I didn’t have a chance to do a narrative of the call last Wednesday.

My brother-in-law and three of his boys were visiting. I took the morning off and took O1 skiing with Jerry and his boys. After we left the ski area, we stopped for lunch in the town where the ski mountain is.

My first responder squad does not presently have a transport license and so our transports are covered by the squad in the town with the mountain; Ludlow. A member of the Ludlow squad was having lunch in the same restaurant that we did. I have worked with this EMT-I on several calls so I said hello. This guy is a gruff sort of person and didn’t have much to say to me. I have gotten used to the idiosyncasies of the squaddies that I have been working with so I didn’t take it personally.

After a lovely lunch, we headed home. My parents had come for a visit and had gone to pick them up with O2 while O1 and I were skiing. All four of them were at the house when we arrived.

About forty minutes after we got home, my fire department pager went off, reporting a multiple vehicle accident with injuries in town. I grabbed my radio, said goodbye, and left.

Of course, I had no idea what had happened at the time. I found out how the accident had occurred by reading the news the following day.

A car with four teenagers and an eighteen-month old had been speeding north through a school zone. None of the occupants of the car had a seatbelt on; the baby was strapped into a car seat but the seat was not secured within the car.

A pickup truck with two occupants was heading south and had started to turn left across the other lane when the speeding car came up over the rise. The driver of the car slammed on the brakes and skidded fifty or so feet into the truck. The truck was thrown across the intersection and into a jeep that was waiting to turn onto the main road. The jeep was knocked about ten feet back down the side street.

As I was leaving the house, somehow I managed to switch the channel on my radio. I didn’t realize at the time, but I was hearing the dispatch channel on my pager rather than on the radio, and transmitting on the radio over a different town’s fireground frequency. As a result, no one heard me when I tried to sign on.

I drove over to the station. I could hear from the radio traffic that the accident was bad. One of the senior members of my department had happened onto the scene and established command. I could tell by his radio demeanor that the scene was stressful. I tried to call him to ask if I should come direct but he could not hear me due to my incorrect channel selection.

I grabbed my jump kit and oxygen bag and went into the station. I was the first member to arrive at the station. I threw my oxygen bag into a compartment behind the driver’s seat on engine one and put my jump kit onto the floor of the passenger side. I grabbed the AED from the station office and put that onto the truck, then went and put on my turnout gear. By the time I had my boots, pants, and coat on, another member had arrived to drive the truck. I climbed into the passenger side of the truck and we left the station, lights and siren.

As we drove to the scene, the chaotic radio communication underscored the severity of the accident. There were multiple serious injuries. There was no medical coverage on scene. The scene commander, from my department, had not heard anyone sign on and had no idea that engine one was enroute.

I’m not really sure what I thought about on the way to the scene. Usually I consider the reported situation and think about what I might find and how I should deal with it. This time, though, it was clear that the scene was way beyond anything I had dealt with before. I watched the scenery go by, listened to the radio chatter, and was otherwise pretty vacant.

We pulled up to the scene. We were the first engine to arrive and there were no ambulances yet. The town police officer was the only official on scene other than our department’s officer.

When we pulled up, I saw the first accident vehicle. I have learned that the vehicle was a green Escort wagon. At the time, I could tell it had been a car. There were pools of engine fluids around the car. I could see that there was one person on the ground outside of the car and one person apparently in the car.

I jumped out with my kit and went around the truck to get my oxygen bag. As I walked up to the car I looked around. I could see a third victim on the ground on the side of the road and a child’s car seat nearby. All of the victims had bystanders providing care.

About this time I ran into the scene commander. I said hello. I could tell that he was relieved to see me.

I threw my gear on the road and did a quick triage of the four victims I had noticed so far.

There was a young woman lying across the floor of the back seat of the car. Her head and face were bloody. Her c-spine was being held by a woman from our department. She appeared to be unconscious.

There was a young man lying on the pavement, very close to the car. His face was bloody. His head was being held by a bystander who I recognized as being a local. This patient appeared alert; his eyes were open and he was talking to the guy holding his head.

There was the young woman on the side of the road. She had several people around her, one holding her head. She was talking to the people.

There was a little kid in the car seat. He was crying. There were several people around trying to console him.

There were groceries all over the scene; I specifically remember numerous bananas and bottles of water strewn across the road. At the time I was too distracted to think about why those things were there; now I know that the truck the car hit was coming back from grocery shoping and had bags of groceries in the back.

Based on my visual triage of eyeballs and talking, I could tell that the girl in the car was the priority patient. I went back over to the car.

The firefighter holding the patient’s head told me that the patient had been verbally responsive initially but that she hadn’t been able to get any response from the patient recently. I tried talking (yelling) to the patient and confirmed the loss of verbal responsiveness; then I pinched her sternum and was able to elicit a painful response. This was not as positive a sign as verbal responsiveness but better than totally unresponsive.

I went to get the oxygen bag for this patient. As I backed away from the car, I inadvertently stepped hard on the foot of the patient on the ground outside of the car. He screamed loudly. I apologized profusely, massaged his foot for a moment, and went for the oxygen.

I brought the oxygen bag to the car. I pulled a cervical collar out of the bag and prepared it for the patient in the car. It was a style of collar I was unused to despite the fact that I had it in my bag; it took me some time to figure out how to set it up. I switched c-spine with the firefighter in the car for a moment; the FF was in a very uncomfortable position and wanted to reposition so that she could better hold the patient’s head. After she readjusted and took back control of the c-spine, I placed the collar on the patient and then started high-flow oxygen. Oxygen never hurts and can be lifesaving in situations where oxygenation has been compromised. This patient looked like a head injury so oxygen was the best intervention I could provide on scene.

Around this time, another fire department officer came up and asked if I wanted a helicopter. I told her I wasn’t able to make that decision but to please expedite the ambulance and to have the ambulance staff make the medevac call. She said the ambulance was coming as fast as possible, and did I maybe want the helicopter on standby? I agreed that medevac standby was a good idea.

I made sure the firefighter in the car was okay with her situation and went to retriage. At this point, there were only three obvious additional victims. As per my previous visual assessment, all three had patent airways and no life-threatening bleeding. Based on my continuing assessment, the three were a toss-up for priority.

I stopped and looked at the young man on the pavement, the guy I had stepped on. I apologized again and asked him what his issues were. He had lower spinal pain. I did a quick head-to-toe exam and found no obvious serious injuries. I reached underneath him and palpated his spine, finding no deformities but finding point tenderness in the lumbar spinal area. The patient had some major scalp lacerations but was not heavily bleeding. I would have put this patient on oxygen but my setup was supplying the priority patient in the car. There wasn’t much further to do for this patient before transport.

Around this time, the administrator from the nearby elementary school came up to me and asked if I needed anything. I asked her to try to find blankets for all of the patients.

Finally the first ambulance arrived from the professional squad that serves our town. I met the EMTs at the car and we perfomed a rapid extrication for the young woman in the car. I helped them strap up the back board and then went off to work other patients.

By this time a second ambulance had arrived from the nearby large town. This crew started boarding my second patient so I went over to look at the little kid.

The kid was strapped into a car seat. He was a cute blond boy, very upset. At first glance, there were no obvious injuries, although there was a small amount of bleeding from the nose and mouth. I looked at his face and noticed that his left eye was squinting. The kid was crying for his mom. Although I did not know the kid, I felt that his reaction was age-appropriate and not indicative of altered mental status.

An EMT-I from the local large town had arrived and apparently taken control of this patient. The I-tech seemed a little stunned and at a loss; he knew the boy and seemed momentarily incapacitated. I helped hold c-spine on the little kid while we worked out how to improvise better support. The boy was clutching a small Pooh bear, so I sang the Pooh song and tried to block the sun from the boy’s eyes. I was cognizant that the boy was terrified and that two firefighter/EMTs were not a calming influence despite the singing. The boy tried to pull my hands off his head; he was not happy about the immobilization. This was my lowest point during the call; for a moment I thought I was going to cry but I managed to put it away and regain my working attitude.

The school administrator came by again and I asked her to get some towels. She came back with the towels and we rolled them up and taped them into the car seat around the boy’s head to act as spinal immobilization. By this time, the kid had developed the largest forehead contusion that I had ever seen and was getting sleepy. The I-tech decided the kid needed immediate transport and scooped up the seat. We took the kid over to the second ambulance and the paramedic got in with the kid. I went back to work more patients.

Around this time the third ambulance arrived, I think… I’m not sure, since I never consciously saw the third unit or its crew.

Things started to slow down around this point. I was alerted to the fifth passenger from the car; a young man standing off to the side holding his arm. I went over and assessed him. His elbow was very painful and apparently broken. I checked his spine and it appeared clear. I listened to his lungs and they were clear. The first ambulance had not left yet so I went over to find a frac-pack; a bag containing splints for fractures. There was one EMT-I in back with my first patient, speaking with the local hospital by radio. He asked me about the number and types of injuries and I gave him my best estimate. He told me where to find the frac-pack and I rooted through some of the cabinets on the side of the rig. I couldn’t find the frac-pack so I decided to splint with Sam splints; flexible rolled alumiunum splints.

I went back over to my current patient, stopping to rifle through someone’s jump kit for a Sam splint. I did a poor job of splinting the guy’s elbow with the Sam splint and a found pillow (left on the side of the road by the first ambulance crew when they put the boarded patient on the stretcher). Then I took a set of vitals. Conveniently, a bystander in OR scrubs was standing with the patient and I enlisted her to take ongoing heart rates and respiration rates on this patient. The patient was getting shocky so I retrieved my oxygen bag and started him on oxygen by nasal cannula.

After the departure of the three ambulances with the four most serious patients, I was again the only EMT on scene. The scene commander asked me to assess the three occupants of the other two vehicles. I left my current patient in the care of the bystanders and went over and assessed the other people. One of the people in the truck had a stiff neck and the driver of the third vehicle had a scraped knee; I advised them to go to the hospital.

There were no local ambulances left to be called and Ludlow had eventually been toned for this accident. The Ludlow rig arrived with two volunteers including the guy I had seen at lunch. He reassessed my broken-elbow patient and decided that the patient needed spinal precautions based on the mechanism of injury and other injuries in the vehicle. The patient was initially resistant but the EMT-I was able to explain the risk in such a way the the teenager eventually agreed to the medical necessity.

I helped with the takedown and backboarding. The Ludlow EMT-I needed an additional EMT for patient care (as his partner was driving) and he pointed to me and stated that I was going with him. I asked a fire department officer to bring my gear back to the station and climbed into the ambulance.

I worked the clipboard and oxygen and took vitals under the direction of the EMT-I as we drove to the hospital. The local hospital was maxxed out from our priority patients so we were directed to a hospital about fifteen miles away. The patient was very uncomfortable on the ride as his elbow was unstable. I spent much of the ride holding his elbow in both of my hands and trying to find the joint angle that was most comfortable for the patient.

We arrived at the hospital and transferred care to the emergency department. We changed the linens, then left. On the way back to my station we stopped and got a soda. While we were in the store, the gruff EMT-I told me that I had done a good job. I took that to be an extreme compliment based on my previous relationship with him.

The ambulance dropped me at my station on their way back to Ludlow. I went in and filled out the paperwork describing my assessments and the care I provided. As I finished, engine one returned with my gear. The Ludlow ambulance had replaced my oxygen delivery supplies and collar, so I repacked my stuff. Various FFs returning congratulated me on my performance, which meant a lot to me.

Then I went home.

In retrospect, there were a few aspects of patient care that I provided that I was unhappy with. I stepped on a patient, I should have closely assessed the child earlier and called the helicopter for that patient, and I should have started immobilization on the fifth car passenger as soon as I realized he had been in the car.

Rabid and O1 were at a restaurant earlier today and overheard a teenager discussing the accident with her parents. My priority patient is off the ventilator and talking with friends by telephone. Another patient, I assume my second patient, is paralyzed for now. The car with the unbelted baby and four unbelted teenagers was traveling almost seventy through the 25 mph school zone.

While I have spent time analyzing my performance, I haven’t had any PTSD symptoms, and I don’t think I will. I think I provided very good care, especially considering that I was virtually by myself at the beginning and in a situation way more serious than any I had been in previously except in training. Even in training, I was part of a group of EMTs whenever I dealt with any hard calls.

I’m pretty happy with the outcome; I’m feeling less of an EMT poseur and more of an asset to the community.

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