A Really Long Day Becomes a Really Busy Week

A Really Long Day Becomes a Really Busy Week
By Joe Moore

Nothing ever happens here on the most remote inhabited island in the Great Lakes;  never any emergencies, never any serious problems, and certainly never any need for more than one two member crew to respond to the emergencies that do occur.  Such are the thoughts of some members of this community, but I’ve a story to tell about one serious disaster that occurred on this island, and, thankfully, we had the volunteers available to help take care of the patients involved.

“Beaver Island EMS, respond to Donegal Bay for a Tracker rollover accident with unknown number of victims.  Repeating,  Beaver island EMS, respond to Donegal Bay for a Tracker rollover accident.  Unknown number of injuries,” Central Dispatch paged for our local EMS.

“ Enroute to the garage,” I responded on the radio, and off I went to get our emergency response vehicle (ERV) that was parked down at the old medical center building next to the ambulance garage.  I drove my car carefully from about a half mile away, and just as I arrived, I heard others call in route to the garage.

“57 Echo 3 is enroute to the scene,”  I responded on the radio after jumping out, grabbing the keys from the garage, and getting into the ERV, starting it, and keying the microphone on the radio.

Man, was I nervous as I turned on the lights and siren of the ERV, drove past the school, and turned onto Donegal Bay Road.  Central Dispatch did not help matter when they radioed, “We have a total of five teenagers who were riding in the Tracker as reported by a bystander.  The Tracker was going too fast, traveling from the south to north, and was unable to make the curve.  The vehicle is laying on its side.  All five passengers were thrown from the vehicle as the vehicle rolled.  None are trapped, but fire has been alerted as well as law enforcement.”

Passing the campground and the S-curve by the campground, I begin hearing EMTs calling enroute to the garage, and I begin to calm down a little bit.  After all, I am the most experienced EMS person on the island that still participates in emergency care of the ill and injured.  As the on-call paramedic on the scene, it will be my responsibility to do the initial triage of the scene and determine who needs to be treated and transported. 

Luckily, the law enforcement officer is also a paramedic, and there is one more paramedic on the island as well as several EMTs.  As I pull up on the scene, I shut the siren down, block the right hand lane of the road with the ERV, and note that the Tracker is demolished and has rolled at least twice based upon the marks on the road.  This is called scene size-up, and I’m the first and only trained person on the scene at this moment.
There is no one trapped in or under the vehicle, and as I walk up toward the roll-over, one of the bystanders states, “The driver is right over here.  He seems confused, but is not complaining of any injuries.”

“57 Alpha 2 is on scene,” the radio on my belt blares.  “What do you need, Joe?”

On the radio, while walking up to the driver, I said, “I’m checking over the driver.  Let’s all get spread out and find all the passengers.  Mechanism of injury suggests c-spine stabilization.  I need an EMT up here by the ERV.  I’ll do the triage as soon as all passengers are located.”

“1527 is on scene,” I hear on my radio while I begin to assess the driver.

“1527, can we get fire to take care of traffic, and can you grab your jump kit and be paramedic on this scene until we get all the patients triaged?”  I asked over the radio.

“Roger,” 1527 answered. 

“Fire copies direct, blocking the roadway for through traffic.  We’ll turn them around on both sides of the accident scene,” fire responded on the radio.

My EMT partner Cindy arrived and took over cervical spine protection on the driver of the car.  I looked around and noticed that there were at least two EMS providers by each of the five people in the car.  I walked over to the first teen passenger, and overheard her say, “My neck hurts.”  I palpated her neck from the base of her skull to the tailbone, and said, “Full spinal immobilization for all five based upon mechanism of injury.”
I radioed the other providers, “1527,  will you take two patients?  5746, will you take one?  I’ll take two patients and we’ll immobilize all five.”

Both responded in the affirmative, and I returned to my first patient.  After a head to toe examination, the only issues were neck and back pain.  We used a cervical collar and a backboard and immobilized the driver.  I left Cindy to monitor the driver’s vital signs and went on to my second patient, the girl who complained of neck pain.  Another EMT, Dawn, was holding cervical spine protection, and I noted that this patient had serious deficits in sensation on one side of her body which had not been there when I first saw her.

“Central Dispatch, 5740, EMS Command,” I radioed.

“Go ahead, EMS Command,” Dispatch responded.

“Please contact our local airlines and check on availability of aircraft.  We need at least two aircraft ready for patient transport,” I requested.  “Please call me back as soon as possible.  We’ll be in route with the first patient in about ten minutes”

As we fully immobilized the spine on the second patient, I heard 57 Alpha 1, our back-up ambulance and another paramedic arrive on scene.  On the radio, I said, “Glad you are here , Bob.  We’re going to start transporting these patients in a few minutes.  I’m taking this first young lady due to lack of sensation.  She is the most seriously injured patient based upon triage.  I’m turning the scene over to you, and I’m heading to the airport with this first patient.”

The young teen began to cry, and I calmed her as we loaded her backboard onto the 57 Alpha 2 cot for our primary ambulance.  “We’re going to get you to the hospital as a precaution based upon the roll-over accident.  How are you doing now?  Close your eyes, please.  Can you feel me touching your leg?

“Yes,” she said.

“Sharp or dull?” I asked her.  I was using a point of a safety pin.

“I can’t tell,” she cried out loudly.  “What’s wrong with me?”

“We’ll find out when we get you to the hospital,” I spoke firmly by quietly.  “When we get you into the ambulance, I’m going to start an IV and hook you up to a cardiac monitor.  The electrodes will need to go on your arms and legs, as well as in the center of your chest and under your left breast to your armpit.  I will be very careful, but I want you to know that I am not getting fresh or anything.  We will not need to cut your clothing since your bikini will allow us to keep your privacy. After we cover you with a sheet, we’ll load you into the ambulance, and start our treatments.  Do you have any questions for me?”

“Are you Courtney and Andrea’s dad?” she asked.

“Yes, I am.  How did you know that?”  I responded.

“I met them at the beach yesterday,” she said.  “I’m getting feeling back in my leg now.  It’s starting to hurt a little bit, but I’m happy you are my paramedic.  They both said you were amazing at what you do.”

“That’s sweet of you to say,” I blushed.  “I’m not sure you’ll like me in a minute or so.  I’ve got some things that I need to do while we are moving down the road.”  This was said as the patient was loaded into the ambulance.

I climbed in the back with my EMT partner.  One of the firemen, who was also a medical first responder,  offered to drive the ambulance.  My EMT partner set up the supplies for an IV start while I continued to assess my teen female patient.

“I’ve got to put some electrodes on your chest to make sure that everything is okay with your heart,” I stated as a matter of fact.  “But, before we can do that, I need to wipe the sand and dirt off.  It looks like you rolled in the sand after you were thrown from the Tracker.  Do you remember doing that?”

“We were all having so much fun after spending a few hours at the beach.  I don’t remember anything about anything regarding the accident, but you are right.  I can feel the sand all over.  It’s probably sticking to my skin because of the sunscreen that I had just put on before we got in the Tracker to leave,” she stated.

“I noticed that the electrodes didn’t want to stick to your skin.  That’s why I’m wiping the sand away and then using this alcohol pad to get the electrodes to stick.  I’m going to listen to your breathing also, now that there aren’t a bunch of people standing around and all we have is the gravel road noise around us,” I continued to reassure her.  “Your heart looks like it’s just fine,” I said as the 12-lead EKG printed out, “and your lungs are clear with normal breath sounds.”

“ Would you write that down for me?”  I said to my EMT partner Cindy.

“That stethoscope was cold,” my patient stated.  “Are you Courtney’s and Andrea’s dad?”

Now, I was becoming more concerned that I was previously about this patient.  We had already been through this discussion, and my concern was based upon her neurological events going on.  First of all, she couldn’t tell the difference between sharp and dull.  Then she said her feeling was coming back into her leg.  I had retested her sensation levels twice with the same results as before, and now she didn’t remember our prior conversation.
“Okay, here comes your poke with the needle,” I said as the catheter went into her vein in her left arm.  “IV is in, and you’re heart rate is back down to normal.  Blood pressure is good.  Thanks, Cindy. We’re on our way to the airport to fly you off the island and get you to the hospital.”

“I’m going to Charlevoix?  Why am I going to fly?  Where are my parents?  What are you doing to me?” my female teen patient blurted out as she began crying once more.

I calmed and reassured her that all this was a precaution, and we were just making certain that she got the best care possible for the situation.

“What do you mean, ‘the Tracker rolled over’?” she said.  “I don’t remember that.  Why don’t I remember that?”  she started crying once again.

I was concerned that my patient had something going on inside her head, possibly some bleeding, but definitely some bruising of her brain, like a concussion with lapses in memory.  No matter what, this patient needed to be checked out in the hospital and probably get a CT scan or an MRI of her brain.  She hadn’t lost consciousness while I had been in contact with her, but she didn’t remember the accident at all.  Could that have been caused by unconsciousness or was that lapse in memory due to a concussion or something more serious? 

“We’re at the airport now,” I reassured my patient.  “We’re going to be in Charlevoix in about 20 minutes.  Can you give a telephone number for your parents, so they can meet you there at the hospital?”

She gave me a phone number, and I asked Central Dispatch to contact her parents to meet her at the hospital.  Central assured me that this would be accomplished, and I was able to go back to the continuing assessment, monitoring, and treatment of my patient.

Just before take-off of the airplane, and before the engines started, I said to the patient, “Cindy is going to hold your hand.  You are going to feel the blood pressure cuff squeeze your arm on and off during the flight.  If you need us for anything, just let us know.  We’ll let you rest during the flight.  Are you ready to go?”

She was still crying softly, and while I wiped her tears away, she said, “I’m ready.  Boy, are my parents going to be mad.”

We monitored this young lady during the twenty minute flight across the water to Charlevoix.  There was a complete patient report given over the radio to the hospital.  They were notified that there were going to be up to four more patients arriving at the emergency room as quickly as we could transport them.

Upon arrival in Charlevoix, we unloaded the patient’s cot from the plane and loaded it into the ambulance in Charlevoix for further transport to the hospital.  I pulled the Charlevoix paramedic aside and gave him a report out of the hearing of the patient, notified him of my suspicions of possible head injury, and let him know about more patients coming.

After helping to load my patient into the ambulance, I climbed in with them and said, “Young lady, I have to get back to the island to help out your friends back there.  We’ll need to bring them all across to be evaluated.  I am not abandoning you.  This young man here is Bob.  He is not only a great paramedic, but also a good friend of mine.  He’ll take good care of you.  Your parents will meet you at the hospital.  I want you to know that you will get the best care possible, and I will follow up to find out how you are doing.  I hope I see you on the island again in the future.”

She said, “Thank you.  Courtney and Andrea were right.  You are terrific.”

I blushed as I left the Charlevoix ambulance and walked back to the plane.  And off we went back to the island.

I ended up flying three of the five patients from the island to the mainland that day.  Three trips back and forth across the thirty-two miles of water were made by this paramedic.  The other two paramedics did an excellent job of moving patients from the scene to the airport.   They made good use of the EMS personnel available.  One flight was staffed by an EMT and a first responder.  One flight was flown with a paramedic and EMT.  All five were flown across the water in less than two hours.  It was a pretty amazing accomplishment by our very rural EMS agency.

After the transports, there were three patient care reports that needed to be written by me which took another two or three hours, and then I assisted the others in writing their reports as well.  It is interesting to note that no one in the group of EMS providers was making even minimum wage for helping out these young teens.  Whether alcohol was involved in this accident or not was never determined, nor did it play any part in the assessments, treatments, or transport of any of these patients.

My experience with the first one was the most memorable, but I had one more female teen and one male teen to fly across.  We shuttled ambulance cots back and forth across the water of Lake Michigan using the local air transport service.  We had successfully protected the five patients from further injury and transported them all to definitive care in a very short period of time.  None of these teens were transported to the medical center because they all needed spinal x-rays read by a radiologist.  All of the teens were treated for minor injuries at the hospital and released except the first young lady that I had flown.

My first patient was kept in the hospital to be observed overnight.  She was released the next day.  I got this information from my EMT partner Cindy, and I forgot about this patient as I went on with my life of teaching high school and junior high, and continuing to respond to others in their time of emergency.

The week was quite a busy one and included seven people in the water from a broken dock at the yacht dock, as well as two other medical runs that involved difficulty breathing for one case and another of cardiac origin.  Luckily it was summer time, and I didn’t need to be away from my real job at all.  School teachers have classes to take during the summer, but I was caught up with my required credits, so I was able to be on-call without too many breaks.

Three years later, I was down at the ambulance garage washing the ambulance when a young lady walked up to me and said, “Hello, Joe, do you remember me?”

“I’m sorry,” I said, “I don’t remember you.”

“Do you remember a Tracker accident three years ago?” she asked.

“Now I remember,” I said.  “How are you doing?”

“First of all,” she said, “I want you to know how much I appreciate your help back then.  You kept me safe, and you were complimented by not only the ER doc, but also the guy in the ambulance in Charlevoix.  But, more importantly, you wrote about my failure to remember things in your report.  That turned out to be much more important than anything else.”

I was confounded and quite confused, but also interested.  I said, “Why was that important?”

“Thanks to you and your written report, my parents had the ER doc refer us to a neurologist.  They discovered that I have something called absence seizures.  It took almost six weeks to figure out what was going on, but now I am here all the time instead of just once in a while.  Without your report and the doctor’s belief in what you wrote, I might still be walking around, but absent part of the time.  My medication keeps me in the present all the time.  We’re all glad that the problem was not a head injury like you thought, but also very glad that I got diagnosed and treated.  Can I give you a hug?”

“Now you’re talking,” I said, and she gave me a big hug and a peck on the cheek.

“Courtney and Andrew must be very proud of you and what you do for this island,” she choked out through tears.  “I am so glad that you were my paramedic that day.  I will forever be in your debt.”

When she walked away, I was in tears.  None of the other four ever contacted me, and neither did their parents, but this one visit verified my reasons for helping out in my community.