It's Pronounced Frahnk-en-steen...

As these stories often seem to begin, I was working overtime at another station when this call went down. We were responding to a call for an unknown medical with an unknown age patient. What else is new? En route we got an update that the patients wife was calling because her husband had fallen in the other room but was behind the door, blocking it, so she couldn't get in. She stated that he was making snoring sounds earlier but now wasn't making any noise at all.

Yeah. That's not good.

On arrival we were met by a surprisingly calm older woman who relayed that same story to us again. I asked when this had occurred and she said at noon. It was now 12:25! Not sure why she waited so long to call but it didn't matter now. 

     

The next thing she said was that it was really "crowded" in the house. As we entered we realized what an understatement that was. It was a full on hoarder house with a strong smell of cat urine, even through our P-100 masks. A couple cats bounded out of the way as we went in. My firefighter was ahead of me and had the large airway bag on his back and the cardiac monitor in his hand. I was carrying the drug box and trying in vain to catch all the things he was knocking over as he tried to maneuver through the debris field and stacked towers of god knows what. I told him just to ditch the gear if he could find a spot because it wasn't going to make it through.

We reached the door and it was indeed blocked. Whether strictly by the patient or by an avalanche of possessions and garbage, we didn't know. We asked the wife if there was window to that room and she said yes and told us to follow her. She was still very calm and slow as she led us through the back of the house and outside. We found the window but it was locked and while the firefighter attempted to jimmy it loose I went back around the outside of the house to enter the front door again and see about forcing the bedroom door and get access to the patient.

My firefighter apparently had the same idea and abandoned the window but wound his way back through the house and was already pushing his way into the room when I got there. He was able to squeeze in and lift the patient enough that we could push the door open.

The patient then basically flopped half way out of the room landing at my feet. A quick check for pulse and breathing revealed what was already very obvious, that he was dead. He had a large purple shiner around one eye from a previous fall and just didn't look healthy...on top of being dead that is.

My captain asked if I wanted to work this call right there and I responded with an emphatic no. There was no room at all and it was awful everywhere. So, I grabbed his wrists and the firefighter grabbed his ankles and we worked our way through the mess to the front lawn. Outside, out of the corner of my eye, I saw an ambulance employee standing there; the first bit of good news. My captain said we should set him down in the shade to work and I said we should carry him straight to the gurney. I then realized that the guy on the lawn was an EMS supervisor and that the transport ambulance wasn't there yet. He had heard the call come in and was close by and thought it sounded serious. He was right and it turned out to be good news anyway because he was able to help out with initial treatment and speed things up.

Out on the lawn I did another pulse check and a check for rigor or lividity or any sign that would let us pronounce him dead and not have to work up this obviously futile resuscitation attempt. No such luck. So we put the automated cpr device on him and began rescue breathing with a bag valve mask. The supervisor applied the cardiac monitor while I made a long shot IV attempt. I had the sup set up for an IO in case the IV attempt failed, which it did. He was able to get an IO established in the humerus so we were good to go. Our first rhythm check showed the patient was in asystole, as expected.

The protocol for an asystolic arrest is to give three rounds of epinephrine, each ten minutes apart, and if no change after 30-40 minutes we can pronounce death in the field and discontinue resuscitation efforts. It was clear this was the route the call was going. I administered the first round of epi as the ambulance arrived and took over managing the patients airway and dropping in an et tube.

We all agreed that this was pretty much going to be a three rounds and out call and there were no other treatments to add to the protocol we were working with. I did ask one of the medics to check a blood sugar for me just to rule it out. Turns out his sugar was very high, in the 400s, despite us being told he was not diabetic. This didn't change the course of treatment though may have been indicative of a metabolic reason for the arrest.

At the next rhythm check there was some electrical activity on the heart monitor but no pulse (pulseless electrical activity or PEA). Still no change in treatment and that can often happen as a side effect of the medications we were giving. We call them Epi beats. They say with enough epi you can get electical activity from a rock. After ten minutes I administered the second dose of Epi. It's always an odd part of the code when the machine is doing most of the work, all procedures are in place, and you have ten minutes until you can give the next drug. It seems like an eternity of standing around doing nothing. I went ahead and drew up the next dose of Epi for when the ten minutes was up.

But...

After another two minutes of cpr we paused for the next rhythm and pulse check. To all of our surprise, the medic said, "I've got a pulse." 

What?!?

The monitor confirmed a consistent sinus rhythm tracking with the pulse he was feeling. The patient still was not breathing on his own so the rescue breathing continued as we slid him onto a tarp and moved him to the gurney to head to the hospital. 

I jumped on board as a rider and took over rescue breathing. A reassessment of vitals showed a strong regular pulse, a more than sufficient blood pressure, and (probably due to the amount of fluid we'd given through the IO) a blood sugar now in the high 200s. It was about a ten minute ride to the hospital during which there was nothing to do but monitor the patient and breathe for him. The ambulance medic and I both marveled at the turn of events and how neither of us thought this call was going in this direction at any point.

The patient was delivered to the ER and their staff took over from there. He still had a good blood pressure and pulses but was still not breathing on his own. Based on the 20 plus minute downtime I wouldn't expect him to come out of this neurologically intact and if he does survive he's going back to that hoarder house which is no place to be cared for or to recuperate and get healthy. But, we did our job and executed all of our procedures pretty seamlessly, worked well as a team, and essentially re-animated the dead (for a little while at least). 

I doubt I will find out what the ultimate outcome ends up being for this patient and whether his resuscitation will have turned out to be a good thing or a bad thing. But it's always interesting to see the protocols and procedures work as intended and (for good or bad) be able to restart a heart, especially without defibrillation. It certainly changes the tone of the resuscitation in the end as well.

I'll Tumble For Ya

As my station is one of the water rescue houses, in addition to the dispatch radio, we monitor the coast guard radio. This radio is down the hall at the other end of the station so sometimes we just hear snippets of broadcasts or static filled conversations.

Today I heard what sounded like a frantic young woman's voice coming over the radio but couldn't tell what was being said. I went down the hall and turned up the coast guard radio so I could copy down the traffic and see if we had a water rescue on our hands. To my surprise the voice came over the dispatch radio repeating the same message and still with a distinct sense of urgency, "medic 4752, we've been t-boned in the intersection of Lewis and Howard and the ambulance flipped on its side".

Wow, an ambulance struck in an intersection and sent flying? I hope no one was in it.

                               

I called out to the crew, "Holy crap! Are you guys hearing this?". I got no response so I walked down to the kitchen to fill them in. As I got some distance from the radio I heard one of our other rigs asking dispatch if that was the ambulance that just left with their patient. I didn't yet know the importance of that question.

In the kitchen I filled the crew in on what I'd heard and we grabbed a portable radio to listen in on the call via the tac channel. Our crews had a quick response and we started hearing odd bits of radio traffic, "Engine 44 we have your firefighter on our tailboard". We listened for a while, but there wasn't much info coming over the radio and it sounded like, whatever the call was, it was winding down despite multiple patients being transported.

But then info started to trickle in via texts and radio and other sources that one of our guys had been riding in to the hospital with the ambulance and was hurt in the crash.  This brought the portent of the previous radio traffic asking which ambulance it was into clear understanding. That must have been a horrible feeling for that captain as he realized what had happened. Those two crews who were on the initial medical call were the first ones to respond to the crash. I can only imagine what that long three minute ride must have been like for them.

Then the tones went off in our station and we were dispatched to that same intersection.
What?
We were then informed that we were needed to stand by in place of the original engine until the investigation and clean up was done at the scene. The crews who performed the extrication and rescue of all involved in the wreck were headed off to a CISD (critical incident stress debriefing) to make sure they were doing okay.

The scene was a mess still and we still didn't have all the information about what exactly had happened. Analyzing the accident scene, looking at the vehicles, and talking to the chiefs on scene we started to piece it all together:

Initially, Engine 44 and our rescue unit had responded to a code blue (cardiac arrest). When they arrived they found family members giving cpr to an elderly patient. They took over cpr, started an IV, and gave a couple of rounds of meds and ended up getting pulses back at some point (or so I believe but can't confirm). I don't know if the patient was breathing on their own or not but I understand that their heart was possibly beating. They loaded the patient into the ambulance and took one of the firemen with them for assistance en route to the hospital.

They were headed down a major street on the way to the freeway and were crossing a large intersection when they were struck on the passenger side by a car who continued through the intersection. Witness reports state that the ambulance had lights and sirens going and that while other vehicles pulled over this car sped up to try to make it through. The investigation, traffic cams, and the black box from the ambulance will eventually tell the whole story but it sounds like the ambulance was doing the right thing. I certainly hope so.

The force of the impact and the top heavy nature of the ambulance sent it over on its side and sliding across the intersection. The driver was trapped but conscious and able to radio in the accident and their exact position. That got our crews moving and to the scene quickly.
In the meantime a rush of bystanders flocked to the ambulance to try and help get people out. The drivers door was on the ground and the back doors jammed. Our firefighter (with what we later learned were two broken ribs and a large gash to his head) was able to climb out the side door which was now the roof. No access could be made back into the ambulance and he wound up rendering medical care to the driver of the car that had hit them.

From the look of the ambulance when we arrived I guessed that when the fire crews got on scene they cut the windshield out of the ambulance to get to the driver and used the rescue tools (jaws of life) to pry open the rear doors and get the other medic and the patient out. The patient did not survive (assuming they was alive in the first place). Both ambulance crew members had only minor injuries thankfully and our firefighter had moderate but non life threatening injuries and was patched up and released from the hospital pretty quickly. We were told he was in good spirits and doing well shortly after. Adrenaline is an amazing thing.

We remained on scene through the entire investigation (which took a couple of hours) and the righting of the ambulance (which was impressive in its own right - no pun intended) and removal of both vehicles from the roadway. Even seeing what we could inside the ambulance from where our engine was parked you could see what a nightmare it must have been. The gurney had broken loose from its mount and was upside down, equipment was thrown about everywhere (oxygen bottles, two heavy cardiac monitors, etc). It's incredible that the crews weren't hurt worse. And of course there was no way to continue life saving measures on the original patient until the extrication was done and I'm sure at that point it was too late. The question remains if the patient died because of the crash or from her original heart failure. That will become an important legal question and this mess is not likely to go away anytime soon. The investigation and lawsuits could be intense.

The poise and control of all the emergency crews was certainly impressive and they should all be commended. I'm glad they sent the responding engines to a CISD after. Given the nature of these guys and the fact that our firefighter was okay I doubt any of them went home after and they probably continued to work and do their jobs but I'm glad they all had an opportunity to talk about it and were given the option to take care of themselves as well. It could be that the department would send them home anyway, which I believe would be advisable.

Definitely a shit show and one we will hear much more about in the coming months I have no doubt.

PSA: If you see an emergency vehicle with lights and/or sirens on pull to the right and come to a complete stop. If you see other vehicles pulling over to the right and stopping and don't yet see or hear the emergency vehicle...still pull to the right and come to a complete stop. Thank you.

Fire Family

There is no question that emergency personnel see a lot of horrible things. I certainly have a handful of calls and images that will never leave my head. Although I also have plenty of good ones too. We see people often on their very worst day. One of the ways we cope with that is knowing that we are the helpers. We are the ones who are trying to make it better or easier and most of the time we succeed, even if not to the level we aspire to. Even when the outcome isn't what we hoped for we know that we gave it all we could and in the aftermath continued to help in whatever way we can.

But it's not just the ones who call 9-1-1 that we see go through awful events in their lives, it's each other. Unlike any other job we live with our coworkers. A third of our lives are spent together. Our lives are often shared on a level that most won't experience in their jobs. I've seen countless divorces (including my own). I've seen guys lose spouses, parents, and even children. I've seen guys burnout and guys muster up the courage to go through rehab. I've seen guys battle cancer (including my own to a degree); I've seen guys lose that battle too. I've seen guys struggle with injuries (my own included here too) and fight to recover and come back from them. I've seen guys retired out early due to injury wonder what they will do now.

What I've never seen in my career is someone not being supported in whatever they are going through. If an effort is made to reach out for help, someone will be there to grab that hand. Guaranteed. You just have to be able to ask which may be the hardest task we will ever undertake.

The fire service is called a family and we refer to each other as brothers and sisters. And though I may not be close enough to a lot of people to mean that with all of it's literal sincerity, there are some I hold that dear. But in a time of crisis, those labels hold true, for all of us.

The issue of mental health, emotional fatigue, and ptsd in the fire service has become a much bigger topic in the last several years. In my career we have always had the option of CISD (critical incident stress debriefing) after harrowing calls if it's needed. But again, being the one to say they need help or something extra is very hard to do. Suicide rates amongst emergency service personnel are very much on the rise. But even that still seems abstract...until it hits close to home. I know the stats. I understand the whys. But I didn't know how it would feel, the questions it would raise, the hole it would leave.

Brothers. Sisters. Family.

We share a good portion of our lives, but you can never really know what someone is going through inside. No matter how close you are.
So, how do you help? That's what we do, what we chose to do with our lives, and what we want to do, help. I don't have an answer to that question unfortunately. Other than continue to check in with each other. Always say you're there to help if needed. I think we all know it, but actually say it. The more a thing is repeated the more it becomes cemented in our brain. And the simple act of caring, reaching out, can make a huge difference.

I once had a member call me out of the blue to let me know he was available to me if I needed anything because he'd heard I was going through a rough time. That's amazing. It turns out he had me and another guy mixed up but it didn't matter, I still felt so grateful that he took the time to reach out and would have been there for me if I did need help. And I know now that if I ever need to I can go to him with anything. Experiencing that in a time when I may not have needed it, as opposed to mid-crisis, boosted my spirits immensely just knowing that support was available.

I want to express my deepest thanks and admiration to all those in my department who have gone through the CISD training, peer counseling training, grief support training, our chaplains, or anyone who puts themselves out there as a go to for anyone who feels that they are struggling. Your services and time may be invaluable, so thank you.

And to anyone who is struggling please remember that you can come to ANY of us at anytime. Fire stations are staffed 24/7, you can always reach someone. And you are welcome to call me or anyone else at anytime and we will do everything we can to assist you.

You are family.

Hustle

So this post isn't really about firefighting. It's just about go getters, customer service, and a positive attitude.

I was working overtime the other day in a different district than my own. The captain was on overtime too so we decided to eat out and try a new place neither of us had been to before.
We pulled up in front of the place and noticed that there was a pretty decent line inside. We figured we'd give it a shot anyway.  The line was almost out the door and we just fit inside with the doors at our back. The place seemed pretty hoppin' which was a good sign. We got a couple "Oh hellooo firemaaan" from the ladies in front of us as they primped their hair (directed at my captain and young firefighter no doubt) and I saw my captain waving off one of the workers behind the counter. A young man with a great big smile and a lot of great energy had signaled to him to see if he could just get our order going. We had no issue with waiting in line so politely declined. As we got closer to the register the ladies in front of us offered to let us go ahead as well and we again declined. We began chatting with the young man behind the counter about how it seemed busy.
"You think this is busy?1? Oh it gets way more hoppin' than this."
We chatted a bit about the nature of having to bail on food or shopping or meals in our job and just as we stepped up to the register to order we got toned out for a medical call.
We waved and bailed out of line and headed out to the medical.

After the call we debated going back and having to wait in line again but decided to give it another try. As we parked in front of the place we noticed the line was out the door this time. We decided to stick it out and had just gotten off the rig when we got banged out for a structure fire. We grabbed our gear, changed real quick, and leapt back on the engine. As we were pulling out I saw the young man with a clipboard in his hand coming out of the restaurant and calling to us. I think he was offering to take a to-go order for us. There was no time to wait though and we pulled out with lights and sirens to the fire.

The fire was in the next district over and when we were just about a block away from the scene we got cancelled by the first due company. It was just an outside fire pit. False alarm.

Decision time.

Do we try one more time or get out of dodge and back closer to our home station and grab something there? Or do we head back again? To my surprise the captain said let's give it one more shot. So we returned, got out of our gear, and headed over.
This time as we were crossing the parking lot to get in line the young man was waiting for us out in front with his clipboard ready.
"Third time's the charm!" I called out to him.
"Oh yes sir, it is. What can I get for you gentlemen?", he said with that big smile.

We placed our order and he ran it inside, brought us our drink cups and made sure we were taken care of. When my captain came back from paying he told me the kid had given him a big discount which he tried to refuse. He wound up putting about $25 in the tip jar instead and told the kid if he was ever interested in the fire service to come see us. He said, "Oh most definitely!"

We got our food and got back on the rig talking about how that kid was going to be going places and how you just don't see that kind of hustle, attitude, and joy in the workplace much anymore.
We were driving away and had got about a block from the restaurant when the captain said "Wait. Wait. Hold up!" We stopped the rig and I could see him looking back out the window and I figured something had happened or we were getting flagged down by somebody on the street. That's when I saw the kid running down the street after us calling out to us that he forgot one of our sandwiches in the bag!
He chased the fire engine down for a block and a half!!

We pulled into a parking lot and the captain walked back with him to the restaurant and got his food.
He returned even more impressed.

Needless to say we were all duly impressed. We need more of that guy in the world.

Dressed For Success

Let's revisit, for a minute that "does anybody really care what we wear" debate that comes up all the time regarding uniform policies. This tour, I responded to two separate calls in a wetsuit.

 

We were out for our weekly rescue boat training and just as we were about to launch, a medical call came in that we were in the best position to take. We had driven the engine down with us in addition to the boat so we were able to respond, but I was dressed to swim with wildland pants over my springsuit and I wasn't going to take the time to change.

The call turned out to be for a woman on the grounds of the adult school who was sans pants and masturbating in public. Hooray. When we arrived we found a woman, fully clothed, walking across the lawn who then proceeded to lie down right where she was when she saw us coming. We approached and made contact with the patient who said she was here with her father. The only man in sight was sitting at the picnic table about fifty feet away. He looked to be about twenty years younger than her so I assumed she was making that part up. The man then got up, approached us, and identified himself as her father. Turns out she was just so haggard from hard living that she looked worn far far far beyond her years. She had no medical needs and her father agreed to take her home for the day, reign her in, and keep her out of trouble. This seemed like the best solution so we were able to leave it at that.

We returned to the dock and did our boat thing for a while. We ended the training session with some victim removal exercises with me being pulled repeatedly from the water into the boat.

As soon as we were done and got back on shore we got toned out for another medical call. I threw my wildland pants back on and off we went, this time with a decidedly still wet wetsuit on underneath.

This time we responded to one of the most stubborn diabetic patients ever. Well one of them anyway. The patient was alert and oriented but with a very high blood sugar and a couple other issues going on as well.  They flat out adamantly refused to go to the hospital. Family had called 9-1-1 not the patient. Now low blood sugar is something we can treat in the field. High blood sugar requires the hospital. We could not force this person to go to the hospital or by ambulance but the family was very insistent. We stayed on scene for quite some time attempting to reason with the patient and offer all sorts of options, deals, etcetera to get them to go. All this while I slowly soaked through my shirt and pants. No one seemed to notice or care (or at least they didn't say anything) being too preoccupied with the frustrating situation at hand.

So, I am still inclined to say that, all in all, it doesn't matter what we wear on calls as long as it's the right gear for the job and we still look and behave professionally.

It just so happened that we ended the night by responding to a sheared hydrant with no shut off to be found anywhere and I wound up thoroughly soaked again by the geyser of water flowing from this thing. Kind of wish I'd been in a wetsuit then instead of turnouts.

TB Or Not TB...That Is (Truly) The Question

Every once in a while in this job you get a scary moment. I don’t mean a fire or a threat of personal danger or injury, I mean a dark cloud, ominous, oh crap, scare.

We responded to a report of a patient feeling dizzy. See? Sounds ominous and scary already doesn’t it?

There turned out to be a few factors that added to the difficulty level of this call when we arrived. First, there was a bit of a language barrier. The patient spoke broken English but was difficult to understand. Secondly, his wife was of no help and after letting us in she disappeared to the living room which reeked of dog and unkempt living, which was the third problem.

The patient himself was in the family room using a walker to get around when we found him. He said he was feeling dizzy and I told him to have a seat on the couch so we could check him out. He tried to maneuver backwards to the couch but the walker hung up on something and he tumbled backwards, landing (fortunately) on the couch unharmed. Not a great start though.

Our evaluation showed that our patient was pretty warm to the touch although not truly feverish, he was dizzy and stated he had thrown up. While taking vitals and checking his blood sugar he coughed a little bit though otherwise he didn’t seem to be what we call “big sick”. He was not a great historian about his medical history or medications he was taking so the captain went to the kitchen to try and get some info from the wife.

Our ambulance company arrived and one of the medics went to join the captain in the kitchen to help sort out the medication question. At this time the patient said he felt sick and needed something to throw up in. We gave him an emesis bag and he began to vomit and cough into it. It wasn’t a copious amount but it was a decent amount of blood thrown up into the bag.

It was about this time that the ambulance medic came back in from the kitchen holding a pill bottle. He asked the patient what he was taking this medication for. It was a powerful antibiotic. It took a minute to sort it out but we finally determined it was for TB.

Crap.

So we’d been in a smelly house with a patient who was coughing and/or throwing up blood and NOW we find out he has tb? The ambulance crew put a mask on the patient and themselves to load him up for the trip to the hospital. We were already outside and away from the patient now but the medic came back to tell us he would call us from the hospital when they know the patients status so we can figure out what to do.

We rode back to the station in that charged eerie silence of worried people. Back at the station we began looking up the protocol for exposures and whether what we had would be something that would require testing or treatment.

We all went and took showers and shortly after that we heard over the radio that our ambulance was going “out of service - administrative”. Ohhhhhh that can’t be a good sign. We let the captain know what we had heard and after filling out the exposure reports we decided to head over to the hospital to find out where things stood.

The ambulance and crew were still in the parking lot and came to meet us right away. The first thing the medic said was “good news”. What? Really?
The patient was on antibiotics for tb but it was latent tb possibly from an old vaccine. He also had an unrelated GI issue that was causing the coughing and vomiting blood.

This was all incredibly relieving news.

The whole incident had taken place over the course of an hour or hour and a half but it was still harrowing. So many awful thoughts go through your head: health, family, career...where do they all stand? I’ve only had to be treated for a potential exposure once before in my career and that is one time too many.

That's What Happens When You Get Mandoed

Well, I suppose I was due. I hadn't been on a nasty wreck in a long time. It just doesn't happen in my district very often. So, of course, this happened when I was working a mandatory overtime. And even at that the rig I was on was covering in at a different station so I was out of place twice.

The call came in for an auto accident at an intersection quite a ways down a two lane road that led into a neighboring jurisdiction. It was reported that someone was trapped in a vehicle. It took a little while driving until we found the wreck.

As I pulled up to the scene we could see a chp officer yanking on the damaged drivers side door of one of the vehicles trying to get it to open. It appeared that one driver had drifted over the line while coming around a bend on this two lane road and had run head on into the other car.

With CHP and bystander vehicles stopped in this small space we couldn't really get a good view of the other car or the true extent of the damage. We got out and my firefighter started to grab the extrication tools so we could free the one trapped victim we did know about and of course stop the CHP officer from continuing to rock and shake the vehicle with the injured driver in it regardless of his good intention.

As I came around the back of the engine I was met by a man who was holding a bloodied and dazed two year old girl in his arms. An ambulance medic was holding manual C-spine and a firefighter from the neighboring jurisdiction was walking beside them. Despite the fact that the girl did not look in good shape I was encouraged by the fact that apparently an ambulance and another fire engine were already on scene. Although if I had really thought about it I would have wondered why the girl wasn't being taken to the ambulance and instead was being carried to us at the back of my engine. But I was a little more focused on what we were going to do for this kid.

I was told that she was in a car seat in the rear of the vehicle but that was all we knew. She had a bloody nose and mouth, unequal and non reactive pupils, was staring blankly ahead, and was unresponsive to anything we did. We set up to suction her mouth and found her jaw clenched down tight as well. None of these are good signs. The kid obviously had a pretty major head injury.

To add to the confusion, the man was just a bystander and not involved in the accident at all. So....why was he holding someone else's kid? And where was the parent or driver?

Turns out that the ambulance medic holding c-spine was just coming off duty in his own car and still in uniform when he encountered the accident and stopped to help. The other firefighter on scene had the same story so we actually didn't have any other help on scene. Just then however, Truck 15 arrived and went to work on the extrication which was pretty simple actually. Our first ambulance arrived right after that.

We knew this kid was critical and one of us would be riding into the hospital with the ambulance. My firefighter was also a medic and not a driver so he agreed to go with the ambulance. Fortunately for us the off duty ambulance medic said he would go ahead and ride in with her which left us free to help with other patients on scene. He left his keys with us and when all was said and done we drove his car back to the station with us so he could pick it up there.

Once the girl was loaded and secured on the ambulance and they had taken off I turned my attention to the rest of the scene as our second ambulance arrived. The truck crew had the drivers door off already and the patient assessed - multiple fractures at least but alert, oriented, and pretty calm considering. They were waiting for the ambulance before they took her out of the vehicle so their engineer and firefighter had moved on to the third patient.

This was the driver of the first car and presumably the mother of the kid. She was laying on the ground and the crew, with assistance from yet another off duty hcp (a nurse), were cutting her clothes off and getting ready to secure her to a backboard. I helped them get her in full c-spine precautions and loaded up for the third ambulance when it arrived. I also got an IV established with the nurse handing me tape and other supplies as I worked.

It's awfully nice to have professional help you can actually count on helping out on scene. This call could really have gone sideways if the patients were flipping out and there was no help around and if our other resources hadn't arrived as quickly as they did.

As it was, the husband and father of our two patients arrived on scene and he was understandably pretty worked up. I ended up with the job of filling him in on what was happening with his wife and daughter and keeping him calm. He was collected enough to understand and devise a plan for where to go and how to get there safely. Tough spot considering his wife was going to one hospital and his daughter to another. Where do you go first? We got him sorted out and calm, all patients off to hospitals with their ambulances, bystanders and helpers thanked, the cars moved, the road reopened, and were able to return to quarters.

Still...there was the girl. It's part of the job of course and, all in all, the rest of the call went very well and smoothly but it does suck when you just know a patient is going to have a bad outcome. When the medic came back to pick up his car he said they had to divert to a closer hospital because they couldn't secure her airway due to her jaw being clenched shut. A doctor got on the ambulance and got the girl was intubated using sedation to loosen her jaw and allow for tube placement. They were then able to continue on to a children's trauma hospital.

It's rare that we get any follow up on our patients nowadays with tighter HIPPA laws and all, but a month or so later I worked with that firefighter again and he said he ran into the ambulance crew and they had just learned that the girl left the hospital with no deficits and neurologically intact. She had some seizures in the hospital and may continue to have them periodically throughout her life but she has no permanent or debilitating brain damage.
This really blew me away as I hadn't expected to hear anything like that or even to get any news of this patients outcome. I was quite surprised but definitely relieved. It's nice to get good news now and again.