Blood, Sweat, and Tears (Part 2 of 2)

… I approached the car from the front, as I was always taught to do.  The intent is to get the patients attention without causing them any surprise that would cause them to jump or turn their head.  Things were already not going like the book says it should; all I could see from the front of the car was a wall of torn metal.  The bumper was about waist high, and the remains of the hood were pushed back over the windshield opening.  Even on my tiptoes, I could not get a glimpse of my patient, so I made my way around to the driver’s-side window.  The intrusion had deformed the car tremendously, but I could see that he was still sitting straight forward, with the steering wheel against his face.  I noticed no signs of life, but realized that the opposite side of the car had not caved in as far and my best access would be from the passenger’s side door.  I tried the handle, but knew by looking at the creases behind the hinge that this door would not be opening any time soon.  My visual assessment through the window was not pretty, but I did see that his eyes were open and moving around in bewilderment, like a newborn examining the world for the first time.  I found a place to perch my supplies and managed to wiggle my ass through the window opening.   Yes, I was a bit more svelte and agile in my younger years.  I introduced myself, and began methodically running through my trauma assessment checklist.  

      

This poor guy was in bad shape.  The impact of the collision left his frail body entombed in plastic and metal.  The four-inch gash on his forehead was spilling blood down his face, and the only extremity he had free was his right arm. Other than a few cuts on his hand, his arm seemed fine.  He alternated between wiping his eyes of the crimson river that kept blinding him, and trying to push the dash and steering wheel from in front of him.  I threw a trauma dressing and “kling” snugly on his head to plug that leak, and helped him wipe his eyes and face.  I was honestly thinking about making him as comfortable as possible…there was little else I could do at the moment.  I engaged him in some small talk to distract him, as well as assess his mental state.  He clearly had no idea where he was, who I was, or what had happened.  I tried my best to explain the answers he sought, while I assessed his situation.  I was looking at the dash, floorboards, steering column and door that had him pinned in to see what we would need to free him, and he was looking at the same things trying to understand what they were.  I remember being able to touch the radiator cap, it was that close to me.  No doubt that directly behind the flooring was the hot engine block pressing tightly against his legs. In the steamy atmosphere, I could smell the coppery taste of his blood, the sweetness of the antifreeze, the stench of burned motor oil.  The five or ten minutes I spent with George in our demolished little “world” seemed like a life-time.  I learned that he was 70 years old, worked on the railroad his entire life, and was only a few weeks from retirement.  

As I was clearing debris to create some wiggle room, he spotted a lunch kettle of the floor and asked me if that was his!  I remember it was a well-worn, dark gray plastic hinged-top Thermos brand lunch pail.  I remember because he asked me to look inside of it.  Not sure what he was after, I obliged his request and gave him a verbal inventory of what was inside.  This is also when I discovered his name was George; it was in red Dymo label on the front of his lunch pail.  Once we determined he had already eaten, he immediately made the connection that he must have been on his way home from work.  “My wife will be worried”, he sadly whispered to me, as a wilting frown fell from his face.  “I have never been late coming home from work in 48 years.”  He didn’t say much more after that, and I was at a loss for words myself.  I kept talking, but I may never know if he kept listening.

I watched as his color drained, and his eyelids grew heavier.  His breathing became shallow and more labored, despite the oxygen I was pumping through the non-rebreather mask.  I heard determined voices surrounding the car, and the familiar clunking of wood cribbing as the rescue squad started stabilizing the car.  Before long, I felt the door behind me shifting from the strength of the Hurst spreaders.  “Hang in there, George; we will have you out of here in no time!”  There was no response…  “George?”  Still nothing ...  Even his right hand that was gripping me a few short minutes ago was limp and listless.  

I remember a simultaneous sense of frustration and relief, as I gave up my position for a medic that had arrived to take over patient care.  By now there were responders everywhere, so I grabbed the opportunity to catch a breath and take in the scene from a wider perspective.  I immediately began my self-critique and mental debriefing.  The adrenaline kept me from crying, at least until I got home later that afternoon.  As I left the car, I told George I would see him later, but I knew that was a lie.  I hope he forgives me…

Blood, Sweat, and Tears (Part 1 of 2)

I had only been running with the ambulance association for a few months.  In fact, the patches on my uniform sleeves were still very crisp and clean.  To this point, however, I had proven myself to be a reliable asset to whichever crew I was riding with.  As a “third”, I was like a bonus provider… not necessary, but often very valuable.  I was learning the “old school” methodical treatment from the regular Monday night stalwarts, Ron and Glen, and picked up loads of great experience by watching them work.  You could tell right away that they had been partners for quite some time.  Each knew exactly what needed to be done, and there was seldom any unnecessary activity or discussion; just compassionate care delivered with confidence and efficiency.  

During the weekdays, things were different.  There was much less regularity in the crew schedule.  This gave me the opportunity to learn from a host of different providers.  I picked up many great habits from a number of different partners, and the diversity helped me hone my own style of emergency medicine rather quickly.  I learned I could deliver the skills required by protocol in the manner dictated by my own personality.  I had been on a few difficult calls, helped save a few lives, saw some trauma, and of course, dealt with the multitude of “hospitality calls” that required a smiling face, a little bit of TLC, and 2% oxygen via nasal cannula during the trip to the emergency room.  

One particular afternoon sticks in my head.  While some of the specific details have faded over the years, I still remember the roller coaster of emotions that I felt as the event unfolded.  It was the kind of call that you knew right away would be in your memory for a long, long time.  The radio began to squawk about a 10-73 (yes, I pre-date the elimination of the 10-codes) in a town about 15 to 20 miles away.  The severity quickly escalated, and before long we were dispatched to assist.  Because of the location and status of several units in the area, we went from 4^th or 5^th due, to “guess what, we will be 2^nd arriving”.  I had the swagger of a young trauma junkie, but was ill-prepared for what we were about to encounter.

What started as excitement soon eroded into terror as we went screaming up the highway toward the scene.  The radio chatter painted a rather bleak picture of a head-on, two-vehicle crash with conflicting reports of up to 8 patients and heavy entrapment in both vehicles.  I had been running rescue calls as a firefighter for a couple of years, but my company was rich with very talented rescue technicians and a strong tradition of earning your place.  Most of my on scene work included staging, cribbing, tool set-up, and peeking over the shoulders of the more experienced guys.  As an EMT, most of my trauma experiences were visual only, from endless slideshows (with actual 35mm slides) during training.  All of that was about to change.  I could do the math…8 patients, 5 EMTs… It was time to suck it up and prove my worth.  

I sat back, and tried my best to quietly control my adrenaline rush.  I needed to compose myself, but my brain was spinning with all the things I may be called upon to assist with.  I didn’t want to screw up, and I could tell by the tone of the voices of my crew that the normal ass-busting and goofing around that was sometimes an appropriate part of our team-building was not part of this mission.  We were about 2-3 minutes from the scene when I heard quite a bit of “exasperation” from the cab.  I broke from my attempts of calming meditation to spin around and look through the windshield to see the first due ambulance whiz by us, en route to the Reading Hospital with two Class 1 trauma patients.  Through the profanity laced heat -of-the-moment critique being conducted by the other 2/3^rds of my crew, I gained immediate understanding of the need to triage when you are first-due.  We were now, for all intents and purposes, starting fresh, and would be FIRST DUE to an accident involving 6 patients and multiple entrapment.  I felt oddly comforted knowing the two in the front of our rig were as stressed about this call as I was, despite their experience during their years of service.  

We approached the scene, which by now looked like a disaster area!  There were car parts splashed from one side of the road to the other.  A few public servants were on the scene, but the majority of the people swarming the site were civilians… panicking, hollering, pointing, crying civilians.  There were so many cars and people choking up the scene that we still hadn’t laid eyes on the involved vehicles.  We hopped from the rig, and grabbed as much trauma gear as we could, and headed into the core of the disaster. 

Along the guardrail was one young, teenage patient, buckled over from pain and spilling blood on the side of the road, but sitting and conscious.  The two vehicles involved in the wreck sat only 20 feet from each other, after what was an obvious headlight to headlight impact.  The first vehicle had one male, heavily trapped behind the wheel, and gravely injured.  The second still held three young patients, also in poor condition from first glance.  Our medic and the driver were forced to make a quick game plan, as the next due EMS unit was about 20 minutes away.  We would triage and treat the remaining patients (as the first unit should have) and through the process of selective elimination, I was assigned to assess the old man in the first car.  I gulped back the fear of the overwhelming responsibility that was just entrusted to me, grabbed what I thought I may need from the jump bag, and made my way over toward him.  I have to admit that I was mentally prepared, and fully expecting to perform a quick assessment and determine that there was nothing we could do for him.  The minutes that followed would test my skills of emergency medicine and patient care in a manner that would mold my compassion for all future patients that would ever be in my care.  

Watch for my next blog post on “Hittin’ the Hot Spot” for the conclusion of this story…