ViewsHound passes along ideas for us to write about for those times when our creative juices are stopped up. One that caught my eye was entitled "Horrors in the emergency room."
I rode an ambulance for almost 20 years in a rural county in Georgia that has no hospital. Our normal in-transit time to the hospital was most often a half-hour or so.
I'll probably tell y'all about some of that one day, but right now they asked specifically about the ER, and they wanted "horror stories." Well, I'll give you one, but you most likely ain't gonna like it.
I'm not going to tell you where I worked but I will tell you that we served four different hospitals, depending on the severity and nature of the problem, the distances involved and the patient's preference if he was conscious, alert and oriented.
I just retired at the end of 2009 and, at that time, we were seeing the results of seat belt use and air bags. Fatalities and serious injuries in car crashes are becoming much less commonplace than once they were. The one, though, of which I am about to speak, was back before air bags and in a time when few wore seat belts.
There are, in this county, some particularly winding roads and they are places with which we, the EMS, are intimately familiar.
It was on one such road, a few hours after midnight, about the time the bars close, when two vehicles ran together, nose-to-nose at perhaps 65 miles-per-hour. There was a bunch of smashing and mashing and tangling of metal and glass. One guy had done gone to the light by the time we got there and he wasn't coming back. There was another guy bad hurt. An older gentleman.
He was pretty well messed up but at least he was alive. He had some broken bones and a lot of bruising and bleeding but our most immediate concern was that one of his external jugular veins was pretty much sliced in two.
Now if you have a serious wound to an arm or leg, we can pretty much stop the bleeding by covering it with a mess of gauze pads and then wrapping it tightly enough to let blood flow through the injured extremity but not out of the hole. Eventually it will stop. You can even do the same with the abdomen or thorax, even with the head. The neck is quite another matter. The idea of putting a tourniquet around a neck may not be the best idea that's ever happened. The same is true of wrapping a neck tightly with gauze. It's generally a good thing if blood can get to the brain and air can get to the lungs. You probably don't want to cut those things off.
The external jugulars run up and down on either side of the neck. They vary in size but they're big. When one gets severed, you've got a mess. Your patient is FTD (Fixin' To Die) or "Headed to the light."
Most every ambulance carries two people, a paramedic and an EMT. The paramedic normally deals with the patient while the EMT drives. Sometimes though, you need two people in the back so you grab a deputy or firefighter and tell them to "drive like the wind." That's what we did this time.
We covered that wound with about four inches of gauze to start with and one of us held it in place while the other one dealt with all the other problems.
Once we knew what we had, we called the closest ER and told them what we were bringing, what we were doing and when we'd get there. Then we rode, hanging on for dear life, and adding layer after layer of gauze to that wound.
We got there and they were waiting for us at the door, all gowned and gloved. We went through the outside and inside doors and wheeled the patient into the first trauma room.
About six nurses and a doc were in there with us. They went to work while we recited everything we knew, crisply and clearly so everyone would know what they had to deal with.
The doc immediately ordered O-negative blood and told a nurse to call the surgeon on call and get him to get up and come in.
Once everything was all set up, the doc started to uncover the wound so he could get a look. I had already told him that the external jugular was severed but, if he could, he needed to see it for himself. The only repair for that is surgery so, if he takes my word for it, he's got to have an operating room and a whole team to support the surgeon who is coming in. He would look awfully foolish if they did all that and discovered in the OR that it was a superficial laceration that the ER doc could have fixed. As things now stood, the surgeon could be cancelled and everything would be ok if it was a false alarm.
He very gently pulled layer after bloody layer of gauze off and dropped it into a bucket. He got within an inch of the wound and blood began to ooze through the gauze. He stopped and said that was as far as he would go until the blood bank brought the blood. He had a nurse dial the blood bank and hand him the phone. When he got an answer, he asked when we would be getting the blood. He listened for a minute and then he threw the phone down on the floor, smashing it to pieces.
Turns out the bank couldn't release the blood until Doctor X got there in person with the key and he was at a party and would "come in before too long."
Okay. It is what it is. The bleeding is pretty well stopped. The IV fluids have gotten the patient's pressure to at least a minimally acceptable level. The man is breathing 100% oxygen. Nothing for anyone to do except to wait.
A nurse added a bunch of new gauze to the wound and taped it down securely with wide tape.
I went out to the ambulance where my partner was trying to clean up the blood. In a case like this, that is a major problem. I grabbed some towels and started helping. After a few minutes I gathered up a bunch of bloody towels and went in to get some clean ones. As I went by the trauma room, I looked through the window in the door. Nobody but the patient. I stepped inside and looked. Blood was flowing from beneath the tape, running down onto the plastic mattress.
I grabbed a bunch of gauze, piled it on and did the best I could to get it temporarily stopped, then I took off to find a nurse.
Nobody at the nurse's station. I started going from room to room. Finally I saw a nurse coming out of the break room, ran and grabbed her and told her what was going on. We both went to the trauma room and she started redressing.
I asked her where everybody was. "Oh —— is retiring and we're having her going away party in the break room."
I went back out, put my bloody towels in a decontamination bin and got a bunch of new ones. Back out to the truck.
We cleaned and wiped and sprayed and wiped and cleaned some more.
Almost done. I gathered up the trash and bloody towels. Back into the ER.
Nobody in the room.
I stepped inside. Same thing. Again I got it stopped.
I headed to the break room, burst in and let everybody within earshot understand exactly what the situation was and how I felt about it. Several of them, mad as hornets, came out and headed for the room.
I went again to dispose of my stuff. As I headed out the door, I heard the loudspeaker. "CODE RED, CODE RED, TRAUMA ONE. CODE RED, TRAUMA ONE."
I went out to the truck. My partner finished cleaning while I wrote up the report. I went back inside to find the doc and get his signature. Nobody would look me in the eye. I found the doc, he signed my report without looking at it or me and I put a copy in the bin.
As I walked out, I looked into the room. He was, of course, still there, covered entirely by a sheet. His life's blood was in a pool on the floor.
We got in the truck and went back to quarters to be ready for the next one.
Be assured, this matter was not done in secret. It was thoroughly investigated. The doctor, the head nurse and the nurses involved were interviewed and appropriate action was taken. Stuff happens. No one has been a paramedic or an ER doc for more than a very few years without doing something stupid and, perhaps, killing someone or, at least, failing to save their lives. It is the nature of the work.
The Coroner's report? "Patient exsanguinated secondary to a neck wound sustained in a high-speed motor vehicle accident."
Case closed.
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