# My first big trauma



## SC Bird (Mar 23, 2008)

Had an internship on Friday that turned out my first trauma.  We got dispatched for an MVA rollover with 2 ejected.  Arrive on scene, one pt. prone in the roadway and another pt. in the ditch.  Truck is demolished.  Medic gets out of the truck and says, "Take the one in the ditch."

After five seconds of the oh **** factor...I snap into it.

So there I am on my own with a police officer/first responder.  Pt. is conscious and alert but confused.  Pt. is in mud and a couple inches of water and she is COLD.  Difficulty breathing and lower back pain is primary complaint.  Despite pt. talking to me and responding to questions, I can't find a pulse. :unsure: :unsure: :unsure: :unsure: :unsure:  I know I need to get her off scene and quick.  By that time, FD shows up.  She's collared, backboarded and secured.

At this time ( since transport to Level 1 center they are undoubtedly both headed for is 25 min-30 min ), the medic has decided to fly his pt (multiple avulsions, deep laceration to left abdomen, no feeling inferior umbilicus :sad.  We have a five minute run to the LZ, so we need to get both pts in our rig.  Mine goes up onto the bench seat and is secured.  Other pt. comes in on the stretcher.  Everbody goes to work.  Pts. exposed, head to toes done, IV's started, fluid running.

On scene time, 7 minutes. B)

I give the medic my update on my pt.  Three crew members unable to find a pulse on my pt. who is still talking and screaming in pain.  Can't get a pressure.  Large contusion across sternum and left breast.  Lung sounds are clear but diminished in lower left.  Pt. not tolerating NRB, SpO2 95%. Rigid abdomen but no distention.  Pelvis is tender.  Pt. feet appear to be posturing. Motor and sensation present in all extremities but no pulses.

We rendezvous with the bird.  Turns out one of my instructors is one of the crew who will be flying my pt's in.  Decision is made to fly both pts.

Transfer of care is made....bird lifts off.

:wacko::wacko::wacko:
"That was crazy...but I loved it," I thought to myself.

Updates on the pts.  Patient number 1 (my preceptor's patient), T6, T7, T8 completely exploded. :sad::sad:  
My pt. had a spleen laceration, liver laceration, and pulmonary contusion. :sad::sad:  Both were on the vent and "deep in the woods".

So there ya go....my first trauma call.

-Matt


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## JPINFV (Mar 23, 2008)

SC Bird said:


> My pt. had a spleen laceration, liver laceration,



[in best Mythbusters voice]Well, there's your problem...


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## Chimpie (Mar 23, 2008)

Matt,

Sounds like an interesting call.  Thanks for sharing.

Chimp


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## Jon (Mar 23, 2008)

Sounds like a great call to get while you are doing your ride-time. I don't wish bad things on people... but if bad things are going to happen... it might as well be when I'm around and have a student.

From my perspective, you having a few "oh :censored:" calls as a student will make you a better provider. You've now seen a bad call, and next time you see a bad trauma, you've already been there, done that, so you should know what you are doing.

A question, though... was the EMT-B of the crew with you? Were you working alone? You said you transported both patients in 1 rig... were other units not available, or is that just how your system works?

It is common for a 2-EMT crew, or even a P/B crew to split and take care of multiple patients until additional resources arrive... but around here we've usually got additional EMS units onscene, and it is rare to take 2 critical patients in one rig.


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## SC Bird (Mar 23, 2008)

Yeah, Jon....I certainly did not enjoy seeing a 17 y.o. and 18 y.o. girls in this situation...but I was thankful that I got the experience and got to use the skills I have learned to help them.

As far as your question goes, the ride was in a relatively rural (to this area) EMS system and the closest available unit to transport was approximately 8-10 minutes out (not sure why another unit wasn't toned out immediately knowing 2 potentially critical pts on scene - may have to do with the county's system).  The crew I was riding with was composed of an EMT-B and a Paramedic.  When we got in the back of the rig and were transporting our patients, we had myself (acting as an EMT-I), a firefighter-paramedic working my patient with me, both crew members and another firefighter working the spinal pt.   All said and done there were 7 persons in the back of the rig and suprisingly everybody had enough room to get their jobs done.  Was that the safest option....probably not.  But we had both pts. safely transported to the LZ in less time than it would have taken the closest available unit to reach the crash scene.


There was some argument later about flying both patients....but I believe that the medic and the supervisor who concurred with the medic on flying both made the right decision.

-Matt


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## Jon (Mar 23, 2008)

Thanks for the added info, Matt. Question... are you certified as an EMT-I, in EMT-I school, or are you part-way through medic school?

I think it is cool that your aeromedical provider is capable of flying 2 patients in 1 craft... around here, some of the services CAN do it... but they fly 2 patients rarely, and usually only do it with children - because of their weight concerns.


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## SC Bird (Mar 23, 2008)

Jon,
I am in EMT-I program now, so all internships I am acting as an EMT-I.  The degree program I am in started in Basic and will end up with us (hopefully) being medics.  

The Paramedic portion starts this May. B)

-Matt


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## rescuepoppy (Mar 23, 2008)

Good break in call for your internship there Bird. By the way do you use Regional, or are you somewhere other than the Upstate area?


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## Jon (Mar 24, 2008)

Cool... it is great that it is in stages like that.

Jon


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## SC Bird (Mar 24, 2008)

rescuepoppy said:


> Good break in call for your internship there Bird. By the way do you use Regional, or are you somewhere other than the Upstate area?



Omniflight, I'm down in the Lowcountry. B)

-Matt


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## paramedix (Mar 25, 2008)

It's not always that you get your trauma calls so quickly... meaning that when you just qualified or you just joined a new company...everything appears slow.

Usually when I work with Ops Paramedic, we average to turn out to about 8 to 13 calls where most of them are trauma and yes, most of them can be quite hectic.


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## SC Bird (Mar 25, 2008)

I got a chance to talk with my instructors today to get feedback from every aspect of the call.

I was on scene and provided care to the most unstable pt.
One of my instructors flew both pts. in.
Another of my instructors received the pts from the helicopter and transported into the ER.

They've both got a long hard road ahead of them....

-Matt


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