Tuesday, September 04, 2007


We carry the gear a few hundred yards down the dirt slope, to where the small group of people is clustered. The moon is just rising through the trees; it's a bit past one in the morning.

They've got a few blankets over him in an attempt to keep him warm. "My chest!" he says. "I can't breathe! Please help me!" Over and over, no matter what we say. His friends stay close, refuse to move, get in our way.

He's drunk. They're all drunk. They were playing around on dirt bikes and he crashed his. It landed on top of him, apparently. The offending machine lies a few yards away, dark and silent now. Sunday night was fun, but not anymore.

When I press on his chest he moans, but nothing crackles or scrapes or moves. We can't find any bleeding. He doesn't hurt anywhere other than his chest, but it's hard to get him to be quiet long enough to listen to his lungs clearly. He says he didn't pass out.

"Do you want the bird?" my partner asks. We're way out in the boonies. I think for a long moment, and look at her. "I don't know yet," I answer honestly. "Let's get him in the car, get him assessed better. I'm sure he's a trauma entry, but if there's nothing bad wrong, we could probably drive him..."

We board him, carry him back up the slope to where the waiting emergency vehicles sit, floods casting cool white light on the grass and trees, diesel fumes filling the night air. I cut his shirt off, ask the fire department EMT to get vitals, try and listen to his lungs again. Maybe a little less on the left, the hurt side? I listen again. Nah, they sound about equal.

But his fingers are cold, we can't get a sat, and even on a mask cranked to 15 liters he's saying he can't breathe. I throw the end-tidal on him, and though his CO2 is fine, he's breathing forty times a minute or more. The EMT says his pressure is a hundred by palp. I look down to my partner, standing at the back doors. "What do you think?" I ask. She shrugs. "Your call."

I look down at him, think for a second longer, let out a long breath. I can't find a big red flag, but he's obviously hurting, even through the ten beers. I look at the vitals again, look at him, look down at my dusty boots. "Hell with it. We'll fly him."

She nods, closes the door, talking to the fire department IC. Ninety seconds later, as I'm getting a bag of saline spiked, the portable radio -- forgotten on my belt -- beeps out tones. "Engine 305, respond for the landing zone..."

We bump and judder down the rough logging roads back to the nearest clearing, an opening on a hilltop. I hang on for the ride, get the IV in, try to get a sat, all the while talking to him and trying to reassure him.

When we pull up, I can see flares through the side window, and a firefighter in turnouts wetting down the dirt. My partner climbs in back. "Medflight is about five out. What do you need?"

"Well, I've got a line, and the EMT here is taking a manual pressure. I'd like a second line, but first listen to his lungs."

She listens, and goes from left to right to left back to right, and then to left again for a long moment. She looks at me. "How's his pressure?"

"Uh, one nineteen over sixty eight," says the young EMT. I'm already listening again, and now it's clear: the lung sounds on the left side are diminished, way fainter than on the right. I look at my partner. "Do we need to..." I ask, knowing the answer, probably, but wanting to have her years of experience behind my decision.

She reaches up over the patient, pulls open a cabinet, tosses me a paper-and-plastic wrapped package. "Get it ready, at least," she says. "I'll get you a second line."

I look at the package. COOK EMERGENCY PNEUMOTHORAX SET. God. I rip it open, dump the contents out. Get the valve set up. Put the catheter on the syringe. It's a three-inch twelve-gauge. It looks like a whaling harpoon. Jesus wept.

He looks up at me as I start counting ribs down from the midclavicular notch. I can hear the bird outside now.

"My chest hurts! Why don't you believe me?" He's almost whining -- but when I look in his eyes I can see the confusion and fear there, awareness that Something Is Wrong finally penetrating past the alcohol. I lean down to his ear. "I believe you -- that's why you're going to a helicopter ride! Hang in there. You're doing great, and we're going to take real good care of you."

I make the mark on his chest, a little X, and I'm relieved to see my hands aren't actually shaking. Outside, the helo is touching down. "Wait for the medflight nurse?" I shout. My partner nods, and a minute or two later a pair of red flightsuits climb into the ambulance. I give the nurse my report. She listens carefully to his chest and nods to herself.

"Needle him?" I ask. She shakes her head no. "His vitals are alright. We'll do it on the way, if we need to. Twelve minutes to the trauma center."

We roll the stretcher across the bumpy ground, crouching under the whirling rotors. Slide him into the bird, quickly get back out of the way. A minute later, as we huddle behind apparatus, the low whine ramps up to a full-throated roar. The wind and dirt and pebbles and twigs rip at us, and we close our eyes and try not to breathe. The pilot takes his time lifting off, and when I can finally open my eyes I see why -- he's done a Hollywood takeoff, straight up. Trees all around. The helo curves away, and I watch it go, blinking lights against the mountains and stars.

Behind me my partner swears. "We forgot to close the ambulance! There's dust everywhere."


Shazam! said...

Nicely told. Even though you didn't, you thought it all through, and that's important. It was decent of you to wait for the flight nurse, but it's a tough call to make in the field. First do no harm. So did he or didn't he?

PDXEMT said...

Oh yeah. He had a pneumo and a pulmonary contusion and rib fx'es. But the flight crew didn't needle him either; he just got a cx tube when he got to the trauma center.

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