basric: (lifeflight)
[personal profile] basric
**W*A*R*N*I*N*G

This is trauma, a five car accident where children were involved in one vehicle, though I just give a swift abbreviated version of what occurred with them.

Tennessee Good Samaritan Law concludes That anyone who assists at the scene of an accident “shall not be liable to such victims or persons receiving emergency care for any civil damages as a result of any act or omission by such person in rendering the emergency care, or as a result of any act or failure to act to provide or arrange for further medical treatment or care for the injured person, except such damages as may result from the gross negligence of the person rendering such emergency care.”

Tennessee State Law also states anyone with healthcare experience may drive by and not stop to give aid at the site of an accident. However, If they stop and then leave the scene before emergency care arrives they are not held harmless from any civil law suits and may be charged with a Class B Felony. If the victim dies they may be charged with manslaughter.

I pass a lot of accidents, mostly fender benders with people outside their cars milling about talking or ranting; except this particular Friday in September.

At six p.m. the sun was below the horizon but there would be light for another hour. The air was warm so I had the top down on my car. The cars in front of me came to a screeching stop from seventy mph to zero and I-65 South became a parking lot. The far left two lanes of the six lanes began to move. In fifteen minutes I could see the blockage.

Five vehicles that made up the accident, two cars crossed four lanes with an SUV T-boned into a Cadillac and a sedan T-boned into a small Dakota truck. A SUV had rear ended the first SUV.

A nurse in pink scrubs had pulled onto the shoulder of the interstate and was standing beside the sedan.

Traffic was slowly feeding by in the far two open lanes. Slowly so the rubberneckers and lookyloos could search for some sign of blood or brains that they could say “Gross” then rush to call a friend, “Martha you’ll never believe what I just saw”,

I thought of driving on, then I thought of how bad the accident appeared – smoke boiled out from under the Cadillac's engine. The nurse who wore baby pink scrubs gave me serious pause. She was likely an OB nurse. The thing is though you study all the fields in school, you KNOW ones you practice. I pulled in behind her car and grabbed my emergency bag from the trunk.

Carla was her name and she told me in no uncertain terms that I could go. She was handling it. This was HER accident scene.

“Have you been to all five vehicles? Called 9-1-1? Do you have any trauma experience? Where do you work?”

She huffed at me Women’s Hospital. She turned to the small blonde lady buried beneath an air bag, “Tell her I’ve got this. I am taking good care of you.”

The young woman was buried under an airbag. She was having obvious trouble with her breathing. I didn’t wait for an answer, my temper took over. I unzipped my bag and removed the tool with a hammer on one side and a knife on the other. I pulled off the knife’s sheath and bumped pinkie with my hip, “I’m going to deflate the bag.” I punctured it from the back. An explosion of air had the other nurse gasping. “Can you take off the seat belt?” I asked you young woman.

After she unfastened it she held her head, “I feel kindda dizzy and my chest hurts.”

“That is probably from the airbag,” Pinkie advised.

Ya think?>I opened the door and assessed her lungs. "Can you recline your seat? Lay back and concentrate on breathing slowly.”

“I was here first. I can handle this,” Pinkie actually gave me a shoulder bump to move me. I almost slugged her.Yay for temper control.

I turned on her, “You stay here and follow my directions. She’s having trouble breathing, keep an eye on her while I check the others. Watch to see if she coughs up blood. Do you have a penlight? Good, keep checking her eyes – equal and reactive. Don’t let her try to get out of her car. If her breathing gets labored, you see blood, yell for me. Do you have a cell phone –- then call 9-1-1.”

“Why should I take any orders from you?”

“Lady, I AM a trauma nurse; I KNOW what I am doing. This is where my expertise lies. Help or get the hell out of the way.”

The cries from the truck in front of me alerted me that we had children involved. It was a small truck. There were three very young children splayed across the seat and in the floor. There were no car seats for the children. I opened the door the eldest a girl about five or six was unconscious her head having hit the window fell into my arms. She had a weak pulse and slow respirations. I moved her carefully to the ground. Her younger brother was awake and screaming.

He was younger, maybe around three. It was obvious the bone was broken in his arm as it was protruding against the flesh of his arm and wrist. A hematoma was enlarging around it so apparently it had cut through a vein or artery. There was a lot of bleeding from a cut on his forehead. I called Vandy’s Pediatric Hospital’s Trauma Center and spoke with their Attending.

He walked me through how to care for each child and sent a LifeFlight for them. I will not go into details of how I cared for them. This is the stuff of nightmares for me. The third child, an infant, had hit something so hard his skull was crushed. He was DOS. I did not move him from the floor.

The woman had been driving without a seat belt and her upper body had been crammed into the space above the steering wheel. Her head against the windshield and had sent spider webs of cracks across it but it hadn’t shattered. The steering wheel had crushed her chest and her head was at an angle usually seen in horror movies. She had no pulse and was also DOS.

A man and woman – Good Samaritans -- came to offer help.

I left them with instructions on what to watch for on the children and to talk calmly to the boy so I could check the other cars.

The doors were jammed so I crawled through the open window into the Cadillac. I took care of the air bag and had to cut the seat belt as it had locked. The driver was about thirty and I heard no sounds from his right lung. He had coughed up blood twice and it hurt for him to breath. The seat had shoved forward and his legs had been mangled into the small pedal area, obviously bones were fractured and his legs were trapped. There was a great deal of blood so I cut his slacks at the thigh to reveal a long open gash with some kind of jagged metal in it.

I used my home cell to call my triage and talked with the Attending. The femoral vein was nicked so I clamped each end with hemostats, double checked the exposed femoral artery was intact then secured the metal and packed and wrapped the wound. I put pressure bandages where I could reach and covered exposed muscle and bone, He was in severe pain. But the paramedics would have to take care of that. I squeezed his hand and promised to be back. That help was on its way.

The SUV was accordioned with its front between the side of the Caddy the rear which had been crushed from behind. The doors were crumpled. I yelled at her to turn away and broke the rear side window and heaved up and crawled in then over the seat. I took care of the airbag first. Somehow the gear shifter had broken free and was lodged under her right ribs all the way to the thick handle. Dark blue, thick blood oozed slowly from around it. Her liver had been impaled.

I talked with the Attending, who ordered a LifeFlight and I spoke with him as I examined her. She was short so the airbag had done a job on her face and chest. I told him I thought her jaw was broken, and she had a spreading bruise on the left side so she had internal bleeding probably from her spleen. She had lacerations on her arm from the crumpled metal. I wrapped her arm and secured the shifter. She was unconscious by the time I finished. Her respirations were strong and even. Her eyes reactive and equal. I felt safe to leave her.

I needed to recheck the other victims. EMS and the police would have tried to come from the exit behind accident and would have found all lanes and emergency lanes blocked by motorist in a hurry so they would have to back up, backtrack and go to the exit in front of us.

I knew I had three helicopters coming with no place to land. Cars were using two lanes to funnel past the accident. I walked in front of the next car in line and stopped him. After he swore at me, called me crazy, he finally agreed to pull his car across the two lanes. Cars began to blast horns.

I itched to give them all the finger—but I must be professional. Cars in the far lane slipped over to use the left emergency lane to pass us. Frustrated I stepped in front of the next one and he actually bumped me lightly with his sports car. He bumped me! Twice!

“YOU! SON OF A BITCH! STOP!”

He got out, stormed over to me dressed in his thousand dollar suit, “Get the fuck out of my way, bitch. I have some place to be.” He stepped into my personal space but I didn't step back.

“I have seriously injured people over here. I need open lanes for emergency vehicles.”

“Don’t you know who I am? And bitch I don’t care, I will run your ass down. So move it or lose it. I’m on a schedule.”

“Do it. Go ahead.” I got in his face. “You’ll enjoy going to jail. I’m not moving and neither are you. Your idiocy is keeping me from people who need my help.”

“Damn you,” he actually balled up a fist and drew it back, but I didn’t move. (I told you when I lose my temper I am crazy) “You crazy bitch I will knock you on your ass.”

“Brother, not cool hitting a woman,” a mammoth of a man from eighteen wheeler and two other men circled around us. “Now, mam, what do you need?”

“Keep all these cars and any people back; I need someone to get the fire extinguisher from my trunk and use it on the engine of that smoking Caddy, there. And he needs to return and stay in his car.

The truck driver said he had big extinguisher in his truck and would take care of the Caddy. The two other very large men ushered Mr. Threat to his vehicle where he sat steaming.

As I turned to check the people in the SUV the lady yelled at me that a child had stopped breathing. I ran.

Still, on the phone with peds triage . . . I juggled phones and reviewed peds CPR with them, then showed the man how to do CPR on the child. When I saw he was handling it, I checked on the female driver and was relieved to see none of the bandages had bled through.

In the last SUV the driver was shaken but breathing alright with good lung sounds. She told me she was six months pregnant so the airbag was off but though the seat saved her from the steering wheel the belt left a welt beneath her breasts and over her left shoulder with abraded spots that were bleeding. I bandaged them then I had her recline the seat until her breathing eased.

I went back to Pink Nurse Carla and sent her to care for the pregnant woman. The woman she had been watching was talking. She complained pain in her left side. I opened the door and kneeled beside her. The lack of lung sounds on that side had me lay her seat back and turn to the weak side. Her lung was probably collapsed. She coughed and sprayed me with blood. I was back on the phone with triage when I heard the first sirens.

I ran back to the children and though the girl was still unconscious she had a weak pulse and shallow respirations. A policeman, thankfully one I knew, listened as I gave him a report from the time I reached the accident.

The Peds LifeFlight hung over the interstate until they made room for them and the children were whisked away.

The fire truck used foam on the still smoking Caddy and hit the undercarriages of all the other vehicles and that included my shoes and pants legs.

An ambulance carried the pregnant woman to the nearest ER.

I heard one cop call for the Medical Examiner for the deceased woman and child. Something I had not done.

Thankfully two LifeFlights landed one after the other to carry away the first woman and the woman in the crushed SUV. The second had to sit while the male victim’s car suffered through the Jaws of Life as they shredded the metal from around the man. Once freed, he was carried to the waiting helicopter. The resident called and asked if I wanted to ride in with them, but I wasn’t leaving my car.

The ride along resident offered to drive my car and I could take his place since I had all the information for triage. I think he just wanted to drive my convertible but I gave up my keys, told him where to park and secure it; then I left with the team, my nursing bag over my shoulder.

The flight was uneventful until we landed and the patient coded. I told them, “Put me on the gurney to do CPR. You’ll just have to change out in triage otherwise.” So, we came in with me straddled the man doing CPR on their gurney. They worked as one to move the victim and me to the table where I continued CPR and the LifeFlight Team headed out for another MVA.

They handed the Ambu bag off to respiratory who switched the oxygen from tank to wall. Day shift was still working, now so was I. As I did compressions I gave the Attending report. Drugs were administered, I circulated them with my compressions, I was lifted to the floor and the patient was shocked. Leads had been connected during my CPR and he was now showing a normal sinus rhythm. The Attending assessed the patient and looked at me, “You stabilized everything. You could have put the chest tube in and saved me from doing any work.”

I smirked at him, “I’ll have to remember to put one in my trunk for my next accident. I just hope your resident doesn’t wreck my car.”

“You took his place?” At my nod he asked, “You still driving that little gold Sebring convertible?” Again I nodded. “Hell, we’ll be lucky if he comes back.”

‘You know you have blood all over you?” one of the nurses asked.

“Yeah, it was a cough from one of the victims.”

“When you write this up, put it in my inbox – write EVERYTHING you did and I’ll sign off on all of the orders,” the Attending instructed me.

“I have a Peds to write also. There was an infant fatality.”

“Put that one in my box, too. I’ll get it signed.”

“I’m going to shower.”

“Barbra?”

“Sir?”

“You did a hellava job out there.”

High praise from our Trauma God.

Everyone I helped survived. The woman driving the children was their Nanny. The bereaved parents came later that night and thanked me for saving two of their children. I never gave anyone of the relatives or patients my name so when the newspaper reporter came asking questions no one had any answers for him.

He found Pinkie who was happy to take credit for saving the day. It was quite amusing.

Trauma is MY wheelhouse and you are in it whether you are in triage, the jungle, on a beach or the interstate. Trauma is my field of expertise and I am damn good at it.

Pinkie called my manager to complain about me—not by name but she knew where I had to work and what I looked like. My manager thought she was ridiculous. Maybe next time I ought to just let Pinkie handle it -- Nah.

Everything that happened at the scene of the accident took less time than it did to write this.

I edited out the most graphic sections for my gentle readers.

ABBREVIATIONS:
dos DEAD ON SCENE
hematomablood collecting in the deep muscle and under the skin
MVAMotor Vehicle Accident
OB Nurse Obstetric Nurse
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September 2013

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