It had been a slow Sunday. Much of the day had been spent hanging around the station; chores done, nothing to do. Around lunch time, I called in our shift’s order to the local pizza place. After waiting for twenty minutes, Becks and I took the ambulance to go pick up our order; we take the ambulance when we run errands so we can respond immediately if something happens.

Just as we pulled out into the street from the barn, the radio spoke.

“Ambulance, stand by for tones”.

I pulled over. There was a 50/50 chance we were heading the right way.

We waited. After about fifteen seconds, the tones played. After the tones, the dispatcher came back on.

“Ambulance, please respond to 244 Cricket Lane for a five-month old child that has fallen on its head. Repeat, ambulance, please respond to 244 Cricket Lane for a five month old who has fallen on its head.”

Neither one of us was familiar with Cricket Lane; Becks pulled out the maps. I got on the radio and reported that we were responding.

Becks told me that Cricket Lane is off of Locust. I knew where Locust was; behind us.

I flipped on the lights and siren, looked about, then pulled a u-turn to head back up the street. We passed the station and continued up, took a left, and headed out of town.

Dispatch came on with more information. The infant had fallen from a bed onto a hardwood floor, cried briefly, gone to sleep, and could not be roused. The kid’s condition sounded bad; the circumstances sounded weird from a number of aspects. This was not going to be an easy call.

Our tension level increased. As I drove towards Locust, I focused on calm for myself and my crew. Kid calls are the worst for maintaining composure. Becks and I were already amped from the dispatch information; we needed to keep it together.

I radioed the hospital; they had been listening to our dispatch channel and were aware of what was going on; they would be standing by for an update.

We pulled onto Locust and then to Cricket. Between the two of us and the stress, we misremembered the address. We both thought it was 224. We pulled up in front of 224, called on-scene, and jumped out. Becks grabbed the first-in bag and we ran to the house. There were a number of people in yards watching us as we climbed the steps to the porch and knocked on the door.

No one answered. I tried the door; it was locked. We went around back; still no way in. I started to get suspicious that we were in the wrong place; I radioed dispatch from my portable to verify the address.

Dispatch corrected us. We ran back to the ambulance and jumped in, roared up the street. A man was waiting on the street for us; we couldn’t see him before because of a slight hill.

We signed off on location for the second time. We got out and followed the man into an apartment building and up the stairs.

On the way, the man said that the kid, a boy, was his stepson. His daughter had been watching the baby on a bed; the girl had got up to change a DVD and the kidlet had rolled over and off the bed. The baby had gone to sleep very quickly and they couldn’t wake the kid up.

We got upstairs and into the room with the baby. The ten-year-old daughter sat on the bed, looking nervous. The kid was in a swing-seat. As I approached the baby, I could see that he appeared asleep. I could see the big red mark on the left temporal area where the kid hit the floor. The kid was in a onesie; he appeared clean and cared for. There were no other visible marks on the kid. Between the environment, the kid’s physical appearance, and dad’s earnest and open demeanor, I was immediately less concerned about this being an abuse case.

Still; the kid didn’t look good. He was pale and not moving.

Before I touched the kid, I clarified with dad that the mark was where the kid had hit the floor. It was. I asked for the kid’s name; Fred.

I tried speaking to the kid first.

“Fred, yo, Fred! Yo, wake up!”

Nothing.

Using two fingers, I rubbed on Freddie’s sternum.

“Yo! Freddie! Wake up!”

Still nothing.

I warned the dad and daughter that I was going to try to elicit a painful response. They nodded.

I pinched Fred’s big toe, then the sole of his foot while I yelled his name at his face from eight inches away.

Nothing.

This was looking bad.

I took Freddie’s tiny fragile head in my giant clumsy paws and felt his skull. I could feel the fontanel; it did not seem to be depressed. The bony parts appeared to be intact. This was all good but still nothing to rule out a closed head injury.

Freddie didn’t resist my pawing at his head.

I asked Becks to see if she could take vitals while I went to call the hospital. She got to work while I stepped into the next room, away from the family members. The hospital ED is on my speed dial; in moments I had the PA on duty on the phone.

I explained my findings and stated that we had not yet quantified vitals. The PA asked me about breathing and airway; I reiterated that we had not yet gotten numbers but that the child did not appear to be in respiratory distress.

The PA recommended that we take the child directly to the regional trauma center. I was not pleased; the trauma center is 22.5 miles away while the local hospital is two miles away. I could not disagree with the PA’s reasoning, though; the hospital could do a cat scan but would have to send the child to the trauma center for treatment in any event; taking the kid to the local hospital would delay definitive care. The trauma center has a pediatric trauma team on call in the hospital; they would be able to start dealing with the issues right away. The kid had to go to the trauma center and for the best outcome, Becks and I would have to take him direct.

It was a recommendation, though; the PA did not tell me what to do. We could bring the kid in to the local ED if we wanted to.

On many calls a long transport is okay; there are quite a few things that the prehospital practitioner can do to directly aid the patient or to prepare the patient for the waiting trauma team. Little tiny kids are very specialized, though; there’s not much a basic or intermediate crew can do but drive faster.

I went back to the other room. Becks had numbers for heart rate and respiration; they were fine. I squeezed the little guy’s fingers to assess cap refill; that looked good, too. So we had no excuse not to drive him all the way to Regional. I told Becks and the family that we were going to the regional trauma center.

Dad was on the phone with mom. I told him we were leaving immediately; he told mom that we were going to Regional and rung off. Mom was working near Regional and would meet us there. He went outside and asked a neighbor to look after his daughter.

My plan was to scoop and run; I’d carry the kid to the rig, we’d go. Becks gathered up the first-in gear while I poked more at Freddie; then I picked up the kid, put him against my chest and over my shoulder and made for the door.

As soon as the kid hit my shoulder, he woke up. He cried for about three seconds and then was quiet. I looked over and saw him looking at me, sleepily, quizzically.

Becks and I looked at each other. All of a sudden, this was a different call. Maybe the kid was just a heavy sleeper. Certainly, the fact that the kid was now awake and making noise made this much less serious.

We got in back and changed the airway seat over to a kid seat. I strapped Freddie in; he was alert and watching me and the environment. We asked dad to get in back with me, Becks got in front and we took off. I sat on the head of the cot, facing Freddie from about two feet away.

Freddie had a grand ride; he looked around and checked everything out. Now that he was awake, he was very interested in everything. He was very compliant with my poking and assessing; he was even patient with the blood pressure cuff even though it seemed to be uncomfortable for him.

I thought about giving Freddie a stuffed animal from our supply but decided against it; I figured he was too young to appreciate it. I did wipe down a stethoscope with alcohol and gave it to him to play with; he hung onto it and waved it around.

Freddie frequently smiled and laughed; the bumpy suspension seemed to give him great pleasure. Freddie, dad, and I enjoyed the ride.

I patched to the regional center and told them that we were enroute, gave them the current situation. After a while, we arrived at the hospital. I waited until dad got out of the rig then handed Freddie down to dad to carry; as much as I was enjoying the little guy, I felt that he would be more comfortable with dad and that dad would be more comfortable with Freddie.

We left the cot in the rig and walked in. Mom was already at the ED; she was visibly relieved to see an alert Freddie on dad’s shoulder. We were given a room assignment, went in, and transferred care. We said goodbye to mom and dad and waved to Freddie.

Everyone was happy; an excellent outcome.

We drove back to town and picked up lunch at the pizza place on the way back to the barn; the food had been ready for an hour and a half. Lunch was soggy but delicious.

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