It was what started out to be just another typical day on the MICU. Now that I think about it, most of the time days like this start out as "just another day". You really don't think too much about them then you get "that call" that changes the feeling, tempo, and even vibe of that day. And that call was one of them.
We did our first call of the day. It was a simple transfer from a physicians office to a local hospital. Other than the morbid obesity, it was a very simple call. Nothing exciting except for the fact that everyone was dressed up for Halloween. You have to love going to scene where everyone is dressed up as something crazy. The nurse that gave us report was dressed like a zombie. Go figure...
Ok, so we got our first call out of the way thinking that we were going to do the usual priority 3 purgatory calls that we were sure dispatch has holding for us due to a lower than usual ambulance deployment thanks to a certain hurricane on a certain coast. But instead we get a call for a fall. Perhaps it is not going to be that kind of a day after all.
I will spare you the details of our pt that fell 10ft off of a ladder for the sake of getting to the point. So we clear that call and head on out to again be man kind's last hope for survival. While enroute to our predesignated post, we get a call over the radio to start heading priority one to an MVA at the very south west of our coverage area. And with the application of that damn law Mr. Murphy came up with, ther was no quick way of getting there. There was even traffic on roads that never have anyone, ever! So after some dodging and weaving, we are just about there. As we reach the crest of the hill before the intersection of the MVA, we see a melee of trucks and twisted metal.
Apparently we are the third ALS unit in and don't have a patient. However, the other two ambulances and FD personnel are busy with extrication and care. We provide some help, "go for" style. Moving trucks, getting equipment set up, and heavy lifting. We get everyone out of the wreckage and hear that there is another wreck just down the road. Great. However, since we are the closest ALS truck to the scene with no patient, we hop in our truck, flip the lights on and blair the sigren to the next call.
It literally is only about 2 miles down the road. But is seemed as though it was taking forever. Probably since the adrenalin was still flowing from the first call. The good thing about adrenalin is that a little bit of it gives you a heightened sense of things. The bad thing about it is that a lot of it causes you to think from your brain stem and you tend to loose fine motor skills. Thankfully I have been doing this long enough were I have a sense of urgency and I can still remember how to spell my own name. Ok, now that my own horn has been tooted, back to the call.
We roll up to find two heavily damaged vehicles and immediately call for a second ALS unit. At first glance, I thought one of them was actually up on it's side. In fact it was actually right side up with such major damage that it intruded into the passenger compartment trapping the driver. The other vehicle was also a heap of twisted metal and broken glass. from the looks of it, both vehicle hit each other head on and there were no skid marks. Who knows why they collided, but the driver in the first vehicle was dead. He probably died on impact, judging by the damage to the vehicle. On to vehicle number 2.
With damage just as extensive, the FD was going to have to cut the car apart. My partner asks me if I want to call in the bird. I tell him absolutely and he gets on the radio. Meanwhile, I climb into the back seat of the car to get access to my patient. This pt is semi-conscious with obvious deformities to the lower extremities and does not have palpable radial pulse and weak carotid. It looked as though my pt had two sets of knees. That is how angulated his legs were. C-spine stabilization is taken and I start talking to this patient to keep him awake as best I could while we are literally cut out of the vehicle. We cover up our pt and the FD starts popping, splitting, shearing, and shattering everything they can in a very efficient manner. It still took us a good 20 minutes or so to get the pt out of the vehicle. While inside I kept talking to him asking him question after question to make sure he stayed awake. I also started to cut off his clothes to make the ALS portion of this call slightly easier. When we did finally get him out of the vehicle, it was from the seat to the back board/gurney. And of course he goes unconscious! Great. "Hey! Sir! Wake Up! <sternal rub>". He wakes up and looks at me puzzled. "Do that again and we won't be cool any more".
Now that we are finally out of the vehilce, my partner tells me that the weather is too bad and that the bird isn't flying. Great. Looks like we have a long bumpy drive to the closest trauma center. We get our first set of good vitals and expose our pt to see everything. I use the term good loosely here. They were accurate, but they were far from good. Initial set of vitals was 60/30 and a heart rate of 130. Can we say hemorrhagic shock? One of our sister company medics jumps up in the back of the a truck with the rest of us and lends a hand with all the rapid trauma stuff. We are now set to do some low level flying. It is what my partner refers to driving priority 1. And we do everything else enroute.
Two big IVs, cardiac monitor, high flow O2, and so on. We even attempted to straighten out his legs and get them splinted. However, they were so angulated that it was impossible too. He also had an unstable pelvis. We attempted to manage that as best we could as well. I call a head to active the trauma team and we continue to reassess and reevaluate everything that happened,what was done, and what else can we do. I kept talking to the patient to make sure that he stayed awake and that he was still breathing. V/s were taken every 5 minutes and they were not much better. You know it is a bad call when the best bp you get is 88/40. Holy hypotension, Batman! We even hung blood tubing for trauma team. Our pt is now profused enough to be a pain in the ass. He kept trying to pull off his oxygen mask. I told him to stop or we are going to tie his arms down. He still tried. Of course.
As we turn into the the trauma center and get our pt ready to go inside, I make a mental list of my report that I am going to spout off to the trauma team. When you roll a critically ill or injured pt into any ER, you are the center of attention for about 1 minute. You give a brief description of what happened, any history you have on the pt and what you did. Some of the staff was surprised to see the open tib/fib fractures and asked why we didn't splint them. We tried. Believe me, we tried. They take over, intubate the pt, and do all the other trauma resus stuff that they do.
After it was all said and done, it turns out there was bilateral tib/fib fractures (duh!) and a shattered pelvis. Not broken, shattered. Like a bag of pasta. Not sure what happened from there, but I have to say that as much as I love a good trauma call, it is probably for the best that we don't do that everyday. The burnout rate would be exponentially higher. And in true EMS fashion, on to the next call.
