{"id":4446,"date":"2023-12-31T09:00:00","date_gmt":"2023-12-31T09:00:00","guid":{"rendered":"https:\/\/melange.ink\/?p=4446"},"modified":"2024-03-31T04:20:30","modified_gmt":"2024-03-31T04:20:30","slug":"christmas-crash","status":"publish","type":"post","link":"https:\/\/melange.ink\/index.php\/2023\/12\/31\/christmas-crash\/","title":{"rendered":"Christmas Crash"},"content":{"rendered":"\n<p class=\"has-text-align-right\"><sup><em><a href=\"https:\/\/stocksnap.io\/photo\/antique-books-8LWW70V4KC\" target=\"_blank\" rel=\"noreferrer noopener\">Featured image<\/a>: Accident scene image<\/em><\/sup><br><sup><em>provided by author (dated 2022)<\/em><\/sup><\/p>\n\n\n\n<p><\/p>\n\n\n\n<p><\/p>\n\n\n\n<h6 id=\"from-the-melangeoccasional-journal-of-health\" class=\"wp-block-heading\">From The <em>M\u00c9LANGE<\/em><br><em>Occasional Journal of Health <\/em><\/h6>\n\n\n<div class=\"pk-dropcap pk-block-bg pk-dropcap-bg-inverse pk-callout\">D<span style=\"font-size: 24pt;\">Unit 5153 is the first on scene<\/span>. <span style=\"font-size: 18pt;\">We scan the situation in the ditch on the southwest corner of TX\u00a0289 and FM 902.<\/span><\/div>\n\n\n<p>&#8220;Allegiance 5153 to Grayson dispatch. We&#8217;ve got\u2026 two vehicles, one truck on its side, one car with significant intrusion, apparent rollover\u2026 bystanders attempting extrication, one patient entrapped, multiple bystanders. We&#8217;ll need additional units, and a helicopter on standby based on mechanism.&#8221;<\/p>\n\n\n\n<p>There&#8217;s some good news: We have daylight, it&#8217;s only 4 p.m. this Christmas day. The trapped patient in the crushed car is screaming bloody murder, which means she has a patent airway, and I can leave the intubation kit in the bus. For now. Fire trucks and police cars begin to arrive, and I&#8217;ve zeroed in on our entrapped female, the highest acuity patient based on first impressions. I had put on the day-glow vest <em>en route<\/em>. I get out, take my ceremonial Zen breath then snatch the scene bag from the back of the box before walking to the car.<\/p>\n\n\n\n<div class=\"wp-block-group alignright\"><div class=\"wp-block-group__inner-container is-layout-constrained wp-block-group-is-layout-constrained\">\n<figure data-wp-context=\"{&quot;imageId&quot;:&quot;6a06ff1bddbec&quot;}\" data-wp-interactive=\"core\/image\" data-wp-key=\"6a06ff1bddbec\" class=\"wp-block-image size-large wp-lightbox-container\"><img loading=\"lazy\" decoding=\"async\" width=\"576\" height=\"1024\" data-wp-class--hide=\"state.isContentHidden\" data-wp-class--show=\"state.isContentVisible\" data-wp-init=\"callbacks.setButtonStyles\" data-wp-on--click=\"actions.showLightbox\" data-wp-on--load=\"callbacks.setButtonStyles\" data-wp-on-window--resize=\"callbacks.setButtonStyles\" src=\"https:\/\/melange.ink\/wp-content\/uploads\/2024\/03\/2014-11-05-16.18.37-576x1024.jpg\" alt=\"Side of ambulance and overturned automobile on a highway, wet with rain, under an overcast sky, with approaching cars, headlights shining through the mist\" class=\"wp-image-4617\" srcset=\"https:\/\/melange.ink\/wp-content\/uploads\/2024\/03\/2014-11-05-16.18.37-576x1024.jpg 576w, https:\/\/melange.ink\/wp-content\/uploads\/2024\/03\/2014-11-05-16.18.37-169x300.jpg 169w, https:\/\/melange.ink\/wp-content\/uploads\/2024\/03\/2014-11-05-16.18.37-768x1365.jpg 768w, https:\/\/melange.ink\/wp-content\/uploads\/2024\/03\/2014-11-05-16.18.37-864x1536.jpg 864w, https:\/\/melange.ink\/wp-content\/uploads\/2024\/03\/2014-11-05-16.18.37-1152x2048.jpg 1152w, https:\/\/melange.ink\/wp-content\/uploads\/2024\/03\/2014-11-05-16.18.37-380x676.jpg 380w, https:\/\/melange.ink\/wp-content\/uploads\/2024\/03\/2014-11-05-16.18.37-800x1422.jpg 800w, https:\/\/melange.ink\/wp-content\/uploads\/2024\/03\/2014-11-05-16.18.37-1160x2062.jpg 1160w, https:\/\/melange.ink\/wp-content\/uploads\/2024\/03\/2014-11-05-16.18.37-scaled.jpg 1440w\" sizes=\"auto, (max-width: 576px) 100vw, 576px\" \/><button\n\t\t\tclass=\"lightbox-trigger\"\n\t\t\ttype=\"button\"\n\t\t\taria-haspopup=\"dialog\"\n\t\t\taria-label=\"Enlarge\"\n\t\t\tdata-wp-init=\"callbacks.initTriggerButton\"\n\t\t\tdata-wp-on--click=\"actions.showLightbox\"\n\t\t\tdata-wp-style--right=\"state.imageButtonRight\"\n\t\t\tdata-wp-style--top=\"state.imageButtonTop\"\n\t\t>\n\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"12\" height=\"12\" fill=\"none\" viewBox=\"0 0 12 12\">\n\t\t\t\t<path fill=\"#fff\" d=\"M2 0a2 2 0 0 0-2 2v2h1.5V2a.5.5 0 0 1 .5-.5h2V0H2Zm2 10.5H2a.5.5 0 0 1-.5-.5V8H0v2a2 2 0 0 0 2 2h2v-1.5ZM8 12v-1.5h2a.5.5 0 0 0 .5-.5V8H12v2a2 2 0 0 1-2 2H8Zm2-12a2 2 0 0 1 2 2v2h-1.5V2a.5.5 0 0 0-.5-.5H8V0h2Z\" \/>\n\t\t\t<\/svg>\n\t\t<\/button><figcaption class=\"wp-element-caption\">Another automobile collision, dated November of 2014. Photo provided by author.<\/figcaption><\/figure>\n<\/div><\/div>\n\n\n\n<p>Two bystanders are vainly trying to pry the passenger door open, and two firefighters arrive in short order, ushering them to the \u201cbystander pen&#8221; (in this case, just a tree that\u2019s clear of the debris field) and setting out the <span class='tooltipsall tooltip_post_id_custom_94e2d058e09398cc44788d9f27be6fe2 classtoolTipsCustomShortCode'>extrication<\/span><script type=\"text\/javascript\">jQuery(\"document\").ready(function(){ toolTips('.tooltip_post_id_custom_94e2d058e09398cc44788d9f27be6fe2','<span style=\\\"font-size: 14pt; font-family: junicode-regular; line-height: 110%;\\\">Use of high powered \\\"heavy rescue\\\" equipment to stabilize, cut, or otherwise displace material such as automobiles, industrial equipment, architecture, large animals or trees, etc., that have crushed or otherwise trapped a patient. Frequently used simply to mean removing a patient from a dangerous environment safely, with or without tools.<\/span><br\/><span style=\\\"font-family: junicode-regular; font-size: 12pt; line-height: 110%;\\\"><em>(Definition provided by author.)<\/em><\/span>','0','extrication'); });<\/script> equipment. The passenger side is crushed in, and the roof is smashed, with busted-out windows all around. It appears the car was t-boned at high speed, rolled over, and landed wheels-down at a shallow angle in the ditch. The driver &#8220;self-extricated&#8221; before we arrived and is triaged into the \u201cwalking-wounded pen\u201d (the <em>other<\/em> tree\u2026 over <em>there<\/em>).<\/p>\n\n\n\n<p>The driver&#8217;s side door, while damaged, opens enough to grant access.<\/p>\n\n\n\n<p>&#8220;My name is Brad, I&#8217;m a paramedic for the county. Can you hear me, ma&#8217;am.&#8221;<\/p>\n\n\n\n<p>&#8220;Yes,&#8221; she pants, &#8220;my leg fucking hurts, it&#8217;s fucking crushed.&#8221;<\/p>\n\n\n\n<p>I dust the gravel of broken windscreen from the driver&#8217;s seat and crawl in. A firefighter has arrived behind me and asks me what I need.<\/p>\n\n\n\n<div class=\"wp-block-group alignleft\"><div class=\"wp-block-group__inner-container is-layout-constrained wp-block-group-is-layout-constrained\">\n<figure data-wp-context=\"{&quot;imageId&quot;:&quot;6a06ff1be0c27&quot;}\" data-wp-interactive=\"core\/image\" data-wp-key=\"6a06ff1be0c27\" class=\"wp-block-image size-large wp-lightbox-container\"><img loading=\"lazy\" decoding=\"async\" width=\"612\" height=\"1024\" data-wp-class--hide=\"state.isContentHidden\" data-wp-class--show=\"state.isContentVisible\" data-wp-init=\"callbacks.setButtonStyles\" data-wp-on--click=\"actions.showLightbox\" data-wp-on--load=\"callbacks.setButtonStyles\" data-wp-on-window--resize=\"callbacks.setButtonStyles\" src=\"https:\/\/melange.ink\/wp-content\/uploads\/2023\/12\/BradCowanEMS-40-612x1024.jpg\" alt=\"A white pickup truck overturned in a median with bystanders, dated 2011\/12\/25\" class=\"wp-image-4613\" srcset=\"https:\/\/melange.ink\/wp-content\/uploads\/2023\/12\/BradCowanEMS-40-612x1024.jpg 612w, https:\/\/melange.ink\/wp-content\/uploads\/2023\/12\/BradCowanEMS-40-179x300.jpg 179w, https:\/\/melange.ink\/wp-content\/uploads\/2023\/12\/BradCowanEMS-40-768x1284.jpg 768w, https:\/\/melange.ink\/wp-content\/uploads\/2023\/12\/BradCowanEMS-40-919x1536.jpg 919w, https:\/\/melange.ink\/wp-content\/uploads\/2023\/12\/BradCowanEMS-40-1225x2048.jpg 1225w, https:\/\/melange.ink\/wp-content\/uploads\/2023\/12\/BradCowanEMS-40-380x635.jpg 380w, https:\/\/melange.ink\/wp-content\/uploads\/2023\/12\/BradCowanEMS-40-800x1338.jpg 800w, https:\/\/melange.ink\/wp-content\/uploads\/2023\/12\/BradCowanEMS-40-1160x1940.jpg 1160w, https:\/\/melange.ink\/wp-content\/uploads\/2023\/12\/BradCowanEMS-40-scaled.jpg 1531w\" sizes=\"auto, (max-width: 612px) 100vw, 612px\" \/><button\n\t\t\tclass=\"lightbox-trigger\"\n\t\t\ttype=\"button\"\n\t\t\taria-haspopup=\"dialog\"\n\t\t\taria-label=\"Enlarge\"\n\t\t\tdata-wp-init=\"callbacks.initTriggerButton\"\n\t\t\tdata-wp-on--click=\"actions.showLightbox\"\n\t\t\tdata-wp-style--right=\"state.imageButtonRight\"\n\t\t\tdata-wp-style--top=\"state.imageButtonTop\"\n\t\t>\n\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"12\" height=\"12\" fill=\"none\" viewBox=\"0 0 12 12\">\n\t\t\t\t<path fill=\"#fff\" d=\"M2 0a2 2 0 0 0-2 2v2h1.5V2a.5.5 0 0 1 .5-.5h2V0H2Zm2 10.5H2a.5.5 0 0 1-.5-.5V8H0v2a2 2 0 0 0 2 2h2v-1.5ZM8 12v-1.5h2a.5.5 0 0 0 .5-.5V8H12v2a2 2 0 0 1-2 2H8Zm2-12a2 2 0 0 1 2 2v2h-1.5V2a.5.5 0 0 0-.5-.5H8V0h2Z\" \/>\n\t\t\t<\/svg>\n\t\t<\/button><figcaption class=\"wp-element-caption\">Another (different) Christmas crash, dated Dec. 25th 2011 at 2:45pm. Photo provided by author.<\/figcaption><\/figure>\n<\/div><\/div>\n\n\n\n<p>&#8220;<span class='tooltipsall tooltip_post_id_custom_1c53c457ce9e48a307ad7604d31ec27e classtoolTipsCustomShortCode'>C-collar<\/span><script type=\"text\/javascript\">jQuery(\"document\").ready(function(){ toolTips('.tooltip_post_id_custom_1c53c457ce9e48a307ad7604d31ec27e','<span style=\\\"font-weight: 400; font-size: 14pt; font-family: junicode-regular; line-height: 110%;\\\">Cervical spine immobilization collar. The small bones that join the skull to the spinal cord are very delicate and vulnerable to trauma. After a major trauma, the cervical spine is immobilized as a priority to prevent paralysis.<\/span><br\/><em><span style=\\\"font-weight: 400; font-size: 12pt; font-family: junicode-regular; line-height: 110%;\\\">(Definition provided by author.)<\/span><\/em>','0','C-collar'); });<\/script>, <span class='tooltipsall tooltip_post_id_custom_00151adcb061ad7084f5c8aa2f4f3b6e classtoolTipsCustomShortCode'>shears<\/span><script type=\"text\/javascript\">jQuery(\"document\").ready(function(){ toolTips('.tooltip_post_id_custom_00151adcb061ad7084f5c8aa2f4f3b6e','<span style=\\\"font-family: junicode-regular; font-size: 14pt; line-height: 110%;\\\">Medical scissors designed with a blunt leading edge and an angled grip intended for quickly cutting off clothes, bandages, seatbelts, etc. without risking cutting-edge contact with skin.<\/span><br\/><em><span style=\\\"font-family: junicode-regular; font-size: 12pt; line-height: 110%;\\\">(Definition provided by author.)<\/span><\/em>','0','shears'); });<\/script>,&#8221; I say. I&#8217;m a bit embarrassed because on a good day, I&#8217;d already have them in hand. He ruffles through the scene bag and delivers them shortly.<\/p>\n\n\n\n<p>The airbags have deployed, so concerns for getting clobbered with a delayed bag ejection are eased.<\/p>\n\n\n\n<p>&#8220;Can you tell me your name ma&#8217;am,&#8221; I say, reaching back for the collar and shears.<\/p>\n\n\n\n<p>&#8220;Jamie,&#8221; she says, pushing back her hair and wiping down a torrent of tears. &#8220;Oh it fucking hurts so bad!&#8221;<\/p>\n\n\n\n<p>&#8220;Ok Jamie. The fire department has to cut open your door to get you out, so we have a little time to help with your pain and get a better idea of how bad you&#8217;re hurt.&#8221; She replies with a peal of crying and a face twisted in terror.<\/p>\n\n\n\n<p>&#8220;You&#8217;re breathing ok, that&#8217;s good. Did you get knocked out? Go unconscious?&#8221; She nods: No.<\/p>\n\n\n\n<p>&#8220;Do you remember what happened?&#8221;<\/p>\n\n\n\n<p>&#8220;It just came out of nowhere, fuck, oh my god, my leg, we got hit by a car, <em>fuck<\/em>.&#8221;<\/p>\n\n\n<p class=\"pk-callout pk-dropcap pk-block-bg pk-dropcap-bg-inverse\">&#8220;I&#8217;m going to put this collar on your neck. It\u2019s a brace intended to keep it stable in case there&#8217;s a spinal injury.&#8221; The usual script just rolls off my tongue as I quickly feel her neck, skull, and orbits. No <span class='tooltipsall tooltip_post_id_custom_41e1dcd5ac5504f8a21dde580ecb8dbc classtoolTipsCustomShortCode'>crepitus<\/span><script type=\"text\/javascript\">jQuery(\"document\").ready(function(){ toolTips('.tooltip_post_id_custom_41e1dcd5ac5504f8a21dde580ecb8dbc','<span style=\\\"font-family: junicode-regular; font-size: 14pt; line-height: 110%;\\\"><strong>Crepitus<\/strong> is the name for crunchy, bone-on-bone grinding, indicative of fracture, often found during <strong>palpating<\/strong> (<em>i.e.<\/em>, gaining information from touch, such as taking a pulse, feeling for rigidity, tenderness, swelling, fever, etc.)<\/span><br\/><em><span style=\\\"font-family: junicode-regular; font-size: 12pt; line-height: 110%;\\\">(Definition provided by author.)<\/span><\/em>','0','crepitus'); });<\/script>, no pain: pleasant surprise. I gather her hair as best I can (it\u2019s a nest of glass and dried blood), slide the collar like a shoehorn under her neck and bend the device back on itself to lock the brace into place.<\/p>\n\n\n<p>&#8220;<span class='tooltipsall tooltip_post_id_custom_397d1696c789107381e64a3e2ed389f7 classtoolTipsCustomShortCode'>Extrication<\/span><script type=\"text\/javascript\">jQuery(\"document\").ready(function(){ toolTips('.tooltip_post_id_custom_397d1696c789107381e64a3e2ed389f7','<span style=\\\"font-size: 14pt; font-family: junicode-regular; line-height: 110%;\\\">Use of high powered \\\"heavy rescue\\\" equipment to stabilize, cut, or otherwise displace material such as automobiles, industrial equipment, architecture, large animals or trees, etc., that have crushed or otherwise trapped a patient. Frequently used simply to mean removing a patient from a dangerous environment safely, with or without tools.<\/span><br\/><span style=\\\"font-family: junicode-regular; font-size: 12pt; line-height: 110%;\\\"><em>(Definition provided by author.)<\/em><\/span>','0','Extrication'); });<\/script>&#8217;s go,&#8221; the firefighter says through what once was a passenger car window.<\/p>\n\n\n\n<p>I look down into the footwell of the passenger side. Her right leg is mangled, but intact. Bleeding appears controlled. The foot itself looks to be clear of the damage \u2014 a Christmas miracle. She&#8217;s cussing and crying enough, I know that odds are good her brain, spine and lungs are uninvolved. Enough to give the thumbs up to the heavy rescue crew.<\/p>\n\n\n\n<p>The pneumatic spreader whines and chugs to life. A firefighter&#8217;s jacket is draped over us as the unholy clamor of buckling steel and pneumatic pressure bite at the door; a rain of glass pitter-patters onto our improvised Kevlar tent. I do a quick head-to-toe: palpate the neck, ribs, extremities, abdomen, what I can reach of her legs. No bleeding; no new yelps of pain in tender spots; no fountains of vomit or blood from brain injury or hidden traumas. Lucky girl.<\/p>\n\n\n\n<p>&#8220;It hurts so fucking bad,&#8221; she cries.<\/p>\n\n\n\n<div class=\"wp-block-group alignright\"><div class=\"wp-block-group__inner-container is-layout-constrained wp-block-group-is-layout-constrained\">\n<figure data-wp-context=\"{&quot;imageId&quot;:&quot;6a06ff1be4033&quot;}\" data-wp-interactive=\"core\/image\" data-wp-key=\"6a06ff1be4033\" class=\"wp-block-image size-full is-style-rounded wp-lightbox-container\"><img loading=\"lazy\" decoding=\"async\" width=\"756\" height=\"1008\" data-wp-class--hide=\"state.isContentHidden\" data-wp-class--show=\"state.isContentVisible\" data-wp-init=\"callbacks.setButtonStyles\" data-wp-on--click=\"actions.showLightbox\" data-wp-on--load=\"callbacks.setButtonStyles\" data-wp-on-window--resize=\"callbacks.setButtonStyles\" src=\"https:\/\/melange.ink\/wp-content\/uploads\/2024\/03\/Resized_20240318_153257.jpeg\" alt=\"Foam-lined box showing vials of medication with green tags and lids hand-labeled with Sharpie\" class=\"wp-image-4624\" srcset=\"https:\/\/melange.ink\/wp-content\/uploads\/2024\/03\/Resized_20240318_153257.jpeg 756w, https:\/\/melange.ink\/wp-content\/uploads\/2024\/03\/Resized_20240318_153257-225x300.jpeg 225w, https:\/\/melange.ink\/wp-content\/uploads\/2024\/03\/Resized_20240318_153257-380x507.jpeg 380w\" sizes=\"auto, (max-width: 756px) 100vw, 756px\" \/><button\n\t\t\tclass=\"lightbox-trigger\"\n\t\t\ttype=\"button\"\n\t\t\taria-haspopup=\"dialog\"\n\t\t\taria-label=\"Enlarge\"\n\t\t\tdata-wp-init=\"callbacks.initTriggerButton\"\n\t\t\tdata-wp-on--click=\"actions.showLightbox\"\n\t\t\tdata-wp-style--right=\"state.imageButtonRight\"\n\t\t\tdata-wp-style--top=\"state.imageButtonTop\"\n\t\t>\n\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"12\" height=\"12\" fill=\"none\" viewBox=\"0 0 12 12\">\n\t\t\t\t<path fill=\"#fff\" d=\"M2 0a2 2 0 0 0-2 2v2h1.5V2a.5.5 0 0 1 .5-.5h2V0H2Zm2 10.5H2a.5.5 0 0 1-.5-.5V8H0v2a2 2 0 0 0 2 2h2v-1.5ZM8 12v-1.5h2a.5.5 0 0 0 .5-.5V8H12v2a2 2 0 0 1-2 2H8Zm2-12a2 2 0 0 1 2 2v2h-1.5V2a.5.5 0 0 0-.5-.5H8V0h2Z\" \/>\n\t\t\t<\/svg>\n\t\t<\/button><figcaption class=\"wp-element-caption\">Medication vials. Photo provided by author.<\/figcaption><\/figure>\n<\/div><\/div>\n\n\n\n<p>&#8220;Ok Jamie, we&#8217;re going to get some pain meds on board while we have a second.&#8221; I realized as I said it that my <span class='tooltipsall tooltip_post_id_custom_4a217607a49e2f56dfe6c871bc2520fd classtoolTipsCustomShortCode'>narc<\/span><script type=\"text\/javascript\">jQuery(\"document\").ready(function(){ toolTips('.tooltip_post_id_custom_4a217607a49e2f56dfe6c871bc2520fd','<span style=\\\"font-family: junicode-regular; font-size: 14pt; line-height: 110%;\\\"><strong>Narcs:<\/strong> Narcotics, but not strictly speaking <em>pharmacologically<\/em> narcotic agents, <em>e.g.,<\/em> morphine or fentanyl, but any Schedule I drug that has a high potential for abuse and is strictly controlled. Currently I have authority to administer ketamine, Versed, Ativan, morphine and fentanyl \u2014 all of which must be keep under lock and key.<\/span><br\/><span style=\\\"font-family: junicode-regular; line-height: 110%; font-size: 12pt;\\\"><em>(Definition provided by author.)<\/em><\/span>','0','narc'); });<\/script> kit is locked up in the ambulance safe. Fuck. My partner Ellen arrives, after triaging the other patients, right in the nick of time. &#8220;I need an IV, Ellen, I gotta grab the narcs.&#8221; I&#8217;d send her, but I&#8217;m the only one with access to the safe.<\/p>\n\n\n\n<p>&#8220;Got it,&#8221; she says, quickly procuring a start kit from the scene bag. I double back to the ambulance, Incident Command spots me and gives me a few words: &#8220;Your bird&#8217;s in the air. <span class='tooltipsall tooltip_post_id_custom_7bde0577281ebdf512418f00be27a78e classtoolTipsCustomShortCode'>LZ<\/span><script type=\"text\/javascript\">jQuery(\"document\").ready(function(){ toolTips('.tooltip_post_id_custom_7bde0577281ebdf512418f00be27a78e','<span style=\\\"font-family: junicode-regular; font-size: 14pt; line-height: 110%;\\\">Landing Zone<\/span>','0','LZ'); });<\/script> established; road&#8217;s shut down. One other patient with a medic. No other ambulances available. You need anything?&#8221; I glance back at the car, the extrication is coming along, good timing. &#8220;I need the stretcher, a <span class='tooltipsall tooltip_post_id_custom_8d4b658cd4f1564ce800759ad64c2cc2 classtoolTipsCustomShortCode'>backboard<\/span><script type=\"text\/javascript\">jQuery(\"document\").ready(function(){ toolTips('.tooltip_post_id_custom_8d4b658cd4f1564ce800759ad64c2cc2','<span style=\\\"font-family: junicode-regular; font-size: 14pt; line-height: 110%;\\\">A six-foot long rigid plastic board designed originally to immobilize a patient\\'s spine, used in combination with a c-collar and \\\"head bed,\\\" a device that holds the patient\u2019s head in place. The board is all plastic, in order to be X-ray transparent. In recent years, studies have shown that backboard use for spinal immobilization is ineffective at best. The device, however, is still frequently used for extrication: removing patients from cars, beds, floors, etc. It is also used to provide rigid support for patients during CPR.<\/span><br\/><em><span style=\\\"font-family: junicode-regular; font-size: 12pt; line-height: 110%;\\\">(Definition provided by author.)<\/span><\/em>','0','backboard'); });<\/script> and a frac bag to patient one.&#8221; A nod of acknowledgment, and I continue to the truck to fetch the Good Drugs. It&#8217;s a real Christmas treat to have so many hands on board. Too frequently, all the gear humping is on me. I return quickly to find Ellen has a beautiful patent line with a pigtail ready for me. The passenger door is off the car, I have a quick look at that right leg, and enter in the driver&#8217;s side again to push 10mg of morphine and a flush.<\/p>\n\n\n<div class=\"cnvs-block-slider-gallery cnvs-block-slider-gallery-1711493074362\" >\n<div\n\tclass='gallery cnvs-gallery-type-slider'\n\tcnvs-flickity=\"init\"\n\tdata-sg-page-dots=\"true\"\n\tdata-sg-page-info=\"true\"\n\tdata-sg-nav=\"true\"\n>\n\t\t\t<figure class=\"gallery-item\">\n\t\t\t\t\t\t\t<a href=\"https:\/\/melange.ink\/wp-content\/uploads\/2024\/03\/2019-11-19-04.00.47-scaled.jpg\">\n\t\t\t\n\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"1160\" height=\"680\" src=\"https:\/\/melange.ink\/wp-content\/uploads\/2024\/03\/2019-11-19-04.00.47-1160x680.jpg\" class=\"attachment-csco-large size-csco-large\" alt=\"Image of a truck on fire in the median of a highway at night.\" \/>\n\t\t\t\t\t\t\t<\/a>\n\t\t\t\n\t\t\t<div class=\"caption wp-caption-text gallery-caption\">Truck fire from another incident, dated November of 2019. Photo provided by author.<\/div>\t\t<\/figure>\n\t\t\t\t<figure class=\"gallery-item\">\n\t\t\t\t\t\t\t<a href=\"https:\/\/melange.ink\/wp-content\/uploads\/2024\/03\/IMAG0173-2-scaled.jpg\">\n\t\t\t\n\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"1160\" height=\"680\" src=\"https:\/\/melange.ink\/wp-content\/uploads\/2024\/03\/IMAG0173-2-1160x680.jpg\" class=\"attachment-csco-large size-csco-large\" alt=\"Image of small aircraft wreckage on grass. Confederate flag on the plane&#039;s vertical stabilizer.\" \/>\n\t\t\t\t\t\t\t<\/a>\n\t\t\t\n\t\t\t<div class=\"caption wp-caption-text gallery-caption\">Wreckage of small airplane, dated October 2011.\n\n(From Ed.: Note the confederate flag on the vertical stabilizer; much like the Confederate States of America themselves, this aircraft suffered a spectacular, humiliating and permanent defeat.)\n\nPhoto provided by author.<\/div>\t\t<\/figure>\n\t\t\t\t<figure class=\"gallery-item\">\n\t\t\t\t\t\t\t<a href=\"https:\/\/melange.ink\/wp-content\/uploads\/2024\/03\/BradCowanEMS-26-scaled.jpg\">\n\t\t\t\n\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"1160\" height=\"680\" src=\"https:\/\/melange.ink\/wp-content\/uploads\/2024\/03\/BradCowanEMS-26-1160x680.jpg\" class=\"attachment-csco-large size-csco-large\" alt=\"Image of ambulance parked next to sidewalk, with two adults and ten children.\" \/>\n\t\t\t\t\t\t\t<\/a>\n\t\t\t\n\t\t\t<div class=\"caption wp-caption-text gallery-caption\">Our author (seated) with a colleague (standing) engaged in community outreach with area children. Photo provided by author.<\/div>\t\t<\/figure>\n\t\t\t\t<figure class=\"gallery-item\">\n\t\t\t\t\t\t\t<a href=\"https:\/\/melange.ink\/wp-content\/uploads\/2024\/03\/2013-05-02-20.34.10-scaled.jpg\">\n\t\t\t\n\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"1160\" height=\"680\" src=\"https:\/\/melange.ink\/wp-content\/uploads\/2024\/03\/2013-05-02-20.34.10-1160x680.jpg\" class=\"attachment-csco-large size-csco-large\" alt=\"Photo of an overturned vehicle on the shoulder of a road at night, headlights still shining\" \/>\n\t\t\t\t\t\t\t<\/a>\n\t\t\t\n\t\t\t<div class=\"caption wp-caption-text gallery-caption\">Another accident, dated may of 2013. Photo provided by author.<\/div>\t\t<\/figure>\n\t\t\t\t<figure class=\"gallery-item\">\n\t\t\t\t\t\t\t<a href=\"https:\/\/melange.ink\/wp-content\/uploads\/2024\/03\/Brad-Cowan-2009-09-21.jpg\">\n\t\t\t\n\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"640\" height=\"266\" src=\"https:\/\/melange.ink\/wp-content\/uploads\/2024\/03\/Brad-Cowan-2009-09-21.jpg\" class=\"attachment-csco-large size-csco-large\" alt=\"Image if school bus partially submerged in a small pond, with large white building in the distance.\" srcset=\"https:\/\/melange.ink\/wp-content\/uploads\/2024\/03\/Brad-Cowan-2009-09-21.jpg 640w, https:\/\/melange.ink\/wp-content\/uploads\/2024\/03\/Brad-Cowan-2009-09-21-300x125.jpg 300w, https:\/\/melange.ink\/wp-content\/uploads\/2024\/03\/Brad-Cowan-2009-09-21-380x158.jpg 380w\" sizes=\"auto, (max-width: 640px) 100vw, 640px\" \/>\n\t\t\t\t\t\t\t<\/a>\n\t\t\t\n\t\t\t<div class=\"caption wp-caption-text gallery-caption\">Submerged school bus, dated November 2009. Photo provided by author.<\/div>\t\t<\/figure>\n\t\t<\/div>\n\n<\/div>\n\n\n<p>&#8220;Jamie, any changes? I have the pain meds here, we&#8217;re gonna take the edge off before we pull you out. Are you allergic to morphine?&#8221;<\/p>\n\n\n\n<p>&#8220;No, uh, <em>fuck<\/em>\u2026 I&#8217;ve never had it, I don&#8217;t know.&#8221;<\/p>\n\n\n\n<p>&#8220;Ok, I&#8217;m giving you morphine. It might make you feel sick, but it will take the edge off. Tell me if you are going to throw up, ok?&#8221;<\/p>\n\n\n\n<p>&#8220;Ok,&#8221; then more reassuring crying. Lucky girl.<\/p>\n\n\n\n<p>&#8220;I&#8217;m going around to the other side to get you out, ok?&#8221; I take the opportunity to cut her seatbelts and brush glass and gravel from her lap.<\/p>\n\n\n\n<p>&#8220;Ok.&#8221;<\/p>\n\n\n\n<p>The backboard, stretcher and frac bag arrive as ordered, and efforts from two firefighters are already underway.<\/p>\n\n\n\n<p>She&#8217;s seated more or less normally in the passenger seat, with the seatback sprung all the way back nearly flat, and her right foot is clear of the crunchy bits. Two field splints get strapped to her leg with gauze.<\/p>\n\n\n\n<p>&#8220;Ok, we&#8217;ll nose the head of the backboard under her butt and bring her out feet first, in-line,&#8221; I say to the firefighters who are already in place, familiar with the technique. Plenty of hands, for a change. Thank you, Santa. We gently get the right leg out from the footwell with much attendant screaming. The other limbs follow swiftly, dressed neatly along the length of the six-foot backboard and secured with 3 seatbelt straps. Collared, splinted, doped and boarded \u2014 fully packaged. We heave the litter onto the cot and hustle her over to the truck.<\/p>\n\n\n<p class=\"pk-callout pk-dropcap pk-block-bg pk-dropcap-bg-inverse\">Alright, now we get started for real. Ellen and I scissor up the length of each pant leg and grab a proper contour splint from the cabinet. &#8220;<span class='tooltipsall tooltip_post_id_custom_7ddd6afdbd52cbc73d0dc48699bf9c5e classtoolTipsCustomShortCode'>Pedal pulses<\/span><script type=\"text\/javascript\">jQuery(\"document\").ready(function(){ toolTips('.tooltip_post_id_custom_7ddd6afdbd52cbc73d0dc48699bf9c5e','<span style=\\\"font-family: junicode-regular; font-size: 14pt; line-height: 110%;\\\">Pulses of the foot. The presence or absence of which, as well as the quality (strong, weak, slow, \\'thready,\\' etc.), is very informative as to the integrity of the vessels of the leg. Absence of pedal pulses in the event of a leg fracture indicates severe injury and the possible need for amputation, as blood flow has stopped along some point of the extremity.<\/span><br\/><em><span style=\\\"font-family: junicode-regular; font-size: 12pt; line-height: 110%;\\\">(Definition provided by author.)<\/span><\/em>','0','Pedal pulses'); });<\/script> present,&#8221; she says, and makes an \u201cX marks the spot\u201d with a sharpie. &#8220;Looks like a <span class='tooltipsall tooltip_post_id_custom_67d2e73e514d3387414d268d92a832f9 classtoolTipsCustomShortCode'>tib-fib<\/span><script type=\"text\/javascript\">jQuery(\"document\").ready(function(){ toolTips('.tooltip_post_id_custom_67d2e73e514d3387414d268d92a832f9','<span style=\\\"font-family: junicode-regular; font-size: 14pt; line-height: 110%;\\\">\\\"Tibia-fibula.\\\" A common fracture involving both bones of the lower leg. A <strong>\\\"closed fracture\\\"<\/strong> (formerly called a \\\"simple fracture\\\") indicates that no bone has protruded from the skin. This is in contrast to an \\\"open fracture\\\" (formerly \\\"compound fracture\\\"), where bone penetrates the skin. Open fractures are considered more serious due to the increased possibility of hemorrhage and partial amputation.<\/span><br\/><em><span style=\\\"font-family: junicode-regular; font-size: 12pt; line-height: 110%;\\\">(Definition provided by author.)<\/span><\/em>','0','tib-fib'); });<\/script>, maybe ankle too, closed fracture, no uncontrolled bleeding.&#8221; There&#8217;s a hint of surprise in her report: Ellen saw how jacked the car was.<\/p>\n\n\n<p>I&#8217;m checking pupils with a penlight and palpating the neck, skull and face again, in case I missed something. Shoulders, clavicles, ribs, hips: stable. Palpate the four abdominal quadrants: soft, non-tender. &#8220;Do you have any medical conditions? Diabetes? Seizures? Surgeries? Is there any possibility you&#8217;re pregnant?&#8221; Brief response: &#8220;No, uh, no.&#8221; Blood pressure cuff, <span class='tooltipsall tooltip_post_id_custom_dbbdc0bdecf3b68bd50ae21b3e9490e5 classtoolTipsCustomShortCode'>4-lead EKG<\/span><script type=\"text\/javascript\">jQuery(\"document\").ready(function(){ toolTips('.tooltip_post_id_custom_dbbdc0bdecf3b68bd50ae21b3e9490e5','<span style=\\\"font-family: junicode-regular; font-size: 14pt; line-height: 110%;\\\">Electrocardiogram. A recording of the electrical signal of the heartbeat. The morphology (shape) of the EKG wave is diagnostic of many dysrhythmias (misfires of the heart\\'s conductivity). Dysrhythmias have effects on blood pressure, among other things, and must be corrected (often with drugs or electrotherapy) and may also be diagnostic as secondary effects of other disease or trauma.<\/span><br\/><em><span style=\\\"font-family: junicode-regular; font-size: 12pt; line-height: 110%;\\\">(Definition provided by author.)<\/span><\/em>','0','4-lead EKG'); });<\/script>, <span class='tooltipsall tooltip_post_id_custom_840b0ef397b8da47d7330d6e87b16b1d classtoolTipsCustomShortCode'>pulse ox<\/span><script type=\"text\/javascript\">jQuery(\"document\").ready(function(){ toolTips('.tooltip_post_id_custom_840b0ef397b8da47d7330d6e87b16b1d','<span style=\\\"font-family: junicode-regular; font-size: 14pt; line-height: 110%;\\\"><strong>Pulse oxymetry<\/strong>; also Pulse ox, SpO2, or O2 Saturation. The use of laser light to measure the percentage of red blood cells in circulation carrying oxygen. A typical healthy SpO2 is 95% to 100%. Below 90% is considered pathological and requires treatment. <strong>Room air (RA)<\/strong> indicates that an SpO2 reading is based on a patient breathing local ambient atmospheric air, as opposed to patients breathing supplemental pure oxygen via a mask or other device.<\/span><br\/><em><span style=\\\"font-family: junicode-regular; font-size: 12pt; line-height: 110%;\\\">(Definition provided by author.)<\/span><\/em>','0','pulse ox'); });<\/script>, recheck the IV site. Looking good Vitals good. Simple trauma. Lucky girl. That car was a crushed beer can.<\/p>\n\n\n\n<p>The ambulance&#8217;s side door opens, and another firefighter medic ushers in the driver of the crushed car, a twenty-something stoner kid. He&#8217;s covered in small abrasions and has blood on his face and hands. A bang at the back doors follows soon after.<\/p>\n\n\n\n<div class=\"wp-block-group alignleft\"><div class=\"wp-block-group__inner-container is-layout-constrained wp-block-group-is-layout-constrained\">\n<figure data-wp-context=\"{&quot;imageId&quot;:&quot;6a06ff1be88c2&quot;}\" data-wp-interactive=\"core\/image\" data-wp-key=\"6a06ff1be88c2\" class=\"wp-block-image size-full is-style-default wp-lightbox-container\"><img loading=\"lazy\" decoding=\"async\" width=\"768\" height=\"1024\" data-wp-class--hide=\"state.isContentHidden\" data-wp-class--show=\"state.isContentVisible\" data-wp-init=\"callbacks.setButtonStyles\" data-wp-on--click=\"actions.showLightbox\" data-wp-on--load=\"callbacks.setButtonStyles\" data-wp-on-window--resize=\"callbacks.setButtonStyles\" src=\"https:\/\/melange.ink\/wp-content\/uploads\/2024\/03\/Resized_20240307_031726.jpg\" alt=\"A paramedic's face with a house fire in the background at night\" class=\"wp-image-4651\" srcset=\"https:\/\/melange.ink\/wp-content\/uploads\/2024\/03\/Resized_20240307_031726.jpg 768w, https:\/\/melange.ink\/wp-content\/uploads\/2024\/03\/Resized_20240307_031726-225x300.jpg 225w, https:\/\/melange.ink\/wp-content\/uploads\/2024\/03\/Resized_20240307_031726-380x507.jpg 380w\" sizes=\"auto, (max-width: 768px) 100vw, 768px\" \/><button\n\t\t\tclass=\"lightbox-trigger\"\n\t\t\ttype=\"button\"\n\t\t\taria-haspopup=\"dialog\"\n\t\t\taria-label=\"Enlarge\"\n\t\t\tdata-wp-init=\"callbacks.initTriggerButton\"\n\t\t\tdata-wp-on--click=\"actions.showLightbox\"\n\t\t\tdata-wp-style--right=\"state.imageButtonRight\"\n\t\t\tdata-wp-style--top=\"state.imageButtonTop\"\n\t\t>\n\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"12\" height=\"12\" fill=\"none\" viewBox=\"0 0 12 12\">\n\t\t\t\t<path fill=\"#fff\" d=\"M2 0a2 2 0 0 0-2 2v2h1.5V2a.5.5 0 0 1 .5-.5h2V0H2Zm2 10.5H2a.5.5 0 0 1-.5-.5V8H0v2a2 2 0 0 0 2 2h2v-1.5ZM8 12v-1.5h2a.5.5 0 0 0 .5-.5V8H12v2a2 2 0 0 1-2 2H8Zm2-12a2 2 0 0 1 2 2v2h-1.5V2a.5.5 0 0 0-.5-.5H8V0h2Z\" \/>\n\t\t\t<\/svg>\n\t\t<\/button><figcaption class=\"wp-element-caption\">Our author, with a house fire in the background.<\/figcaption><\/figure>\n<\/div><\/div>\n\n\n\n<p>&#8220;Your bird&#8217;s here, crew&#8217;s ready.&#8221; Two women in trademark blue jumpsuits amble in. This is becoming a very crowded kitchen. The FF-Medic is looming over me, the bleeding stoner kid takes a seat in the captain&#8217;s chair and gets a <span class='tooltipsall tooltip_post_id_custom_0d5bddc6478e1eec1a59d65b0c56b2b8 classtoolTipsCustomShortCode'>C-collar<\/span><script type=\"text\/javascript\">jQuery(\"document\").ready(function(){ toolTips('.tooltip_post_id_custom_0d5bddc6478e1eec1a59d65b0c56b2b8','<span style=\\\"font-weight: 400; font-size: 14pt; font-family: junicode-regular; line-height: 110%;\\\">Cervical spine immobilization collar. The small bones that join the skull to the spinal cord are very delicate and vulnerable to trauma. After a major trauma, the cervical spine is immobilized as a priority to prevent paralysis.<\/span><br\/><em><span style=\\\"font-weight: 400; font-size: 12pt; font-family: junicode-regular; line-height: 110%;\\\">(Definition provided by author.)<\/span><\/em>','0','C-collar'); });<\/script>. The flight crew had their own monitor, so we swap out our <span class='tooltipsall tooltip_post_id_custom_c501bd22eda2832d6734e00258b49d72 classtoolTipsCustomShortCode'>B\/P<\/span><script type=\"text\/javascript\">jQuery(\"document\").ready(function(){ toolTips('.tooltip_post_id_custom_c501bd22eda2832d6734e00258b49d72','<span style=\\\"font-family: junicode-regular; font-size: 14pt; line-height: 110%;\\\">Blood pressure or \\\"B\/P,\\\" a measure of the heart\\'s ability to perfuse the body with blood. Too high, and vessels can rupture; too low, and tissues can be starved of oxygenated blood. Critically low blood pressure is called shock, and indicates imminent brain damage and death. Critically high blood pressure can result in aneurysm (vessel rupture) and hemorrhagic stroke (aneurysm of brain vessels, causing brain damage with systemic effects in the body). In trauma situations, low blood pressure is usually a sign of bleeding, especially internal bleeding, or otherwise unseen bleeding, known as occult (hidden) bleeding. Occult blood is the most badass type of blood, and preferred for Satanic rituals.<\/span><br\/><em><span style=\\\"font-family: junicode-regular; font-size: 12pt; line-height: 110%;\\\">(Definition provided by author.)<\/span><\/em>','0','B\/P'); });<\/script> cuffs, leads and <span class='tooltipsall tooltip_post_id_custom_3da64296667cb4c4d024d1e24d27b595 classtoolTipsCustomShortCode'>SpO2<\/span><script type=\"text\/javascript\">jQuery(\"document\").ready(function(){ toolTips('.tooltip_post_id_custom_3da64296667cb4c4d024d1e24d27b595','<span style=\\\"font-family: junicode-regular; font-size: 14pt; line-height: 110%;\\\"><strong>Pulse oxymetry<\/strong>; also Pulse ox, SpO2, or O2 Saturation. The use of laser light to measure the percentage of red blood cells in circulation carrying oxygen. A typical healthy SpO2 is 95% to 100%. Below 90% is considered pathological and requires treatment. <strong>Room air (RA)<\/strong> indicates that an SpO2 reading is based on a patient breathing local ambient atmospheric air, as opposed to patients breathing supplemental pure oxygen via a mask or other device.<\/span><br\/><em><span style=\\\"font-family: junicode-regular; font-size: 12pt; line-height: 110%;\\\">(Definition provided by author.)<\/span><\/em>','0','SpO2'); });<\/script> and wire up the stoner kid.<\/p>\n\n\n\n<p>&#8220;24-year-old female,&#8221; I start for the waiting flight medic. &#8220;Restrained front passenger, apparent T-bone with roll-over, entrapped. Denies <span class='tooltipsall tooltip_post_id_custom_568fe096c51670bbedf8107a0265801c classtoolTipsCustomShortCode'>LOC<\/span><script type=\"text\/javascript\">jQuery(\"document\").ready(function(){ toolTips('.tooltip_post_id_custom_568fe096c51670bbedf8107a0265801c','<span style=\\\"font-family: junicode-regular; font-size: 14pt; line-height: 110%;\\\">Loss of consciousness \u2014 or level of consciousness, depending on context.<\/span><br\/><em><span style=\\\"font-family: junicode-regular; font-size: 12pt; line-height: 110%;\\\">(Definition provided by author.)<\/span><\/em>','0','LOC'); });<\/script>, <span class='tooltipsall tooltip_post_id_custom_5465e56c7dc0c927d3e7fe42a7080643 classtoolTipsCustomShortCode'>A&Ox4<\/span><script type=\"text\/javascript\">jQuery(\"document\").ready(function(){ toolTips('.tooltip_post_id_custom_5465e56c7dc0c927d3e7fe42a7080643','<span style=\\\"font-family: junicode-regular; font-size: 14pt; line-height: 110%;\\\">\\\"Alert and oriented times four.\\\" The standard field test for mental alertness, comprised of four simple questions. If the patient can verbally state their name, their location, the day or date and accurately describe their situation, they are said to be alert and oriented times four. A score of less than 3 indicates some degree of disorientation and diminished awareness. A score less than 3 also legally constitutes \u201cimplied consent\u201d for medical treatment, important in cases where patients are resistant to care, belligerent, confused or unconscious and informed consent to treatment cannot be obtained. This is a field test. Other scoring systems (such as the Glasgow Coma Scale) are considered definitive and are used for making treatment decisions.<\/span><br\/><em><span style=\\\"font-family: junicode-regular; font-size: 12pt; line-height: 110%;\\\">(Definition provided by author.)<\/span><\/em>','0','A&Ox4'); });<\/script> on contact, extricated and packaged. Main concern is right tib-fib and ankle, apparent closed fracture, strong <span class='tooltipsall tooltip_post_id_custom_257f539086163907bd64e9c4297981eb classtoolTipsCustomShortCode'>pedal pulses<\/span><script type=\"text\/javascript\">jQuery(\"document\").ready(function(){ toolTips('.tooltip_post_id_custom_257f539086163907bd64e9c4297981eb','<span style=\\\"font-family: junicode-regular; font-size: 14pt; line-height: 110%;\\\">Pulses of the foot. The presence or absence of which, as well as the quality (strong, weak, slow, \\'thready,\\' etc.), is very informative as to the integrity of the vessels of the leg. Absence of pedal pulses in the event of a leg fracture indicates severe injury and the possible need for amputation, as blood flow has stopped along some point of the extremity.<\/span><br\/><em><span style=\\\"font-family: junicode-regular; font-size: 12pt; line-height: 110%;\\\">(Definition provided by author.)<\/span><\/em>','0','pedal pulses'); });<\/script> as marked. Good sensation distally as well. Hips appear stable. Alert, pupils <span class='tooltipsall tooltip_post_id_custom_f89b3f5e119f9bcefb848720ec554905 classtoolTipsCustomShortCode'>PERRL<\/span><script type=\"text\/javascript\">jQuery(\"document\").ready(function(){ toolTips('.tooltip_post_id_custom_f89b3f5e119f9bcefb848720ec554905','<span style=\\\"font-family: junicode-regular; font-size: 14pt; line-height: 110%;\\\">\\\"<span style=\\\"text-decoration: underline;\\\"><strong>P<\/strong><\/span>upils equal, <span style=\\\"text-decoration: underline;\\\"><strong>R<\/strong><\/span>ound and <span style=\\\"text-decoration: underline;\\\"><strong>R<\/strong><\/span>eactive to <span style=\\\"text-decoration: underline;\\\"><strong>L<\/strong><\/span>ight.\\\" Simple way to communicate that the eyes, sensitive indicators of nervous system function, are responding to light stimulus in normal ways. Deviance from the PERRL baseline is highly indicative of brain or nervous system damage.<\/span><br\/><em><span style=\\\"font-family: junicode-regular; font-size: 12pt; line-height: 110%;\\\">(Definition provided by author.)<\/span><\/em>','0','PERRL'); });<\/script>, no pain or <span class='tooltipsall tooltip_post_id_custom_a2e3d13014638927709c603e4b4d5137 classtoolTipsCustomShortCode'>DCAPBTLS<\/span><script type=\"text\/javascript\">jQuery(\"document\").ready(function(){ toolTips('.tooltip_post_id_custom_a2e3d13014638927709c603e4b4d5137','<span style=\\\"font-family: junicode-regular; font-size: 14pt; line-height: 110%;\\\">\\\"<span style=\\\"text-decoration: underline;\\\"><strong>D<\/strong><\/span>eformities, <span style=\\\"text-decoration: underline;\\\"><strong>C<\/strong><\/span>ontusions, <strong><span style=\\\"text-decoration: underline;\\\">A<\/span><\/strong>brasions, <strong><span style=\\\"text-decoration: underline;\\\">P<\/span><\/strong>unctures, <span style=\\\"text-decoration: underline;\\\"><strong>B<\/strong><\/span>urns, <strong><span style=\\\"text-decoration: underline;\\\">T<\/span><\/strong>enderness, <strong><span style=\\\"text-decoration: underline;\\\">L<\/span><\/strong>acerations, <strong><span style=\\\"text-decoration: underline;\\\">S<\/span><\/strong>welling.\\\" An acronym for the litany of traumas. Originally a mnemonic for students, now used in the negative to communicate that no new injuries have been found, e.g., \\\"No other DCAPBTLS noted.\\\"<\/span><br\/><em><span style=\\\"font-family: junicode-regular; font-size: 12pt; line-height: 110%;\\\">(Definition provided by author.)<\/span><\/em>','0','DCAPBTLS'); });<\/script> in neck, back, shoulders, thorax, abdomen. Denies history, denies meds, denies pregnancy, no evidence of <span class='tooltipsall tooltip_post_id_custom_76ae6dd7b03f3c2e146dce7956ecd072 classtoolTipsCustomShortCode'>ETOH<\/span><script type=\"text\/javascript\">jQuery(\"document\").ready(function(){ toolTips('.tooltip_post_id_custom_76ae6dd7b03f3c2e146dce7956ecd072','<span style=\\\"font-family: junicode-regular; font-size: 14pt; line-height: 110%;\\\"><strong>Ethyl alcohol.<\/strong>Official abbreviation for documenting alcohol intoxication, often used as a euphemism for communicating such in sensitive contexts.<\/span><br\/><em><span style=\\\"font-family: junicode-regular; font-size: 12pt; line-height: 110%;\\\">(Definition provided by author.)<\/span><\/em>','0','ETOH'); });<\/script>. 10 of morphine via 18-gauge <span class='tooltipsall tooltip_post_id_custom_b2f692c019cec017ce799b7984b69fca classtoolTipsCustomShortCode'>LAC<\/span><script type=\"text\/javascript\">jQuery(\"document\").ready(function(){ toolTips('.tooltip_post_id_custom_b2f692c019cec017ce799b7984b69fca','<span style=\\\"font-family: junicode-regular; font-size: 14pt; line-height: 110%;\\\">\u201cLeft antecubital fossa.\\\" The antecubital fossa is the area at the bend of the elbow, which is a common location for IV cannulation due to large surface veins.<\/span><br\/><em><span style=\\\"font-family: junicode-regular; font-size: 12pt; line-height: 110%;\\\">(Definition provided by author.)<\/span><\/em>','0','LAC'); });<\/script>. Pressure&#8217;s beautiful, <span class='tooltipsall tooltip_post_id_custom_cb872d773312961d34908f4d447f82d0 classtoolTipsCustomShortCode'>98% on room air<\/span><script type=\"text\/javascript\">jQuery(\"document\").ready(function(){ toolTips('.tooltip_post_id_custom_cb872d773312961d34908f4d447f82d0','<span style=\\\"font-family: junicode-regular; font-size: 14pt; line-height: 110%;\\\">Pulse oxymetry; also Pulse ox, SpO2, or O2 Saturation. The use of laser light to measure the percentage of red blood cells in circulation carrying oxygen. A typical healthy SpO2 is 95% to 100%. Below 90% is considered pathological and requires treatment. <strong>Room air (RA)<\/strong> indicates that an SpO2 reading is based on a patient breathing local ambient atmospheric air, as opposed to patients breathing supplemental pure oxygen via a mask or other device.<\/span><br\/><em><span style=\\\"font-family: junicode-regular; font-size: 12pt; line-height: 110%;\\\">(Definition provided by author.)<\/span><\/em>','0','98% on room air'); });<\/script>, sinus tach on the monitor.&#8221;<\/p>\n\n\n\n<p>The flight medic scribbles my report on a wide piece of white cloth medical tape plastered to her thigh, nodding with acknowledgement at each data point. Her partner fusses over the leads and monitor gear and introduces herself to the patient.<\/p>\n\n\n\n<p>&#8220;Awesome,&#8221; she says, &#8220;sounds good. We&#8217;ll just get her on our basket and be on our way.&#8221; It\u2019s a bit of a farce as we try to sort the stretcher straps from the backboard straps, get the backboard in the air enough to slide their flight litter under the backboard, and get all the straps sorted and buckled. With seven people stuffed into the ambulance box all grabbing and switching mismatched seatbelts for a few minutes, I started to hear \u201cEntrance of the Gladiators\u201d in my head.<\/p>\n\n\n\n<p>Firefighters waiting outside take the stretcher and flight basket, loaded with Jamie, to the landing zone with the flight crew. I can now turn my attention to the kid bleeding from his head holes sitting at the other end of the ambulance.<\/p>\n\n\n<p class=\"pk-callout pk-dropcap pk-block-bg pk-dropcap-bg-inverse\">My first thought is, \u201cWell, shit. I sent the wrong patient to the helicopter.\u201d Jamie had a simple tib-fib fracture, the kind of break you can get falling off a porch step. I made the call based on \u201cMechanism\u201d: Mechanism of Injury, shorthand for how fucked her particular circumstances were. Odds were good she might have had a spinal injury, internal bleeding, a femur fracture or two, a dead fetus inside\u2026 a real Christmas gut-slinger.<\/p>\n\n\n<p>Granted, I don&#8217;t have X-ray vision or a crystal ball, but after putting hands on the problem it looks like she got stupid lucky and just had a plain ol&#8217; broke leg. Her boyfriend, the driver, was walking around on scene and was triaged by someone else. Might have signed a refusal form, even. But now that I lay eyes on him and get a report from the firefighter? Protocols say that bleeding from the ears trumps a broken leg, and Kevin here earned the bird, by the book. It&#8217;s always something, though. You gotta make calls based on guesswork and limited information. Until recent changes to the law, that might have been a $60,000 mistake for the patient, depending on the vagaries of her insurance terms and conditions and however that intersects with the fine print of my charting narrative. Likewise, the walking wounded stoner kid Kevin may have a massive subdural, and will have to ride ground-service 45 minutes or more to the nearest Neuro center in McKinney. Plenty of time to bleed into his braincase and stroke out.<\/p>\n\n\n\n<div class=\"wp-block-group alignright\"><div class=\"wp-block-group__inner-container is-layout-constrained wp-block-group-is-layout-constrained\">\n<figure data-wp-context=\"{&quot;imageId&quot;:&quot;6a06ff1be9bf3&quot;}\" data-wp-interactive=\"core\/image\" data-wp-key=\"6a06ff1be9bf3\" class=\"wp-block-image size-full wp-lightbox-container\"><img loading=\"lazy\" decoding=\"async\" width=\"600\" height=\"800\" data-wp-class--hide=\"state.isContentHidden\" data-wp-class--show=\"state.isContentVisible\" data-wp-init=\"callbacks.setButtonStyles\" data-wp-on--click=\"actions.showLightbox\" data-wp-on--load=\"callbacks.setButtonStyles\" data-wp-on-window--resize=\"callbacks.setButtonStyles\" src=\"https:\/\/melange.ink\/wp-content\/uploads\/2024\/03\/IMG_4556.jpg\" alt=\"Firefighters responding to a house fire at night.\" class=\"wp-image-4655\" srcset=\"https:\/\/melange.ink\/wp-content\/uploads\/2024\/03\/IMG_4556.jpg 600w, https:\/\/melange.ink\/wp-content\/uploads\/2024\/03\/IMG_4556-225x300.jpg 225w, https:\/\/melange.ink\/wp-content\/uploads\/2024\/03\/IMG_4556-380x507.jpg 380w\" sizes=\"auto, (max-width: 600px) 100vw, 600px\" \/><button\n\t\t\tclass=\"lightbox-trigger\"\n\t\t\ttype=\"button\"\n\t\t\taria-haspopup=\"dialog\"\n\t\t\taria-label=\"Enlarge\"\n\t\t\tdata-wp-init=\"callbacks.initTriggerButton\"\n\t\t\tdata-wp-on--click=\"actions.showLightbox\"\n\t\t\tdata-wp-style--right=\"state.imageButtonRight\"\n\t\t\tdata-wp-style--top=\"state.imageButtonTop\"\n\t\t>\n\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"12\" height=\"12\" fill=\"none\" viewBox=\"0 0 12 12\">\n\t\t\t\t<path fill=\"#fff\" d=\"M2 0a2 2 0 0 0-2 2v2h1.5V2a.5.5 0 0 1 .5-.5h2V0H2Zm2 10.5H2a.5.5 0 0 1-.5-.5V8H0v2a2 2 0 0 0 2 2h2v-1.5ZM8 12v-1.5h2a.5.5 0 0 0 .5-.5V8H12v2a2 2 0 0 1-2 2H8Zm2-12a2 2 0 0 1 2 2v2h-1.5V2a.5.5 0 0 0-.5-.5H8V0h2Z\" \/>\n\t\t\t<\/svg>\n\t\t<\/button><figcaption class=\"wp-element-caption\">Our author, assisting firefighters with a house fire.<\/figcaption><\/figure>\n<\/div><\/div>\n\n\n\n<p>And now back to the show.<\/p>\n\n\n\n<p>The stretcher returns unladen from the landing zone; the thrumming rotor wash of the helicopter is slowly rising and fading away. Ellen and I strip the cot sheet and set off a hail of glass gravel.<\/p>\n\n\n\n<p>A fresh sheet is tucked in, and we help Patient Two to the stretcher.<br>Mike, a young volunteer firefighter I know from the Gunter station, is giddy at all the excitement. He pops his head in the side door.<\/p>\n\n\n\n<p>&#8220;Hey, y&#8217;all need a driver?&#8221;<\/p>\n\n\n\n<p>&#8220;We do, Mikey. Light her up, Med City McKinney.&#8221;<\/p>\n\n\n\n<p> <em>Woop-woop<\/em>.<\/p>\n\n\n\n<p>Kevin is bleeding from his ear and nose, but it\u2019s controlled. Which is to say: it\u2019s not spurting bright red. There is no otoscope on the box so I can&#8217;t say if he just whacked his ear or if it&#8217;s coming from his brain. A field &#8220;halo test&#8221; (dipping the blood in gauze and looking for cerebrospinal fluid migrating out of the blood puddle) is negative. Good. He&#8217;s covered in cuts and scratches, but all the major systems are intact, no new ouchies or oomphs. Ellen and I both try to get an IV, no luck. It&#8217;s not something I ever got good at, finding veins with needles in truck beds speeding down country roads. Forty-five minutes of just talking to him to gauge his alertness levels and periodically checking his pupil response with a penlight. No projectile vomiting, no repetitive questioning, no nodding off or other signs of head trauma to speak of. Which is nice.<\/p>\n\n\n\n<p>Ellen points out that I have time to do my chart. She&#8217;s not wrong. She takes sinister pride in her ability to wrap a chart before the bay doors close on arrival at the station. Really rubs it in. Goody two-shoes. Fuck charts!, I say. I have my chicken-scrawl notes and I will put charting off until it&#8217;s irresponsibly late, thank you very much.<\/p>\n","protected":false},"excerpt":{"rendered":"Featured image: Accident scene imageprovided by author (dated 2022) From The M\u00c9LANGEOccasional Journal of Health DUnit 5153 is&hellip;\n","protected":false},"author":8,"featured_media":4594,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"csco_singular_sidebar":"","csco_page_header_type":"","csco_custom_appearance":"","csco_disable_excerpt_posts_layout":false,"csco_page_load_nextpost":"","csco_post_video_location":[],"csco_post_video_location_hash":"","csco_post_video_url":"","csco_post_video_bg_start_time":0,"csco_post_video_bg_end_time":0,"footnotes":""},"categories":[30,28],"tags":[],"class_list":{"0":"post-4446","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-health","8":"category-personal-histories","9":"cs-entry","10":"cs-video-wrap"},"_links":{"self":[{"href":"https:\/\/melange.ink\/index.php\/wp-json\/wp\/v2\/posts\/4446","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/melange.ink\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/melange.ink\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/melange.ink\/index.php\/wp-json\/wp\/v2\/users\/8"}],"replies":[{"embeddable":true,"href":"https:\/\/melange.ink\/index.php\/wp-json\/wp\/v2\/comments?post=4446"}],"version-history":[{"count":97,"href":"https:\/\/melange.ink\/index.php\/wp-json\/wp\/v2\/posts\/4446\/revisions"}],"predecessor-version":[{"id":4669,"href":"https:\/\/melange.ink\/index.php\/wp-json\/wp\/v2\/posts\/4446\/revisions\/4669"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/melange.ink\/index.php\/wp-json\/wp\/v2\/media\/4594"}],"wp:attachment":[{"href":"https:\/\/melange.ink\/index.php\/wp-json\/wp\/v2\/media?parent=4446"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/melange.ink\/index.php\/wp-json\/wp\/v2\/categories?post=4446"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/melange.ink\/index.php\/wp-json\/wp\/v2\/tags?post=4446"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}