Stabbing

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.