The carnage is amazing for only having one vehicle involved. The car has flipped multiple times - that much is obvious, from the impact marks in the grass trail of car parts from the roadway. To top it off, the car, which was now skidding on it's driver's side, slid roof-first into a large, sturdy oak. The passenger compartment is like the inside rim of half a donut, with the trunk of the tree filling the donut hole.
The driver is sitting on the ground next to a cop car. He has a lac on his head but is awake and talking, so I downgrade him to "Can Wait a second" as I walk over the car. It's pretty rough.
"One inside," says the fire captain who is prepping his extrication gear. "He's hurt pretty bad."
"Breathing?" I ask.
"Yep. Twisted around in there pretty good though. We're going to take out the back window to see if we can slide him out."
I crouch down to the back window where a firefighter is reaching inside maintaining immobilization. This patient isn't going anywhere for the time being. A quick look in the back shows most of his body lying along the interior driver's side of the vehicle, along the roof. His right leg looks wrong, but I'm not sure why yet.
"Can you hear me, sir?" I ask the the young man. "Are you hurting anywhere?"
"No, not really. My nose kind of itches."
"Ok. Do you remember what happened?"
I walk back over to the driver and do a quick assessment. He has a small lac on his head. My partner, who has been prepping immobilization equipment, takes over. I walk back over to the smashed car as the extra unit pulls up.
The car is actually leaning against the tree it hit, allowing me access in through the rear driver side window. When I wedge my hefty frame inside, I am a mere foot away from the entrapped patient. There is plenty of blood on the roof from what looks like a lip laceration, but nothing else seems to be actively bleeding. I ask the patient his name. Now that I am inside, I can see that his right leg is covered by jacket, obscuring my view. I pull it aside and find out why it didn't look right.
The femur obviously has at least two fractures - it's bent in the shape of a "C". There is a large lac below that. And there is an ominous bulge in the front of the patient's loose gym shorts.
I grab the patient's hand.
"Hey, bud, can you squeeze my hand?"
There is no squeeze.
"Bud, squeeze my hand"
"Tell me when you feel my pinch." I pinch his fingernail. Hard. Hard enough to make someone
pull away and yelp.
There is no reaction. He just stares up at ceiling. I take my pen from my hip pocket and drive it into his palm.
There is no reaction.
His eyes dart over to me. "When are you gonna pinch, man? Don't leave me in suspense."
Well, that's why his leg isn't hurting. He's paralyzed.
I do a couple of tests. He's numb from the navel down, and shoulders out.
It takes 35 minutes to extricate him. When we get him out he's starting to get shocky. The bulge I saw earlier is priaprism, an indicator of spinal injury in this case - I don't think the kid has had time to pop a Viagra with all the commotion. The chopper is fogged in, and our limpdick dispatcher is waffling about sending me some more back up. Our third and fourth trucks in the service area have both gotten emergencies on their way to the wreck scene, he says, and he can't spare anyone. It's going to be at least a 30 minute drive to a real hospital.
Tired of his jabber on the main radio, I pick up the 800, and lean forward into the cab, so the patient can't hear me. "Listen B, I don't care who you send me or where they come from. We can do an intercept. But I'm going to need someone soon, or I'm not going to need anyone at all."
I get my back up about 6 minutes later.
We manage to get some large IVs started, and hurry the kid to the hospital. He's starting to go in and out on me, and I have my intubation equipment set up, but a gentle verbal command perks him up and gets him breathing again.
We transfer care.
At home, in the shower, I wash broken glass out of my elbows, and try to wash the exhaustion off of everything else