Close to the Heart

Some patients just get to you—especially kids.

“Campground command to Medic 5,” the radio crackled.

“Medic 5 answering command.”

“Medic 5, this is a mess out here. I think you should call for paramedic backup.”

“Will do, command.”

I was all alone on the intercept truck, so I contacted dispatch and requested a second ambulance be sent to the scene. I wondered what the heck I was getting into. The dispatch information was sketchy at best, only a “10-year-old girl pinned under a tree.”

A series of severe thunderstorms had passed through the area, and as I got closer I saw more and more debris on the road—branches, leaves, grass. This area experienced some real wind, I thought. On the campground road, I had to do some fancy driving around some big branches. At the end of the road were some camp staff, frantically waving and directing me to the victim’s location.

This doesn’t look good, I thought as I pulled up and stopped the truck. The first thing I saw was a minivan with its roof crushed and its front end crunched under two pine trees about 12 inches in diameter. Just beyond, sitting on another fallen tree was a small girl with one of the first responders. He’d put a cervical collar on her, and the EMT was holding a towel on her lower back.

“What do you have?” I asked as I approached.

“This is Emily,” responded the EMT in a fast, almost breathless voice. “She was in a tent with her brothers when the storm hit. The wind blew the trees down over the car and onto the tent, crushing both. The boys got out, but Emily was pinned under the tree. Bystanders lifted the tree off her. We just started checking her over. She has a cut on her back that looks like it needs attention right away.”

“Emily, my name is Mike,” I told the girl. “I’m a paramedic. You’ve been in an accident, and I’m here to help you. I’m going to check you over. Please let me know if anything I touch or do hurts you.”

I turned to the EMT holding the towel to the back wound and said, “Let me take that for a minute so I can see what the injury is.”

What I saw was a hole as big as a man’s fist. There wasn’t much bleeding, so I could visualize the extent of the injury. Oh, shit! Is that a lung I see moving in there? I called the EMT back to hold the towel over the wound. I hoped I looked calmer than I felt, and that my eyes were back from their bugged-out position. 

What to dress this with? My choices in the jump kit were 4x4s or a trauma dressing. Trauma dressing it was. She was so thin, it wrapped completely around her. With lots of tape to keep it in place, it was time to move out.

I turned to the first responders and said, “You guys get her onto the backboard and into the ambulance ASAP, and I’ll meet you over there.”

“But we need to get vital signs first,” came the response.

“No, we need to get her moving out of here,” I said. “Vitals in the rig. Let’s get going.” Walking back to the ambulance, I called the ED and gave a brief update so they could get the trauma room ready.

In the ambulance were two more first responders. Turning to the first I said, “When she gets in here, get the monitor attached and get some vital signs,” and to the second, “Have a non-rebreather ready and put it on her stat.”

The rear door opened, and Emily, on a backboard and stretcher, was loaded into the ambulance. The oxygen mask went on her immediately. Then the side door opened, and one of the first responders stuck his head in. “Mike,” he said, “command is checking on the availability of a helicopter.” I said OK but thought as I said it that the storm front was still in the area and the ceiling was too low to fly.

I started to assemble supplies to start an IV and saw neither the monitor nor the BP cuff had been attached. “Where’re my vital signs?” I asked.

“We don’t have a pediatric cuff to fit the monitor.”

“You’re kidding, right? How about a manual BP?”

Looking sheepish, the EMT said, “I can’t find one small enough.”

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