I want to share a story with you... This story is about two people. One of them is an 18 year old girl.
Jessica woke up to the sound of her alarm clock and her mother hollering from down the hall. She didn't feel like it, but she rolled outta bed and planted her feet on the carpet and stretched. The sun was just making its way over the horizon and it promised to be a beautiful day. Jessica made her way to the bathroom and showered, put on clean clothes and sat before her mirror brushing her long dark hair. She paused to put a picture or two in an album that was laying on the table. A project of hers that she had been working on. It was filled with photos of her family, her dog, her friends at school and her boyfriend whom had recently asked her to the prom. She was so excited about it. Her and her girlfriends were planning to go dress shopping today after school.
She looked up at the clock on the wall and realized that she was gonna be late. She sent a text message to her boyfriend not to look for her before school and another to her friend whom she gave a ride to saying that she was running behind.
Running downstairs she grabbed her books and her keys, gave a quick kiss to her father reading the paper at the kitchen table and out the door she went. Jessica yanked the door open of her little sports car and jumped in the drivers seat. Off she went with a flash of brake lights at the end of the street....Her parents never saw her alive again.
Jessica stopped at her best friends house and didn't have to wait long before her friend came running out holding 2 steaming pop tarts wrapped in paper towels. They ate as they went. Jennifer eating and driving and be-bopping to the latest tune on the radio, grinning around her pop tart. She was speeding, but that didn't seem to matter. She knew the road to school well and had lived here all of her short life.
A delivery truck loomed in front of her as she navigated around a sharp bend in the road causing her to jam on the brake. Cursing, she pulled to the left to see if she could get around, a car blaring its horn caused her to jerk back into her lane. She knew a short cut to the school was just up ahead. Riding the tail of the truck in front of her, she was mentally counting up the times she had been tardy, knowing her first period teacher would cut her no slack.
With her turn just ahead, she could see the road as it cut away from the highway she was currently on. She swerved to the left and accelerated. Too late did she see the full sized pick up coming straight for her. Too late did she hear the sharp intake of breath from the passenger seat. Too late for Jessica...
I woke up that morning to the sound of the alarm clock ringing its shrill tones to anyone within earshot. I reached over and jammed the snooze button down almost hard enough to break it and rolled over. I lay on my back and stared at the ceiling in the semi-darkness. I rolled outta bed and stretched. I made my way to the kitchen to start the coffee machine and headed for the shower. Drying off after my morning wash I could hear the steady drip-drip of the coffee machine. I sat on the edge of the bed and dressed, making sure my name tag was straight in the mirror and putting the Cross pens my wife gave me for Christmas last year in my shirt pocket. I crept into each of the kids bedrooms and gave each a soft kiss, trying not to wake them, then back to my wife for another kiss and whispering "I Love You", hearing the mumbled return.
I slung my bag over my shoulder and grabbed my coffee and out the door I went. I sat in my truck for a few minutes, letting it warm up before backing down the drive. I be-bopped to a favorite tune playing from my i-pod as I made my way to the station. Getting there and then completing my morning ritual of checking of the truck, placing things within easy reach where I like them. My partner has taken the day off and a new part-time EMT has taken her place for the day. While we sit around chit chatting the pager goes off...
MVA less than five miles from the station. Bystanders on scene state the vehicle is down an embankment, multiple patients, patient status: unknown. I look at my watch and think: school traffic.
We jump in the rig and tear out, siren wailing. We arrive on scene in a few short minutes and pull up next to a small red car pointing straight down the embankment, the hood smashed in and resting against a tree. My partner had already jumped out of the rig, almost before I got it stopped. I grabbed my turnout coat and the jump bag out of the back and hurry to the edge of the road. My partner is already down the hill at the drivers side. He looks up and I can see the fear in his eyes and he yells "You better get down here."
I make my way down the 15 foot embankment to the drivers door and look inside. I see a young girl, obviously unconscious, her head pinned between the seat and the post of the door. I also see another teen aged looking female in the passenger seat. She looks dazed. I ask her if she is hurt. She says that her leg is hurting and is pinned in the floor board, she can't get it out. I tell her in the most reassuring voice I can muster that its going to be OK, that I am a Paramedic and am here to help.
I reach in and lay my hand on the chest of the driver, she isn't breathing. I notice that she is also pinned in a very bad way. I can't see anything below her chest, the steering wheel is bent and broken, the dash is pushed all the way over her thighs against her chest. I turn to tell my partner to get the BVM and he is no where in sight. Damn...where the hell did he go? I yank the zippers on the bag and grab the equipment I need and then try to place it on the patient. I cant reach in far enough, because of the way the vehicle is sitting and the mangled portions make it impossible for me to get both hands where I need them. The back window is halfway down, so I take my coat off and throw it over the patients head and grab the top of the back window and jerk. It shatters, sending glass everywhere.
Now I stick one hand in from the font and the other in from the back, bagging the patient as best as I can. I feel for a pulse in her neck. She has a strong one, but I can tell without having to count that its too slow. I feel my vision starting to narrow, the all to familiar feeling of tunnel vision. Shaking my head, trying to clear it and keep my thoughts and feelings in check, I look around for help. To my astonishment, I see an off duty Medic making his way towards me. He asks me what I need. I say my airway box, extrication equipment, monitor and someone to go to the other side of the car to check on the passenger. He promptly turns and marches back up the hill. Returning in just a few minutes with the familiar red and white box that contains all my airway supplies and several people in tow, I recognise one as another off duty medic in fire dept turn out gear.
They split as they reach the car, the first off duty medic coming to me and the others going to the opposite side of the car. I say we need to intubate this one now and he gets the equipment in order with relative speed. I can't intubate as I normally would, due to how the patient is positioned. So I hand the blade back to him and he sees instantly what I am thinking before I speak. He goes in from the front window, the blade reversed and uses a technique we always called "potato digging" and others call "the tomahawk method". While I reach through the back window with the tube. Working in unison, we manage to position her airway with very little movement of her head and neck. During this I notice something very bad. She has a definite step-off about midway down her neck. Her neck has got to be broken, I think. I peer inside her open mouth and also see that she has braces. For some reason this disturbs me. This is not supposed to happen. I am not supposed to be sticking a tube down someones throat that is still wearing braces. Christ Almighty....
The next shock happens as I ask for a little pressure. He responds by pressing down on the front of her neck, the cords pop into view, but with a shocking revelation. I can see the almost gleaming white of the vocal cords. But they are clamped shut. No darkness between them that is my target for the end of the tube. I remember something at that moment that my instructor had told me. I pull back my head slightly and send a hot breath down the tube, while watching the vocal cords. Nothing, no response. I try again. Still nothing. I try to push through them, nope...not working. I pull out and grab the bag again. Thinking, I'm gonna have to trach her.
My monitor is laying on the ground and I tell my coworker to get it ready as I check for a pulse. She still has one, and it's slower than before. I can hear the rumble of the equipment as the crew on the other side of the car attempts to pop the door to free the passenger. I can see her face peering out from under the turnout coat that is over her head. Her face is white as a sheet and her mouth stands agape. I realize that she has been watching me attempting to stick a tube down her friends throat and just as quickly realize that there is nothing I can do about it right now.
"Is she gonna be OK?", she hollers over the loudness of the spreaders and screaming of metal on metal.
"We are doing everything we can", is my return as I mentally reach 5 in my count and slowly squeeze the bag. Knowing full well that I didn't answer her question. Thankfully she doesn't ask again, but I see the tears start streaming down her face.
I turn my attention back to the driver and my coworker. He has the pads out and is trying to find enough room on the patient to place them. He has her shirt up yet there just isn't enough room to place them properly because of her position and the distortion of the interior of the vehicle. When he is done, the pads are almost touching. I look down to the screen and see the complexes look fairly normal, but way too far apart. I ask for the trach kit with dread. I have never done this before on a patient.
He tears away the plastic with hands that are shaking, his dread apparently matching my own. I switch places with him so he can bag and I can cut. I prep the area, and do what up to this point I have only done on a pigs trachea. He attaches the bag and squeezes air into the patient. I listen to lung sounds and they are decent enough that I know I did it right. I step back wiping sweat from my brow and take stock of the scene when I hear a long beep from the monitor at my feet. Looking down I know what I will see...flatline. No, not now, please not now.
I look over and see that the other crew is having difficulty getting the other patient out, as her left foot is still pinned under the dash. Just then I hear someone shouting at the top of the hill. Something about another patient down the hill on the other side of the road.
Time seemed to stop. It was decision time. The dreadful decision that I didn't want to make. I take stock of my patient. Probable broken neck, airway compromise for an untold amount of time, asystole, probable multiple internal injuries, etc, etc. I add this up and realize that there is nothing I can do and there are too many others here who need help. I reach down, and hit print on the monitor, tearing off the strip and sticking it in my shirt pocket.
I grab the radio from my belt and tell dispatch, "Confirm code blue on scene." As I make my way around the car to the other victim.
We get her out eventually and get her packaged. She has several scrapes, cuts and bruises, an angulated left wrist and an open fracture to her left ankle. We make it up the hill with her and to my waiting ambulance.
There I learn of the other patient and vehicle. It was down an almost 50 foot embankment on the other side of the road. I never even saw it. Another crew had arrived and had gotten him packaged and loaded while I was down the hill with my 2 patients. I also learn the chopper is waiting for us just up the road to take our patient to the nearest trauma center. I finish my assessment, start a couple large bore IV's, splint her leg and wrist as we make our way to the LZ.
We hand off the patient and the bird takes off. I sit on the bumper with my head in my hands. A fireman comes up and offers a smoke which I gladly take. Drawing deep on the cigarette. We start to clean up the back of the truck and I realize my airway box and jump bag on still on scene. We make our way back to the scene and the supervisor advises us that our equipment is in the back of his truck. They are still in the process of getting the dead girl out of the car.
I grab the equipment and take it to my truck. Then grab my camera and return to take a few pictures, careful not to get any shots of the body or license plates. We make our way back to the station. I learn then where my partner went. He had went back to the truck to get the things he thought we would need and while rounding the back of the truck had heard someone yelling. He looked over the embankment and saw the other vehicle and went to help who ever was inside.
The rest of the shift was uneventful, a few calls, nothing of note. The next morning I came home and printed the pics I had taken from the wreck. Reliving it all over again. Wondering if I had made the right decision. I take the pictures and place them in a photo album that is laying on the table in my office. In it are other photos of wrecks I have run, notes on various calls and interesting 12 leads that I have saved.
I sat looking at it for a long time...remembering...