Sunday, May 27, 2007

- Wreck

The Wreck Post, as promised.



We got paged out 30 minutes past crew change for a wreck Eastbound on Big Highway . We arrived on scene to find two cars about 100 yards apart from each other on opposite sides of the interstate, both in the trees, one flipped over.

A bystander ran up to us and advised us that a woman was trapped in the flipped car and was making gurgling noises. They could not pull her out. I asked him to hold our spotlight and directed a VFF to attend to the lady sitting on the grass, holding her arm. I climbed in through the back side window and found that the victim inside the car was lying prone on her roof - the car was upside down. Her head is pointed towards the driver side window in the back seat and the lower part of her body is lying along the roof over the driver seat, with her feet down under the steering wheel. She is having agonal respirations.

I wiggled back out and politely asked The Gimp (standing there having an extended period of thumb-ass interaction) where our F----ing spine board, bag and collar were. Please pop your hand out of your bum and get it the f--- together, I think to myself. Why didn't I grab that stuff on my way out? I knew he wasn't going to. I need to act more like a Basic instead of jumping all over this call. But shit, this chick is really messed up, she is circling the drain, there's blood all over and I don't know why and I do not trust him with this lady right now. I just want to get her out right now. F---. F---.

He runs off.

"I need a flashlight! Troop, I need your flashlight!"

He hands it to me and I crawl back into the car. It's eerily silent for about thirty seconds, me trying to hold c-spine on this lady with one hand. The flashlight is in my left hand and I shine it around the interior of the SUV. Luckily, she's not really pinned under anything. All I can hear is the rush of traffic on the interstate behind me and assorted yelling and faintly, incredibly, Mazzy Star's "Fade into You" playing on the radio inside the car. And finally, after an eternity, the clomp clomp clomp of The Gimp's big, stupid feet. He hands me the c-collar and I put it on the lady and tell him to take over c-spine. I crawl back out of the back passenger side window and tell the gathered deputies and state trooper my plan - I manage to drag open the driver side back door, giving us better access to her shoulders and head.

I crawl back in and yell for two of the troopers to reach in and grab the waist band of her pants and under her prone shoulders I grab around the knees and give the count and we start to pull her out. She budges a few inches, really smooth, but then jerks and stops. I use the flashlight and shine up and down her body again. I take a closer look. Her feet are tangled up in the gas pedals.

"Oh, you bitch!" I shout.

This is going to be a pain in the ass. I yell at them to hold up and crawl into the front of the car and unhook her feet. We try pulling her out again and she comes right out. We get her out and flip her over, and in the light I am unexcited to see dirt and mud in her mouth. The Sheriff's deps and troopers secure her under my direction and without really thinking, I finger sweep as much as I can out. A few inches of mud and dirt come out and I try to start bagging. At some point in between us pulling her out and flipping her over she has gone into cardiac arrest. I give the bag to a bewildered looking Gimp and slap the pads on her, for a quick look. Asystole. Her eyes are staring up at me though half shut lids. Her pupils look blown.

Double Turds. Maybe it's just the lighting.

Coming up the hill with her on the spine board backup showed up with HotThang and SpiderMan, two friends of mind. HotThang is a Basic who is...well, she's hot, and SpiderMan is her paramedic. We've gone out drinking a few times and we get along pretty well. Anyway, we got her loaded and The Gimp and HotThang started working her up as I teach Spotlight Bystander (who in my head I quickly rename Hero Bystander) to do compressions. I let him take over for HotThang and tell her to see if Spidey needs a hand with the other patient.

Gimp, his hands shaking, drops his ET tube in between the wall and the seat. I hand him another one and he opens her airway with the scope. Apparently my finger sweep did some good (cleared the airway out) or some bad (pushed the mess into the airway so deep we can't see it) but he manages to pass the tube with minimal suction. I prepare the IO and spike a bag. After a few cycles of CPR I ask everyone to hold on, and sure enough, on the monitor, a rhythm. Bradicardic, just a small narrow complex barley there, but to me right now barely is good enough. I feel for a pulse but can't find one - PEA. We start compressions again and get an IO established on the lady with our EZ-IO (whoever thought of mixing power tools and pre-hospital medicine is a genius. I nearly made the "Rawr rawr rawr" noise from Home Improvement the first time I saw it.).

I slam in an epi and an atropine, and, all though the lady is still in PEA it is quicker now, at a rate of about 40. We give another Epi and the VFF Chief comes into the back. I switch with him and run out the back to see if Spidey and HotThang need a hand but they're OK. I run back to my unit and tell Hero Bystander he's done a great job and ask if he has a card. He does, gives it to me, and I tell him I will never forget him and his help. I stick my head back into the module and tell The Gimp and VFF Chief that we're leaving. The Gimp gives me a thumbs-up with his big goofy face and I toss my gloves into the trash and close the door and hop up front.

We got the lady all the way back up through a functional rhythm and she went into pulseless V-Tach. As we pulled up I heard the Gimp clearing the patient. We shocked her once and brought her into the ER, where she coded after about 5 minutes.

She was later found to have a 4 inch lac above her left ear and a skull fracture that we could not see in the dark and was only notable after they took her off the spine board. All though she did not make it we gave her every chance possible. The other two patients from the scene were brought in with minor injuries.


I walked out of the ER to clean up the unit. I noticed a few of the techs outside smoking and staring at me.

"What?"

Puff, puff. "Dude, your shit is all fucked up."

The ER techs are almost as vulgar as I am.

"What?"

Puff, puff. *Blows smoke out of nose* "Look at it. You've got blood all over. Damn."

I step back into the light outside of the ER doors and look at my shirt. It's got grass stains and it looks like someone threw Ragu all over, f---ed up Christmas colors. F---. I end up taking off my shirt and undershirt (the blood had gotten through my uniform) and putting on a paper hospital top.

We don't have any information on the patient and it's only after calling the friend who was sitting in the grass holding her arm do we learn she's a foreign citizen, down here on vacation. I walk back into trauma and look at her, naked, staring up at the ceiling through half lidded eyes with blown pupils. I touch her arm.

"Take it easy, babe. Sorry I snapped at you."

I walk out.

The next week, when I drive by the accident site, there is a small white cross up in the tree line. The next day when I pass by I pull over and walk down the hill, singing the lyrics to "Fade into You", by Mazzy Star under my breath and pay my respects.

The song stays in my head for a week.

Epilouge: Spider comes up to me the next day.

"You did a good job on that call last night. You really controlled the scene."

"Thanks," I tell him. "I'm glad you guys backed us up. It was a rough call."

"Seriously man, good job. (The Gimp) was standing there looking at you the whole time. You pretty much ran his call."

Later that week, when I found out I had passed my registry exam, I call my FTO. After he congratulates me, he asks me who I want to clear with. I tell him I want to clear with Spidey.

I start on Monday. Here's hoping he's still as impressed with me after our first shift.

-MM

3 comments:

Blue Ridge Medic said...

Nice post, sounds like you had your hands full. I found you through Ambulance Driver, gonna link to you, hope you don't mind.

Regards,
BRM

nursemary said...

What a great post. One question though, what is a 'Gimp'?

Medicmarch. said...

The Gimp is my partner - I had the post down for some editing issue but it's up now! Read below...