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.