Now how exactly did you get out here...on top of that?

      Fairly recently I was working a fairly busy 24 hour shift out in my usual coverage area. We did our fair share of calls during the day, but nothing that was too exciting or in this case, blog worthy. So we get back to the station to hopefully settle in for what we always hope is a slow, quiet, uneventful, and basically filled with hours and hours of sleep. However, just the lights go off in the station, so do the tones. Ugh! Now what! Do people know not to get hurt or have a medical issue after 10pm?
     The call is actually right down the street (figuratively) for a traffic accident. So far it doesn't really get our adrenalin pumping. That is until the dispatcher states that it was a roll over and the pt had been ejected from the vehicle. Lights and sirens, here we go!
     3,2,1 we are on scene with the FD who had shown up just a minute or so before us. The collection of metal and plastic pieces that used to be a car was now nothing more than a heap of twisted metal. Mechanism of injury = bad. But where is the pt? Sometimes under the haze of midnight, flashing lights, and the flurry of activity between passing on lookers, PD, and fire, things can get a bit hectic. However, we find our pt awake, in pain, and on top of what I thought was the front windshield. As it turns out it was actually the rear windshield. WTF? How did you do that?
     Apparently this pt was not wearing a seat belt and was subject to the totally random injury pattern/movement of the vehicle when it rolled more times than a hot dog at 7-11. As it turns out, the pt was actually laying on top of the rear windshield. Apparently he felt he needed to take it with him on his 20ft flight from his vehicle to the lawn of the person that I hope called 911. Now I am very much an advocate for the whole "Seat belts save lives" concept, but this guy was very much the exception. If he had his belt on, he would have to be cut out of the jungle gym that was now the front compartment of his vehicle. Then things would have to get more complicated, helicopters would need to be called, injury would probably be worse, and so on.
     So what we start the typical trauma/pre-hospital checklist with a sense of urgency. A,B,C's are good but our pt with the wreck any NASCAR driver would be proud to have caused looks uncomfortable to say the very least. Oh and our rapid trauma assessment (eyes and scissors) revealed that it would have been a very bad idea to roll him to the right side since he had what could be either a hip or femur fracture. Either way, a bunch of orthopedic badness that requires surgical intervention.
     At this point he is carefully manhandled in a calm and professional way to ensure he is packaged properly for transport to a trauma center. His vitals are stable-ish but due to the injury and the crazy damage to the car, we felt it would be a good idea to get two big antecubital lines in this particular pt. My partner and I both pop in 16g IVs and I am sure the collective thought process in the back of this ALS rig was "boom goes the thunder".
     And now we are off towards the interstate to take us to the trauma center so this pt can make it to a surgeon, preferably an orthopod. The ride is uneventful and the pt is well enough to tell a couple of dirty jokes and complain about the "great roads" we have in the area.
     As we roll into the trauma bay, report is given and care is transferred to the trauma team. Sometimes you can get complacent with the idea that nothing other than diabetics and COPDers live in your are, but severe trauma can happen anywhere.