Wow, that takes me back… A paramedic ruminates

The other day I was up at the station having a conversation with one of our firefighters when she described a call where she found that “this guys legs were like, all messed up. They were like every which way and stuff. Gross”

Now while I have to give credit to great medical terminology where credit is due, I find it amazing how conversations like this can pull me into my own mental imagery. After ten short, well-paid, and relaxing years on the ambulance (ha!), I’ve got, well a few mental images stored up in the ol’ dusty recesses of my mind that pop randomly into the forefront of my mental picture show. I can’t turn them off. It’s completely random with what stimuli will trigger a vivid memory. One minute I’ll be walking up some stairs somewhere, and the next I’ll be mentally carrying someone down some staircase somewhere on a stairchair while the patient continuously pukes on me.

“It’s ok Ma’am”, I’d say. “People tend to puke on me. I get that a lot.”

So, after hearing this most eloquent firefighter describing her “all messed up legs” call, I found myself in the front seat of an ambulance.

This was some time ago, for some service I might have worked for somewhere. I was driving and New Medic partner was riding shotgun. He was describing his most recent fling while I was living vicariously through him describing his most recent fling. This was well before Gkemtb made my life Awesome, so it’s ok. We were headed to BigNun Hospital for a transfer.

“Dispatch to Ambo 74” Crackled the radio. “Copy Code-3”

“Sweet!” I love getting called off of transfers. NM got out his trusty notepad to write down the address as the tones dropped out.

“dooooooo doooooooo” Went the tones. “Medic 74 respond Code 3 with Blueberry Hill fire. I-333 at the 34 and a half mile marker for the one vehicle roll-over. State police are advising to expedite”

“Cool!” I love trauma, always have. There isn’t a medic alive who doesn’t like good trauma. Sure it’s sad (see: Splashed Sadness) but nonetheless good, adrenaline pumping trauma gets the heart beating.

NM partner, however, being a New Medic Partner, acknowledged the call and said “Uh, Ck? I haven’t had a good trauma yet and I don’t know how I’m gonna do”

“I gotcha buddy, just follow my lead” I said as I flipped on the twinkles and woo-woo’s and headed out to the Interstate. When we got onto the Interstate traffic was a mess. We were shoulder riding through stopped traffic the whole way. Our lane was stopped dead and the other line was completely devoid of cars. That’s never a good sign. It means that both interstate lanes are blocked at the accident scene and traffic can’t proceed in either direction because the incident is blocking both lanes… either that or there’s gawkers in the other lane. Both aren’t good.

After a while of fighting traffic, fire arrived on scene and asked for our ETA before giving their scene size up.

“About a minute” was my reply.

We arrived on scene and found an image that is burned into my brain to this day. The vehicle, a half-ton white pickup truck, had obviously rolled multiple times coming to rest on its wheels perpendicular in the roadway with the passenger’s side facing the ambulance as we pulled up. The patient’s head and torso was hanging out of the passenger’s side window. The patient was face-down with his chest resting on the window about the level of his nipple line. I can still see the 6 inch wide streak of red dripping down onto the pavement from the patient down the passenger’s door. The red blood contrasted sharply against the dirty white paint of the truck.

We called on scene, hopped out of the ambulance, and grabbed our gear.

“He’s conscious and in a lot of pain” one of the firefighters told us as we approached the truck. I had NM stay outside of the truck as I crawled into the open driver’s side door.

The truck was a mess. Apparently the patient was a construction worker as evidenced by the amount of unsecured tools that had bounced around the truck as it rolled, impacting against the unsecured driver countless times and causing a lot of trauma. An open soda bottle had sprayed its contents all over the scene and the patient as well, giving everything a sugary sweet smell that comingled with the bitter smell of the blood that had splashed onto everything.

But that wasn’t what surprised me.

The patient was face down, hanging out the passenger’s side window. A bystander who identified her as a “nurse” had been supporting his shoulders, head, and neck which were outside the truck. Inside, I was shocked to find that his legs had been completely dislocated from the pelvis on down. It was grotesque. Every one of the joints in both of his legs had been dislocated and twisted. His feet pointed backwards, his knees rotated sideways with one being wrapped around the gear shift pointing oppositely from where it should be. His other was wrapped underneath him. Nothing was in anatomic position.

Gross.

And the patient… yea, he was awake and alert to feel all of this.

“Dispatch from Medic 74” I said, urgently. “Send us the Helicopter. Blueberry Hill fire will be the LZ coordinator. LZ will be the Interstate. Traffic is completely blocked southbound from the scene.”

“Captain, I’m calling in the bird to transport. Can you land it on the roadway?”

“Sure thing” said the BHFD captain on scene, as he grabbed a crew to set up the landing zone.

“Hey NM, whatcha got up there?” I asked. He’d gotten vitals. The Pt was understandably tachycardic but he had a pretty good blood-pressure. Respirations were rapid and shallow. His o2 sat was 100% on the 15-litres-per-minute by non-rebreather mask that NM had put him on. He was in the process of putting the patient in a cervical collar when I asked.

So at this point I had pretty much no good ideas on how to get this guy out of the truck. His legs were just plain FUBAR’ed to use the term correctly. I couldn’t roll him onto his back with his legs the way they were and I couldn’t figure out a way to get them back into shape in the close quarters of the truck. I palpated down the length of the long bones in his legs and couldn’t feel anything that was broken other than the obvious joint dislocations. Finding distal pulses in the feet was pretty much out of the question with his thick boots on. On top of that, now the patient was beginning to actually feel the position he was in and was beginning to moan in pain.

“NM, any ideas on how we’re going to get this guy out from up there?” I asked.

“Aren’t you supposed to be here to figure that out?” was his reply.

After deliberating for a moment, I came up with a bright idea. I had the fire guys get our cot out with two backboards. My idea was to rest a backboard just underneath the passenger’s side window and slide the patient onto it, face down. His legs? Well… I figured that the damage had already been done to them and that since I would probably have to realign them anyway to restore distal circulation that I would just guide them out as they lifted and pulled him onto the backboard from the outside.

I recruited a wide-eyed EMT-Basic firefighter for the inside part of the plan.

“Here’s what I want to do y’all” I talk southern sometimes when I’se stressed.

“We’re going to sandwich him between two backboards. Y’all on the outside are going to lift and pull him onto a board face first. Me and this guy are going to guide him out from this side.” I calmly stated. “Everyone ready?”

“Um, you sure about this CK?” asked the wide-eyed FF/EMT-B. “Yea, you take this leg ‘cuz it’s not as bad. I’ll take (gulp) this one” I assured him.

“Sir?” I asked our conscious patient. “Get ready. There just isn’t any good w
ay to say this… it’s going to hurt a bit. You may want to take a deep breath.”

“Everybody ready? On the count of three. 1-2-3 go!”

They pulled and lifted and slid. The FF/EMT-B and I twisted and guided the rubbery legs around the gear shift and from under the seat. For his part, the patient uttered barely a whimper.

The legs, and this is one of the coolest things I’ve ever seen a human body do, simply “rubber banded” back into position. It was fast and easy the way they just snapped back into place. Freaky like. The patient slid right onto the board and onto the cot.

I hopped out of the truck and over to the patient. We placed a backboard on his back, picked him up between both of them and rotated him into the correct position. I then went to the truck to set up IV lines and let NM stay there to continue packaging the patient.

I ran down two IV lines as they were bringing the patient into the ambulance. I could hear the helicopter landing in the distance.

“Make him naked” I told a FF/EMT-B from the Fire Dept. Using one of my trademarked lines as I tossed him my trauma shears. He did, and to my amazement his legs, save for some abrasions here and there, didn’t look too bad. He had strong pulses in both feet as well.

I completed a head-to-toe trauma assessment as NM popped in a 14gauge IV. The helicopter medic entered and got another 14 in his other arm. We gave our passdown to the flight crew, finished the packaging, trauma assessment, and IVs and handed the patient off to them. They had kept the engine running on the helicopter for a “hot load”.

I hate hot loads. Something about walking under the spinning main rotor blade of a helicopter gives me the willies. We did though, wheeled our cot under the blades to load the patient in the bird. The chopper took off in a cloud of dust, taking the patient the 5 minute flight to the level 1 trauma center.

“So, NM. Was it good for you?” I asked him as we started cleaning up our truck. It was just plain destroyed with all of the treatment we gave this guy. We cleared the scene unavailable and out of service to return to the base hospital to restock and decontaminate the truck.

“I think that I like trauma” NM said. See? Everybody likes a good trauma now and then.

After cleaning, restocking, and returning the truck to service at our base hospital which happened to be the level 1 trauma center where the patient came to, we checked in with the ER doc.

“Hey, how’d the patient turn out?” We asked.

“Not too bad, he’s already up on the floor” Doc answered.

“What’d you find with his legs?” I asked.

“Nothing. His legs were fine. Just the airway and facial trauma. That was pretty much it” He said.

What?? I told him what we had on scene. He was skeptical. He said that he hadn’t found anything with the guy’s legs at all and that they were fine when he checked them.

I never did get a chance to follow up with this guy. I don’t know what ever happened to him. It was pretty common back then with how busy we were, and even more common now with the HIPPA privacy act.

The firefighter I was talking to at the beginning of the story? I dunno what she said while I was in my own little world. Something about lunch?? Hmmm… speaking of which, I remember a time….

  • The Happy Medic

    Great call CK! Way to think creatively with extrication, I like it.

  • medicblog999

    That's always where the best learning takes place CK, on scene and on the fly. It's the sort of stuff they never can teach you in training school because it is so unique tithe situation at hand.

    That reminds me of a call I had when…… Nope! I think that will make a good post!

    Stay tuned for more matey!!

  • WWWebb

    I'd rephrase that as "SOME trauma".

    I used to hate having to crawl into upside-down cars where the glass had shattered.

    The little cubes of glass weren't bad, but sometimes it seemed as if WEEKS would pass before you got all the little glass slivers out of your hands.

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