A surgical challenge on the evacuation train

I was on holiday in Greece when news broke that a wildfire had erupted northeast of Athens, rapidly approaching the small town of Varnavas. On the morning of 12 August 2024, the skies were already heavy with smoke, and the wind carried an ominous, ash-laden warmth. I had planned a brief train trip north to admire the countryside, but instead, I found myself in the midst of an emergency evacuation, with local authorities urging everyone to board trains heading away from the fire zone.

I was ushered onto a crowded carriage filled with anxious families, many clutching their belongings in small bags. The train began rolling slowly southward, but before long, the atmosphere grew tense and unsettling. Amid the chaos, a frail-looking older man, who had been coughing incessantly, suddenly collapsed in the aisle. I identified myself as a doctor (the only medical personnel on board) and rushed to his side.

When I knelt down, I noticed a small wound on his arm. He must have brushed against jagged metal or broken glass during the hurried boarding. He was also breathless, appearing to verge on shock. Quick assessment revealed that in addition to the laceration on his forearm, he might be suffering from inhalation of smoke or an exacerbation of a chronic lung condition.

With minimal supplies on hand, I had to improvise. I asked a fellow passenger for a clean scarf, using it as a makeshift tourniquet to control bleeding from the wound. Bottled water helped me clean the area. Fortunately, I found a small first-aid kit tucked under a seat, which contained some gauze, tape, and antiseptic wipes. After carefully cleaning the wound, I bandaged it firmly to stem further bleeding.

The real challenge was his breathing. Without oxygen or advanced medications, I had to encourage him to sit upright and coach him through controlled, slow breaths. The train staff cleared a seat by an open window, allowing fresher air to flow in. I monitored his pulse and consciousness as we chugged along, hoping our destination, a safe station far from the fire, would have proper medical facilities.

The man’s condition stabilised, though I stayed by his side until the train finally pulled into a station to the south. Emergency services were waiting, and together, we safely transferred him to a waiting ambulance. The look of relief on his face, and on the faces of his family members, was unforgettable.

The entire experience underscored how surgical knowledge can be invaluable even outside the traditional setting of a hospital. A simple wound might escalate into a bigger crisis if not addressed quickly in stressful circumstances. Though I felt the weight of responsibility on that rattling train, it was also an important reminder of why I chose to pursue a career in medicine: to serve people in need, no matter the setting even on a cramped, smoke-filled evacuation train in the midst of the Attica wildfires.