Tuesday, January 19, 2010

- Scalped

I'm a city boy. I'll cop to it.

I work a rural area, however. This has its advantages - there's a slaughterhouse near our station that THE freshest meat I've ever had the privilege to eat. Ink pan-fried some burgers the other day and proofed them in the oven. I've never had a burger that satisfying. Ink and I sat, faces greasy, bloated on delicious cow flesh. AMAZING.

Disadvantages are present too. The area around our station is primarily agricultural - sugar cane fields. They just got done with the last harvest, leaving wide open plains with no wind-blocks. Sometimes the breeze feels like a low-grade hurricane. Plus, there's the dirt.

This isn't normal dirt, mind you. This is vitamin rich, well tilled, 100 percent pure-dee GROWING dirt. Which is great, if you're a farmer.

But if it's been raining for a week? All that dirt turns into the ickiest mud I've ever encountered. It's like cold, wet, napalm. It sticks to everything, it gets into equipment, and it tastes horrible.

And then someone runs their car into one of the ten foot ditches at the surround these mudflaps, and we have to rescue them.

The mud is most of the way up my boot ankles with each step. The patient slid off the road going about 60 and flipped into the ditch, up the other side, and then cartwheeled across the cane rows until coming to a rest on the driver's side. There's no chance we're getting the unit back here. We're either going to have to carry the patient out on the board or figure something else.

I've been working out in Backwater for quite some time and know the firefighters pretty well. They are clustered around to the left of the car, kneeling and standing adjacent to the roof. They wave me over. I shlosh to the front of the vehicle.

If you've never smelled it, large wounds have a smell all their own, which I call "The Gore Smell". I've never been able to smell it anywhere else. It's kind of flat, maybe a little coppery. I can smell it now even though I'm ten feet away. Once I reach the windshield, I pop a squat. Inside is an older man, maybe 50 or so, rotund, and bleeding, sitting on the drivers side window.

I introduce myself. "I'm March, with XXXX Ambulance. How are you feeling?"

His eyes flick up to me, and what he says next drops my internal temp by around 30 degrees.

"Man...I feel like I'm gonna die." His face is so pale, he looks like a black and white photo come to life. He coughs a clot up and spits it at the console, which is level with his head now that the car is on its side. I can see that he's missing three teeth on the bottom. The seat behind him is simply painted with dark crimson. The firefighter holding c-spine is pale. He looks pointedly at me and then down at the back of the guys head, then back at me. Message received. Big boo boo.

"Well, I'm gonna do my best so that you don't. We're going to get you out of here. Let me take a look at your head real quick." I lean over and look.

There's a chunk of flesh and hair the size of my hand on the back of the man's head, flapped over like an open book. I can clearly see skull. I gingerly reach over, and flap it back, and adjust the firefighter's thumbs to hold it in place. I wink at him, and step back.

"Sit tight. We're going to have cut you out of the car. I'll be right back. Someones right behind you, keeping your neck still as a precaution, OK?" I hate to leave the guy, but I need to get things rolling on the medical side.

I stand back up and start giving orders, politely but firmly, with my paramedic face on. My preceptor, Spiderman, once told me that as the paramedic, you need to be cool, even when you're scared shitless. If you stay cool, it helps everyone else stay cool, and things will for the most part run smoothly. Stay in control, but don't get bossy. Take care of your first responders and they take care of you.

"Genetleman, we need him out, ASAP. Maintain c-spine, O2 on him at 15, and keep him warm. If you please, can you send one of the fellows out to the Ag center to set up a night landing zone for the chopper." I get on the radio and request the chopper. They will arrive in 15 minutes.

At this point, an off duty deputy runs up to me through the mud. "March, my truck has 4 wheel drive. I can back it up over to the access road, and you can put the spine board on it."

I look at the mud on the ground. Even with 6 people carrying this is going to be incredibly rough terrain to get across.

"OK, sounds good." He scampers off to get in and pull around.

I go back to the front of the car with a c-collar from the bag I left near the car, and call for the KED. The man, however, has so little neck that not even the shortest setting on the collar will fit him. Fuck it, I think, I'll just do a really good tape job.

A blanket covers all of us as I assess more injuries and the firefighters take out the posts at the top of the roof. A ton of sensitivity on both ribs, and when he breaths, I feel a large section just below his nipple moving out of sync with the rest. I've never actually gotten to feel paradoxical motion. His lungs sounds are slightly diminished just underneath that area, as I expected. The right side is OK. In addition, his left shoulder is dislocated or fracture. I start to sweat a little bit but manage to keep my cool.

His BP (136/84) and pulse (104 and regular) are ok, but he's breathing around 24 times a minute and his room air sat is 90%. I put the oxygen back on. I here a wrenching of metal and the blanket is pulled off. The whole roof of the car has been pulled down from the side of the car, an eerie mirror of the man's head injury. They lay a board down, and we grab the handles on the KED, easing him over.

Quicker then quick we get him into the truck bed and drive out of the field. We load him in the unit and drive the short half a mile to the Ag center. I expose him completely but find no more injures. As the chopper's landing I attach a bulky dressing and make a little bastardized sling/swathe for his shoulder. His lung sounds aren't getting any worse, and his color has returned with the O2. As the flight medic pops the doors open, I'm the phone with the Trauma Hot-line, who gives me a destination. We get him loaded up.

I look down as I walk back to my unit. My boots and cuffs of my pants look like someone rubbed chocolate covered cherries over them - mud and congealed blood all over. Damn.

Ink does a great job getting everything cleaned up as I phone in a report to hospital - the Trauma Hot-line should've let them know, but I want to make sure the hospital knows he's coming.

It takes us over an hour to get the mud off of everything. My boots simply will not get clean. One of the firefighters, Slim, stops by and laughs at me. "Jesus, how long have you been out here, March? Don't you know how to clean cane mud off of something?"

He takes a bottle ofIvory out of his truck and sets to work. Within ten minutes my boots, although damp, are mudfree.

I take them back from him. "You know, you're not too bad for a fucking country bumpkin, Slim."

"Ahhhh...go fuck yourself. I'm gonna tell Mom not to sell you any more ground beef at the slaugherhouse." He walks off laughing.

"Slim, I was only joking. Slim? Buddy?"

Shit.

-MM