“They need another medic at the other call.”
I strap in and we take off. It is only about six or seven blocks away. As we turn off Maple onto a side street, I can see a huge crowd on both sides of the street. There are two ambulances there, a couple of fire trucks, several squad cars, and police tape already lashed across the road. We park and get out. I break through the crowd, then duck under the yellow tape. All I see is twisted black metal, broken windows, and firemen. Rick shouts to me, “I’ve got two unresponsives.” The fire department is helping the basic crew pull the passenger out and slide him onto a board.
“I’ll take him,” I say to Rick. We get the board on the stretcher and start strapping the patient down and rolling back toward my ambulance at the same time. I glance at him—he looks to be in his early twenties. He is out cold. He has a deep cut below his mouth. His color is funny—it’s a purplish blue tint. I stare at him as we wheel rapidly, ducking under the police tape. I see his shoulders shake as he breathes. In a matter of seconds we are back at my ambulance. I rip out our stretcher and then help Bob Bahan, one of the EMTs, lift the patient into the back, and scramble up. His partner hops in with me. “What can I do for you?” she says. “Let’s get his clothes off and secure him to the board,” I say. I reach for an oxygen mask, strap it on him, then stop. I look at him more closely. He shakes as he takes a breath, but he doesn’t take another one. He has stopped breathing. “I’m going to have to intubate him,” I say. I get out the intubation role, slide a stylet in a number eight tube, attach the syringe, take out the laryngoscope, open up the blade. I detach the front collar of the patient’s cervical collar, slide the blade in. He has no gag reflex. I look for the cords, but see nothing but blood. I drop the laryngoscope, suction the airway, and shout that I need a driver. Bob is getting a blood pressure.
“I’ll have to move my rig,” Bob says.
“Do it and come back quick,” I say. I am tempted to just have his partner drive, but I don’t want to be alone with this patient. I have too many things to do. I drop an oral airway in his mouth to keep his tongue from obstructing his airway, and start bagging. With each squeeze of the bag his chest rises. His color improves almost instantly. I tell the partner to take over.
Glenn is nowhere to be seen. Over the radio I hear someone say there are two working one hundreds—cardiac arrests. Glenn must be helping Rick with the other patient. The partner is bagging while I am putting the guy on the monitor. I get on the radio and say, we don’t have a one hundred, but a critical patient. Should we go to Saint Francis? I ask. Hartford is only blocks away, while Saint Francis is a five-minute drive, but two critical patients is a lot to handle even though a trauma center is equipped to take two. The dispatcher says Hartford is expecting two patients. “Okay, Hartford,” I say.
The guy has a normal sinus rhythm at 80. His pressure is 100/60. The man is stripped except for his briefs. He doesn’t seem to have any other injuries, but it is hard to tell because he is totally unresponsive. The other ambulance backs up past us. “Where is your partner?” I say aloud as I spike a bag of Ringers Lactate. “I may need you to drive.”
“Tell me what you want me to do,” she says.
Just then Bob appears in the back door. “Drive,” I say.
I strap a tourniquet around the patient’s arm, and sink a large bore fourteen into his AC. We’re moving now and as we go around a corner, I am tossed. I lose pressure on the vein and blood spurts from the catheter. By the time I get it shut off, my gloves are soaked in blood. I attach the line, run it wide open, then try to tape it down, but the tape sticks to my gloves. I grab two strips of the spare tape I have hanging above the cabinets. I attach the two strips and secure the line. Still there is blood everywhere from everything I have touched. I reach back for the laryngoscope, but we are already at the hospital. It is just a two-minute trip. I reach for the spare oxygen, unhook the bag from the wall supply, hook it up, and set it between the man’s legs. I hear him gurgling and tell the partner to suction. Bright red blood again fills the suction tubing.
“Let’s move,” I say.
We pull him on the stretcher. I grab the monitor and bag of fluid. The partner is doing a good job bagging. We hurtle through the ER doors, headed for the trauma room.
“Hold on a minute,” the triage nurse says. “Did you radio?”
She steps in front of us and tries to stop us. She is dragged several feet before we can stop.
“We were told you were expecting two. This is the second one.”
“You didn’t patch. What’s the story? I see he has a heartbeat.” She is looking at the monitor. “Then you have time to talk to me. What’s wrong with him?”
“He’s unresponsive, not breathing, and his airway needs to be suctioned.”
“What’s his name?”
“I don’t know.”
I am angry at this woman right now. She has no idea what we have just gone through. All she wants to do is show that she—the triage nurse—is the boss. She finally says, okay, you can take him in. We wheel him into the trauma room where a full second team stands around the trauma table expecting us, while another team works Rick’s patient who is in traumatic arrest. “They didn’t radio,” the nurse says.
The doctor ignores her. “What’s the story?” he asks me as we lift the patient on the board onto their table.
“Unresponsive, car demolished. One hundred over sixty, eighty, and respirations of about two. He’s got a lot of blood in his airway.”
They try twice to intubate but are unsuccessful. Rick Ortyl, who is standing against the wall, steps forward and taking a laryngoscope in his hand, sinks the tube.
“I don’t think you’re in,” a doctor says.
“Pulse SAT one hundred percent,” a nurse says, referring to his blood oxygen saturation.
“I’m in,” Rick says.
The room is crowded so all the prehospital people are kicked out. We stand outside talking about the call. Almost everyone says they have never seen a car so destroyed. Glenn, who rode in with Rick and Joel Morris, another paramedic, says the car was so horseshoed, the front end and the back bumper were almost touching. The crew who rode in with me are sent off to get their rig, which they beached at the scene. I thank them for the good job they did.
I sit down back in the EMT room to write my run form. I have a name for the patient now, and as I write it in the blanks, the battered body takes on a new form. Twenty years old. Just a half an hour ago, as I sat in this very room, he was driving around with his buddy in a muscle car, enjoying the day, listening to music, maybe checking out the babes on the avenue, driving a little too fast, a whole life to live, immortal. They bang one car and spin away, racing off the scene, hollering with youthful craze as they peel away. They hear a siren behind them and step on it even more. The car handles great as they cut up a side street, everybody on the street turning their heads. The radio pumping. A car is coming at them. They swerve.
I think about all the times I drove too fast in my youth. In Colorado driving down the Rockies, stoned out of my mind, thinking I was in a pinball machine. In Massachusetts, the passenger this time, breaking the windshield with my head, not getting medical attention, spending the next day vomiting. I think about the friends of mine who didn’t make it. One sticks in my mind more than the others. A twenty-year-old girl, whom just a couple of months before I had escorted home from a bar in a beautiful white snowstorm. She’d told me to come see her, and I didn’t, though I often thought to. I woke up one morning, got the paper from my door, and saw the photo of a body under a sheet on the dark, wet road, with her name listed in the small print of the story about a car coming back from a party in the country, going out of control, and hitting a bridge abutment, killing the passenger instantly. I thought how maybe if I’d gone and seen her, she might not have gone to that party that night, but might have been with me instead, sitting in a cloth robe, fresh out of the shower, sharing fresh fruit, homefried potatoes with sausage, a
nd the comics.
I break out of my reverie. I quickly write:
Pt. 20 y/o male passenger unbelted in head-on into telephone pole MVA. Car horseshoe shape around pole. Pt. unresponsive, cyanotic. Rapidly extricated. C-spine immobilized. Intubation attempted X 1. Airway suctioned of blood. Oral airway inserted. IV #14 in LAC LR Wide open. Pt. ventilations assisted. Pt. n. sinus on monitor.
Pt. transported to HH, airway monitored and suctioned and airway assisted with bag valve mask. Pt. turned over to ED staff with full report.
He gets a Glasgow coma score of three, the lowest score. No eye opening, no verbal response, no motor response.
Then I go out to look at the ambulance. The car is trashed. Blood is everywhere—on the floor, on the seat, on the cabinets, on everything I touched. The airway kit is scattered on the floor. The main oxygen is still running. I turn it off. There are IV dressings and wrappers and a broken blood tube on the floor, along with the needle.
It takes an hour to clean and restock the ambulance so it is ready to go. Every time we think it’s done we spot some more blood—on the stretcher bars, on the stretcher straps, on the monitor casing, on some trauma dressings in the cabinet. We finally clear the hospital. One dead, one critical.
“Well, that call ought to last us for a couple weeks,” Glenn says.
“Yeah, I guess.”
Scenes of the wreck are on the ten o’clock news, though I miss it because I am too tired to stay up. In the morning a picture of the wreck is on the front of the Courant’s Connecticut page. The call went so fast I never really got a chance to look at the car, but Glenn was right—the front and back ends are only feet from each other, wrapped around the pole like a ring. I learn later in the day that my patient has succumbed to massive brain injury.
That night I take off my boots as I sit on the couch with a beer already opened. With the reading light on high, I notice something on my boots. Dark red splotches run down both boots from the ankle to the sole. I shiver.
Wiffle Ball
Glenn is out for a few weeks with a strained ligament in his knee, so I am working with Darren Barsalou. It is a beautiful day. We’re playing Wiffle ball by some trash heaps in area two. Darren has taped a strike zone on the side of the ambulance and laid a longboard against the rig to keep the balls from going under it. He stands back forty feet and fires the Wiffle ball at high speed. I foul it off. There is no score in the top of the fourth. A short but strong and limber athlete of twenty-three, Darren plays on league softball and football teams. Glenn and I used to play Darren and his partner in basketball back in the spring whenever we were in area nine together. That was before I broke the tip of my right ring finger and twisted my ankle in a Saturday pickup game and had to retire from contact sports for fear it would knock me out of work. Back then I had earned the nickname “Kareem” and “The Tower of Power.” I sense he thinks he has met his match. Though I am an old man by ambulance standards, I still have the memory of how to swing a bat, and though my pitches lack his blazing speed, I am crafty with a Wiffle ball, changing velocity, getting lots of movement, throwing the ball in and out, keeping him off balance.
As he winds and throws, I crouch and then step into the pitch, ripping it deep but foul, just to the left of the evergreen that serves as the left-field foul pole.
“You exploded on that one,” he says.
The next pitch whizzes at my knees, and I narrowly avoid being hit.
On the two and one count, I step in again, catching the ball squarely over the middle-belt high, and drive it deep to center over the cement blocks and into the weeds. Home run.
“I’m not used to playing someone who knows how to swing a bat,” he says. “Clemens is rocked.”
“Conigliaro goes deep,” I say. “The Sox take a one-nothing lead. Frank Malzone to the plate.” I am the 1965 Boston Red Sox. He is the 1995 All-Star team.
In the bottom of the fourth, he rips the first pitch off former twenty-game winner Bill Monbouquette right at my head. I duck then turn to see it skip into the weeds for a Mo Vaughn double. I am stunned that he hit my submarine snaking curve. I fire a fastball at his head that bounces off his shoulder. I glare at him. I throw the big hammer swooping curve. He clocks it over the center-field fence. This is followed by three blistering singles, then a towering blast over the trees in left. I come back out of the overgrowth to see him smiling. “Instant replay,” he says, looking to the horizon and tossing the bat down like Barry Bonds.
“I quit,” I say.
“Giving up already?”
“Yeah, my arm is killing me. I don’t have any more throws left.”
Before he can protest or call me a wimp, the radio calls our number and we are sent for a back pain.
We start a new game in area nine that afternoon. I lead off with a single, but our number is called again and we’re sent for a woman unresponsive on Whitney Street.
“I had runners on first and second and was ahead one nothing, wasn’t I?” I say to Darren as he hits on the lights and sirens.
“Dream on,” he says.
The game resumes in the parking lot of Hartford Business College. I go down quickly. The game is scoreless for two innings when he catches hold of my sinker and lines it by my head. I pelt him with the next pitch. He homers. He homers again. Soon it is five nothing. He hits his third homer of the inning. “Keep walking,” he taunts as I plod after the ball that is still rolling away from me. When I turn back, he does his Barry Bonds slow-motion replay. I bean him twice in a row. My arm is really throbbing now, killing me.
I am saved by a call for a motor vehicle accident.
“If you were smart, you wouldn’t beat me so badly,” I say. “I don’t think I’m going to play anymore.”
“Girly-man,” he says.
“I used to be good at this game.”
“You want me to give you four outs and I’ll pitch underhand?”
“Fuck you.”
It is nearly dark when we resume play in a vacant lot off the Sisson Avenue ramp of I-84. We start the game from scratch. It is scoreless when I come up in the bottom of the third. After two singles to the pitcher’s right, he hangs me a curve. It looks as big as a grapefruit. I am off balance, but manage to keep my hands back. I drive it high and deep. It drops on the far side of the crack line in the asphalt that we have declared to be the fence.
“You ripped that one,” he says.
I glare at him.
He goes down in order, then we get a call for a man down on Broad Street, which turns out to be a drunk. I try to bring him around with ammonia inhalants, but he is too out of it. His pressure is okay, but he is tachycardiac. I give him an IV and check his blood sugar, which is fine. He smells of cheap wine, has snot coming out of his nose, and has flatulence all the way to the hospital.
It is now dark. We sit in the ambulance, waiting to be called in. “Well, you’re ahead,” he says. “We’ll have to finish the game another day.”
I eye him closely. “You were just toying with me,” I say.
“You capitalized on my mistake. You hit it good.”
“You hung it up there for me.”
“You think so?”
“I know so.”
He laughs. “It was a good game. We’ll play again next week?”
“We’ll see.”
That night on the news, I catch a glimpse of our ambulance at the accident scene. You can see the taped strike zone on the side.
Trauma Regs
On October 1, 1995, the new state trauma regulations go into effect. The regulations call for patients to be taken to designated hospitals that can best care for their injuries based on a triage algorithm. The idea is to get critically injured patients to operating rooms where skilled surgeons can save their lives.
The regulations took ten years to develop into law. When I went to the state health department in 1991, they were on the back burner. Because of my experience in EMS, I took an active role in reviving the regulations and maki
ng EMS a priority in the department. We formed a trauma committee, whose job it was to produce a draft of the regulations acceptable to the various warring factions in EMS that would meet the need. We chose Dr. Lenworth Jacobs of Hartford Hospital to chair the committee. A nationally renowned surgeon and a gracious, diplomatic man, he had the political skills necessary to bring disparate elements together.
There were many battles to be fought both within and without the EMS community. Emergency department physicians were worried surgeons would usurp their authority; small hospitals were worried big hospitals would take all their patients; volunteer EMS groups were worried new burdens would be placed on them. Dr. Jacobs, with help from Dr. Morgan, kept the focus on the patient. Dr. Jacobs reminded people that a trauma system was inevitable and that better it be developed by those who worked on the front lines than imposed later by bureaucrats. Dr. Morgan gave impassioned speeches about people dying needlessly that rang true to those who worked in the system.
I had thought at first that all you had to do was say “Let’s do it,” and it would get done, but government is a slow process. There were countless meetings, setbacks, and delays along the way. One of the hurdles we had to overcome was the resistance of some of the members of the Commission on Hospitals and Medical Care (the Commission) to the way we proposed to designate hospitals. Under our plan, in order to be designated as a trauma facility, a hospital first had to be verified by the American College of Surgeons, an organization that sets the standards for trauma facilities. The College verifies hospitals based on a hospital’s showing it has met certain criteria such as patient volume, staffing, quality-assurance programs, etc., over a fourteen-month period. Existing law gave the OEMS the right to categorize hospitals based on treatment capability. The Cost Commission’s Statutes gave them authority for approving new services. The Commission’s argument was that they should get to approve trauma hospitals because they are new services. OEMS’s argument was that we should get to approve them because we were designating them based on what they had already done. We had several meetings with Commission members over a period of many months. As new commissioners came and went, we had to make the same presentation again. In the end, I used my Weicker card to settle the issue. Ironically, before the regulations went into effect, the Commission itself was targeted for elimination.
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