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Friday, March 8, 2013

Not in Any Book

Stapled hand-outs, chapters in books and practice with all sorts of equipment offered a basic idea of what I should encounter on any adrenalin-depleting ambulance run; however, there are things that they just don’t put in all of that paperwork!

Still in the early days of training, working an accident, I mostly did the scut work and watched others do what I was learning in class or practice sessions. That was fine with me; my heart raced fast enough just to be in that position of little responsibility. During the actual ambulance call, my brain constantly scrolled through material I’d read, figuring out the why’s of what I was seeing my colleagues do and anticipating their next step. Truly, there was a ton of stuff to remember and assimilate into the space of a few critical minutes.

If the dispatcher had given enough information, my training partner gave me instructions, as emergency items were pulled from cubbie holes and bins around the periphery of the ambulance. The sound of the siren, the roar of the engine accelerating intermittently as we made our way through intersections and onto the Interstate highway to the accident scene, along with the bodily tossing around that goes with being in the victim’s end of the ambulance, all made hearing any instructions a challenge. Needless to say, the instructions were not repeated; get it the first time was the unspoken understanding.

“Car exploded, on fire, victim thrown from car. May be others. Follow me.”

Bulky bandages were squeezed into the several others in the Jump Box, which was tossed to me. Oxygen tubing was rammed onto the port just as the driver threw open the door. As soon as my feet hit the ground, I moved aside for the trainer, who was Marie on that day. Together, we ran full-out towards the victim, lying next to the smoldering vehicle.

“Any more vic’s?” The trainer shouted to the uniformed officer, while glancing back to see Bill pushing the ambulance cot over to us. The Patrolman couldn’t hear her; he was trying to keep the onlookers away from us. “Sojourner, no bleeding, breathing okay for now. We need to get her out of here. Help Bill get her onto the cot and loaded in. As soon as you get her in, pull off the O2 tubing I hung. Break open the sterile box and get gloved. Don’t use anything on her that comes from anywhere but that box. Got that?” I nodded, while carefully rolling the lady slightly to one side for the backboard. Marie continued instructions as Bill and I lifted the board to the waiting cot. “Get a sterile mask and start the O2 at 10. I’m taking the Jump Box. Get her clothes off, a sterile sheet on. Remember,” Marie was nearly too far for me to hear at this point, because we had been moving in opposite directions, “Remember; don’t touch her with anything that doesn’t come out of that box!” I just held my hand up; I knew I could never shout loudly enough for her to hear me.

Getting the victim into the ambulance was a piece of cake, because the legs of the cot smoothly collapsed as it was pressed into the open door. Getting my short legs, with me attached, up that high was another matter. At five-foot, four-inches, I couldn’t just put my booted foot onto that high floor and slide into the vehicle with the ease of the cot. Oh no, I had to lift up one knee and then the other, scooting over to the side bench before I could pull myself up enough to sit and slide over to the built-in equipment boxes at the front. Once there, all went well, but I was grateful for the victim’s inability to see me get inside to care forhim/her! The victim might have lost confidence in the Ambulance Service.

After opening the appropriate box, I donned the sterile gloves. Putting the O2 mask on this dear lady’s head was difficult because of her burned skin. I gingerly placed the mask and tried to slip the elastic strip around her head, but the hair proved so fragile that it crumbled at the touch of the elastic, no matter how loosely I laid it over her head, Next I reached for the sterile sheet and opened the plastic, outer covering. The inner layer would protect the sheet until I needed it. I took the sterile scissors and positioned myself to begin cutting her clothing off. The plan was that as soon as an area was clear of the clothing, I would finish unwrapping the sheet, and lay it over that one portion. How I longed for Marie to get back to be sure I was doing things correctly.

I had only made a few short cuts when the door opened and Marie slipped in. One bang on the side and Bill had us in motion.

“Sojourner, what are you doing?”

As I had been trained to do, I didn’t look up but kept working as I answered. “I’m cutting off her pantyhose. Then I’ll lay the sheet over her legs—“

“Stop!” I immediately held the scissors up and turned to Marie. Hmm? I had thought she was just quizzing me to be sure I knew what to do; guess not.

“That isn’t pantyhose. It’s her skin. Take the sheet and lay it over her legs now. Come over here and I’ll move up to cut away her cotton blouse.”Marie had already donned the gloves, so I handed her the scissors.

To be honest, the very thought that I was cutting away her skin, froze my brain. I was relieved that there wasn’t anything for me to do; I was trembling.

When the clothing was gone, we carefully placed sterile sheets over her and a warm, thermal blanket. Heat loss is nearly as important as fluid loss for the burned victim.

In those days, we could carry the intravenous solutions with us, but the law still dictated that the IV be ordered by a physician. The hospital, to which we were connected on that run, did not have an on-site physician. We’d be there before he got to the hospital, so there really wasn’t much more we could do. Well, physically, that is. I prayed silently for this young woman. Yes, she was breathing, but it was abundantly clear that she had been badly burned over much of her body. Survival would mean a lot of pain for a long time to recovery.

Soon after, our victim had been admitted to the hospital. No longer a victim, but a burn patient. Though I didn’t wish anyone ill or injured in the near future, I did look forward to checking in on her the next time we made a run to this hospital.

Over coffee in the hospital cafeteria, I learned that what I had done was a common error for a rookie. What the books don’t tell you is that the victim who is inside or very near the car that explodes, has flash burns. Not that the flames lick the skin, but that the extreme heat of the explosion literally lifts some of the layers of the skin away from the body. Our victim had been wearing polyester pants, which had melted into the skin. It looked like she had been wearing tan-colored pantyhose, when it was actually her skin.

Sadly, or perhaps in God’s mercy, the lady succumbed to the burns. Her lungs had not been able to recover from the heat’s attack on her fragile lung tissue.

As hard as it was to work at the scene of such horrible accidents, adrenaline fueling my body to move when the sight would freeze the normal young adult, the death of a patient always affected me for longer than I’d like to remember. Learning that it is God who knows best and decides the outcome is a very hard life’s lesson for a twenty-something who thinks she will live forever. Seeing an agemate in an accident brought the truth of real life right to my door!

It, definitely, matters how I live; I never know when I will die and face the One Who created me, waiting for my accounting of how I spent the life He gave me.

****Field Medicine: Victims Known…Next Post

1 comment:

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