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I'm in the second quarter of a 48-hour shift at my paid department. No calls last night; par for the course for my paid department. I haven't been on a call on this department for the last four or five shifts I've worked. On the other hand, my volunteer squad gets banged out every time I'm here; twice last night while I was here.

That was before. Just as I typed the above, we got toned out for a list-assist; someone had fallen out of bed. We ended up taking them to the hospital; they had bumped thier head on the way down. Nothing too serious, though. It was my partner's call to work in back; the next one would be mine.

We had already had breakfast, done truck checks, and run all of the gas-powered equipment before the call came in.

We got back from the hospital and I came back to work on my blog post. Just as I sat down, we were toned to a car versus tree on the interstate. After we were on the way, dispatch called back and said this was a possible fatality. I asked dispatch to put the helicopter on standby. In a minute, dispatch radioed that the helicopter had been grounded due to the weather.

We got to the accident scene. The car was wrapped around the tree. The car had become airborne and hit the tree, bottom first. The car was u-shaped and the roof and floor of the car were within about two feet of each other. One could see the lower part of the driver's leg visible through through the hole where the windshield had been. Looking in through the back window, one could see the back of the driver's head. The driver was breathing loudly; agonal respirations. Someone called dispatch and asked for a paramedic on scene.

I put on my turnout gear and helmet and worked my way into the back of the car. The driver was wedged between the window and the floor. I was able to reach up and hold the patient's head to open the airway and hold c-spine precautions. I was able to feel the carotid pulse with my right hand.

The fire department cut the roof off the car and we moved the patient to a backboard. A member of the local rescue squad started to suction blood and mucus out of the patient's airway and assist ventilations with a bag-valve mask while other people started to strap the patient to a backboard. I went to the ambulance and prepared to start IVs.

The patient was put inside and we all got to work. We cut off the patient's clothes and did a rapid trauma assessment. There was some instability in the patient's rib cage but it seemed that a head injury was the most significant problem.

I put a huge 14-gauge catheter in the patient's left arm and started running fluids. The paramedic arrived and tried twice to intubate the patient without success. I suggested that we should put in a Combitube and the paramedic agreed. I dropped in the tube and inflated the cuffs; the paramedic bagged the patient through the tube while I checked for proper placement by auscultating for epigastric sounds (none) and lung sounds (good on one side; diminished on the other probably due to a pneumothorax). Various local rescue squad members got off the ambulance and we got under way direct to the Level-1 trauma center.

I bagged the patient all the way to the hospital while the paramedic did a secondary survey. I patched through to the hospital (called on the radio to alert them to our arrival) and declared a trauma alert.

We got to the hospital and wheeled the patient into the resuscitation room. The room was full; sixteen people were waiting for our arrival. We transferred the patient to the resus room table and were done.

I watched the resus team work for a while and then went out to clean the truck. There was blood on the floor and seats; there was trash from various tools on every surface. Various bags and tools were strewn around. It took about twenty minutes to clean up and mop out the back of the truck.

The paramedic said nice things about how we handled the call. My partner was very impressed with my skill putting in the IV and Combitube.

A bit later, we had another car accident; the patient was probably okay but had some back pain. We put the patient on a board and took them to the hospital.

Twenty-six more hours 'til I go off shift.

qrsline_small

Comments

( 7 comments — Leave a comment )
geckospot
Oct. 28th, 2006 11:13 pm (UTC)
Yikes, tree wins
So do you get much of an adrenalin rush working on cases like that? How long does it take to shake it off?
I'm guessing the patient was unconcious. I'm sure that's easier to deal with than screaming hysterics.

Doesn't a large portion of on the job practical experience count towards training credits? I'm sure there's still plenty to learn but ain't nothing like the real thing (baby).
bxiie
Oct. 30th, 2006 02:48 pm (UTC)
Re: Yikes, tree wins
Re: the adrenalin rush; I guess so. I get very focused on the patient to the exclusion of much else. I couldn't tell you how many fire engines the local FD had on scene. I had no idea what color the car was until I saw the pictures.

As soon as the patient is turned over to the emergency room staff the focus goes away like a light being switched off. I don't emotionally invest in the patient so I don't have any issues after the fact. I'm sure it will be a different story the first time I work a kid with a bad outcome but I'm fine with adults.

The patient was apparently speaking right after the accident but was not when we got there. The patient was truly unresponsive as she didn't flinch when I put in the 14 gauge catheter. If you consider the internal ink tube in a Bic pen, that's about a 14. Not my arm, thanks. The patient did stare at me through one half-opened eye through the entire ride; I spoke to them, but I don't think they were really 'there'.

Screaming is somewhat harder to deal with, but not much harder, really.

No part of actual care counts towards continuing education, actually. It does seem bizarre at first blush but makes sense on further reflection. One develops bad or sub-optimal shortcuts and practices while actually doing the job; training fixes or improves these.
fr_defenestrato
Oct. 29th, 2006 07:30 pm (UTC)
bravo for continued heroics and continued great stories!
bxiie
Oct. 30th, 2006 02:48 pm (UTC)
Thank you!
katyaoddio
Oct. 30th, 2006 07:08 am (UTC)
You're a good man, Albert Brown. Another gold star pasted on your chart.
bxiie
Oct. 30th, 2006 02:49 pm (UTC)
Thanks. That makes two?
timehole
Nov. 2nd, 2006 08:07 pm (UTC)
wow, you really can see the imprint of the tree.

to launch a car 70 feet, do you get a sense they were going way too fast, especially considering the weather conditions, or is that fairly typical of highway accidents?

keep up the good work, bx. thanks for the px (later post)
( 7 comments — Leave a comment )

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bxiie
Bjamexza Q. Pyndejo / James O. Payne, Jr.
Bxiie Q. Pyndejo

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