Wednesday, April 29, 2009


As an Army Medic, I'm a specialist in trauma medicine. My skills allow me to keep a soldier who's been wounded in any number of horrible ways alive, long enough to reach a higher echelon of care. Unfortunately, my training is for just that-soldiers only. Acting as a civilian, or on a civilian, my skills are automaticly lowered to the level of Nationally Registered EMT-B, and New York State EMT-B. None of those extra skills matter, even if it means life or death for my patient. This is one case, where it may have mattered, or may not have. Either way, it was a difficult choice for me not to do more then I was allowed.

My 42 year old victim lies on my cot, circling the drain, but I'm helpless. She and her three middle-school aged children ran off the road and into the woods at a high rate of speed. The little Honda Civic was folded up like an accordian. One of the kids was DOA, the other two were gettin' there. I didn't get to see much of them, being the last truck on scene. One was airlifted, the other leaving by ground moments after I arrived.

Fire department spotlights illuminate the car as if it was in a patch of daylight. I climb into what remains of the car-there's no roof left, and thankfully the hose-jockeys have already gotten the door popped too. I size a collar and my partner positions the board for a rapid extrication. She is breathing rapid and shallow, dimished on the left side, and it doesnt rise quite as far as her right. She is covered in minor-to serious bleeding cuts all over her upper body from glass and twisted metal. Both legs have nasty open tib/fib fractures. One of these is bleeding very heavily and I wrap a pressure dressing on. What seems remarkable to me is that she was seen as the least serious case in the car-aside from her son the DOA. We're only a 10 minute haul from the hospital, maybe less because the State Police have the traffic lights for us, and my partner can drive like a bat outta hell when she wants to. I have no ALS. They are tied up on other jobs. One could be sent from two towns over, but she'll be at the hospital quicker then they would be able to get here. We load and go.

"Jane Doe" is unconcious, with a GCS at 3. I have an NPA in, but according to my pulse ox, she's only satting at 85 with 15LPM of 02. She needs a tube, but I have no medics. Were she a soldier, I could pop a King airway in, but she is not, and I'm a basic EMT in New York. They don't trust us with tubes, other then oxygen tubing. Her respriritory trouble is getting worse, trachea deviating off to the right. There are no left side lung sounds. If she were a soldier, I could fix that pneumo she seems to have, with a 14 gauge needle. But she's not, so I simply apply a bulky dressing and hope that the one lung is enough for another 8 minutes. Her pressure is dropping, from 110/70 on scene to under 80 systolic now. Were she a soldier, I could start an IV and push a 1000ml saline bolus, or better yet, that nifty Hextend stuff to get her pressure back up. But she's not, so I can only sit and watch. We're 7 minutes out when I start bagging, and her oxygen sat goes up for a moment, until her heart stopped. I'm still doing compressions when we arrive at the ER, but they didn't really matter. There was nothing I could do....and everything that I could have done.


  1. :(

    None of that stuff probably would have helped anyway.

    Sad case.

  2. Wow, Thats Intense.

    So To Clarify, EMT-B's South of the Border Cant give IV's ? King AIrways ?

    Thats Too bad. IV's Are Standard Up here for EMT's, we can use King Airways...but for Cardiac Arrest Only. Needle Decompressions are an ALS Procedure only. Would be cool to do tho, I have never seen Tracheal deveation before, lots of Paramedics i talk to say its pretty rare to see in the feild.

  3. EMT B's cant do IV's in my state-down here the state has the final say. I think there are a few where it's allowed. We have OPA/NPA's...nothing else for airway. Tracheal Deviation isnt seen very often-It's a late sign and usually means that they're probably not going to be saveable, at least in the field