Ghosts: A Tale of a Career Paramedic.

Luck of the Draw

In 13 years I have seen some of the worst luck people can have, but I have also seen people who if had played the lottery that, would surely have won. When it comes to the woes of this job, it truly is the luck of the draw. I'm sure many of you have watched those videos on YouTube of 'near misses' or 'just avoiding danger'. Those videos are as true as it appears, sometimes you are in the right place at the right time, sometimes you are not. Just the other day a fire crew brought into the ER a young man of 40 something that had fallen through a skylight 30 some feet to a hard concrete floor. He was working construction and either the skylight had given way or he tripped and fell through. Those are the best guesses because no body witnessed the fall, just heard the commotion. As a result of the fall he has massive bleeding inside his skull with a midline shift of his brain stem. Although his heart was still beating, he was dead the moment he hit the ground. I imagine when he woke up that day he did not think that day was going to be his last. Like most people, it was just going to be another day at work, maybe go out with the fella's after for a beer or two. I think that's why these terrible unfortunate events can have such an affect on me at times. It puts into stark reality that how close and quickly death can come. Its also what helps me to appriciate the small things in this world. The different cultures, the sights, sounds and smells. As crappy as the late fall weather is here in MI at the moment, the greens, yellows and hints of red of the leaves is a beautiful sight. How many of these small things would I miss out if death were to come for me now? It's something that many of us overlook daily, and hardly ever give it a second thought. But the ability to walk is something to be appreciated. I responded to a report of a PI (Personal Injury) off the side of the highway. I arrived shortly after fire and was told there was one person stuck in his SUV in the brush. It was a white, newer model SUV, showing only minor damage to the front end. It had impacted a thick tree head on, but all of the brush and tall grass had lowered its speed significantly. Intombed behind a wall of side curtain airbags was my patient. I yelled over the traffic and the density of the airbags.
"Sir, can you here me?!"
"Yes."
"Are you hurt?!"
"I'm not sure."
"Ok?"
I told the Capt. that I wanted to get inside the car. The doors were jamed and or locked and were at the moment, not an option. So I suggested that we break the back window and I crawl in. I'm not shy of crawling through windows over broken glass in order to gain access to my patient. The Capt. was aware of this, we had been working together for many years at this point, and has a solid trust with one another. He grabbed a small hand toom, vice grips I believe, and struck the bottom corner of the rea window. The familar sound of glass shattering and it hitting everything sharply filled the night. I being the eager type hoped right in. I crawled over a brand new 52in LCD TV still in the box. I got in behind my Patient who was in the drivers seat. I took in my surroundings as I began to assess him. The front airbags had gone off, the passenger one spider webbing the glass of the front windshield. He was not wearing a seatbelt, but I saw no evidence of deformity to the steering wheel or window. So he had at least stayed put when he hit the tree. I asked all the standard questions as I placed my hands on the sides of his head to maintain inline stabilization of his spine. Other than some mild/moderate neck pain, he didn't feel any other pain, or I should say couldn't. The plan was that fire was going to use the jaws to pry the drivers door open and we would move him out onto a backboard. It was pretty standard stuff for that type of call. Usually we dont have to use the jaws, but since the doors were jamed we had no choice. I was the only one in the car with him, so a proper assessment couldn't be done. I remobed one of my hands and placed the other on his forehead and pressed his head back into the headrest. I did that so I could still keep inline stabilization as I used my other hand to due a half ass phyisical assessment. I felt no obvious breaks or deformities. I got to his legs and began to squeez to see if he had any tenderness or pain upon palpation. I asked if he felt any pain when I squeezed, he said he couldn't feel anything.
"What? What do you mean?"
"I can't feel you touching me."
A short wave of horror washed over me. Could he really be paralyzed? The accident wasn't that bad, was it? I gave a very hard painful pinch to his inner thigh, an area I thought would be the most sensitive to pain. Nothing. Not even the slightest flinch or whimper of pain. Holy shit, this guy is paralyzed.
"Captain!" I yelled. (A bit panicked I'm certain) He stuck his head in through the back window and I without turning around, now holding c-spine as secure as I ever had yelled back.
"He's paralyzed, we need to be really careful getting him out!"
He acknowledged and I could hear from inside him barking orders to the rest of the crew. My partner had poked her head in and asked what I wanted when he was extricated from his car. I said I wanted two IV's ready and the shock blanket ready. I at this point staryed trying to figure out how bad the damage was. I asked him what he could feel and his answer disheartened me even more. He said he couldn't feel anything, all he felt was his face. How? How is this guy now paralyzed from the neck down? It was a realitvly low spped crash. And like most times the puzzle pieces fell into place. He hadn't been wearing his seatbelt, and even though he hadn't went flying through the window, there was a deployed airbag. Now I can't say for certain, but my guess is when he hit the tree the airbag went off and he went forward into it, but not as you should. I think he went forward straight into it instead of bending at the waist into it. I think that the airbag exploding at near lightspeed snaped his head back and causing his high cervical fracture. Ot was only after finding out that he was paralyzed that I could hear the fear and panic in his voice. Who could blame him really? Hell, if it was me, Id be screaming in terror. After a short time he began to become more and more lethargic and kept going in and out of consciousness. Most everyone has heard of people going into 'shock', but there are several types of shock. Hypovelemic shock is from low blood volume, caused by to mich blood loss. Cardiogenic shock is caused by low ejection fraction of the heart causing hypotension and pulmonary edema. Neurogenic shock is caused by spinal cord injuries mostly. The blood vessels in the body begin to dialate since the brain can't send signals to constrict. Although you may not have lost any blood, the dialation causes low blood pressure because the vessle is to large for the blood to fill it. And low blood pressure means less profusion to crital organs, I.E. the brain. The brain is a diva. It requires a constant supply of oxygen and glucose. A decrease in any one of those results in the brain shutting down, which was happening with my patient. I yelled back to the Captain and told him we needed to get him out now and forget being slow and easy. He was dying and the damage has obviously been done already, life over limb at this point. Within a few short minutes the door had been poped open. The cot and a backbkard were right next to the door. He was pulled out of the car as quickly and safely as could be done. I remember seeing his arms flop off to the side absent of any muscle tone. His wife was at the ER by the time we had arrived. She told me he had just left a department store to get a TV. The same TV I crawled over. The last thing on his mind leaving his house was that walking out of the store with his brand new TV would be the last time he would ever walk again.

But not everyone has bad luck. I went to a call for an attempted suicide with lacerations to the neck. A young man depressed over a recent separation and pending divorce tried to commit suicide. It was the manner in which he did so that sticks out the most. Alone in a bathroom he took a small powered hand tool to his neck. It was one of those small blade circular saws used for small cuts and trim work. At full revs he took it to his neck and sliced upward at a slight angle. Apart from a gapping hole, nothing... No blood loss. Bewildered and perplexed at the lack of high velocity blood splatter he mustered the courage and went to the other side. Again the revs at full speed he dug into the other side of his neck cutting upward and at a slight angle. Again, nothing. Now he was left with two gapping holes and no arterial splatter. Now defeated and still bewildered he called 911, stating that now he just needs stiches. In fact when we got there he was sitting on the from porch just waiting for us. Being that it was an attempted suicide the police also showed up. One of the cops was in a word, 'shook'. He came over to me as I was walking up, "Do you see his fucking neck?!" I could see everything, the muscles, fat, and all the major vessels. The external jugular, the internal jugular, and the all might carotid. I didn't need to feel his wrist for a pulse, I could simply count the pulsation from his carotid visually. The stroke of good luck this young man had was amazing. The last time he had used the saw was to do some trim work that required a sharp angle. He had left it on that angle and shallowed the blade depth just enough to cut everything but the major vessels. He definitely should have played the lottery, he could have gotten a really good lawyer...