Adrenaline.

I’m kneeling in broken glass, a puddle of gasoline, and god knows what other automotive fluids.  My knees are killing me. The sun is beating down on me like I’m it’s own personal red-headed step child.  Sweat runs down my face.  My uniform is clinging to me.  I’m holding c-spine on my patient… My patient who just had an SUV roll over her.

I’m not supposed to be here.  I’m working a transfer truck today.  I should be hanging out in nursing homes, wound care offices, and dialysis clinics.  Not kneeling in the middle of an intersection surrounded by twisted metal and broken glass.

**********

“So how’s your clinical going?”  I’m on the phone with a real Trauma Junkie (that fact alone should have screamed foreshadowing), standing out behind one of our stations.  TJ’s telling me about neb tx’s and the other assorted joys of being a Respiratory Therapy student when I hear something that just doesn’t sound right.

The sound of kids playing basketball in the street and radios blaring rap music is replaced with the sound of an impact.  Grinding metal.  Splintering glass. People screaming.

I turn my head to look towards the origin of the noise, and I see a truck rolling down the street.  I watch as a figure is ejected from the SUV like a rag doll.  The SUV then rolls over the rag doll.

Oh my Jesus.  That is NOT good.

I completely forget that TJ is on the phone and start screaming like a little girl a maniac the intrepid saver of lives I am for my partner who is inside the station.  “K!!!  KAY!!!!  KAAAAAAAYYYYY!!!!! ROLLOVER AT THE END OF THE BLOCK!!!!”  I realize that I’m still on the phone with TJ and manage to spit out “HeyIGottaGoBye!” as I sprint towards the truck and lunge for the radio.

“Hey Dispatch, it’s Epi on truck one, let the county know that there’s a rollover accident with an ejection at *insert random city intersection here*.  We’re going to run down to the end of the block and see what we can do.”

K, my Superstar Partner (and soon to be Medic) comes running out of the station.  “What’s going on???”

I point towards the scene.  There is an overturned SUV directly in the intersection, a mini van as well.  We can already see people rushing towards the SUV.

Dispatch lets us know that they will alert the county (part of our contract with the county stipulates that we have to let them know if we witness an accident and are going to initiate patient contact).  Before I know it K is running down the block towards the vehicles and the quickly growing crowd.

I jump in the truck and turn it around.  By the time that I’m heading in the right direction K is on the scene running triage.  The SUV is now upright, the ejected patient laying on the ground.

I can feel my heart racing.  I take a deep breath and move to to join my partner.  Five steps outside of the truck I see her running back towards me.

“I’m bleeding,” K blurts out.  She holds out her hand, gloved with a gigantic tear in the palm.  Blood  is running down her outstretched fingers.

Perfect.

As she heads to the truck in an effort to stop the bleeding, she yells,  “Femur fracture and possible pelvic/hip fracture on that one.  Those two have chest pain, and the one in the truck has a possible leg fracture, she took a huge hit.  Can’t tell….”  Her voice trails off.

I pause for a second to think.  I’ve never been in this type of situation on my own.

Uhm… Epi?

It’s my inner wanna be medic talking. You think you might need additional resources?

I need help and I need it now.  “Itty bitty ambulance to County, regarding that MVC we’re on, you might want to send two ALS trucks.  We have one, possibly two trauma alerts and two chest pains.”  My voice is strong, even if my hands are still shaking.

The county doesn’t think twice about my request.  “Okay Itty Bitty Ambulance, we’ll roll another truck your way.”

I throw gloves on and take a second to survey the scene.  One patient on the ground.  One clutching her chest and sweating on the sidewalk next to a teenager who seems to be having an anxiety attack, one in the SUV that rolled, and another patient in the minivan.

But… but… I’m on a transfer truck today…

I shake that thought from my head literally and figuratively. I’m trying to focus, but there are voices coming at me from every direction.  A crowd of close to 25 people are milling about and I need to get control established now.  Until K comes back, I’m on my own.  I may be out of my element, but that’s just the way it’s going to be right now.

“You NEED to check my Moms out… She has a heart condition and she’s having chest pain!”  The teenager is sobbing.  “Why wont anyone listen to me???” She grabs my arm as I’m running to the cars involved.

“Have her sit down by the ambulance,” I yell over my shoulder as I yank my arm away.  “I’ll be right there.”

“My legs huuuuurt,” the patient on the ground starts to say.

“Did you see that?  That was INSANE!!!” A bystander yells to his friend across the street.

“I didn’t see her coming!” One of the drivers is insisting.

“We rolled the car off of her,” a witness boasts.

“Someone needs to check on my Mom!!! Her CHEST hurts!!!” The teenager is shrieking again.  Her Mother is pacing the sidewalk, sweating and talking to herself in Spanish.

“HAVE….HER….SIT…DOWN!” I yell again.

I step towards the patient who had the SUV roll over her.  I can see that her thighs are grossly swollen under her thin sweatpants.  I’m fairly certain that K is correct about the femur fx’s.  “Can you move your toes?”  I kneel down next to her and attempt to find a pedal pulse.  The patient can wiggle her toes and I find a pedal pulse on both feet.  “Okay, Ma’am, don’t move, I’ll be right back.”

I move on to the patient still inside the SUV.  She had been driving, and is now sitting in the passenger seat.  Every window in the vehicle is shattered, and the driver side of the vehicle intrudes into the passenger compartment at least a 18 inches, possibly more.  The patient is calm, she’s more worried about her friend laying on the ground.  Her complaint is a possible fracture to her lower left leg and her left wrist. Her color is good.

“Ma’am, sit tight, try not to move, more help is on the way, okay?”  I use my sleeve to wipe some of the sweat from my face.

When I get to the minivan the driver is up and walking around holding her small child.  The passenger looks fine.  I ask them both if they’re okay and they both nod in the affirmative.

I know what I’m doing, why am I shaking like a leaf?

Adrenaline. That’s why I’m shaking.  It’s just adrenaline.

I return to the original patient who is now sitting up, attempting to collect some of the contents of the car that are now laying around her.  I dont think that she realizes she’s moving at about 1/4 speed.  CDs, chapstick, and a couple of dollars worth of loose change surround her.  I can see her purse sitting near the curb some 15 feet away.  I instantly take c-spine.  “Ma’am, I need you to stay very still.  You were in a serious accident and you could have fractures to your neck or back.  I’m Epi, I’m an EMT and I’m here to help.  Let me do all of the work for you, okay?  Don’t shake your head, just say yes or no if you understand me.”

Of course she tries to nod her head.

“No no no, stay still.  What’s your name?”

“Jessica.  My legs,” she has to pause to draw in a breath, “My legs really hurt.”

“I know, Jessica.  We’re going to take care of that.  I’m going to lower you back down.  Don’t help me, let me do all the work.  How does your back feel,” I ask as I ease her back down to the ground.

“My back doesn’t…hurt… Just my legs.”  Her bottom lip starts to quiver as tears begin to roll down her face.

“I know you’re scared, just keep breathing for me, nice and easy, and we’ll get you all taken care of.”  I’m doing my best to reassure her while looking around frantically for K.  She appears at my side in an instant.  A large lump is under her new glove.

“I think I need stitches,” She starts.

“You’re okay though?”

“Yes.”

“You take care of the one in the SUV, I have this one,” I motioned to my patient.  “I told the one chest pain to take a seat on the side step of our truck –” I’m cut off by the sound of sirens approaching.  Several sirens.  All heading towards us.

“Thank God,” I mutter under my breath.

I can see the bag with our collars sitting on the corner, just ten feet away.  I ask one of the onlookers to grab a red collar and bring it to me.  He fumbles through the bag and produces one.

“Would you mind ripping that open for me?  Just tear the plastic and… that’s right, just like that.  See that curved part?  Bend that forward.  Perfect.”  Can’t say I’ve ever had such fantastic help from a bystander before.  I thank him several times as he slides the collar around my patient’s neck.

A police officer in a blue uniform approaches us, “Did anyone see what happened?”  She has a notebook out and is actively writing.

I look up at her, “I did.  Just give me a minute.”  My patient is starting to look extremely pale and it’s worrying me.  I slip my fingers through the hole in the side of the c-collar and can feel her pulse taching along at a rate that I’m guessing is around 140ish.  I would love to have her towel rolled, taped down to a backboard, and heading to the level I trauma center about six minutes away.  I absolutely hate feeling helpless and there’s really not a lot more I can do until we have more help.

“Keep talking to me Jessica, what day is it?”  I start looking around for K while my patient thinks about her answer.

She whispers so quietly that I have to lean down and ask her to repeat herself.  “Payday, I think.”

Well it could be payday…

“No, I mean what day of the week is it?  Do you know?”

“Thursday,” She whispers.

“Very good! Do you know what happened?”I brush her blond hair out of her eyes and attempt to shield her face from the sunshine beating down on us.  I want her eyes open as much as possible.

“I was in an accident.” Her voice is taking on a very sleepy tone.

“Yes, you were.”

The first fire truck shows up, immediately followed by the the squad.  Navy blue uniforms were swarming around us.  I had more help than I knew what to do with.  Finally I was able to exhale.  We got Jessica immobilized and the medics loaded her into their truck.  A minute later she was being sped away code three to the ER.

K’s patient was extricated and sent BLS to the same ER.

The two chest pains both signed AMA forms.

K and I were left sitting with no patient, and short a collar and a backboard.  Kind of an anticlimactic ending, I guess.

**********

So what did I learn from this whole thing?

I still get nervous.  I still get shaky.  And that’s okay.  As long as I continue to do my job.

I was reminded that just because I’m working on a transfer truck some days does not mean that the feces can’t hit the rotary oscillator.  I should know that by now.

I learned I shouldn’t have allowed the TFD to take our BLS patient.  (That’s another post for another day, however.)

I learned, once again, that seven minutes can feel like seven years when you’re waiting for more help.  Or any help.