Ripped him a new one

This year started off pretty active, from New Year’s Day on.  And I think that the higher level of interesting calls is entirely due to our rookie this year.  She was a full-on black cloud death magnet right out of the chute.  She rode as a ride along for New Year’s Eve, caught some calls and got bit by the bug.  The next week she was joining the department and signing up for classes.  She smart, and has a degree in Forensic Anthropology, like the chick in Bones on TV, but we saw enough codes and dead people in the first few months, I wasn’t sure we’d keep her.  To her credit, she learned to adapt, and how to cope pretty quick.  As I recall, this was the first call where I thought, “Well, there goes the rookie”.  I’m glad I was wrong.

It was early in the year, and middle of the night.  We get punched for a call just into our second due.  The call is for an unconscious outside a fast food joint, and not in the best part of the area.  The engine from that due was out first, along with my crew and our engine as well.  Unconscious calls get three pieces where we run, just for manpower, just in case.  That night we were all on duty, Cat and Jen in the back, Wayne driving and I was leading.  We didn’t even crack the map book for this one; we know this place pretty well.  The first due engine jumps on the radio as we respond and puts our engine in service, they have a full crew, and enough people to handle whatever comes.  This doesn’t concern me too much, that crew is one we run with all the time, and that station is in our department, so we are all friends and familiar with each other.  To be honest, the odds are we are dealing with someone passed out from drinking too much in this area, so we aren’t too fired up on the way.  

The engine gets there a bit ahead of us and radios back that the call is a hit-and-run, the patient is at least unconscious.  Well cool.  The engine officer adds that the patient is badly lacerated.  I don’t remember his exact words, but I do remember that whatever he said, it wasn’t up to the reality when I got there.  We pulled up about the same time as the police, and I was struck by the mannerisms of the firemen on scene.  They were doing all the right things, but had the look of a bad call.  I know they were glad to see our lights coming up the hill, and they were all looking over as we stopped.  I saw the patient laying on the ground in the entranceway to the fast food place, kinda curled up in a fetal position, with a bike half under him.  He had a huge gash from his backside up to his back.  

We hopped out and headed over.  As I approached I thought “Holy Shit, that’s GOTTA Hurt!!”  The patient was ripped open.  The rip appeared to start somewhere about his anus, and travel up his lower back.  Specifically, I think it went up to about mid-lumbar and stopped mid-way from his spine and his hip.  The wound was flayed open, and at the widest point I could have fit my fist into it without touching the sides.  (I feel I need to tell those who know me that NO, I didn’t actually try that.)  He wasn’t bleeding much, but had been previously, and there was a bit on the ground.  Bad sign.  I can see at 10 feet that we are well past a community hospital here, it’s trauma center or bust.  Time for the universal hand signals of medic sign language:  a finger point (“you”), a finger straight up (“one”), and the finger twirls in the air, like whoop-de-doo (“helicopter”).  I’ve started a clock on myself, I know that things are going to start moving, and I have a lot to do before the bird gets there.  I haven’t started yet, or even fully assessed things, but if this guy has any chance, the time counts.

As I’m kneeling to the patient, the fire Lt. is telling me, “I can’t find a pulse.” And he heads off to make the radio calls for the helicopter, and call my engine back to set up a landing zone at the strip mall at the bottom of the hill.  Well, boo.  That’ll change things.  One of life’s truisms: Dead people can’t fly.  In this case, it means that we don’t fly people in a code, there’s no room in the bird for the number of people it takes to do the job.  I see another firefighter checking, and I ask him.  “I don’t think so.”  I know that means “No”, but it is surprisingly hard to be definitive in making that statement when you don’t do it often.  Okay, either he’s dead or he ain’t.  If he isn’t then we gotta boogie to save his butt – pun intended.  If he IS, then we’re all over a serious crime scene (remember, hit and run) and we need to consider that in what we are doing.  Of course, I have to call in to have the ‘code’ called by a doc for him to be legally dead, and until then we are supposed to be trying to save him.  So we have us a bit of a situation both medical and legal.  Okay, I’m not feeling a pulse either, and I’m not seeing him breathing.  He’s still in the fetal position and a bit face down, but I’m not flipping him over just yet.  His airway is unobstructed so we can work with it.  “Cat, let’s get him on the monitor RIGHT NOW.  You” pointing to a firefighter, “get the BVM out of the oxygen bag and get that ready.”  Nice thing about our lifepacks, they are really good at identifying dead and not dead.  If we see any rhythm, we work with it, if not, well, that’s easy.  The patient’s clothes are being cut off to make sure we aren’t missing something else, and I pass on word to be careful what we do with them.  The monitor is on in a flash, and the three flat lines that appear on the screen are pretty unambiguous.  “Cancel the helicopter, I have to make a phone call.  Get ready with the backboard, but DON’T move him yet.”  I’m already hitting the speed dial on my cell phone to the doctor at the ER.

As the doc answers, I walk off a bit to get to a slightly more quiet area.  “Doc, it’s Medic 512, I got a mid-thirty’s Hispanic male, victim of a hit-and-run. Unknown how long ago.  He’s got a 10-inch or so open laceration ripped into his lower back, pulseless and apnec.  Unknown down time and asystolic in three leads.  I want to call this and leave the crime scene for the police.”  The doc repeats most of that back and confirms the unknown down time.  (I do have to give my respect to the doctors. Here they are in the ER, probably dealing with some case of the flu when the phone on their hip rings.  Immediately following “Hello Dr. Soandso” they get hit with that report, and a medic they can’t see asking them to declare a patient they can’t see dead, and needing the answer, Right Now.  Tough job description).  “Okay, call it.” He says.  “Thanks, doc” and I’m headed back to the patient giving the hand across the throat signal.  The helicopter was cancelled by the fire Lt.  and I see the engine cleaning up the LZ in the distance.  “Okay, this is a crime scene now, everyone back straight out.  Leave the clothes where they are and disconnect the monitor.  Do NOT cover the body.”  The police have been clear on that one lately.  Seems that EMS crews have been covering bodies, particularly in public, trying, honorably, to preserve the dignity of the patient, but also adding and removing trace samples and driving the forensics guys nuts.

“Oh, I’m going to court” I think to myself as I look over the body again.  The damage was impressive.  The bike had been moved over to the sidewalk to get it out if the way and I see that the seat is busted and missing.  I’m thinking the guy got hit, the seat busted and went up and through the guy.  Ouch.  I look for the officer in charge.  I tell him that we’ve called it, the guy is dead and I’m having my people back off to give him the scene.  “Anything else you need?” I ask.  He has me hang on for a bit until a more senior officer arrives, and tells me that they are going to need the names of my crew.  (Of course they are.)  “Ouch” I say to the officer as I look over at the body.  “No kidding” and a wry grin are his reply.  “Think the seat did that?” I wonder aloud.  “No, check this out…” He’s headed for the bike.  He shines his lights on the handlebar.  Ewww.  The first eight inches or so of one handle is covered in blood and…is it…yeah…fat.  To this day I’m not sure how that works, but I’m guessing the guy was rear ended from the way the back tire was pretzeled in an Auntie Annie meets Tim Burton way.  The front tire may have turned and folded and as the guy went over, he got caught on the handle.  Did I say ouch?  

The lead officer arrives and I give him our contact information and a quick run-down of what we did.  I explain that the body is in place, the clothes are cut off, but over there, and the bike was partially under the patient, but is moved to the side, and has not been touched since.  He nods, thanks us, and gets to work.  His night just got long.  

I go over to Jen and ask if she’s okay.  Not everyday you see someone newly dead, and traumatically so.  “Yeah”.  I can see in her face a look that want’s to say “Coooool”, but is not sure if that is the right way to feel.  She keeps looking back one more time too.  But she’s smiling, and a little bit pumped.  She’ll be fine.  Cat and I share a quick look – ain’t that some stuff?  And we mount back up on the unit.  Wayne is grinning at me, and you just know comments are coming.  “Well, I’ll never hear ‘ripped him a new one’ the same way again.” I say.  We have a laugh, and the stress starts to melt.  Yeah, we’re fine.  Time to make it official.  Over the radio:  “Medic 512 is ready.”