Priority Calls

Late-afternoon house duties are interrupted by a call for a motor vehicle accident with possible injuries, and the location given is “in the vicinity of a rural address.” The Attack One crew knows being dispatched to somewhere “in the vicinity of” anything usually means a serious problem. If the excellent call managers in the 9-1-1 center can’t pinpoint a good location, there is often a bigger problem than the average call.

When they mark en route, the dispatcher is prepared with some additional information. “This call was originally reported through a vehicle-based security system in this rural area, based on GPS locating,” she reports. “An additional call from a bystander indicates there is a vehicle way off the road with an unconscious driver.”

The Attack One crew leader requests additional rescue resources, and the crew prepares for a trauma victim. On arrival, they find a single vehicle about 400 yards off the road, down an embankment in a field, with a single male driver belted into the driver’s seat, unconscious. Vehicle damage is relatively minor; the automobile had impacted a small tree, which triggered the air bags and the vehicle’s GPS-based emergency notification system. An operator is still on the vehicle’s integrated cellular phone system, and that individual reports he’s heard no response from any vehicle occupant at any time.

The paramedic initiates assessment, and the rescue resources set up for victim removal and transfer back to the street. The patient is diaphoretic and unresponsive to all stimuli, but has only small abrasions and contusions, which appear to have come from the air bag deployment. Crew members note no trauma to the head, chest or abdominal areas, and no visible extremity deformity. Pulses are regular and strong, and the victim is not tachycardic. The paramedic opens the victim’s eyes, and the pupils are midsize and reactive. There is no smell of alcohol. Pulse oximetry reveals good oxygen saturation.

The Attack One crew leader sets up for trauma care and rapid removal, and the crew slides the victim onto a backboard and immobilizes him. They administer oxygen and ask colleagues back at the road to prepare for intravenous fluid therapy. It will take several minutes to carry the victim back up the embankment.

The victim remains unresponsive into the ambulance, and yet his perfusion status appears adequate. He also remains diaphoretic, although the outside temperature is not overly warm.

A thought occurs to the paramedic: Altered level of consciousness plus diaphoresis means blood sugar assessment. The medic quickly inserts an IV line, takes a drop of blood out of the catheter, places it on the blood sugar measurement strip and inserts it in the glucometer. The reading is 23.

The patient has the intravenous line connected and receives a pressure infusion of 500 cc of normal saline as a 50% dextrose solution is prepared. The sugar is administered, and the patient’s diaphoresis clears quickly. His mental status slowly improves, and he begins to move around within his immobilization straps, but does not open his eyes or talk during transport to the trauma center. A secondary trauma assessment en route finds no additional signs of injury and no victim identification. The paramedic calls the hospital via cell phone to report on the patient’s mechanism of injury and altered mental status, as well as good perfusion and lack of signs of significant trauma.

As the team and victim arrive at the emergency department, the victim finally opens his eyes and asks, “Where is my phone?”

“We’re not sure what you’re talking about, sir, but fortunately you’re doing OK,” the paramedic reassures him. “It looks like your blood sugar dropped and you drove your car way off the road. Maybe your phone is in the car, so we’ll ask someone to try to find it.”