Thursday, September 06, 2007

Open Mouth, Insert Foot

I should never, ever have said anything when I last wrote about it hopefully being an easy shift. Teach me to do that again....

Got to work Tuesday night in Goffstown and within 5 minutes of starting the shift we got toned to the intersection of Wallace and Shirley Hill for a motor vehicle rollover. Not knowing what we would expect when we would arrive, we moved out quickly. Two engines and a second ambulance from Bedford responded as well. From our location in Pinardville it took us just under 6 minutes to get to the scene. Two vehicles, a VW Bug and what looked like a Chevy Blazer - the Blazer was the one on its roof. One patient out of the vehicle being attended to by on-scene firefighters (on the ground but being assessed), and the other still in the vehicle. Air-bag deployment happened, neither person was secured with a safety belt. The driver, who ended up being my patient, was being assessed/airway controlled and cervical spine being held/mental status being determined by one of the on-scene firefighters. We brought all of the gear we needed to immobilize him, and it was a good thing as he was the classic "load and go", "scoop and screw", whatever choice of phrase you use. He had severe facial trauma and blood leaking from both his nose and his ears. He was conscious but his mental status was fluctuating. He was also cold and diaphoretic - neither of which was something I wanted to see. I called the Elliot Hospital to activate the Trauma Team, told them what we had, and told them what we were doing and I would update them en route to them. They were expecting us.

We got him onto a long board (he was already in a cervical collar), secured him, and got him out of there. As we were moving the stretcher to the ambulance, there was vehicle fluids on the road - anti-freeze and what I thought was transmission fluid but turned out to be a considerable amount of blood. Once we got him on the truck we rolled. There were three of us on the back, and I am glad of that as we needed all hands for this patient, a 19 year-old male who was a fairly big guy. His vital signs were poor: heart rate of 130 and thready, unable to get even a readable systolic blood pressure, respirations of 26-28. The two EMT's in the back with me were doing everything they could to gain IV access and continue to look for injuries, and while I was listening to his lungs and assessing his respiratory effort he vomited the equivalent of Mount Pinatubo - he brought up what looked to be between 1000 and 1500 ml of blood with clots and junk. Most of that ended up on me as I was right over him. Got on my arms, all over my uniform, everywhere. I am glad I was wearing both gloves and a face shield.... Anyway, we had to tilt him to clear his airway as I wanted to protect him from aspirating all that he brought up. From that point on, all bets were off as that told me his blood loss was more substantial than I originally thought, plus I now had a whole other problem to deal with in terms of keeping his airway secure, so I made the decision while we were on the road to instead take him to CMC, which was 3-4 minutes away from the location we were at instead of continuing to the Elliot.

I am not sure he would have survived the 7 or so minutes longer that it would have taken to get to the Elliot, and as I found out it was a good call on my part. I'll explain later on.

We arrived at CMC, and when we walked into their Trauma Room, there was at least 10 people waiting for us. I started giving report to the attending doc who was in charge of the room, and as I was doing this the ED charge nurse walked in and interrupted me, asking, "so what makes this patient a Status 1 and what is he doing in my Trauma Room?" She didn't get the complete sentence out of her mouth before I responded with, "I'm not talking to you - I'm talking to him (the attending doc). So shut the fuck up and back off." And I continued with my report.

Needless to say, that is not what I normally do; I am usually very respectful of all of those in the room, even if they interrupt me when I'm giving a report to an attending physician. However, considering the circumstances I was operating under - I was rather fired up - my outburst was rather justified. And about 20 minutes later I got an apology from the charge nurse, which I accepted and returned. As it was out of character for me, I did feel pretty bad, but not that bad... After all, I had this young man's life in my hands for about 20 minutes.

And now for the rest of the story..... I found out this morning that my patients injuries included the following: an skull fracture, a Lefort I fracture to his face, a fracture to the second cervical vertebrae, and various thoracic injuries including some additional fluid around his pericardial sac. He was stabilized and transferred to the Beth Israel Hospital in Boston. From what I was told, as of this morning he is alive with complete neurological function.

I'm told he is also in trouble with the law as there were controlled substances in his car at the time of the accident and he was placed under arrest.

I don't know which is worse, the medical issues he's going to be facing or the legal ones.

That was Tuesday. Today was an extremely busy city shift. It seemed like all of our calls happened after 11:00AM, and it was on the order of one call per hour. We had a mixed bag, everything from an elderly patient with what appears to be an infection to the bones of her left great toe to a three year-old male struck by a car at low speed. He was going to the neighborhood ice cream truck when that happened; from what witnesses say he slid across the road for 4-5 feet after being struck, then got back up and wanted to go to get ice cream. He was not happy with being immobilized, but it was necessary; there was no way to know if he had lost consciousness, and neither I nor my partner were taking any chances with that.

Yesterday I met my incoming Paramedic student from New Hampshire Technical Institute. Seems like a good person - I'm looking forward to working with him. And as I did with my last student, I'll give him the best I have. I hope he does the same. He starts this Monday. More to follow as time goes on.

Tomorrow night I am in Brentwood, and all I'd need for this week to be complete, in terms of everything going wrong would be to have to take multiple critical patients to various Boston hospitals or to Dartmouth. We'll see.


AlexD said...

Sounds like you had a Gremlin filled we say in the field...Sh*t happens. I noticed all of your times were in the 3-5 minute range. Try this on for size. 25 minutes to the scene 30 minutes extrication, 45 minutes to the hospital. No fire rescue, other Ambulance services will not assist and you have 8 count them 8 patients. Good post and I have had to tell a nurse to STFU a couple of times.

Alex ~D~

The Apocalypse Papers

manchmedic said...

The good news is that we didn't have far to go to get him to the hospital.... I'm fortunate that I don't have to deal with the types of times that you listed. That would be horrible. There are services up here, however, that do, especially the further north you go.

Anonymous said...

Saw you on TalkEMS. Come check out EMT City as well.