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.