Don't shoot till you see the whites of his eyes

Well, that month went by fast.  Work continues to be busy, and this semester’s class is finally wrapping up.  I’m looking forward to a few weeks with Tuesday nights back as my own-ish.  Cat is staying busy with her new job as the EMS Training Lt in the career department in the county where we live, and it looks like life will be staying very full for a while.  Last week was EMS Symposium here in Virginia, which is traditionally a big week here.  There are lots of different classes to take for CMEs all day, and the evenings, nights and early mornings are taken up in the hospitality suite.  Stressed EMS providers and ETOH, quite the combination, and the source of many great stories, some of which never get lived down…..like this one…

Okay, Breathe, I’m kidding.  (To those of you not from this area, a lot of local people got a bit nervous there.)  

I am, however, starting to think that the Trauma Gods are after us.  Not that it is a bad thing at all.  Generally speaking, traumas can be more fun than medical runs, but they each have their points.  A couple of weeks ago, we caught both on the same call, kinda anyway.

Cat, Wayne and I had been having a fairly quiet day with pretty much only a morning DOA behind us.  (Start your day with a D-O-A, Doo-dah, doo-dah) We were making jokes about needing a save or a birth for the day as we were 0-1 for the day right out of the chute, and THAT just can’t stand.  The weather was pretty nice, sunny, and somewhat warm for this time of year.  All in all, not a bad Sunday.  The unit was clean, the bay floors were washed and we were generally taking it easy when the call went out.  First due sickness, us and the engine dispatched.  Nothing serious based on the information waiting for me on the MDT…a 50 something male had been sick for a couple days, and the only thing that sounded like it could be anything was some lightheadedness, but even that is sounding benign.

We arrive on the scene and are met at the door by a nice and very proper older gentleman.  I ask if he is okay, and he requests that we talk inside the unit.  “By all means” I think to myself as I smirk.  If you are well enough to meet me at the door, and walk in without the cot, I’m all about it.  I wave off the engine, placing them in service and we start walking to the medic unit.  Inside, our assessment finds a nice guy, very proper, almost British in his speech, who has had a flu for about a day or two, and wants to go to the hospital.  His vitals are good; he’s been vomiting, but doesn’t need to now. (No puking in my unit rule is explained) and just needs a ride.  I have Wayne start the meter on the taxi, and off we go.  I have a brief chat with the charge nurse at the hospital, and get our gentleman caller a reserved chair in Triage.  On the way I explain that the Blood Pressure we got is a bit elevated, but not to worry….Yes the little red light on his finger is measuring the oxygen in his blood…yes, it’s fine.  Eventually, he is a bit calmer, and seems reassured that we are competent to take care of him.  

We arrive at the hospital as a dispatch goes out in a neighboring due for a shooting.  I hear the call go out, and some follow-on traffic.  Sounds real, units are staging and the Police are figuring out what was going on.  Cool.  The ER is busy and filling up pretty quickly it appears as we walk through.  I let Wayne and Cat push the patient on the cot, through the ER to an area outside of triage where we will transfer him to a wheelchair.  I stick my head in by the charge nurse, “Hey, heads-up, they just dispatched a shooting in  (nearby area).  Sounds real, but I’m sure they’ll fly anyone that is serious…just a heads-up.”  That gets me a “Great. Thanks” from the charge nurse, and a look that says, “that’s all I need right now.”  I smile, and head back to my patient.

He’s in his chair, and I wheel him to the triage area and get him signed in.  The form is a short one, and I have all his info ready to go.  All that is left is to stick my head in with the Triage nurse to give a quick report before I can get back into the sunshine.  I’m standing there waiting with my patient, and the triage tech has to go back into the ER for something.  No biggie, but in retrospect, that was clearly because Murphy called them back.  I say that because no sooner do they disappear and I’m the only health care related person in the room than it happens.

The front doors slid open at their normal pace, but the guy that comes in is moving much faster than normal.  He takes about two steps inside and stops dead…staring at the empty registration counter.  Now, whereas his eyes are about the size of tea cup saucers, and he is focused only on the one place that someone from the hospital should be, a small voice in my head whispers, “Hey, there is someone shot on the front ramp”.  It takes exactly that long for this guy to look over, see me standing there in uniform and ask, “Hey man, you work here?”  I feel myself smile and I think (and yes, this is actually what runs through my head), “There’s someone shot in your car isn’t there?....No, but I DID stay at a Holiday Inn….No, I’m a medic, but that’s not really what you mean….Cool, I get the shooting call after all.”  What came out was, “Uh, close enough” as I was already starting to move for the door.  “MY BOY’S BEEN SHOT” he says a bit too loud and kinda panicky.  I’m heading for the door and to the SUV waiting on the other side.  I turn towards where the triage nurse is and vaguely see one of the admin people walking by.  “Walk-in shooting, get help!”  Amazing how that gets things moving…

The patient is laid out across the back seat, and when I pull open the door on the passenger side, his head is towards me.  A quick look shows that he has been bleeding a bit profusely, and I see that his hand and wrist on his right is shattered and likely the source of the blood.  Okay, bleeding is serious, but not going to kill him right now.  He’s talking and clearly a bit exicted… you know, like a guy who’s been shot.  “Hey, where else you hit?”  I ask.  “My leg man, my leg” he tells me.  “Okay, let’s get you out of here” I say as I finish gloving up.  I turn around and Cat is emerging from the doors, word must be traveling through the ER I think.  Cat is gloving up and sees what is going on.  She pivots back to get our cot which is just on the other side of the triage area when the doors open and an ER nurse comes out with a hospital bed.  Nice.  “All right, we need to get you out of here, and onto this bed.”  I explain.  “Man, my leg, don’t lift my leg” he says as the guy who came into the ER in the first place starts to help from the other side of the SUV.  “You are shot, bleeding and in the backseat of a car….you are going to be moved.  We’ll be careful, but you are coming out.”  I say a bit more sternly to get through the panic.  We wheel the cot to the door and with a bit of help from Wayne, we slide him out to the bed.  He grabs at the door frame briefly, which is not helpful, but he gets with the program pretty quickly.  His right leg is internally rotated, I note as we move him.  

We move quickly back to the ER, and Cat and I are moving at “Field EMS” speed apparently.  “Hey, I like you guys, but if you run me over I’m going to be pissed” says the nurse at the head of the bed as we roll.  I look up and it is the ER Nurse that accompanied us to the pediatric center on that choking call not long ago.  I grin up at her and slow down a notch.  “No problem, I ain’t shot” I think to myself.  The guy is conscious and alert and is answering the usual history, med and allergy questions as we head for the trauma bay.  There are a couple of nurses and techs waiting, and more seem to be on the move as word has spread that we are coming.

The wheels of the bed hit the floor mounts and just that fast Cat has her trauma shears out and working on the patient’s jeans.  My shears are in the unit so instead of starting on another leg, I take the cut Cat starts and rip the jeans all the way up by hand.  “Don’t cut through the holes” a nurse calls from behind us.  She’s thinking evidence preservation and is worried that we are moving a bit fast, but we are thinking about it too and the rip is away from any tears in the jeans.  The guy has basketball shorts on under the jeans, but not for long.  I grin as I realize that Cat, Wayne and I are the only ones hands-on with the patient, surrounded by ER staff.  They are getting organized and are quickly involved, but I note the difference in reaction to a “Field Environment” call in the middle of the “Hospital Environment”.  The staff just needed one minute to shift gears to the situation, but this was happiness and home for us.  

Cat is working up the right leg and comes across the first hole in the patient’s lower right lateral thigh.  We call out the wound to the nurse taking notes and keep going.  Further up, she finds another GSW (Gun Shot Wound) in his right Buttock.  (Okay, all at once in our favorite Forrest Gump voice….”Butt-ock”…you know you were doing that anyway).  We are starting to think we have a matched set of wounds, possibly an in-and-out when Cat finds “a protrusion” (that’s careful medical-type talk for a bullet) just under the skin of his upper right thigh.  I check for a pulse in his right ankle and finding one make sure that the note-taker is aware of that.  (That one gets me a smile from one of the nurses…we may be working quickly, but we are looking out for them).  On the left leg I find holes through his basketball shorts, and find matches in his jeans, but there is no trauma to the leg.  That gets noted too.  

During this time, Wayne is working to get him exposed and with a nurse, they pull of a leather jacket that he is wearing and REALLY does not want us to cut.  His hand is pretty jacked-up with a hole just below the wrist and another between the ring and middle finger of his right hand.  Now, we don’t guess on the entrance and exit of bullets, but it really looked like the bullet blew out through this guy’s hand.  He was bleeding pretty bad, and it looked like that hand was going to a surgeon to me anyway.  

At this point the police detail from the ER was in the room, and there was plenty of hospital staff doing their thing.  An IV line was being placed and the normal rhythm of a trauma in the ER was setting in.  Time to gracefully back out.  I tell the patient that we are going to go, that he is in good hands and to hang in.  He is still a bit worked up of course, but is getting the idea that he’s where he needs to be.  I make sure to check in with the note taker to go over everything we found etc and ensure nothing is missed, then Wayne, Cat and I head out, double checking that the ER staff is good with us leaving.  They are, and we do.

I head back to triage, and my original patient….you know the one I’m actually here for…and find him already in with the triage nurse.  “Hey, He’s mine, I just brought him in and got pulled off…” I start.  “Yeah, the shooting, no problem, nice job” the nurse says.  “Okay, well, you probably already got it, but stable vitals, general sickness times two days, vomiting, No Hx”  Etc etc. I ramble off.  “Got it, thanks” the nurse says and I get a very nice smile from our gentleman.  “Thank you for helping him” he says as I start to go.  “No problem, you get better” I say back.

Wow, now for the paperwork, I think as I head for the report room.  Cat catches me on the way….”Hey, got one for the blog” she says.  THAT gets a chuckle.  I see the guy who first ran into the ER standing in cuffs outside the trauma bay, and I get a “thanks man”.  He’s not arrested, just secured until the Police figure out what is going on here.

First order of business for the report room, I make sure we get a piece of paper with all of my crew’s names and contact information for the officer that is working the case.  I have Cat run that to the officer and explain to her that he’s going to realize he needs that information in about 15 min, but it is probably a good thing for us to do now.  When she gets back, she tells me that the officer got an “Oh yeah…thanks” look, and was grateful for the information.  Hope he’s grateful enough that we don’t get to tell this story in court too.  We’ll see…..