Catalan, persuaded the sisters in the ER room to release him and he returned the same day to his hotel for a big sleep.
Since this incident, adrenaline Epipens are available at all European Tour/R&A events.