"Man, this is what it's all about!"

Rain moves through the area, bringing a flurry of accidents. We're dispatched to one after another. Often times, perhaps due to the construction of cars these days, there are no injuries. We arrive on scene, look around at busted cars and get legal signatures from people who don't want to go to the hospital (and probably shouldn't.).

We clear one accident and are on our way back to the station when we get called back to another one not far from the first. We're in stopped traffic on a two lane road. I pop on the sirens and lights. execute a 3-point turn and we're off to the races again!! Wheeee!

To get into position, we've got to go past the accident on the opposite side of the divided highway and turn around at the next exit. Some clown, on their cellphone while driving, almost takes me out with a 3 lane swerve. I suppose he couldn't see the 16,000lb, 9 foot tall, rolling ambulance with flashing strobes, wailing sirens and an air horn that's beating out a rhythm that sounds oddly like the cowbell in the beginning of "Honky Tonk Woman" by the Rolling Stones. Yes, I'm weird like that.

I start wading our way through the traffic to find the Medic unit in front of us and a trail of bashed, wrecked cars on the shoulders as we proceed. None of them appear to have injured people and we diligently report each one to the dispatch center as we go along.

Traffic is backed up because there is an SUV in one of the travel lanes. It's surrounded by police vehicles from the nearby military base, the state and the particular federal agency that patrols this stretch of highway. (Odd, I know but that's how things go sometimes). The patient is on the shoulder, out of the car already. RT immediately dives in with the medics doing patient care so I take the opportunity have a look at the vehicle.

It's got only 3 wheels. The front, passenger side wheel has only an axle stump where the wheel should be. Somehow, this driver has lost the entirety of the front wheel assembly. Tire, rim, brake caliper, ball joint...the whole mess. Both front fenders look like crumpled aluminum foil and there's not a single piece of intact glass or plastic on the vehicle from the doors forward. The busted grill of the SUV makes it look like a hapless boxer after a bad night.

Inside the car is another story. The patient is already out of the car and on the ground. The side windows have been broken and there is glass on the seat inside. This means that something broke the side windows from the outside. Rescuer? cop? rock? Errant Bird? I don't know. File that away for later.

Both airbags have been deployed. (significant) I can't tell if the driver (who is now being wrestled by the medics and RT) was wearing her seatbelt but the windshield has been broken from the outside and there is no evidence that a head hit it from the inside (hair, blood, brains or skin embedded in the glass). The seats are still bolted to the floor there is no blood or other evidence of trauma inside the car. The dashboard, steering wheel and other interior components are not deformed. This is good. It appears that nobody bounced around too much inside this vehicle.

Our patient has been living a life that is in no way deficient in calories. I dive in to help getting her to a backboard and then to the stretcher. During all this, I notice that her collar has slipped up her face. I go in to correct it and she wiggles her head around to get it out of the collar. She's already got a pretty short neck and her "upper body development" is not making it any easier. We improvise something useful and get her immobilized to the backboard, onto the stretcher and into the waiting medic unit.

While RT and the medics wrangle with the patient, I take a moment to query all the police as to how she got here. Broken windows and a busted windshield: Did she roll over? "No we had to break out the windows to get her out of the car."

Where's the missing wheel? "About 3 miles back. After she hit the 3rd car, she kept driving, on the road and in the median, with only 3 wheels and up to about 75 miles per hour!" I look at the police car that stopped her and see that it's covered in mud on the front of the car from the bumper to the lightbar. Woooh!

How long were you chasing her? "About 3 miles. Once we stopped her, she said that she was not allowed to stop for any police as she's the daughter of the top colonel of the army." Oooookaaayy.

"We pulled her out of the car and cuffed her. She immediately started to complain that her chest hurt. I put her on her side and then she started shaking."

Right-O! I hop into the medic unit and pass all this information onto them. RT is going to drive their unit and I'll follow in mine to take RT home once we get to the hospital. We get rolling onto the nearest trauma center. Halfway there, our dispatch starts calling the medic unit asking for their status. That's when I realize they haven't called with their patient information and destination yet.

After a few calls from dispatch to no avail, I hear RT mark up on the radio and advise them that we're all en-route to a particular trauma hospital and we'll advise upon arrival. Mind you, I'm driving an empty ambulance behind the medic unit and don't have a full appreciation of what's going on inside.

We arrive. Once we do, I park in a convenient spot and pop over to help unload. The doors to the unit are still closed and RT is still up front. What's going on? I pop the back doors open to see two medics looking frazzled and each trying desperately to hold down the patient. She's thrown off her collar. and thrashed around quite a bit. In the confines of the ambulance, the medics are holding her down to keep from getting hit. The looks on their faces are pleas for help. Apparently she's been fighting them for the whole drive and has even tried to fake a seizure or two. The medics have been so busy trying to hold her down and not get hurt themselves, they haven't had time to call anyone on the radio.

"RT! Come open up and get us out of here!" I say as I hop up to the head of the patient to help out. I try to put the collar back on her. Just as she snaps at me with her teeth, one of the medics says, "Watch out! She bites!"

I jack both of my thumbs into the space behind the angle of her jaw and below her ears. This is called the infra-orbital pressure point for law enforcement types and causes a LOT of pain without any tissue damage. I look her in the eye (both of which are very open right now).

"You bite me, I'm going to knock you out!"

Her whole body relaxes enough for us to get her out of the ambulance and into the loving arms of a waiting trauma team. I don't put the collar back on her but I do hold her head to keep it from moving. I also have my fingers placed in the same spot I "zapped" her before as a reminder that if she gets frisky, she's going to pay for it.

The trauma team is ready and, really, not very impressed with her antics. If you thought I was cruel. the trauma doctor is an absolute sadist.

As we clean our gear, one of the medics says to me:

"Man, this is what it's all about!"

The stress of the call sloughs off of us and we laugh and laugh.

--maddog

Kids, kids and More kids!!

We get dispatched as the 2nd ambulance on a car accident.

On our way to the scene, the incident commander (the chief of the neighboring station) asks us if we have a problem taking 3 stable kids in car seats.

RT and I look at each other. He knows he can "tap out" and drive, leaving me in "the back" to handle things if he's over his head.

"Ambulance XXX, We're direct. No worries" I reply.

Here's the deal on scene:

Mom's driving the minivan with two 11 month-old twins and a 22 month-old son in car seats. The minivan gets rear-ended. Kids are fine (that's what car seats are for) but mom's neck and back hurt. RT and I work on mom. We get her extricated to a long board & immobilized to our stretcher. Into the ambulance we go and start doing our trauma assessment to be sure we haven't missed anything.

While we're doing this, firefighters start loading car seats and kids into our ambulance. By the time we're on the road, we have a 38 year old woman in full spinal immobilization as a precaution, 3 screaming children in car seats and RT being a stuffed-toy-laden octopus who's spending equal time entertaining toddlers and treating his patient.

At the hospital, I have to go in and get help from one of the waiting ambulance crews. We roll in. One EMT with a kid in a car seat and two others pulling a stretcher containing a woman on a backboard while holding identical boys on their hips.

At the nursing triage station, it's wait wait wait.

The oldest boy is content to play with his toy while still strapped into his car seat. No escape there. RT has one twin with a biblical name. Biblical name #2 is on my hip.

As I shift Biblical name #2 from hip to hip, I notice a particular smell.

Now, RT has a son but his ex left before the boy was born. Even though RT is very much involved in his son's life now, he's never dealt with toddler management. Mind you, we're already a spectacle in the emergency room with one patient on a cot and three little kids being wrangled and corralled by two harried-looking EMTs.

I catch a nurse's eye.

"Can u get me diapers and wipes?"

Her eyes widen in recognition. I look significantly at the toddler on my hip and nod at her with a knowing look.

"I'll be right back!" She drops what she's doing and dashes off.

Five minutes later, I've got this little man on his back on an exam table and am fighting him to get his onesie off.

Clearly he has a healthy diet! Bleah!

Another 3 minutes pass and he's clean, changed and dressed.

I walk out of the exam room and mom puts a hand out to touch her baby. Her hand finds my arm.

"Thank you."

The nurse from before comes bustling by.

"They teach you that in Paramedic school?"

I smile.

--maddog

Kids, faces, windshields, necks and helicopters.

We get on scene to an accident after the rescue squad. I had to plow through some pretty heavy traffic to get there.

I see a car with front end damage, a spiderwebbed windshield and a knot of firefighters around someone on the shoulder of the road.

I take a moment to look over the car while my partner gets in to see the patient. There is no passenger seat. The driver's seat is there but the front passenger seat has been removed. The windshield has a spot on the passenger side where something round (most likely a head) has struck it from the inside and caused it to shatter and bulge outward. It seems to me that whoever hit that windshield came from the back seat. That's a far way to travel.

Lying on the side of the road, there's a crying kid of about 7 or 8 years of age who's bleeding profusely from his chin. The attending firefighters are as distraught as he is. He's a kid, he's bleeding and he doesn't speak a word of English. Something about hurt kids makes us all get silly. All of the crew from the rescue squad are pretty worked up. these guys are top notch and I've rarely seen them so upset. They won't let my partner get close. It's like a rugby scrum!

In short order, I get everyone to take a moment to catch their breath, slap a dressing on his cut chin, talk to the kid in Spanish and find out the following:

1. He was in the back seat.

2. He was NOT wearing a seatbelt

3. He doesn't remember much

4. The back of his neck hurts A LOT.

From the cut on his chin and his complaint of neck pain, cut chin and the shape of the windshield bulge, I surmise that this kid flew from the back seat and face-planted into the windshield causing his head to hyper-extend, or bend backwards as much as it will go, as his body kept moving forward with the force of momentum.

This is bad.

I look over to the scene commander, my Lieutenant. I point my finger in the air and spin it around a few times. I'm telling him we need a helicopter NOW. This kid is potentially really messed up and needs to get to a children's trauma center ASAP.

"Called for it when we got on scene. ETA is 3 minutes." He says as he winks at me. LT's got my back!

We get the kid packaged (cervical collar, backboard, immobilized) and moved into my ambulance where I have room to work and light to see. The bleeding on his chin, however dramatic, has stopped and appears to be superficial. Good. His pupils are normal and reactive and he's not leaking out of his ears, nose, mouth or eyes (other than the crying). Good. Skull appears intact, no problems on the front of the neck but the back of his neck is very sensitive to touch. So much that I don't have a chance to fully see if anything is out of place. He's too tender for me to probe that deep.

Lungs are clear and he's breathing without too much effort. No apparent injuries to his chest or abdomen. Pelvis stable. All his limbs are solid, intact and have pulses with appropriate sensory and motor response. His other vital signs are pretty normal considering he's in a lot of pain and scared.

Other than his neck this kid's fine! His neck, though is really troubling me.

By the time I finish my assessment, the helicopter has landed and the medic is at the door of the ambulance. He's a tall, stern cop/medic with a no-nonsense, don't-get-in-my-way look about him. His eyes are scanning and talking in the whole scene.

I run down the basics and tell him my assumption about the mechanism of injury. I also fill him in that the kid doesn't speak English. He doesn't look at me until I explain my thinking on how the kid's face hit the windshield and how that relates to his severe neck pain. His eyes dart to me, he nods once and says, "Let's do this."

less than 90 seconds later, the kid is in the helicopter that is roaring its way skyward. I hear the medic on the radio indicate they're taking the kid to the local children's hospital, Priority 1.

I take a moment to watch the flashing lights of the Bell Jet ranger in the clear night sky and then turn around to clean up my ambulance open up traffic and clear the scene.

-maddog