Baptism by fire

Chapter 4

The late Richard Pryor once said, “Death is a MoFugga, so far, don’t nobody we know ever survived death.”

Working in EMS, you will see death, plain and simple fact. But the deaths you will see will range from Granny easing off to see Jesus in her sleep, to the sudden violent death of a young person from a gunshot wound, and everything in between. One learns quickly to cope with it, or one quickly finds another line of work. While death is a natural part of life, seeing it on a regular basis is perhaps not. At any rate, death, traumatic injury, sickness and drama are a integral part of EMS.

Over a period of time, one can tend to become a bit jaded, developing a large callus on your soul to prevent going crazy. We each deal with death and the inherent sadness of our job in our own way. To outsiders, we sometimes seem uncaring or insensitive, but this is not true, we simply have to be the way we are to keep doing our job. But, it effects us all, in one way or another.

Without violating the sacred tenets of HIPPA, a law anyone in medicine knows, I’ll share a few stories of some of the tragedies I’ve dealt with.

On a beautiful, hot Sunday morning early in the summer of 2006, we sat at the station relaxing and tossing about war stories, it had been a quiet day, without a single call so far. I was a fairly green EMT at the time, and wanted something, anything, to break the dullness of the day. I’d only a few minutes before commented to my partner, a seasoned paramedic, that we needed a call, something good were my words. He’d looked at me in disgust and said something to the effect of being careful what I wished for.

As if in answer to my statement, the calm of the morning was broken by the peal of the Rescue Tones.

“EMS, EMS RESPOND TO HIGHWAY 203 SOUTH AT MILE MARKER 21 REFERENCE TO A MVC 4 WHEELER VS CAR” My partner glared over at me, as we jumped to our feet and ran to the truck, “Guess you got what you wished for you Sonofbitch.”

I hopped in the drivers seat and started the truck, he reached for the radio and called us in service, and requested First Responders to be dispatched.

“AFFIRMITIVE M4, FIRST RESPONDERS ARE ON SCENE REQUESTING EMS 10-18.” (as fast as possible)

We rolled out onto the highway, siren and lights blazing, and headed south towards the accident. Our county covers a large area, and where we were headed was almost 23 miles away, and as luck would have it, we were in the slowest truck the service owned. As we turned onto the highway we were passed by several sheriffs deputies, my partner was on the radio trying to get a patient update, which proved difficult with all the traffic on the net.

“M4 RADIO, IS THERE ANYONE ON SCENE TO GIVE ME A PATIENT UPDATE?”

We rounded a large curve, and far in the distance, I could see the deputies disappear over the next hill, I cursed the truck for its sluggishness.

“RADIO M4, PER 243 ON SCENE YOU HAVE TWO CRITICAL PATIENTS AND THREE PATIENTS STABLE AT THIS TIME, STANDBY FOR FURTHER.”

He swore, and radioed back to have Air Med launched, as well as another ambulance dispatched.

“RADIO M4, PER 243 PUT IT IN THE WIND, REQUESTING YOU PUT IT IN THE WIND.”

He looked over at me, “Roll this thing Duke, don’t slow down.”

“You better get out and push then, cause I’m to the floor now” was my response. I squeezed the steering wheel as if that would give me more speed. We continued on towards the accident, and my partner gathered gloves for us, and began to issue instructions.

“When we get there, I’ll triage the patients and tell you which one to take, I don’t know what we got, so be ready for anything.”

“I got a bird coming, we’ll make the decision on which one to fly based on injuries, use the first responders! Let them fetch what you need, we’ll deal with the worst ones and let the other truck take care of the rest.”

We rolled over a small hill and before us was a sea of fire trucks, law enforcement cars, and bystanders, a fireman in a bright orange vest waved us to a open spot in the roadway. I called dispatch and gave our on-scene mileage, and pulled to a stop, even before we stopped, a grim faced volunteer was at the window giving us information.

“You got one here that is critical, she stopped breathing on us twice already, the one there is broke up bad but breathing ok, the ones over there are just scratched up.”

My partner pointed in front of us at a group of people hovered around a prone body, “GO THAT ONE IS YOURS!”

I bailed out of the cab and ran towards the group, as I drew closer I could see a young girl thrashing around on the ground, several people were attempting to hold her still, two firefighters held a large blanket over them to shield them from the hot sun. Her right leg was lacerated and obviously fractured judging by the angle it lay at, her left arm was broken as well, and she had a large approximately 5 inch laceration on her left jaw that went from her chin to her ear. As I knelt by her, someone began telling me she had been unconscious, but now was “awake” and fighting them.

I directed two firefighters to go to the truck, instructing the to bring me a spine board, c-collar and bring me the IV kit and jump bag as well, then quickly began to assess her. Someone told me her name, and I spoke to her loudly, trying to get her to answer me. She only screamed and demanded we let her go, as she thrashed about.

“Hold her head still” “Get somebody on that leg, lets gently straighten it out”

My responders arrived with the spine board and collar, handing the collar to the person across the patient, I instructed them on placing it on her, I grabbed the stethoscope from the jump bag and listened to her lungs, clear thankfully.

“Duke, what do you need?”

I looked up to see Mikey, a former member of our company and a experienced EMT standing over me. Seeing him, the iron band around my chest loosened, and I asked him to get her leg and arm splinted. I started my rapid trauma assessment, checking her from head to toe, finding multiple lacerations and bruises all over her body, a quick check of her pupils showed she had unequal pupils, not a good sign, coupled with her combative nature, we were dealing with a head injury.

“Does anyone know if she had a helmet on?” I asked, no one knew.

My portable radio squawked, “Duke, I the bird will be here in 5 minutes, I’m en-route with my patient to the ER.” This was my partner. I looked up and saw the ambulance rolling away from the scene.

To say that my heart fell into my shoes was an understatement. Here I was, a green EMT, with a critical patient, and my partner and my ambulance had left me on scene. I wanted to run after the ambulance screaming “DON’T LEAVE ME!!!” But I had no choice but to care for my patient and do what I had been trained to do.

My patient was still fighting us tooth and nail, I turned all my attention back to her, as we held her still, I told the firefighters to get the spine board into position and we rolled her towards me, I quickly checked her back, noting a large bruise above her belt line. We placed the spine board behind her, and rolled her back onto the board and began to secure her to it. I opened the IV kit and as I started to attempt an IV, I told Mikey to get me vital signs. In my brief career with EMS I’d started maybe 20 IVs outside the clinicals I’d done in school, but this was the first I’d ever started that counted as it did.

I placed a tourniquet around her arm, located the vein, and swabbed it with an alcohol prep, then quickly slid a catheter into the vein. Rewarded with a quick flash of blood in the flash chamber, I withdrew the needle and reached for a Saline lock. Someone handed me a drip set attached to a bag of saline, and I connected the line. As I was securing the tubing, I could hear the sound of the helicopter over head.

“Let’s get her ready to load” I shouted, “We need a way to transport her to the landing zone.”

“I got my pickup right here, we can use it” a voice said.

“Fine, let’s do it!” I looked at Mikey and said, “let’s get some people on this board.”

Several firefighters rushed forward, and together we lifted the board and passed our patient to the ones waiting in the bed of the pickup, I scrambled into the truck, noticing as I did a roll of barbed wire, wisps of peanut hay, and a few fence post. We arranged ourselves around the various contents of a farm truck, and held the board and patient steady, and our driver, an older farmer in overalls jumped into the seat and we started down the road to the landing zone, which was the yard of a nearby house. We stopped in the driveway, and as we exited the truck, I could see the flight crew headed towards us with their stretcher.

They quickly arrived where we were, and we transferred her from the bed of the pickup to their stretcher and ran to the waiting helicopter. I gave my report to the flight medic as we ran, and we loaded her into the back of the bird. They quickly assessed her and waved us off, and we retreated back to the pickup. With a cloud of grass and sand, they lifted off and disappeared.

We bailed back into the pickup and returned to the scene, as I jumped out of the truck, I saw the backup ambulance and ran towards it, meeting the paramedic as I ran up, he yelled for me to get in the back of the ambulance, “Help her” he said referring to his partner, “she’s got two patients.”

I climbed into the back of the ambulance and saw two patients strapped onto spine boards, one was a young woman in her twenties, and the other, was young boy, approximately 4 or 5 years old. He was covered with blood, which had soaked the entire front of his tee shirt.

“What’s his status?” I asked.

“I don’t know, L checked him, I got my hands full here.” She replied.

I grabbed my scissors from my pocket and quickly cut his shirt up the front exposing his chest. I saw nothing, but he began to cry immediately, and loudly. I quickly palpated his chest, and searching him all over I noticed nothing but a bloody nose. All his vitals checked out, trying to calm him, I asked him.

“Whats wrong little man, are you hurting anywhere?” “Y, Y, YOU CUT SPONGEBOB!!!” came the angry reply. “WHY DID YOU CUT SPONGEBOB?”

What the?? I looked down at the remains of his shirt, and through the blood covering it, I could see the image of Sponge Bob. Apparently his favorite shirt, and I’d ruined it. This was serious.

“Mom will get you another one buddy.” I told him.

“NO SHE WON’T, SHE HATES SPONGEBOB.” Came the reply, his sobs increased.

Needless to say, it wasn’t a pleasant ride to the hospital, I had offended my patient gravely, and nothing I could do, no promise of a new shirt calmed him. Thankfully he was not hurt, but I definitely hadn’t made a friend that day.

Arriving at the hospital, we transferred care over to the Emergency staff, and began to clean our truck, my partner came into the ER, and found me. His patient he told me, had Coded on him as they placed her on the spine board, and they had managed to revive her, but the prognosis was grim. Her injuries were massive, she had been the driver of the 4 wheeler and had taken the brunt of the collision. The two girls had been out riding and were unaware of the fact the road crossed a major highway. They had struck the SUV at approximately 40 mph, causing it to flip several times. Neither of them had been wearing a helmet.

Later in the day, we transported her to a trauma center, but unfortunately, she died soon there after. As for my patient, she was holding her own, and in fact, several months later, as I walked into Wal-Mart, I saw her. Scarred up somewhat, she was doing well.

Footnote: I had the fortune to meet my patient again this past weekend, she is doing great. Scars are healing well, more cosmetic surgery in the future should almost completely take care of them, a beautiful young lady who was given a second chance in life. It made up for every crappy call I’ve run.