# Last night



## Luno (Sep 12, 2004)

I just have to share this with everyone, I've had my fair share of trauma, MVCs, stabbings, GSWs, etc...  But last night, toned out at 0'dark thirty, from a dead sleep, we were running to the rig, to go look for our patient.  Actually our patient hadn't been found yet, but the report was a male, possibly hit by a train.  When we arrived on scene, there were 3 engines, apx. 10 cops, and an ALS unit onscene already, and no one had seen the patient, as far as we could tell.  Keep in mind this was a freight train, multi-engine, so everyone was looking the full length of the train.  The pt was located by ALS, and the cops, we were second in.  Pt had massive open head trauma from the center of his eyebrows past the top of his forehead, pt's right humerus was broken (100% displacement), unk. stability of neck/back, unstable thoracic, poss. unstable pelvis, and needless to say, not conscious.  Tx was tubed (ETT), trauma lines, BB/CC, rapid txpt.  But the most unusual thing was as my partner and I confered post call, was looking into the open head trauma, w/grey matter.  I don't know if he "made it" or not.  It was also interesting to have to lift our package over the train and hike him out to the rig past the tracks.  By far the most interesting call I've had to date.  BTW, call range for yesterday incl. 45 day old w/distended ABD/vomit/diarrhea/no temp elevation, F. crackhead with anxiety/L. Arm Numbness, 35 yo F with chest px/pressure/hypotension/morbid obese/syncope/sig. cardiac hx w/last MI/arrest this year,  80ish F vomit/syncope/likely vagal, 15 yo F/HA, 40ish M w/ruptured spleen, and some facility runs.

Not a bad day for 9/11


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## ffemt8978 (Sep 13, 2004)

> _Originally posted by Luno_@Sep 12 2004, 10:31 AM
> * But the most unusual thing was as my partner and I confered post call, was looking into the open head trauma, w/grey matter.  I don't know if he "made it" or not. *


 Just wondering what your protocols say about this.  Exposed brain matter or heart muscle is one of the "obvious death" criteria for us.


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## Luno (Sep 13, 2004)

It was still w/in the cranial space, but you could definately see the split skull, besides, pt still had HR/BP, so I think that would R/O the incompatible with life decisions.  The pt did get the emergency rush to HMC, but as we got of at 0800 this morning, I haven't followed up.  I will let y'all know when I do.


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## rescuecpt (Sep 13, 2004)

> *Just wondering what your protocols say about this. Exposed brain matter or heart muscle is one of the "obvious death" criteria for us. *



For us it's brain matter in locations other than inside the skull.  If you can look through a hole and see it, but it's not splattered all over outside the skull, you're still good to go.


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## rescuecpt (Sep 13, 2004)

> _Originally posted by Luno_@Sep 12 2004, 12:31 PM
> *
> Not a bad day for 9/11 *


Did you expect less calls?  More calls?

Personally I consider 9/11 to be a bad day no matter what, but that's because of my personal connection to it.


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## Luno (Sep 14, 2004)

RescueLT, actually what I meant was that it was a good mix of calls that allowed us to make a difference in each person's life as a tribute to those who have come before us, and to those who are no longer toned out.


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## rescuecpt (Sep 14, 2004)

Ok.  I've just noticed around here that certain days (including 9/11) have an effect on the number of calls - I guess the usual, drinking, driving etc apply for a lot of the holidays, but I also usually see more heart attacks, anxiety attacks, suicide attempts, etc around Christmas, Thanksgiving, and sometimes 9/11.

On the four calls I went on (one in class A because I left a memorial service to answer an ALS call) everyone apologized to me for bothering me on 9/11.  Nice in a way, but a little strange.


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## PArescueEMT (Sep 15, 2004)

> _Originally posted by Luno_@Sep 13 2004, 03:27 AM
> * pt still had HR/BP, so I think that would R/O the incompatible with life decisions. *


 I had a burn vic that I had to pronounce while still technically still alive. The Patient had full thickness over 98% of their body, barricaded in a room, obviously a successful suicide attempt. I was sent in to see if we were going to extricate. when I saw the Pt. (whose fianceé notified us that she was in there and gave us a picture to aid us in a search), I looked at the picture of a young pale Irish girl And at her, There was no way we were going to get her out and called it on the rule of 9's. I do feel sorry for the guy. 2 weeks later, self inflicted GSW to the head. She died in his house on Valentines day; 3 weeks before they were to get married.



Things like this stay with you. I don't know if I made the right call on that. I know she wouldn't have made it had we gotten her out, but with the fianceé there, should I have made more of an attempt???


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## rescuecpt (Sep 15, 2004)

> _Originally posted by PArescueEMT_@Sep 15 2004, 11:12 AM
> * Things like this stay with you. I don't know if I made the right call on that. I know she wouldn't have made it had we gotten her out, but with the fianceé there, should I have made more of an attempt??? *


 Had the fiance seen her at this point?  It might have been even more traumatic for him to see her like that.  I know it didn't end well for him either, but you had no way of forseeing that.  There were obviously problems with at least one of them and possibly both, and maybe in the relationship as well.  It's too bad they didn't have a better support system to lean on, but this is in no way your fault.

I know second-guessing and thinking of things we could have done differently is a way of life in our line of work, but just remember you go out there with the equipment you have, the training you've had, and the experiences you've had, and you do your best everyday, and that's the best that you can do for your patients and for you.


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## PArescueEMT (Sep 17, 2004)

> _Originally posted by rescuelt_@Sep 15 2004, 06:48 PM
> * Had the fiance seen her at this point?  It might have been even more traumatic for him to see her like that.  I know it didn't end well for him either, but you had no way of forseeing that.  There were obviously problems with at least one of them and possibly both, and maybe in the relationship as well.  It's too bad they didn't have a better support system to lean on, but this is in no way your fault.
> 
> I know second-guessing and thinking of things we could have done differently is a way of life in our line of work, but just remember you go out there with the equipment you have, the training you've had, and the experiences you've had, and you do your best everyday, and that's the best that you can do for your patients and for you. *


 There is a lot more to that call. I takes about a half hour to tell it. short addition is we pulled him out 4 times, and eventually locked him in the patrol car that was out front and removed him from the scene b4 she was brought out by the state FM. I found out l8r that she had lost her mother (who I also happened to call on a scene) in a massive MVC the previous mother's day. 13 cars, 27+ patients. That was a tag and go situation. After a while, we dubbed the MVC the mothers day massacre.

I also found out that at first, the local FM and PD were suspecting murder, but after reading my PCR, ruled it a suicide.


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