Читать книгу My Ambulance Education - Joseph F. Clark - Страница 10

I never liked working the day shift. There were too many supervisors, too many people watching. Night shifts, however, were full of mavericks. No one wanted to work with them—or perhaps I should say no one wanted to work with us. Night shift workers seemed to fall into one of two categories. There were unbridled heroes who did great good for humankind, and there were losers with whom no one wanted to work. Both groups were similar, however, in that they both wanted to get away with something. The first group wanted to do more than they were normally allowed to do. They were frustrated physician or cop wannabes who wanted to be someone they were not. People in the second group were often incredibly incompetent or lazy. They wanted to do the absolute least they could while still keeping their job. They were hiding from the administration. Sometimes, however, people were sent to the night shift because they were being hidden by the administration. The powers that be seemed to think that a person on permanent nights would do the least amount of harm and cause the fewest hassles—out of sight, out of mind. This is totally incorrect, but the overachievers were more than willing to take up the slack. So a kind of symbiosis would develop between a competent overachiever and an incompetent partner. (This benefit would be lost, however, when the administration scheduled two incompetents together.)

I, on the other hand, had other reasons for opting to work nights. At one point I had enrolled in a paramedic class while at the same time working on the ambulance and taking some college classes. I got to the point where I had to decide: college, paramedic school or the ambulance. I chose to drop out of the paramedic class and continue as a full-time college student working on a bachelor’s in chemistry, while working on the ambulance at night to pay for tuition. (Lots of people dropped out of college to become paramedics, but I was known in ambulance circles as the only person to drop out of the paramedic class to go to college.) Plenty of people got sick and had car accidents on weekends and nights, so I always had a job.

Car accidents with injuries were always an adrenaline rush. Auto-body sheet metal has incredible ways of twisting and contorting upon impact. Sadly, it often wrapped itself with unyielding ferocity around not only other cars, tree trunks, and the like, but human flesh. It was all well and good to have ambulance people and equipment at a car accident, but we needed to get the people out of the cars. Preferably in one piece, if they were still alive.

The police and fire departments were experts at cutting up cars. Those guys from the FD are truly a credit to their profession—at least, they looked impressive and had great tools to work with. They had helmets, gloves, boots, goggles and the finest power tools available. Sporting all this safety gear, the fire department personnel would cut a small hole in a smashed-up car in an effort to gain access to a patient. Still wearing all of this heavy safety equipment, they would then turn to me in my short-sleeved shirt and say, “Go on in.”

So, with no safety equipment, I would crawl into the twisted wreck to tend to my patient. While it may sound crazy to enter a wrecked car this way, it was necessary because bulky equipment would prevent access. It could also make a quick exit from the car impossible in an emergency.

Picture, if you will, two people in a space the size of about half a refrigerator: one trapped there and frantic to get out, and the other wriggling into this mess for the sake of the first. As I climbed into these cramped and dangerous spaces, I had no idea who the other person was—all I knew was that both our lives were on the line inside that metal tomb. We had to work together with trust and confidence, but did not have the luxury of time to bond with each other. I usually broke the ice with a little small talk.

“Hi, my name is Joe. How are you doing?”

“OK.”

I would want to say, “If you are really OK, then can I go?” But usually I said something like, “That’s good.”

Now the formalities commenced.

“I’m with the ambulance and you have been in a car accident. We’re here to get you out and take care of you.”

“What happened?” was often the victim’s first question. (It was also the insurance company’s first question.)

“You were in an accident,” I would inform them again. It was often necessary to repeat this, as peoples’ awareness would wax and wane.

“Who are you?” The patient would say with trepidation.

“I’m Joe, from the ambulance.” Just once I would have loved to respond with, “I’m the car accident groupie who travels around the country following only the best accidents. You’re very lucky, this is a 9.5. You don’t get above that number without loss of life, but in your case there is still hope of making it to 9.9.” “Am I OK?”

“Yes, we are doing everything we can for you.”

One time we were at the scene of a single-car, singlepatient accident. The sole male patient was named Ron Dieble, and he was about 40 years old and very scared.

“How am I going to get out of here?”

“Let me help you.”

We were hope brokers. We were in a caring profession. Other caring professions include nurses, doctors, allied health professionals and social workers. People who pursue professions such as these usually say they want to help people. I always wanted to help people too, so I began training in first aid at the age of 13 and completed numerous first aid courses as a youth. I took an EMT class at 17 and became an emergency medical technician less than a year later. I immediately started working on the ambulance, with a view to becoming a paramedic and making a career on the ambulance. My chosen pathway for helping people was to provide care and comfort to the sick and injured when they called an ambulance. This is what I lived for, and that’s what I was doing for Ron. If you were in our ambulance there was still hope. No one ever died in my ambulance. No one dies in an ambulance because we did not pronounce people dead in the ambulance. People would be pronounced dead in the wreck at the scene or when they got to the hospital. But no one ever died in the ambulance. My patient did not know this, though. He was just beginning to come out of the fog and understand that we were there to help him.

From the darkness outside, a voice boomed. “What you got in there?” “A big 6-incher.” “What?”

“A 6-inch laceration across his forehead, broken nose, OK on airway and bleeding, broken arm, chest is fine. Below that I can’t see.” I gave this summary quickly and professionally. I would have to assess the chest and abdomen when we got Ron out of the car. Right now I would focus on head, neck and breathing.

Our extrication of Ron Dieble was relatively simple up until the point where he said, “I can’t see,” with just the right amount of panic in his voice to make me take him seriously. Loss of vision can mean brain damage or other hidden head injuries, so I was quite concerned.

“OK, Ron, you took a good hit on the head. We can take care of you. Sit tight and don’t move. I need to get your head and neck immobilized.” I said while searching through the trauma kit for the cervical collar. The collar would prevent him from further neck injuries. As I placed it around his head and neck, I got a good look at the laceration running horizontally across his forehead. I was familiar with the dermatomes that surgeons follow on a person’s skin to minimize scarring. These are regions where the skin has a grain to it, and some lacerations can cut along the dermatomes. Ron’s cut looked like it was running along one of these lines because it was so straight. Too straight.

“Ron,” I shouted, “Open your eyes and look at me.”

His eyes slowly opened to expose a blank stare. But he was staring at me nonetheless.

“Ron,” I asked, “do you wear glasses?” My common sense said to me that the laceration might be caused by glasses hitting his forehead as his face hit the windshield. So I wanted to find out if he was wearing glasses at the time of the accident. Glasses or frames could also be imbedded in his eyes or face.

He blinked, brought the hand of his unbroken arm to his face and said, “I’ve lost my glasses! You have to find them—I can’t see without them!”

He stared at me with terror at having lost his glasses while I tried to hide a smile as I realized that he had not lost his sight.

“Ron,” I asked, “is your vision like it would be without your glasses?”

“Yes,” he replied tersely. “I need my glasses to see.” Accident victims can become very emotionally dependent upon personal effects like watches, glasses, stuffed animals and keys in the first shock-filled minutes after an accident. So I did feel for him, but my first priority was to get him stabilized and out of the car. I had formed a strategy for this by scanning the wreck for routes out. The doors were smashed, the roof was crushed and the side windows were no good. The front windshield was also smashed on the driver’s side, but it did look like a possible escape route. We could peel the broken windshield out and both exit from there. The safety glass of the windshield had formed a little basket bubbling out in the shape of Ron’s head. Sticking back into the car from this basket were Ron’s glasses.

“Ron,” I said, “I found your glasses.”

Ron was very happy to get his glasses back, and I was happy that he wasn’t blind. I was also glad that the glasses appeared to be intact, so they most likely did not leave pieces in his face or eyes. They were however the cause of his lacerated forehead and most likely the broken nose as well. I will never forget how Ron looked sitting in that wrecked car, with his Frankenstein forehead and broken nose, sporting those eyeglasses that matched his injuries perfectly. All topped with a big smile.

“Ron,” I asked, “do you normally have a front tooth missing?” Ron had lost one of his front teeth in the accident too, and I found it sitting on the dashboard right below where his glasses were. A front tooth loose on the floor would have been easy to miss amid the shards of broken glass around. The good news for Ron was that the root was intact, so there was a good chance the tooth could be reimplanted.

We bandaged up Ron, packed him into the ambulance and shipped him off to the hospital. I must admit that although I often felt scared and apprehensive while in a wrecked car with a patient, it was also exhilarating and almost fun. It was just me and my patient, and I was the one person in the world who could help him or her. Getting someone out alive is an exhilarating high.

Rick and I were dispatched next to a location along the railroad tracks. The call came in as “man trapped.” A PO was already on the scene when we arrived. A plump, elderly gentleman in a security guard uniform was lying on the ground with his left leg trapped under a railroad rail. The ankle was bent in such a way that it was clearly broken. A young couple was standing beside him and comforting him. Rick broke out the trauma kit and I started getting the patient’s vitals. There was a normal pulse in the foot, called a distal pulse, and the foot was warm, with good color. This was a good sign, because it meant the blood supply was intact. The patient’s name was William Robinson, but he wanted to be called “Hobo Bill.” The young woman came up to me and implored us to take good care of Hobo Bill. “Don’t worry, we’ll take good care of your friend.”

“We’re not friends,” she said. “Gareth and I just met him tonight. But it’s our fault that he got hurt.” She looked ruefully at Hobo Bill. “Sorry,” she said.

“It’s OK, Sweetie. Don’t worry about it,” said Hobo Bill.

Hobo Bill was a semi-retired employee of the railroad who was working part-time at night as a security guard. The railroad was repairing this stretch of the track and had dropped off a bunch of railroad ties and long metal rails. Apparently the couple had been walking along the pile of rails when Hobo Bill spotted them and advised them to get down, since the rails were not secured and could roll, especially on the uneven ground at the sides of the tracks. The warning was right and timely, because the moment he uttered this warning, the weight of Gareth and his girlfriend, Wendy, caused one of the big rails to roll onto Hobo Bill’s ankle. The rail was much too heavy for us to move safely.

We had to wait for the FD to come with some jacks to get the rail off our patient’s ankle. Rick and I stabilized Hobo Bill as he consoled the couple for unintentionally getting him hurt. He regaled us with stories of his life on the rails as a conductor. He would often sleep on his trains and this earned him his nickname. In his younger days he would go with the real hobos on overnight trips. He was sad that the railroad company had forced him to retire, and it was only due to some old friends that he was allowed to still work the lines as a security guard. Hobo Bill seemed to swell with pride when talking about his life on the rails and I could see that his ankle was swelling, too. Wendy and Gareth obviously felt bad about the accident and seemed quite relieved when the FD arrived.

Hobo Bill was a pleasant patient and he was gracious to Wendy and Gareth throughout their numerous apologies. We brought Hobo Bill in without incident, and although this was highly irregular, Wendy and Gareth accompanied him all the way. Rick drove while I rode in back with them all. Hobo Bill’s major concern was how soon he would be able to get back to work. The rails were his life. I promised to convey that concern to the ER staff. He seemed comforted by this and Hobo Bill thanked us, which I appreciated greatly. We saw Wendy and Gareth as they were leaving the hospital a few hours later. They said that Hobo Bill’s family had arrived and were going to take him home. They also said that they would be keeping in touch with him. I hoped they remembered to do this, because Bill would surely appreciate two new friends.

The rest of the night was relatively calm until 5:13 a.m., when we were dispatched to an accident on the interstate. The first police officer had requested ambulance, police and fire backup for three cars and multiple injuries. Despite the hour there was a long line of traffic behind the accident, so the PD told us to enter on the exit ramp and come up the highway the wrong way. Traffic was going to be stopped for a while, so we would not be running into any oncoming cars. On the scene we saw the three cars; one was seriously damaged in the back end, another had a crushed front end and the third was on its side in a gulley on the side of the road. We went to the car with the damage to the front end and the other ambulance went to the car on its side. The PD informed us that the car with rear end damage had had four people in it, and they were all under arrest in the squad cars. None were injured and they were under arrest for drug violations.