A bird on the table, and two in the air

Thanksgiving at the firehouse this year was very nice, and the guys who hosted us at the station did an outstanding job with a turkey and all of the trimmings.  All week, I had been planning my post to talk about holidays at the firehouse.  That all changed about 130 in the morning…

Cat had just gone to sleep, and I was just barely holding my own in the poker game when the plextron in the hall went off.  “Box 12-07, for a shooting…” As I fold a miserable hand and start for the door, I can’t keep myself from thinking, “Someone must have had too much family time.”  The pager on my hip starts shaking as I walk over to the unit, and I see that the call taker has noted that there is a lot of screaming on the line, maybe this one will be real.  Cat joins Wayne and I in the unit, as we hear the dispatcher adding the engine to our call.  With us and the BLS unit on the initial dispatch, that makes three units.  That sort of complement is usually reserved for codes and unconscious calls.  The callback information clears up the added piece.  It seems that there are now two people shot at the scene, and the shooter is still there.  We’ll be staging for police, and it is looks like we are in for a call.  

As we are on the way, Wayne and I discuss where to stage.  We want to be close so we can get in quick when the police say things are clear, but this call is not in the best neighborhood, and shooters tend to run.  Letting safety win over, we pull over at a convenience store just outside of the neighborhood and call in our location to the other units.  Not long after, the Basic unit and the engine join us in the wait.  Several police cars race by, flashing blue lights bouncing off the buildings as they go.  “So much for no more calls tonight” – a message appears on our computer from the basic unit teasing us for our optimism on a prior call.  “Double shooting, I’ll get up for that” is my reply.  After a few minutes, the call comes in that the scene is secure, and the PD are requesting us to continue in.  

The townhouse was not hard to find, it’s the one with all the police cars out front, and officers in the front yard.  Entering with my crew, I notice a guy on the floor of the front room in handcuffs, the shooter I suppose, but he’s unhurt, and all the yelling is in the back.  There are a lot of people in the house, kinda typical for this neighborhood, multiple families sharing a house, lots of people, a little space, and the smell of alcohol…no surprises so far.  In the back room, we quickly see what the commotion is about.  Laying on the floor on his right side is a Hispanic male in his 30’s, with three holes in his torso clearly visible.  “Big Bullets” I think, noticing that the wounds are as big around as my pinky finger, and I’m not a small guy.  The other thing I notice right away on him is that he is the classic image of a shock patient:  Grey, clammy, tired looking.  That he is conscious is a plus, but I’m immediately thinking he could crash on us at any time, maybe before we get out of the house.  He’s holding hands with a lady, I assume his wife, who has a similar hole in her left hip, right at the pelvis.  She looks a little better, but more upset, in obvious pain.  “Chris, What do you need?”, Matt, the fire captain on my crew, veteran of 19 years and a guy who has been there and done that more than once asks.  (For reference, he’s the fire captain in the Medics 1, Reaper 0 post, and DTXMatt12 on this site)  The guy is easy, he’s getting flown…provided he makes it that long.  I see that there is a hole at his left lung, midclavicular line, about the 9th intercostal space, and a matching one in the back, same area.  Looks in and out, but I know better than to assume that.  Either way, that lung is in trouble, possibly the heart is damaged, most likely from the cavitations caused by a big heavy bullet sending shock waves through him as it passed.  The one in his belly is concerning too, lots of vascular organs behind that one, and the aorta passes right behind that one, Not Good.  The girl could possibly be handled by the local facility, but I’m thinking likely pelvic fracture, plenty of internal bleeding there, and I don’t see where the bullet went, the femoral artery is back there somewhere, and that would be bad too.  I decide on the scene that she’s going to the trauma center too.  “They are both flying, get me the big chopper for both of them, or two little ones, whatever works.” I tell Matt.  Looking over at the patients, Matt then asks, “Want another Medic?” Good question.  We have the basic, and Cat and I CAN split, each take a patient one per unit and go with it.  But the guy looks real bad, he could be a handful, and the basic crew has EMT I know who is solid but excitable, and two others who seem to be a preceptee and a driver who may or may not be a lead EMT.   I ask Cat what she thinks, and she confirms what I’m thinking.  She wants another Medic dispatched, and does not want to split up care.  “Okay, get 52 here” I say to Matt.  I know they are in quarters, and they are the next closest ALS unit, about 8-10 min away.  

Matt goes off to make that happen, and that is one less thing to worry about.  He’s done this a lot, he’ll pick an LZ and get things moving.  “I’m going to get another pumper to set up an LZ, we’ll hang out here an help.”  Good man, good call.  Okay, the calvery is coming, time to see if we can save these people.  Cat takes the lady and starts her assessment and treatment, I go to the man and do the same.  There is still a LOT of noise in the room, plenty of people wailing about the shooting.  The basic crew is getting into the room, and they are starting their thing too.  I look to Wayne, “He’s gotta go, and right now.  I want a reeves and a cot right here.  She goes second.”  He grabs some help on the way out, and things are moving.  I talk to the guy, get his name, No allergies, no meds, no history.  Great.  I’m moving and talking, and I’m glad he’s got a clean medical slate, because I honestly was only half listening.  I got what I really needed in the fact that he was talking, was making sense, and had no allergies.  The allergies question always seems like a strange thing to ask first thing to a trauma patient, but if they go unconscious, you never get to ask again.  A tip I learned early in my career, and I use it every time.  I’m getting him on the monitor, and getting the B/P cuff put on.  No surprise, sinus tach in the 130s.  Fast and narrow, his shallow, rapid breaths finish the perfect picture of a shocky patient.  The cot and reeves were fast, and we get him up and strapped in.  They’ve brought two reeves stretchers which was good thinking and over the din I get the attention of Matt and Cat.  “Okay, for the rest of this call, THIS is patient 1.  That is Patient 2. Got it?” Quick nods from both.  I notice that we are starting to get a couple of people calling shots on the scene, not an uncommon occurrence on high stress calls, but a bad sign.  “We are NOT going to Cluster F this” I think to myself.  My crew and Matt’s unit have a great rapport, and we are still clicking.  “Okay, as soon as I’m out, get the other cot in here and get her out.  When 52 gets here, that is their patient, get Cat back to me.”  Matt nods and I know that it will be taken care of, noise, commotion and all.  As we start out of the room I ask Cat if she is okay, and I get a “Yeah, but when 52 gets here, they will get patient 2, and I’ll meet you in the unit.” We are on the same page, and the last thing I notice is that she has completed a trauma assessment, and is almost done bandaging the wound.  

As we climb in the back of the unit, it’s just Wayne, a firefighter named Dan, and I.  Wayne get going on hanging two 1000cc IVs, and I have Dan get some big oxygen on my patient.  The first B/P comes back as I’m getting set to start covering some holes and it’s not good.  71/41.  “That’s not enough” I think.  I try to tape down an ‘occlusive’ over the first hole, but nothing is sticking.  The patient is just too diaphoretic.  The bandage is an adaptation itself.  I need something that is airtight, but the bandage in the pack is a gauzy material with a gel, and I don’t trust it to hold air tight.  It is packaged in plastic though, and I DO trust that to block air from going into the wound.  So I’m using the package and all as a bandage.  To get it to hold, I grab wider tape, and some alcohol pads.  I quickly wipe around the wound and try to get the alcohol to dry things some.  The wound is not bleeding much, at lest not externally, but that’s not all that uncommon.  About this time, the door opens and the engine driver is asking if we can spare Dan.  My first thought was “No.” and I say so.  “They are asking for him inside.” Is the response.  Now, I’m feeling guilty about splitting on Cat, and I don’t know what is going on inside, the other medic is a couple minutes out still, I could really use the hands, but well, we’ll make do.  “Okay, Dan go see what they need.”  Now it’s just me and Wayne, and the patient is getting antsy.  Wayne has the IV’s ready, and we hand off tasks.  I hold the ‘bandage’ where I want it and tell Wayne to tape down 3 sides with the tape I toss to him.  “When that’s done, do the same thing with this one” I say, pointing to the hole in the back of the patient’s lung.  As I’m getting out the IV needles and pulling some tape, Cat arrives.  She’s handed off patient 2 to the other unit and is here to help.  In the background, I’m hearing the radio chatter between the helicopters and the LZ engine, they are asking for an LZ brief, so they are close, we need to move.  The patient is laying on his left side, so we can treat his injuries, and Cat is on that side so she gets the lines going as I hold the patient’s arms.  We get a 16 gauge going on the left, and an 18 on the right, and get the fluid flowing.  In the meantime, Wayne bandaged two wounds with the occlusives and I have bandaged the third.  The engine driver pops his head in the midst of this and asks if we are okay.  I tell him we are, but we are going to need a driver to the LZ.  At first he says he’s not sure if there is one.  “There’s gotta be SOMEONE” I say as he heads out.  I think to myself, “I got two medic units, a basic unit, and an engine here.  I should be able to treat two patients and build a small barn before I go.”  Shortly thereafter, about the time the second IV is going in, I hear Matt yell back that he’s driving, and are we ready to go.  With the lines in and running, we start to the LZ.  I get get repeat vitals, and have Cat confirm lung sounds for me.  I had diminished movement on his left, which is to be expected, but just want to be careful.  The IV tape is not doing any better than the bandage tape was earlier, and we quickly wrap tape all the way around the patient’s arm to make sure it holds.  The fluid was running, and the second B/P was better – 106/80-something.  His wounds start to bleed under the bandages, and Cat and I quickly press against them to help stauch the flow.  “Okay, what are we missing?” I ask and Cat and I double check things.  The patient is conscious, and anxious, still looking pale, diaphoretic and sick.  The IV’s are in, the holes are bandaged, and his heart is hanging on, if fast.  There are no other injuries, good movement everywhere, and he’s maintaining his own airway.  His left lung is not moving as much air as his right, but his oxygen saturation is 99% under his mask.  I’m sure he’s bleeding badly internally, but with a quick transport, and the extra B/P, maybe they can get him to an operating table.  

No sooner do we come to a stop at the LZ than the flight crew hops on and gets to work.  We give report and help get the patient off of our equipment and onto theirs.  They note the left sided reduction in air movement, and look clearly concerned for the patient.  I rip off a copy of the report and the ECG tracing to give to the Flight Medic, and help get them moving.  They swap the patient over to their cot and hustle over to the helicopter, rotors running and ready to go.  Behind that one, there is another chopper waiting for patient two.  “Double Play” I think…been a while for that.  Cat tells me that they found the bullet in the left buttock of the other patient, and while she exposed, assessed, bandaged and got initial vitals, the lead from the basic was able to circle the location of the bullet on the patient.  

The second medic was close behind, and they were greeted by the crew of the other unit.  After we watched the chopper with our patient take off, we clear the LZ and head back to the hospital to resupply.  Our unit is a mess, I have a report to write, and there are cards to be played.  On the way back, we quickly compare notes to make sure we didn’t miss anything.  Wayne tells me that he saw some bullets and shell casings by the door, he’s estimating .357 or better in size, confirming my thoughts.  Cat agrees, based on what she felt under the skin of Patient 2.  We give the Doctor on duty the heads up that we flew the patients and a run down of their injuries.  He agrees with our decisions, and teases us about taking his good call from him.  I remind him that he has an open invite to join us anytime.  We’ll see if he does.

I didn’t hear back from the crew as to the patient condition, but the front page story in the local paper today is of the double shooting with one fatality over the holiday.  Seems our guy didn’t make it.  That didn’t come as a surprise to any of us, but at least we gave him a chance for as long as we could.  

Profile updated

Okay, okay.  After getting pummeled by several of you, to include MedicCat, I have updated my profile today.

More Halloween than Easter

Wow, ten days since my last post.  Life has been busy.  I’ve started to receive more feedback, as comments here, and in conversations with people I know.  Just wanted to say thanks for the responses, we continue to be amazed at the people who check in regularly.

This past weekend was Virginia OEMS symposium weekend.  A four day run of classes all day and parties until 3-4 am.  There are plenty of stories generated there, and that is where they’ll stay.  (Listen carefully, you can hear entire departments breathing a sigh of relief.)  While I was there I had several conversations on past calls and postings here.  One call came up more than once, and so I’ll share that one today.

It was an Easter Sunday and much more an April Showers sort of day than a May Flowers one.  A cool, nasty steady drizzle fell all day from a steady bank of high clouds.  Cat wasn’t on duty, so she must have been at work.  I was alone on the unit with my driver Wayne, and I was a bit nervous about it.  I was a new lead medic, and though I’d been an EMT for years, I was new to being alone at the Medic level.  Wayne and I had had a quiet morning and were just hanging out in the station taking it easy when the call came.  “Box 12-09. Shooting…”  The address was for a local gas station/deli chain about 3 miles down a main back road from the station.  What struck me right away was the tone in the dispatcher’s voice.  If you ever run calls, then you’ve heard it – the final definite sound that they have when they KNOW the call is real.  If you don’t run calls, dispatchers tend to have a regular cadence when they are giving out dispatch information.  Each one has their own patterns, and you get to know them by voice.  Most of the time, it is a fairly detached process, and to be honest, you’d be stunned to know how many times what they think we are going out for, and what is really going on is different.  Well, sometimes the dispatch is more animated, like for the Structure Fire that has their phone line lit up.  They know it is real.  This dispatcher always gives the box number and “for a  ...whatever”.  But she didn’t it was “Box 12-09. Shooting.” Period. And a slight pause.  You don’t know that you notice it at the time, but your hairs stand up when you get those dispatches.  You know going to the unit that you aren’t going to be wasting any diesel on this run.  

The callback information came quickly, and indicated that the scene was secure, PD were on scene.  This wasn’t too surprising actually, this place was literally across the street from the police station, and is frequented by officers in search of good coffee.  That also explained the certainty in dispatch – If PD were already there, then they have seen the victim.  Things happened quickly from here.  The Engine was out ahead of us, and blazing a trail in traffic.  I was on my Nextel, summoning the Rescue Chief, Jon, who had promised he was listening and available if the poo hit the fan.  As it turns out, he was in church, and got my Nextel call along with the page from dispatch.  Suit and tie, he was on his way.  Wayne was hauling freight and we flew down the road.  My mind started going over what to expect and what we were going to need to do.  Chopper.  If this guy is hit bad, we need to get him to a trauma center… the rain, damn, no choppers in bad weather, but well…it’s not that bad, more a drizzle..sometimes they come.  I get on the radio.  “Are the helicopter’s flying today?” I ask.  This is important, I need to know if this is even an option.  If they are grounded, then I’m staring a 30 min ground transport in the face with a gunshot wound (by myself as far as medics go).  If they are flying, then I need to get him stable and packaged in the 10 minutes or so it takes them to arrive.  “Medic 512, “ a new voice comes over the radio, an older dispatcher, who has been around forever, “are you on the scene?”  Sigh. She is asking if I’m with the patient, made the assessment and determined the need for medivac.  That’s the norm. And she knows I’m not there, not even Wayne goes that fast.  “We’re responding still, I’m asking if the helicopters are available, not requesting dispatch”. (You interfering, hard-ass bitch, are they flying or not? I don’t add).  “When you get to the patient, then advise if you want a helicopter” was the response from the radio.  Now, Jon had Nexteled back that he was coming and he caught the brunt of my frustration,  “Un-F’ING-Believable” is what he tells me he hears over the phone (NOT the radio).  I don’t remember that, but that’s me, and I’m sure I said that to him.  What I don’t know is that he’s tracking with me, and while flying through town in his buggy, he’s on the phone to the hospital, getting the okay to fly if needed, and talking to dispatch on another channel, working the same issue.  He told me this weekend that he crossed 90 MPH on the way there, and I believe him.

In short order we arrive.  The engine is leading the way, and we have to kinda wrap our way around the building from the side to get to the scene.  This means I get a chance to take in the whole scene as we approach.  In the parking lot between the building and the pumps, there are several cars, one of which has a door open and two men next to it.  One looks like he was poured out of the driver’s seat onto the ground, the other is kneeling down, holding the first’s head in his lap.  Not a great sign, but no obvious blood etc either.  There are a couple of cops there, and more coming from all over, sealing the parking lot behind us as we enter.  The guy helping the patient was an off-duty officer, he was the “PD on the scene” from the dispatch.  We come to a stop, I mark on scene on the radio, and start to hop out.  The engine crew has piled out of the engine and is headed as a group over to the patient.  They are ahead of me and moving fast, as I reach back to grab the bags I’m going to need for this call.  As I turn back towards the patient, he leans his head over and precedes to projectile vomit a stream of bright red blood.  

Now I need to be clear here.  I’ve compared notes with everyone on the scene and we all agree on the details.  When I say ‘a stream’, I mean a full-on Clive Barker horror movie special.  Best estimates say 2 ½ to 3 inch diameter stream of blood that launched past the patient’s outstretched arm and splashed on the pavement.  I’ve never seen anything like it, and I’m not sure I’d believe it if I wasn’t there.  The guys off the engine see this and turn their heads, in unison, right at me.  They seem to be moving in two directions at once, towards me, and towards the patient at the same time.  Their faces are white, eye’s huge and I could almost hear them saying, “Did you SEE that?”.  Like I could have missed it.  The other look on their face was right out of a war movie, “MEDIC!”.  I know that look, I had it too.  Oh yeah, I’M the medic…I’m the one who is gonna fix this…no pressure.  

Without getting back into the unit, I reach for the radio. “Medic 512….My patient is now vomiting blood, Start that helicopter!”  I remember throwing the mic back into the unit and watching it bounce against the console.  Now they will start making the calls…”two minutes lost” I think returning to the task at hand.  I was pissed at the delay, pissed at being doubted over the radio, but that could wait, this guy could not.

Arriving at the patient’s side, I see that he is able to respond to some questions, but is a bit slow.  The off duty officer tells me that he was shot somewhere else, and drove here to call for help.  The patient is not vomiting, or even bleeding all that badly, at least on the outside.  I start to cut off his shirt, and order, “Get the backboard.”  Now this is a rookie mistake.  The command is “You,” and select the individual “get the backboard”.  I realize my error as I remove his shirt and look up to see that the entire crew has departed to get the board and the cot.  “We are NOT going to cluster this” I think to myself, as I try to shake off the fact that I’m now ‘alone’ with the patient.  I see two wounds on his left side, presumably where he was shot.  I ask the usual questions about allergies and medications, figuring he may pass out, and I need that information before he does.  A quick scan finds that there is no trauma past the gunshot wounds, which was what I’d expected, but you have to look.  The patient is looking tired, and emitting that bad vibe you get when someone is really sick.  About this time, everyone returns, and I have plenty of help.  The patient is boarded and collared, lifted to the cot and we are moving to the unit.  It was fast, it was smooth, just like you practice it.  Climbing in the side as they load the patient, I find that Wayne has hung IV’s and they are waiting already.  Wayne rocks.  I start issuing commands. “Get vitals, put him on the monitor (ECG), get him on O2”, this time each command is given to an individual…I can be taught.  I swing around the patient.  “You still with me?”, “yeah man” comes a slow response.  Not good.  Somewhere in there I hear over the radio, “Helicopter en route” and an ETA.  Thank God for small miracles.  Okay, so no 30 min transport.  I need vitals, I need IV access, I need information.  I get a quick listen at lung sounds, he’s moving air on both sides, so I’m not looking at a pneumothorax, at least not right now.  I get set up to start my first large bore IV, and I see he’s got monster veins.  Good for him, that’ll help too.  I start reaching for the largest needle I can find. The vitals start coming in.  His blood pressure is low, though I don’t remember the exact numbers now, his heart is fast (as expected) but regular.  The patient is fading and responding slower and slower.  About this time, Jon arrives.  I see the door open on the side.  “Need a hand?”  “Get in here and start that IV”.  I point to the patient’s other arm.  “a bit over dressed for a shooting aren’t we” I think to myself as I get my line started.  

Okay, the order of things is a bit blurred after that, but I remember that we were suctioning his airway to get the blood out and I had a quick internal debate about lifting his legs.  On the one hand, it could help is pressure, on the other, it could harm his breathing if things move up against his lungs and the blood in his mouth blocks his airway.  We get him suctioned out good, and I elevate his legs.  I’m trying to get his pressure up so he makes it to the hospital.  I double check his lungs several times, and things are holding up there.  Good air movement, no breathing problems.  Good.  The landing zone is a baseball field right behind the scene, so we are there in no time.  I was so glad to hear those rotors.  We get repeat vitals as the Flight Nurse and Medic climb on.  More good news, his B/P is rising, and he is still responsive, but slowly.  

I give report, and get some news of my own.  It seems that the helicopter crew had their radios on and heard our dispatch.  They must have heard the same tone I did, because the medic told me that the pilot was already going to check the radar when I first asked if the choppers were flying.  They heard me ask for the helicopter when the guy puked, and said that they “really wanted to get off the ground for you guys, it sounded like it was bad”.  God bless that pilot, I think that he may not have flown but for the severity of the call. The rain was coming a bit harder, and he could have chosen either way and nobody would have doubted him.  

The flight crew did their thing, getting the patient switched to their monitor, double checking IV’s and patient status.  We get him transferred to the chopper, and they are on their way in no time.  

As the helicopter lifted off, Jon, Wayne and I exchanged hand shakes and smiles.  Things went as well as possible. The guys from the engine crew kicked butt getting him boarded, packaged, and in the unit.  We felt good.  Butt kicked, names taken, and the patient was on the way to the hospital.  We had done everything we needed to, kept the patient from slipping away with that bad pressure, and did it fast.  I didn’t know it until just this past weekend, but Jon went back after the call to see how long it took him to get to the scene.  (He was looking to see how fast he went, but you can use it as a measure of time for the events described).  From the time he got the page, to the time he was on scene… Six minutes.  So that means approximately seven minutes from the initial dispatch to the time I say he climbed in the side of the unit.  Fast, smooth and a full-on team effort.  My crew rocked and it was the sort of call that makes you think you can handle anything, any time, anywhere, ever.  It was the type of call that gives medic’s the famous medic ego if they aren’t careful too…

Post notes:  I got a call later from the flight crew. The patient was in surgery, had a lacerated liver (as I recall) and esophagus.  His BP crashed in the air, and he crashed again between the ER and the OR, but looked like he’d make it.  They also passed on an ‘attaboy’ to our crew and the guys on the scene.  The paper the next day described him as having “non-life threatening injuries”.  Yeah, right.  I told Jon that that must just be the paper showing confidence in our capabilities.

It's hard to soar like an eagle...

In today’s overly litigious society, we in EMS know that proper documentation can be the only thing that saves you from a lawyer with an ad on the back of a phonebook and a person who you tried to help and is now trying to “help themselves”.  We also know that things happen on scenes that could only be written by professional comedy writers.  While not our best moments, they do give us a chuckle, and serve to remind us that we are only humans trying to help other humans.  In all things, Murphy’s Law rules.  Here’s a story from a call I ran years ago as a fairly new EMT, and with lots of, perhaps overeager, help.

I was riding as the EMT on a medic unit that day.  The medic was Jon, the same one as in previous posts (and the medic that complained to me that he wasn’t included in the Cast of Character’s post…grin).  It must have been a weekend, because the sun was up and it was early afternoon, during the week I only run at nights.  I do know that it was the start of “Stupid Season”.  For those who are not familiar with that term, it is during the spring, just as the cold weather from winter breaks, and the warm, sunny days lead to people the shaking of cabin fever and Seasonal Affective Disorder by doing stupid things that result in them breaking things…like themselves.

In this case, the gentleman, hereafter referred to as “the patient”, was riding/racing his motorcycle up the sidewalk of an apartment complex in our first due.  Now, many of you are probably wondering “Why the sidewalk?”.  The reason was that the street had numerous speed bumps installed by the association in a effort to reduce…speeding.  The irony here gets better, keep speed bumps in mind.  So, when racing up sidewalks was no longer thrilling, he proceeded to start jumping up and down the stairs between the sidewalks and the building entrances.  These stairways came equipped with hand rails, for safety.  Well, on one pass, up the stairs I believe, he wrecked, and tossed himself over one of these rails.  That would probably have just hurt, but not required our assistance, but his right leg got caught in the bars of the safety rail as he went over, breaking his femur in at least two places before dropping him in/under a landscaping bush where we found him on our arrival.

I’m not sure why, but we also had an engine and a basic unit with us on this dispatch.  That gave us about 10-12 people on the scene for one patient…lots of help.  We start off like a scene from “How to run a BTLS scenario”.  C-spine held, Airway, Breathing, Circulation assessed, pt at least partially exposed for assessment.  He was alert and oriented, never lost consciousness, and talking.  He was relatively calm for someone in his condition, and other than the new “Z” shape to his right thigh, was more or less intact.  He was a bit agitated, but that is to be expected.  The basic unit connected him to an oxygen mask, which was connected to an oxygen tank that they kept in the bag so the bottle didn’t roll down the slight hill.  (Hence, the need for stairs).  We give him a quick head to toe assessment, and decided that his big issue was the leg (he had good pulses in his feet, and could wiggle them, though it hurt…bad).  He would be boarded and collared to protect his C-spine, of course, but things looked okay there.  We discussed the merits of putting a traction splint on his leg, but opted against it.  One of the fractured areas was extremely close to the head of the femur, a contraindication for traction.  Jon gave the local hospital a call to tell them what we had, and they quickly indicated that they wanted us to have him flown to the trauma center.  It seems that there was not an orthopedic surgeon on duty…weekend remember.  

Okay, so we call for the helicopter and start to get the patient packaged.  We get a backboard and straps brought over and look at the best way to get him boarded with a minimum of movement.  The issue was the bush he was half under.  So, we have two people stand between the patient and the base of the bush, effectively using their bodies to hold back the bush from the patient.  This gives us some room to work with and is typical of the little things that always seem to add challenge to the simple things in EMS.  As I am returning to the patient with a backboard in hand, I hear the command given to “move this stuff out from beside the patient so the backboard can come in.”  At that cue, one of the ladies off the engine starts tossing things to one side. First the aide bag goes 3-4 feet over..no problem..then the O2 bag…the one with the oxygen bottle in it.  Next thing I see is an O2 bag going about 2 feet, until it reaches the end of the tubing for the mask on the patient’s head.  It promptly drops, and I see the patient with his mask hovering about 6” from his face, straps around his head straining, and an EMT trying desperately to maintain C-spine by holding his head still.  “WOAH” yells the patient and I have to stifle an all-out laugh.  “Trust us, we are here to help” runs through my head as I look down at a guy who is truly having a bad day.  This is NOT a confidence builder for the patient.  Jon leans over as we bring the bottle back and re-set the mask and mutters, “C-Spine seems ok..he’s still moving”.  Again, I smirk against a laugh as we very professionally backboard the patient and get ready to roll.  

So, as we are splinting his bad leg and getting him boarded, the patient starts worrying about work the next day.  “Will I be at the hospital for hours?” he asks.  I explain that he will be there for days, and can look forward to some rehab most likely, but he is not listening.  He very calmly and deliberately explains that he MUST be a work tomorrow, and I just as calmly and deliberately explain that there is a helicopter in his immediate future, as well as an anesthesiologist and a surgeon.  But that falls on deaf ears.  

As we load him into the unit, I notice that the thigh is swelling badly..he’s really busted up there, but he’s holding it together well.  I climb in and start exposing the rest of the patient to make sure we aren’t missing anything small.  The patient has a large tattoo on his chest, as I recall it was of a fist holding an semiautomatic handgun and the words “Gansta Killa” over it.  This Gangsta Killa was still talking about work the next day and not understanding how badly busted up his leg really is.  The medic gets a line, we attach ECG leads etc.  As the EMTs finish helping load the patient, they ask if there is anything we need, get a “No, thanks” response, and slap the dump button by the door as they close up.  Now, for the uninitiated, ambulances typically have a “dump” feature, which allows the back end of the unit to dip down with the doors open to ease loading a cot.  What is happening is the rear suspension of the unit rides on air bags to soften the ride.  When the unit dips, it “Dumps” that air and the unit drops down onto the axles.  The newer units now do this automatically, you open the back doors, and the unit dips, close them and it fills back up.  Back then, and on older units, there was a switch in the back that triggered the dump as well as one on the drivers console.  They are wired like a light with two switches on opposite sides of a single room.  This is important, because our driver, a relatively new, and very gung-ho guy was already up front ready to roll.  He looks back and sees the door shut and dutifully hits his dump button…  (I can just see many of you cringing already.)  So, what has happened is the box of the unit was down on the axle, the guy on the back hit a switch to lift it, and driver hit his switch thinking he was doing the same thing, but in fact, that settled the unit back down on the axle.  We don’t notice the difference in the back…we have a patient with a badly busted leg and a helicopter just a few minutes out.  

So, the line is set, the ECG is on, the patient is stable, tolerating his pain and insistent on working tomorrow.  “Eddie, Go!” yells Jon to the driver and off we go.  Now remember why our patient was on the sidewalk?  Speed bumps.  (Wincing again I see).  Yeah, we hit one as the excited driver is accelerating out and bounce the box of the ambulance off the axle.  The instant I feel the unit bottom out I think “OH SHI…” and just that fast my thought is cut off by the most god-awful scream I have ever heard.  This poor guy is strapped to a hard backboard with a femur broken in at LEAST 2 places and we just dribbled him off a speed bump.  “STOP STOP STOP” yells Jon, and we do.  He slaps the dump button again, waits to feel the air returning and returns to our response to the chopper.  We exchange a “You gotta be kidding me look” and try to settle down the patient.  He STILL wants to be home tonight, and working tomorrow.

At the Landing Zone, the flight Medic and Nurse climb on and get report.  The patient has settled down and is talking again.  He starts to tell them that he wants to come home tonight when he is cut off by their conversation.  The Flight Nurse is asking if they think they should put on a traction splint…the same conversation we had had on scene.  The flight medic thinks the breaks may be too close to the head (our call too) and that they may not have room for the patient, a tall guy, and the splint in the chopper.  “Besides, “ he says, “that’s not going to save his life”.  Now the patient, who is in the middle of his own sentence hears that and stops talking.  This guy, who happened to be black, turned stark white and his eyes bulged like nothing I’d seen since that mask flew off his face.  Now I knew that the medic meant that it was not a life-saving intervention because this guy was not going to die of his injuries without the splint, he needed IVs and surgery to fix the damage.  The patient heard “that’s not going to save his life” and was convinced he was going to die.  He never did ask about work again.  And before I could say something to him, the flight crew and LZ engine crew were pulling him out of the unit and off to the helicopter.  Dude was having a bad day.