Internship, shift 13.
On this call, we heard police (APD) and fire (AFD) get dispatched to an "Unknown man down." My preceptor knew it would probably be ours, only because the engine we work with was sent, but for some reason a communication error occurred and an ambulance was never dispatched. We sat and waited for more information on the call, but it never came. Finally, my preceptor decided to just get in the rig and ask AFD for the address of the call because it still hadn't come through our end.
When AFD came back at us with the address, they also let us know that this wasn't just an "Unknown man down."
This was a stabbing.
My heart jumped a little bit. I tried to relax and tell myself, "Maybe it's just like a couple cuts and the dude is fine. Who knows?"
I knew that wasn't true. The firefighter on the radio did not sound like it was just a couple of cuts.
Remember in EMT school, when they tell you that your first priority is scene safety? You run through scenarios and mindlessly babble off,
"Is the scene safe?"
You always get a quick "Yes" and move on without even thinking about it. Today, I finally weighed that statement in my mind. As we pulled up, I saw yellow police tape criss-crossed across someone's front lawn and breathed a sigh of relief. The scene was safe, thank God.
"There he is!" Tracy yelled, as she pointed a finger out the window. I followed her gaze to a figure lying in the grass surrounded by firefighters. Next question on your scenarios from school?
"What's your general impression of the patient?"
My patient was not dead. That's good, right? No-one is doing CPR so he's alive. He has an oxygen mask on which means he's also breathing. Next step?
Always get your ABC's.
As we walked up to him, I looked at him closely.
Alert? Patient is alert and talking, tracks me as I approach him.
Airway? Airway is patent and patient is breathing.
Breathing? Breathing is slightly labored, but good chest rise.
Circulation? Screeching halt here. Everyone slipped and slid all over the grass because it was covered in blood. The firefighters had wrapped his right bicep in gauze, but it didn't seem to do much. Don looked up at me and pointed to the right arm.
"Entrance and exit wound here, entrance only on the left forearm with minimal bleeding. Over here, it's not controlled."
As he finished his sentence, the firefighter next to me on the patient's left side stood.
"Pressure is 70 palp and dropping."
I think back to class. Uncontrolled bleeding scenario:
Apply direct pressure.
Elevate the limb.
If the wound continues to bleed...
"Tourniquets!" Tracy said at the same time as I reached for them. She nodded and smiled at me. "Good, you've already got them." I threw 2 tourniquets to Sarah and Don while I started an IV on his left arm. Another medic stood behind me and spiked a bag. As I hooked it up, I heard Sarah mumbling to Don.
"Tighter, it's not stopping."
I looked over as they elevated his arm more and watched blood pour from the already-soaked gauze. I walked over to his right side, grabbed the second tourniquet and placed it just above the first, tightening it as much as it would go.
"There. It stopped. Sir, how are you feeling?"
The patient opened his eyes and winced. "This hurts, it's too tight. I feel dizzy."
"I know bud, but we need to keep it on because it's bleeding too much and this stops it, okay? We're gonna take care of you, don't worry."
He nodded in understanding and thankfully didn't argue any more.
"Are you hurt anywhere else? Did they stab you anywhere other than your arms that you can feel?"
He shook his head 'no' as I quickly ran my eyes and hands down the rest of his body, looking at his 'kill zones.' Chest was clear, abdomen was clear, neck and spine were clear. Good.
We slid him into the rig and Don jumped in next to me.
"You think I'm gonna let you have all the fun? No way! I'm stoked you got this call, kid. Hold still, you got some blood on your arm, I'm gonna get it with an alcohol prep"
I grinned ear-to-ear as I slid another IV in his arm. "Haha thanks. I know, right? Me too! What's his pressure now?"
"130 and holding. I'll keep his arm up for him cause he'll run out of gas." Don stepped over me and into the seat at the head of the patient. The patient winced again.
"It's really tight on my arm, it hurts."
"I know bud, I know. We have to keep it there for now, I'm sorry. You're bleeding too much from that arm okay? Can you feel me touching your hand? Wiggle your fingers for me."
He nodded his head and his fingers moved slowly in response. I grabbed the phone and went for my report.
"Base this is medic 12, we are coming to you code 3 with a 33 year old male who was involved in a stabbing, wound on the right bicep with suspected arterial bleed, entrance and exit on that side. Wound on the left forearm is entrance only with controlled minimal bleeding. Patient is awake alert oriented, on 15 liters o2 via non-rebreather. Initial pressure was 70 palp, we have 2 IVs established in the left arm, wide open, pressure has come up to 130, pulse remains 130 and tachy on the monitor, no other trauma noted, see you in 5."
"Medic 12, where are the stab wounds?"
"Base, wounds are on the right bicep, entrance and exit with suspected arterial bleed. Second wound on left forearm, entrance only, bleeding controlled."
"Medic 12, base copies. Trauma bay 4 please. Trauma bay 4, team will meet you upon arrival."
I sat back down on the bench seat, out of breath.
"Woah, kid relax. I've never seen someone talk so damn fast." Don said, smiling.
I laughed. "I know, it was like I couldn't get my mouth to move as fast as my brain was spitting out the info."
As we pulled the patient into the hospital and onto the bed, the ER doc came to the patient's right side.
"Tourniquets off, let's see what happens." He said, slowly releasing both tourniquets. Blood oozed quickly from the wound again as the doc inspected it.
"Yep, that's his brachial. Get a pressure cuff back on that arm, he'll need vascular surgery at the trauma center. Pressure is good though, he's probably stable enough to go now."
The team hustled around the bed as we walked out. Exhausted and blood covered, I stepped out into the ambulance bay and let the cool evening soak into my skin.
Smiling, I grabbed a towel and helped Sarah wipe the blood from every surface imaginable in the rig.
Tuesday, September 14, 2010
Friday, September 10, 2010
Code Blue
Internship, shift 12.
"Medic 12, please respond code 3 to [hotel] for respiratory arrest."
It was 4 in the afternoon, so before the dispatcher could even finish her sentence, we were running out the door and into the rig.
"The patient is not breathing. The patient has foam coming from her mouth." Tracy read off of the dispatch page. "Yup, she's coded. Ready?" She said, looking back to me. I nodded and slipped my gloves on, then flipped my protocol book open to the cardiac arrest algorithm. As we pulled up, a slew of curse words erupted from Tracy as she saw one of our other crews running into the hotel.
"God DAMNIT! She KNOWS I have an intern WHY is she jumping this call?! OH HELL NO! Get in there, she shouldn't be here. Let's go!"
As we pulled out our equipment and trotted over to the appropriate room, a crowd of people stood hovering near the door. Police officers, firefighters, other guests of the hotel. I pushed my way past them and into the small hotel room to see a mess of more people. A young woman was draped across the floor, a firefighter was pumping at her chest furiously as we tried to step around and over them. I grabbed the intubation kit and tediously stepped over everyone to her head. Tracy settled in near the woman's right side with the IV kit.
"Just get your tube, okay? I'll run a line and drugs until you get an airway. Concentrate on your tube."
I nodded again as I pulled the laryngyscope out and snapped it open. As I assembled my supplies in a neat line next to me, a voice interrupted my thoughts.
"Hey kid. You ready for your tube?" The fire-medic who had been ventilating her looked up and grinned.
"Oh hey! It's you!" I said, recognizing Don. He had been on most of the shifts with us, and he was awesome. Always helpful, always with positive comments towards me. He had also been the one with us on the bad trauma call last week.
"Whenever you're ready, alright?" He said.
"I'm good here. Let's go. Hyperventilate her and pull the OPA [basic airway] out please."
He nodded, following the order and moving aside. I slipped the scope in and pulled up, leaning in to get a better view of her vocal chords.
"Nothing," I said to Don, "Suction please."
The suction tubing was in my hand immediately and as I snaked it into her mouth, vomit bubbled up. I leaned to the side to avoid being spewed on, but kept suctioning. When the vomit stopped, I leaned in again, pushing the scope deeper and pulling up harder. Nothing still.
"I can't see anything. Keep bagging her." I said, pulling the scope out and backing up slightly.
"I'll hyperventilate her again for a few, then come back in here and look again. I'll give you crich pressure if you need it." He replied. I nodded solemnly, and gazed at her face for a few seconds. This was not the face of a woman who would live. She was dead, she probably had been dead for quite some time. I don't think I would have even attempted to work her up if it had been me who was there first, but since everyone had already started before we got here, we didn't have a choice. Chaos was erupting all around me, but I hadn't noticed since I had been up at her head with Don. As he ventilated her for another few seconds, I looked up and saw the entire scene. Wrappers and packaging everywhere, tubing and wires snaked all across the floor. Blood leaking slowly from each arm as Tracy and the first arriving crew stuck her numerous times for IV access. It was a mess.
Don backed up again and motioned for me to try again. I guided the scope in and pulled up, leaning as far down as I could for a better view. I shook my head, I still couldn't see a damn thing. Don wrapped his hand around the scope's handle above mine and pulled up more.
"Here, I'll hold it. Look again, I think you'll see them."
I bent down, my chest and abdomen against the floor now, and looked. There they were, like a light at the end of the tunnel.
"Got it, I'm going in." I said, sliding the tube delicately down her throat. As soon as the tube passed her teeth, it blocked my view of her chords. I slid it in regardless, and hoped I had made it. As I removed the guide wire from the tube and hooked up the BVM, the firefighter doing chest compressions turned to me.
"I think it's in, I felt it slide down. I felt it go in, you're in."
As Don attempted to ventilate, vomit suddenly filled the tube and leaked from around the seal of the BVM.
"I'm not in, pull it."
Tracy looked up from her IV attempt. "What happened?"
"It's in her esophagus, I'm doing a King airway, I can't get the tube."
The medic that had gotten there first from the other crew stood and stepped over the woman's body.
"Let me look, okay? Get another tube ready."
I backed away and assembled another tube. She grabbed the scope from my hands and looked again.
"Screw it, hand me a King." She withdrew the scope and jammed the King airway in. Immediately vomit filled the tube again, but this time it shot out of the BVM like a volcano, covering her and Don with brown liquid.
"Just try to BVM her, maybe we're still in."
Don squeezed the bag, but it only made the vomit spew more.
"Damnit, okay. I'm gonna have to try for a tube."
Again, she slid the scope in and immediately reached her hand back to me.
"I see it, tube, NOW!" She yelled. I shoved the tube into her hand and she passed it through the chords.
"Okay, it's in. Ventilate."
Don squeezed the bag again and the woman's chest rose slowly. With that problem solved, I finally looked up and let the chaos sink in.
"We can't get an IV, get me the IO.."
"Still asystolic, why aren't the compressions showing on the monitor?"
"IO is in, no infiltration. I think it's running."
"Epi and Atropine, please!"
"Keep checking the pads. When we touch the wires it shows on the monitor, but the compressions just aren't registering."
"Epi and Atropine in, record it!"
"Are you getting good compliance with the bag?"
"She's vomiting again, suction!"
The more everyone talked, the more I sunk into my corner of the room. PD hovered anxiously outside the door, further back I could see curious bystanders struggling to get a look inside the room. I looked at the woman's face again and shook my head.
There's no way. She's been dead for hours.
As everyone shuffled around, I took the BVM from Don and ventilated so he could stand for a few seconds. I listened intently to the metronome.
"Click, click, click, click, click, click, click, click, VENTILATE! VENTILATE!" The robotic voice demanded.
Tracy stood from her spot near the door and walked outside, phone pressed to her ear. I heard a few seconds of her report before she walked beyond earshot. She returned a few seconds later and stood in the doorway.
"Okay everyone, stop. We're calling it. Time of death, 1535. Let's clean up."
Everyone stopped, sat back on their heels, and began breaking everything down. I yanked at the BVM but couldn't detach it from the tube. I struggled, grunting and straining, before Don's hand reached down and held the tube while I yanked one final time, breaking it free. I looked up and smiled tiredly, he grinned back at me and grabbed the airway kit.
Sarah grabbed a blanket and draped it carefully over the woman. She looked up at me and pointed outside.
"There's kids running around outside. I just... It's not something I would want my kids to see."
I nodded and pointed at the woman. "Leave everything on her, right?"
"Yup, just like it is. Everything stays with her."
"Okay."
We quietly tip-toed around each other as we gathered all of our supplies and trash. I glanced one final time down at the outline of the woman, now just a lump under a thin blanket, and turned and walked out.
Back at the station, I sat down next to Tracy as she filled out the paperwork on the laptop.
"I'd just rather have you watch me do this one, it's a lot of information to try to do yourself and I want you to see it done before you have to do it next time." I nodded quietly and folded my hands in my lap.
"How do you think that went?" She asked.
"I mean.. She was a difficult airway. I really just... Couldn't see anything. But I really was trying."
I looked up at her and she stared blankly at the computer screen.
"As a code though, it went horribly." I finished.
"Yeah. There was just too many people trying to do too much." She said quietly, before resuming her typing.
That night, I had a dream about the code. I was at her head, scope in hand, and leaned in closely to look at the chords again. As I leaned in to get a better view, the woman's eyes shot open.
I sat straight up into bed, gasping. Tracy poked her head through the door.
"We have a call."
"Ok, I'm right behind you."
"Medic 12, please respond code 3 to [hotel] for respiratory arrest."
It was 4 in the afternoon, so before the dispatcher could even finish her sentence, we were running out the door and into the rig.
"The patient is not breathing. The patient has foam coming from her mouth." Tracy read off of the dispatch page. "Yup, she's coded. Ready?" She said, looking back to me. I nodded and slipped my gloves on, then flipped my protocol book open to the cardiac arrest algorithm. As we pulled up, a slew of curse words erupted from Tracy as she saw one of our other crews running into the hotel.
"God DAMNIT! She KNOWS I have an intern WHY is she jumping this call?! OH HELL NO! Get in there, she shouldn't be here. Let's go!"
As we pulled out our equipment and trotted over to the appropriate room, a crowd of people stood hovering near the door. Police officers, firefighters, other guests of the hotel. I pushed my way past them and into the small hotel room to see a mess of more people. A young woman was draped across the floor, a firefighter was pumping at her chest furiously as we tried to step around and over them. I grabbed the intubation kit and tediously stepped over everyone to her head. Tracy settled in near the woman's right side with the IV kit.
"Just get your tube, okay? I'll run a line and drugs until you get an airway. Concentrate on your tube."
I nodded again as I pulled the laryngyscope out and snapped it open. As I assembled my supplies in a neat line next to me, a voice interrupted my thoughts.
"Hey kid. You ready for your tube?" The fire-medic who had been ventilating her looked up and grinned.
"Oh hey! It's you!" I said, recognizing Don. He had been on most of the shifts with us, and he was awesome. Always helpful, always with positive comments towards me. He had also been the one with us on the bad trauma call last week.
"Whenever you're ready, alright?" He said.
"I'm good here. Let's go. Hyperventilate her and pull the OPA [basic airway] out please."
He nodded, following the order and moving aside. I slipped the scope in and pulled up, leaning in to get a better view of her vocal chords.
"Nothing," I said to Don, "Suction please."
The suction tubing was in my hand immediately and as I snaked it into her mouth, vomit bubbled up. I leaned to the side to avoid being spewed on, but kept suctioning. When the vomit stopped, I leaned in again, pushing the scope deeper and pulling up harder. Nothing still.
"I can't see anything. Keep bagging her." I said, pulling the scope out and backing up slightly.
"I'll hyperventilate her again for a few, then come back in here and look again. I'll give you crich pressure if you need it." He replied. I nodded solemnly, and gazed at her face for a few seconds. This was not the face of a woman who would live. She was dead, she probably had been dead for quite some time. I don't think I would have even attempted to work her up if it had been me who was there first, but since everyone had already started before we got here, we didn't have a choice. Chaos was erupting all around me, but I hadn't noticed since I had been up at her head with Don. As he ventilated her for another few seconds, I looked up and saw the entire scene. Wrappers and packaging everywhere, tubing and wires snaked all across the floor. Blood leaking slowly from each arm as Tracy and the first arriving crew stuck her numerous times for IV access. It was a mess.
Don backed up again and motioned for me to try again. I guided the scope in and pulled up, leaning as far down as I could for a better view. I shook my head, I still couldn't see a damn thing. Don wrapped his hand around the scope's handle above mine and pulled up more.
"Here, I'll hold it. Look again, I think you'll see them."
I bent down, my chest and abdomen against the floor now, and looked. There they were, like a light at the end of the tunnel.
"Got it, I'm going in." I said, sliding the tube delicately down her throat. As soon as the tube passed her teeth, it blocked my view of her chords. I slid it in regardless, and hoped I had made it. As I removed the guide wire from the tube and hooked up the BVM, the firefighter doing chest compressions turned to me.
"I think it's in, I felt it slide down. I felt it go in, you're in."
As Don attempted to ventilate, vomit suddenly filled the tube and leaked from around the seal of the BVM.
"I'm not in, pull it."
Tracy looked up from her IV attempt. "What happened?"
"It's in her esophagus, I'm doing a King airway, I can't get the tube."
The medic that had gotten there first from the other crew stood and stepped over the woman's body.
"Let me look, okay? Get another tube ready."
I backed away and assembled another tube. She grabbed the scope from my hands and looked again.
"Screw it, hand me a King." She withdrew the scope and jammed the King airway in. Immediately vomit filled the tube again, but this time it shot out of the BVM like a volcano, covering her and Don with brown liquid.
"Just try to BVM her, maybe we're still in."
Don squeezed the bag, but it only made the vomit spew more.
"Damnit, okay. I'm gonna have to try for a tube."
Again, she slid the scope in and immediately reached her hand back to me.
"I see it, tube, NOW!" She yelled. I shoved the tube into her hand and she passed it through the chords.
"Okay, it's in. Ventilate."
Don squeezed the bag again and the woman's chest rose slowly. With that problem solved, I finally looked up and let the chaos sink in.
"We can't get an IV, get me the IO.."
"Still asystolic, why aren't the compressions showing on the monitor?"
"IO is in, no infiltration. I think it's running."
"Epi and Atropine, please!"
"Keep checking the pads. When we touch the wires it shows on the monitor, but the compressions just aren't registering."
"Epi and Atropine in, record it!"
"Are you getting good compliance with the bag?"
"She's vomiting again, suction!"
The more everyone talked, the more I sunk into my corner of the room. PD hovered anxiously outside the door, further back I could see curious bystanders struggling to get a look inside the room. I looked at the woman's face again and shook my head.
There's no way. She's been dead for hours.
As everyone shuffled around, I took the BVM from Don and ventilated so he could stand for a few seconds. I listened intently to the metronome.
"Click, click, click, click, click, click, click, click, VENTILATE! VENTILATE!" The robotic voice demanded.
Tracy stood from her spot near the door and walked outside, phone pressed to her ear. I heard a few seconds of her report before she walked beyond earshot. She returned a few seconds later and stood in the doorway.
"Okay everyone, stop. We're calling it. Time of death, 1535. Let's clean up."
Everyone stopped, sat back on their heels, and began breaking everything down. I yanked at the BVM but couldn't detach it from the tube. I struggled, grunting and straining, before Don's hand reached down and held the tube while I yanked one final time, breaking it free. I looked up and smiled tiredly, he grinned back at me and grabbed the airway kit.
Sarah grabbed a blanket and draped it carefully over the woman. She looked up at me and pointed outside.
"There's kids running around outside. I just... It's not something I would want my kids to see."
I nodded and pointed at the woman. "Leave everything on her, right?"
"Yup, just like it is. Everything stays with her."
"Okay."
We quietly tip-toed around each other as we gathered all of our supplies and trash. I glanced one final time down at the outline of the woman, now just a lump under a thin blanket, and turned and walked out.
Back at the station, I sat down next to Tracy as she filled out the paperwork on the laptop.
"I'd just rather have you watch me do this one, it's a lot of information to try to do yourself and I want you to see it done before you have to do it next time." I nodded quietly and folded my hands in my lap.
"How do you think that went?" She asked.
"I mean.. She was a difficult airway. I really just... Couldn't see anything. But I really was trying."
I looked up at her and she stared blankly at the computer screen.
"As a code though, it went horribly." I finished.
"Yeah. There was just too many people trying to do too much." She said quietly, before resuming her typing.
That night, I had a dream about the code. I was at her head, scope in hand, and leaned in closely to look at the chords again. As I leaned in to get a better view, the woman's eyes shot open.
I sat straight up into bed, gasping. Tracy poked her head through the door.
"We have a call."
"Ok, I'm right behind you."
Thursday, September 9, 2010
Trauma
Internship day 10
Medic 12, please respond code 3 to (freeway exit) near the entrance of (campground) and (lake) for an MVA.
It was 3 am, so I groggily dragged myself from my bed on the couch as soon as I heard my preceptor's tones go off in the next room. I quickly wiped the sleep from my eyes, buttoned my shirt and ran out to the rig. I grabbed gloves and slipped them on, checked my pockets for a pen and sat in the jump seat. My preceptor and her partner climbed in shortly after and we were off.
"Where is it? I can't see it on the map. Oh, there it is. Shit, it's on the pass." My preceptor was talking to her partner while looking on the computer for directions. I tensed as I heard this, the pass was a difficult road to navigate and accidents up there were usually not minor.
"Oh, dispatch is updating the info..Let's see here... Male driver is not conscious, unknown if he is breathing... There is serious blood loss.. Shit." This time, she was speaking to no one in particular, but after saying this, turned to me and spoke again.
"This is going to be bad, and I'm not saying that to scare you, okay? I just want you to know it's going to be bad. Be ready for the worst."
I sat back in my seat, buckled my seat belt and closed my eyes. Taking deep breaths, I tried to calm myself. Opening my eyes again, I saw flashing lights in the distance behind us.
I turned back towards the front of the rig.
"Tracy.. Fire is behind us. Like, wayyy behind us."
"What?! Oh, crap. We're gonna get there first."
What seemed like an eternity passed before my partner, Sarah, slowed to a stop.
"PD is here. Where is the-... Shit, there it is. This is bad."
Because I had been in the back, I had not yet seen what Sarah and Tracy saw. She pulled up further, in front of the wreck, and flashing lights illuminated a truck behind us. From the rig I could see that the truck was unrecognizable as having once been a vehicle. It looked like a ball of twisted metal, and as the lights flashed over it, I caught quick glimpses of an arm dangling from what used to be the driver's side. I jumped out, throwing my reflective vest on, and ran to the truck. A man in plain clothes approached me quickly, flashlight in hand, and started talking to me.
"We were just camping down by the lake. We heard him hit the side of the mountain and came up to make sure everyone was okay. I don't think he's breathing. We've been looking for other people but we don't see anyone, just car parts strewn everywhere."
I nodded quickly and ran past him to the arm hanging from the wreck. I grabbed it, and held his wrist for a few seconds before yelling out to Tracy, "Strong radial pulse. Snoring respirations. We wont be able to get him out though."
She came up behind me and also grabbed the arm. From where we stood, what used to be the driver's door was now a tiny opening from which we could see his head, facing the passenger side, and his arm. Nothing else was in view. The engine was in his lap, the steering wheel over his right shoulder. The truck was angled up, and access through the passenger side was out of the question. The smell of alcohol was drifing from the car, and it was strong. He was drunk.
The fire department arrived and we stood back, waiting for them to extricate him. Cables were running everywhere, loud generators drowned out any noise as they fired up the Jaws of Life. One of the firefighters, also a medic, turned to me.
"If you grab me your IV bag, I'll get a line for you on this arm. Just don't get too close, okay kid? The truck isn't stable, I don't want you getting hurt."
I nodded and ran back to the rig for my IV bag. Once there, Tracy stopped me and quickly said, "Everything out, get everything ready. Your airway bag, the gurney with a backboard. Everything." I nodded again and pawed at my trauma bag, ripping out everything, opening it and throwing it on the bench seat.
Airway kit, check.
Gurney with backboard, check.
Line spiked... Sarah is working on it, check.
IV bag..
I grabbed it and dashed back to the firefighter. He quickly established a 16 guage IV and ran it wide open, throwing the bag towards me.
"Hold this, and squeeze. It's gonna be awhile before we can get him out."
I stood back, IV bag tightly in my hands as I weaved in and out of the firefighters with the IV line, trying to untangle them all as they rushed around the truck. Tracy stood beside me, yelling things back to Sarah who was preparing the rig.
"Get the fast patches out and hooked up. Oh, and another line spiked please. Is the gurney ready to go?"
Tracy turned back to me and spoke quietly.
"How are you doing?"
"I'm okay. I'm scared for this guy. What if they take the dashboard off of him and he codes? What if he's not even in once piece under all of that shit?"
"I know. He's gonna be bad. Just be ready for him to code. We're all scared for him."
"It's been almost 20 minutes." I said quietly, dropping my gaze to the ground.
The fire-medic turned towards us. "He's almost ready, get the gurney over here."
Tracy took the IV bag and nodded for me to go help Sarah. We grabbed the gurney and backboard, wheeling it around all the cables and glass, and up to the driver's side. Suddenly, the man was plopped onto the backboard and we were all feverishly strapping him in, securing his neck with a collar while lifting the gurney and running back to the rig. "We need a rider, who wants to come?" Tracy yelled back to the firefighters. One of the younger guys, another medic, came running up and jumped in. "I'll go," he said, smiling at me, while he sat down on the bench and began cutting the man's clothes off.
"Okay. We're taking him straight to the trauma center, bypassing the local ER. Probably gonna be a 45 minute plus transport. Let's do as much as we can."
The back doors slammed shut and the chaos began. Supplies were flying, all of us yelling out findings over each other.
"Airway is patent, but he's snoring. Jaw clenched, get a non-rebreather on him."
"Pupils unequal. Left is blown and unreactive, right is reactive."
"Pulse still strong at the radial at 140, pressure is 110, lets drop another line."
"Left leg is broken, compound fractures at the tib/fib. I'm leaving the pant leg on because it's controlling the bleeding."
"Pelvis is stable, abdomen is clear so far."
"I've got another line, right bicep, running wide open." I said, with a sigh of relief. The firefighter grinned at me again and slapped my back.
"Good stick, kid." He said. I smiled meekly back at him.
Grabbing my stethescope, I attempted to listen to his lungs over all of the noise. His chest expansion looked odd, but I couldn't quite put a finger on why.
Right lung... Concentrate, listen, drown out all of the other noise and listen..
Grunting, but he was moving air.
Left lung.. Listen, concentrate.
Nothing.
I pulled the bell of the stethescope back up and tapped it to ensure it was working. I heard the "thump thump" of my finger clearly in my ears. I put the bell back down on his left side.
Nothing.
"Right is clear, just grunting. Left is absent." I said, pulling the stethescope off my ears and looking at Tracy. She stopped midway through cutting the collar of his shirt off and looked at me.
"You're sure it's absent? Maybe it's just diminished."
"I'll check again." I said.
I listened again over his left side, tapping his chest wall with my fingers. It felt full, not hollow. There was blood in his chest cavity.
"Absent. His oxygen sat is holding at 98, but there's nothing there."
She nodded again and said "Okay, since his sat is holding we'll leave it. If he starts to drop you'll have to dart him."
I nodded and gulped. A chest decompression? That's such a rare skill to utilize in a paramedic's career, let alone as an intern. I shook my fear and continued re-assessing him. The fire-medic gave a radio report, which I was thankful for because I don't think I would have been able to get the words out as fast as my brain thought them to let the hospital know we were coming. I listened intently as I tried to control bleeding and check the man's pupils again.
"Trauma base, this is Paramedic Gavin on medic 12 enroute to your facility code 3 with a 15 minute ETA. On board we have a 40 year old male involved in a single vehicle accident, truck versus side of a mountain, off the pass. Extensive cab intrusion, patient is unconscious with snoring resps. We have unequal pupils, no obvious head trauma, absent lung sounds on the left with a sat of 98 on 15 liters. Compound tib/fib fractures on the left, no other significant findings. Pressure is holding at 120, we have 2 large bore IVs established. Pulse is 140 and sinus tach on the monitor, he is positive for ETOH, unless you have anything further for us we'll see you on the other side."
"Trauma base copies medic 12, nothing further for you. Trauma team will see you in trauma bay 1 upon arrival."
"Medic 12 copies."
The remaining 15 minutes in the rig passed quickly as we continued to assess and stabilize him. When we suddenly came to a stop and I saw the lights from the trauma center gleaming into the back of the rig, I was surprised we had gotten there so quickly. We pulled him out, trailing blood and guaze and wires behind us, and into the trauma bay. The staff descended on him, and I quickly gave the doc a run down of what we found while he did his assessment, shouting out findings between my report.
"Head is normal, no obvious trauma. Pupils unequal, can we get respiratory in here to RSI him? No JVD, trachea midline. Where's that o2 mask? Lungs absent on the left, I think it's a hemo[thorax]. Abdomen is clean, pelvis stable. Compound tib/fib on the left with major bleeding, we'll need lab up here with a type and cross. Prep an OR, let's get him in."
We left the ER as the sun was coming up. The fire-medic jumped in the back and joked with all 3 of us while we drove him back to his station. I smiled and let out a few chuckles, but I was exhausted and my head was spinning. When we got back to station, Tracy handed me my paperwork for the day and I left for my 2 hour drive home.
On the way home, I pulled off the road and stopped in an empty parking lot. I slowly pulled my shaking hands from the steering wheel and into my lap as I leaned my head down onto the dash. Tears streamed down my face and I wiped them away quickly. I don't know who I was trying to hide it from, no-one was around, but I was still embarrassed that the call had bothered me so much.
I was angry that the guy was drunk. He could have easily killed someone, and he may have killed himself. I was upset with myself for not taking better control of the call, but I knew it was just a bad call and I couldn't let it get to me.
We still wonder if the guy made it. We never found out what happened to him.
I still wonder if I wish he had made it.
Medic 12, please respond code 3 to (freeway exit) near the entrance of (campground) and (lake) for an MVA.
It was 3 am, so I groggily dragged myself from my bed on the couch as soon as I heard my preceptor's tones go off in the next room. I quickly wiped the sleep from my eyes, buttoned my shirt and ran out to the rig. I grabbed gloves and slipped them on, checked my pockets for a pen and sat in the jump seat. My preceptor and her partner climbed in shortly after and we were off.
"Where is it? I can't see it on the map. Oh, there it is. Shit, it's on the pass." My preceptor was talking to her partner while looking on the computer for directions. I tensed as I heard this, the pass was a difficult road to navigate and accidents up there were usually not minor.
"Oh, dispatch is updating the info..Let's see here... Male driver is not conscious, unknown if he is breathing... There is serious blood loss.. Shit." This time, she was speaking to no one in particular, but after saying this, turned to me and spoke again.
"This is going to be bad, and I'm not saying that to scare you, okay? I just want you to know it's going to be bad. Be ready for the worst."
I sat back in my seat, buckled my seat belt and closed my eyes. Taking deep breaths, I tried to calm myself. Opening my eyes again, I saw flashing lights in the distance behind us.
I turned back towards the front of the rig.
"Tracy.. Fire is behind us. Like, wayyy behind us."
"What?! Oh, crap. We're gonna get there first."
What seemed like an eternity passed before my partner, Sarah, slowed to a stop.
"PD is here. Where is the-... Shit, there it is. This is bad."
Because I had been in the back, I had not yet seen what Sarah and Tracy saw. She pulled up further, in front of the wreck, and flashing lights illuminated a truck behind us. From the rig I could see that the truck was unrecognizable as having once been a vehicle. It looked like a ball of twisted metal, and as the lights flashed over it, I caught quick glimpses of an arm dangling from what used to be the driver's side. I jumped out, throwing my reflective vest on, and ran to the truck. A man in plain clothes approached me quickly, flashlight in hand, and started talking to me.
"We were just camping down by the lake. We heard him hit the side of the mountain and came up to make sure everyone was okay. I don't think he's breathing. We've been looking for other people but we don't see anyone, just car parts strewn everywhere."
I nodded quickly and ran past him to the arm hanging from the wreck. I grabbed it, and held his wrist for a few seconds before yelling out to Tracy, "Strong radial pulse. Snoring respirations. We wont be able to get him out though."
She came up behind me and also grabbed the arm. From where we stood, what used to be the driver's door was now a tiny opening from which we could see his head, facing the passenger side, and his arm. Nothing else was in view. The engine was in his lap, the steering wheel over his right shoulder. The truck was angled up, and access through the passenger side was out of the question. The smell of alcohol was drifing from the car, and it was strong. He was drunk.
The fire department arrived and we stood back, waiting for them to extricate him. Cables were running everywhere, loud generators drowned out any noise as they fired up the Jaws of Life. One of the firefighters, also a medic, turned to me.
"If you grab me your IV bag, I'll get a line for you on this arm. Just don't get too close, okay kid? The truck isn't stable, I don't want you getting hurt."
I nodded and ran back to the rig for my IV bag. Once there, Tracy stopped me and quickly said, "Everything out, get everything ready. Your airway bag, the gurney with a backboard. Everything." I nodded again and pawed at my trauma bag, ripping out everything, opening it and throwing it on the bench seat.
Airway kit, check.
Gurney with backboard, check.
Line spiked... Sarah is working on it, check.
IV bag..
I grabbed it and dashed back to the firefighter. He quickly established a 16 guage IV and ran it wide open, throwing the bag towards me.
"Hold this, and squeeze. It's gonna be awhile before we can get him out."
I stood back, IV bag tightly in my hands as I weaved in and out of the firefighters with the IV line, trying to untangle them all as they rushed around the truck. Tracy stood beside me, yelling things back to Sarah who was preparing the rig.
"Get the fast patches out and hooked up. Oh, and another line spiked please. Is the gurney ready to go?"
Tracy turned back to me and spoke quietly.
"How are you doing?"
"I'm okay. I'm scared for this guy. What if they take the dashboard off of him and he codes? What if he's not even in once piece under all of that shit?"
"I know. He's gonna be bad. Just be ready for him to code. We're all scared for him."
"It's been almost 20 minutes." I said quietly, dropping my gaze to the ground.
The fire-medic turned towards us. "He's almost ready, get the gurney over here."
Tracy took the IV bag and nodded for me to go help Sarah. We grabbed the gurney and backboard, wheeling it around all the cables and glass, and up to the driver's side. Suddenly, the man was plopped onto the backboard and we were all feverishly strapping him in, securing his neck with a collar while lifting the gurney and running back to the rig. "We need a rider, who wants to come?" Tracy yelled back to the firefighters. One of the younger guys, another medic, came running up and jumped in. "I'll go," he said, smiling at me, while he sat down on the bench and began cutting the man's clothes off.
"Okay. We're taking him straight to the trauma center, bypassing the local ER. Probably gonna be a 45 minute plus transport. Let's do as much as we can."
The back doors slammed shut and the chaos began. Supplies were flying, all of us yelling out findings over each other.
"Airway is patent, but he's snoring. Jaw clenched, get a non-rebreather on him."
"Pupils unequal. Left is blown and unreactive, right is reactive."
"Pulse still strong at the radial at 140, pressure is 110, lets drop another line."
"Left leg is broken, compound fractures at the tib/fib. I'm leaving the pant leg on because it's controlling the bleeding."
"Pelvis is stable, abdomen is clear so far."
"I've got another line, right bicep, running wide open." I said, with a sigh of relief. The firefighter grinned at me again and slapped my back.
"Good stick, kid." He said. I smiled meekly back at him.
Grabbing my stethescope, I attempted to listen to his lungs over all of the noise. His chest expansion looked odd, but I couldn't quite put a finger on why.
Right lung... Concentrate, listen, drown out all of the other noise and listen..
Grunting, but he was moving air.
Left lung.. Listen, concentrate.
Nothing.
I pulled the bell of the stethescope back up and tapped it to ensure it was working. I heard the "thump thump" of my finger clearly in my ears. I put the bell back down on his left side.
Nothing.
"Right is clear, just grunting. Left is absent." I said, pulling the stethescope off my ears and looking at Tracy. She stopped midway through cutting the collar of his shirt off and looked at me.
"You're sure it's absent? Maybe it's just diminished."
"I'll check again." I said.
I listened again over his left side, tapping his chest wall with my fingers. It felt full, not hollow. There was blood in his chest cavity.
"Absent. His oxygen sat is holding at 98, but there's nothing there."
She nodded again and said "Okay, since his sat is holding we'll leave it. If he starts to drop you'll have to dart him."
I nodded and gulped. A chest decompression? That's such a rare skill to utilize in a paramedic's career, let alone as an intern. I shook my fear and continued re-assessing him. The fire-medic gave a radio report, which I was thankful for because I don't think I would have been able to get the words out as fast as my brain thought them to let the hospital know we were coming. I listened intently as I tried to control bleeding and check the man's pupils again.
"Trauma base, this is Paramedic Gavin on medic 12 enroute to your facility code 3 with a 15 minute ETA. On board we have a 40 year old male involved in a single vehicle accident, truck versus side of a mountain, off the pass. Extensive cab intrusion, patient is unconscious with snoring resps. We have unequal pupils, no obvious head trauma, absent lung sounds on the left with a sat of 98 on 15 liters. Compound tib/fib fractures on the left, no other significant findings. Pressure is holding at 120, we have 2 large bore IVs established. Pulse is 140 and sinus tach on the monitor, he is positive for ETOH, unless you have anything further for us we'll see you on the other side."
"Trauma base copies medic 12, nothing further for you. Trauma team will see you in trauma bay 1 upon arrival."
"Medic 12 copies."
The remaining 15 minutes in the rig passed quickly as we continued to assess and stabilize him. When we suddenly came to a stop and I saw the lights from the trauma center gleaming into the back of the rig, I was surprised we had gotten there so quickly. We pulled him out, trailing blood and guaze and wires behind us, and into the trauma bay. The staff descended on him, and I quickly gave the doc a run down of what we found while he did his assessment, shouting out findings between my report.
"Head is normal, no obvious trauma. Pupils unequal, can we get respiratory in here to RSI him? No JVD, trachea midline. Where's that o2 mask? Lungs absent on the left, I think it's a hemo[thorax]. Abdomen is clean, pelvis stable. Compound tib/fib on the left with major bleeding, we'll need lab up here with a type and cross. Prep an OR, let's get him in."
We left the ER as the sun was coming up. The fire-medic jumped in the back and joked with all 3 of us while we drove him back to his station. I smiled and let out a few chuckles, but I was exhausted and my head was spinning. When we got back to station, Tracy handed me my paperwork for the day and I left for my 2 hour drive home.
On the way home, I pulled off the road and stopped in an empty parking lot. I slowly pulled my shaking hands from the steering wheel and into my lap as I leaned my head down onto the dash. Tears streamed down my face and I wiped them away quickly. I don't know who I was trying to hide it from, no-one was around, but I was still embarrassed that the call had bothered me so much.
I was angry that the guy was drunk. He could have easily killed someone, and he may have killed himself. I was upset with myself for not taking better control of the call, but I knew it was just a bad call and I couldn't let it get to me.
We still wonder if the guy made it. We never found out what happened to him.
I still wonder if I wish he had made it.
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