Aug 16, 2013 - Experiences of a first responder


Sheri asked me to write for her blog some time ago, the experience of the first responder.  The delay was caused not by limited experience of a paramedic to the results of drunk driving but the sheer quantity and the need to tell the story without identifying the individuals involved.  Indeed it is necessary to protect the innocent, while educating the public about drunk driving.  In order to do this I have amalgamated several cases from different parts of the province, each situation has been encountered many times by first responders and I will try and show the method to the madness and involve the chaos and carnage.

The tones go off; dispatch comes on the radio directing us to a single vehicle rollover on a small country road.  We know the area, been there done that!  Lights and sirens flash in the night mostly to scare off the local wildlife; we have an ambulance out of service due to a collision with a deer. 

We arrive on scene; a large SUV is pulled back from a T junction with obvious damage to the front, doesn’t look that bad.  Our first decision is if the scene is safe. Well it’s dark, how many patients, well we can see one person moving (a good sign).  We drive right up and I get out making my assessment. 

I see our patient is on the phone trying to organize a ride or tow.  I politely attract his attention, the large white ambulance with flashing lights apparently being insufficient.  The window whirs down, he impatiently covers the phone.  "I was told you rolled over" I ask. (We are cautious in describing the smell of alcohol or ETOH as we abbreviate it, preferring the legal "I detected the scent which I know to be that of stale beer", In short a brewery.  "The guy replies those idiots speeding", he points to the darkness. I tell him to stay in the vehicle worried as I am about his possible spinal injuries, at least until the police arrive!

We follow his vague directions with our spot light and see steam or more properly water vapour.  As we get there we see a small white car, make, model, can’t tell and people at least a person still inside.  OK we need back up. 

I know all our volunteer fire department are listening on their radios one thirty or not.  Sitting up in bed waiting, that’s what they do. We call "need rescue (RV), pump to close the road".  The answer comes within seconds, eight people up and moving to help.  The bad news is police are delayed, Drunks fighting. 

I grab my trauma bag; my EMT grabs the airway kit- down into the ditch we go.  Again scene survey, and danger, I smell gas; the battery is connected, one spark!  Then we hear a cry, not the sobbing kind from a chick flick but something more primal.  We can`t leave no more waiting.

The car is on the roof and the rear wheels are still slowly turning.  I wonder every call, the wheels still turn seemingly by perpetual motion, I am roused from this by the sight of an arm moving. Next how many patients? I get down, the roof  has held, good! The back windows have gone two people a man and women. 

Women speaks, incomprehensible but she has an airway.  Male, I see staring on the windshield, bad!  Next triage, who do we help first.  Women, RED! (Needs help to live now).  Man, through the jumble of limbs I see breathing but not enough though and I can’t get to him.  BLACK I can’t help him. 

For now I must concentrate on the woman.  My EMT calls on the radio, "one RED" "one BLACK" (very bad) "one GREEN" (a good thing). GREEN heavy ETOH on board``.  We hope the RCMP are listening and get a move on.

I am talking to her now, she can’t feel her legs.  No window (good), can’t open door (bad) the back door opens, a stupid idea I know.  I see a car seat empty (shit) “where is your baby”, wails follow, a bad choice of words. 

My EMT is gone looking for a baby in the ditch.  Babies can go a long way when ejected from a vehicle, think of a quarterback throwing a perfect spiral.  I just carry on, hold hand, try to calm down and grab a pulse.  It is fast and week (SHOCK).  I manage to get half a nasal cannula on her, some oxygen may get to her, better than nothing.

Lovely sirens and flashing lights/ the RV arrives, help!  Flashlights appear. “ I need it cribbed and the door popped”, things are happening. She is calm, and she tells me her baby girl is with her parents at the farm, a romantic date night at the Chinese restaurant.  

I am more worried, adrenaline wearing off- she is very calm peaceful even (shit).  The sound of hydraulics and the metallic pop of the door coming loose- ripping tearing and done. I am still in the back, stupid, trying to stabilize her head a rookie mistake! Still I wasn’t crushed. 

She’s not really talking.  I am out, A,B,C,’s , A-airway, open, B-breathing, insufficient, C-circulation, can’t tell.  Just get her out! “Forget spinal precautions”.  We practiced this many times, strong arms, belts cut, she’s out and on the spine board.  My EMT appears, pale, glassy looking; I guess he has just lost his supper.  “Grab a line”, I grab a BVM (bag valve mask), some getting in, not enough. 

Intubate in the ditch, or carry her up? My thoughts are disturbed by someone shouting at me “when is somebody going to look at me!”  “I want to go home”. Our friend from the SUV is not feeling he is getting the attention he deserves. 

Our fire captain is going towards him; he will sort him out, maybe permanently (good). We got a line “how much” I am asked, “whatever you can get in” is my reply.  –Tube now.  An easy intubation, no response from our lady –shit- I don’t know her name, still “MOVE”. 

I feel better in the truck.  I know where I am.  Monitor on, I see sinus tachycardia (good).  No palpable pulse to the extremities.  An 18g IV running wide open.  Check for other injuries, now we have light wonderful light.  Jeans are cut – deformity to both legs. ‘I think’ spiral femur fracture, bilateral- common when the dashboard strikes your legs at 80KPH. 

Distension to the abdomen, pregnant?  No! Discoloration to the flanks, Grey Cullen’s sign or is it Turners- Bleeding. Patch the hospital – first see if the Doctor is there letting them know a major trauma is coming to our little hospital “stars”? I am asked- “Yes” I say with some doubt. 

Our third unit arrives for the man, can’t worry “GO!” Reassess the patient, airway-chest rise and fall (good a good tube). Oxygen probe on her finger shows < 50%, bad.  No perfusion - end tidal CO2 – 35 good.  Blood pressure 60/ 40 not good even if it is real.  Try to get another line, fail, no veins – neck vein?  Try-got it, normal saline wide open.   Nearly there, in town, reassess, airway good, breathing, I am for her.  End tidal CO2 bad. Still have a rhythm on the monitor, but her heart is not beating or there is no blood left to push around. 

Start CPR we have stopped- sirens still going- can’t think! Pulse- less electrical activity (PEA) treatment, adrenaline.  I push an amp through the vein in her neck, as if by magic, a pulse!  Things look up – “how much fluid”?” 6 litres” in, her blood is as thin as Kool-Aid (not good). 

I know depressingly that her heart is in overdrive, medicated, without enough blood to pump! We call this unflatteringly as circling the toilet, an allusion to the pet gold fish. "MOVE!" we are off, soon we arrive at the hospital, things move like clockwork. 

Experience hands move her quickly to the one trauma bed.  I give my report to my GP, obviously he has just woken up, now doing his hospital duty.  I am going to stay to help, but dispatch has other ideas. 

Another call! Apparently the bar fight went home- stab victim- police on scene BUGGER! Have to sort this out so the Mounties can get to our drunk, still I am pretty sure, our captain is taking care of him, that might be another call! That leaves me with a happy thought as we roll out of the emerg bay.

David Lindfield   B.A., EMT-P., M.S.B, F.L.S, F.R.I


Footnote: It is only in the past year that emergency medical personnel have been granted the right to claim the diagnosis of post traumatic stress (PTSD) our arguments to obtain critical incident debriefing are now being acted upon in large centres not so much in rural areas.  Our pension rights have been limited and we are told we don’t deserve the same as Firefighters or Police as we are told we are not an emergency service, very few EMT’s and Paramedics avoid serious injury through their career, knees ,backs and shoulders give out.  Why do it! We love the job and to serve.  You can help us, just don’t drink and drive; we have enough work to do.


 

Last updated on: 2016-07-19 | Link to this post