After falling 200ft into a ravine, 11-year-old Braham was close to death. His mother, Anna shares their story...

My family and I were enjoying a hike in the Valley of the Rocks, Lynmouth. We were on holiday from Los Angeles, where we had planned to return in four days time. I was behind with my two-year old and my husband Michael was in front with our seven-year-old. Braham, aged 11 years, had been in the middle. Then, suddenly, he wasn’t there.

Our first thought was that he wandered off on another path. For the next 45 minutes, we split up to find him. It didn’t occur to us that Braham might’ve fallen and when I made my way down to the car park and saw Michael standing there without him, the panic truly set in. Michael borrowed a phone and called the police.

Within 20 minutes, there were helicopters, ambulances, boats – the whole effort was massive and immediate; it all felt surreal. Braham had fallen over 200ft into a ravine, landing behind a giant boulder that rendered him invisible. A member of the public was on the beach and heard him moaning. He waved down the coastguard; it was getting dark and the tide was coming in. Throughout this ordeal, we were waiting on the other side of the cliff with two police officers, completely unaware of what was unravelling. It was unbearable. When one of the officers pulled us away from the kids, our hearts collectively sank. ‘We found him,’ he said.

Incident details

The 999 call occurred at 6.43pm; the coastguard and ambulance service were mobilised to the scene. There were no other pre-hospital critical care assets available in the whole of the south west peninsula other than Dorset and Somerset Air Ambulance that evening.

Our team was activated at the request of the search and rescue (SAR) helicopter crew who were already on scene at the base of the cliff. They had assessed Braham as being critically injured and needing prehospital critical care – a fundamental decision point in Braham’s care.

The SAR team winched Braham from the cliff base to the cliff top and worked alongside South Western Ambulance Service paramedics to attempt stabilisation. Despite their best efforts, he was close to death. We met Braham for the first time at the top of the cliff – he was severely injured, his lungs were not functioning properly and his blood oxygen levels were mortally low. He had features of severe internal bleeding and his heart was precariously close to stopping.

Providing critical care

Braham received the following initial care from our team:

  • Breathing support with oxygen delivered at pressure,enabling his blood oxygen levels to rise significantly.
  • Vascular access to enable delivery of medicines and blood components into his blood stream.
  • 2-unit blood transfusion – improving the activity of his heart.
  • Sedation and pain controlling medicine into his veins to allow Braham to be moved without hurting him.
  • Packaged within a heat blanket and hat for warmth and to protect him from the weather.

Due to the windy and cold conditions, Braham was moved onto a scoop stretcher into the aircraft. There he received anaesthesia and a breathing tube was placed in his windpipe, enabling control of delivery of oxygen to his lungs. His breathing was continued with a mobile breathing machine (ventilator). His injured lung was causing pressure on his lungs and his heart, so our team carried out a  surgical procedure on his chest to release the build-up of pressure and enable his lungs and heart to function normally.

Medicines to reduce internal bleeding were given and Braham received continuous sedative and pain controlling medicine by syringe driver. These measures stabilised Braham’s immediate life threats and ensured his brain received oxygen and his heart was pumping around sufficient blood. However, he continued to need further blood component resuscitation to support his blood pressure,  demonstrating his very serious internal injuries.

In view of Braham’s ongoing cardiovascular instability and blood component resuscitation needs, we made the decision to take Braham to the closest regional major trauma centre, Derriford Hospital in Plymouth. During the 31-minute journey to hospital, he received
further warmed packed red cells in response to his blood pressure dropping, lung protective ventilation, assurance of adequate blood oxygen levels, replacement of blood electrolytes to support formation of clots in his injured tissues, continuous infusion of sedation and powerful pain relief.

Braham was handed over to the care of the Plymouth trauma team and his resuscitation continued for some hours. Following further stabilisation in Derriford, the same DSAA crew who attended the incident, offered their services beyond their shift period to transfer him
to Bristol Children’s Hospital later that night. During this subsequent journey, full intensive care was once again provided.

Mum pays thanks

“Braham had a laundry list of issues: hypothermia; broken left tibia and fibula (now held together by a spatial frame); a massive hole in his ankle that exposed bone; shattered left hip; broken sternum and ribs; broken vertebrae; broken left arm; internal bleeding from his
kidneys, spleen and pancreas; and lung contusions. His hip had to be reconstructed and there were concerns about saving his foot. The trauma was serious and widespread. He underwent specialist surgery and spent much time in intensive care and the rehabilitation unit.

Braham opened his eyes a week after the accident and, after five weeks in hospital, he and I were flying home. He spent a further month at the Children’s Hospital in Los Angeles. Braham started 7th grade in a wheelchair; he finished the year walking. Today, he is healthy and active, with some impressive scars to remind him just how lucky he is.

We cannot express how grateful we are to the incredible team at Dorset and Somerset Air Ambulance for saving our son’s life. On the day it happened, we were too stunned and terrified to show you our appreciation. With the greatest admiration, awe and respect, thank you!”

Exemplary pre-hospital critical care

The care pathway that was achieved for Braham and his final outcome exemplify the life-size meaning of pre-hospital critical care delivery. The crucial window of opportunity to save his life was at the top of the coastal cliff. Without team-based, multi-modal and fast-paced critical care delivery on the cliff top, this incident would have been a tragedy. Instead, it is special to all involved. Special because thanks to an enormous multi-agency and multi-professional effort, a fully functional child has now been returned to society to become a young man. Special because on that night, the right team, with the right expertise, provided extraordinary integration of aviation and medical care to give life a chance.

NEXT: Julian's story

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