Lewis, a vet from Bristol, fell 4 metres shoulder first onto a boulder. He explained:
“I'd just negotiated a difficult overhang when I fell. Because of the way I fell, the protection I'd placed was pulled away from the rock rather than taking my weight. I landed shoulder-first on a boulder, breaking both my right shoulder blade, four vertebrae and six ribs.”
Lewis's climbing partners quickly raised the alarm. Following a complex rescue – including a section by boat and a helicopter on standby - he was transported to Southmead Hospital's Emergency Department within five hours of the fall.
Accident leads to research opportunity
As well as his fractures, Lewis was diagnosed with a haemopneumothorax. This is a serious medical condition where both blood and air collect around the lungs. Lewis needed a chest drain, which is a tube inserted through the chest wall, to help drain the blood.
This is where the CoMiT-ED 2 study came in. Bristol NHS Foundation Trust (BFT) Emergency Medicine Consultant Dr Edd Carlton – who was recently seen in BBC Two’s recent Emergency 24/7 documentary – leads this national project. He said:
“The CoMiT-ED 2 study is about testing whether a less invasive chest drain with a smaller tube is better than traditional drains with larger tubes that require surgery to insert. We’re recruiting over 1,500 adult patients from more than 50 trauma centres and units across the UK. Lewis’s injuries meant he was a good candidate for the study.”
How does research work in an emergency?
Research in emergency settings presents unique challenges because patients may be too unwell, injured or medicated to make decisions about taking part.
In these situations, studies can use a process known as deferred consent. Patients are enrolled only when strict safeguards are met, and are then asked for their informed consent once they have recovered sufficiently to make that decision.
If a patient later decides not to take part, their data isn’t used and they continue to receive standard care.
In Lewis’s case, he agreed to being in the study before the chest drain was inserted, but while on a high dose of painkillers. Afterwards, research staff visited him several times until he was considered able to give full consent.
Lewis said:
“My informed consent was delayed by a few days because I was on quite a lot of morphine and felt really unwell. During the researcher’s first visit, I could barely stay awake when I was talking to her. So, I gave my informed consent a few days later.
"Before my fall, I'd never really thought about how emergency care research is done. Knowing that my experience could help improve treatment for future patients made me feel I was contributing something positive from a very difficult situation.”
Lewis has since regained full range of movement in his shoulders and is planning his next climbing adventure.
Dr Edd Carlton said:
"Every improvement in emergency care starts with research. Patients like Lewis make it possible for us to find better ways to treat people in some of the most critical moments of their lives."
