Close to the Heart

“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.”

“What the hell?! Can you at least get the monitor electrodes placed?”

The side door opened, and there were Ben and Zo, paramedics from the backup ambulance called earlier. Their “What can we do?” was music to my ears.

“Ben, if you can get this IV started, I’ll get some vitals. Zo, there were other kids in the tent; could you go check them out?”

“On my way,” said Zo as Ben climbed in and started looking for the IV site.

I got the vitals. “BP 110/70, about right for her age and size,” I told Ben. “I’m working on 70 pounds or 32 kilograms. Does that sound about right to you?” Ben took a good look at Emily and replied affirmatively. “Good,” I said, “hang some saline and give a fluid bolus.”

The scene commander stuck his head in the door and gave us the bad but not unexpected news that nothing was flying.

“OK, then, let’s head out.”

“Her mother is out here. Do you want me to tell her to meet you at the hospital?”

“No, ask her to come with us. Both she and Emily will feel much better, and she’ll be able to give us information we need.” It’s been my experience with kids that they are always calmer if at least one of their parents is with them.

Mom got into the ambulance. I introduced myself and Ben and asked her to sit next to Emily. Mom sat down and stroked Emily’s hair and spoke to her in a soothing voice.

“Does Emily have any medical problems?”

“No.”

“Does she have any allergies to medications?”

“No.”

“Does she take any medicines?”

“No.”

“Ready to go!” I shouted to the driver. With lights and sirens it would only take eight or so minutes to reach the hospital. I turned back to the child. “Emily, I’m going to check you over again. Let me know if anything I touch or do hurts you.”

“OK. What happened to me?” she whispered, sounding very frightened.

I started checking her, gently poking and prodding while I told her what had happened. I told her she was in the tent with her brothers when the storm hit and the tree fell, pinning her down.

Not finding any new injuries other than some abrasions, I listened to her lungs, and…what the hell? Air exchange good all over, but what was I hearing on this left side besides the breath sounds?

“Ben, will you listen to that left side and tell me what you think?”

Ben listened and with a puzzled voice said, “It sounds like bowel sounds to me.”

“That’s what I thought too. Could that tree have been forceful enough to rupture the diaphragm?”

“I don’t know,” replied Ben. “Could be.”

I gave a brief update to the ED with the reassessment findings, and by the time I finished, we had arrived. We moved quickly into the ED trauma room, where the attending doctor and staff were waiting. I introduced Emily and her mom to the staff and recapped the call, giving details of the incident, how the scene looked, the injuries we identified and the treatments we gave.

“OK, let’s take a look at that back,” said the doc. The board restraints were removed, and Emily was log-rolled to her right side, keeping her neck and spine in alignment.

“That’s impressive!” said the doc upon seeing the back wound. “It’s deep, but I’m not sure the lung is punctured. Let’s get a stat portable chest x-ray.”

He turned to Emily’s mom. “This looks pretty serious, and listening to the events that took place, I think we should transfer her to the trauma center. The closest is an hour away. We’ll do a quick x-ray of Emily’s chest to see how her lungs are, and then our staff will transfer her there. Does that sound OK to you?”

“OK, but will Emily be all right?”

“She’s stable right now, and we have a good crew who will be taking her there. They will be in radio contact with us as well as with the trauma center, so if they need help, they’ll get it.”

“OK.”

The x-ray was done and the doctor, looking at it on the monitor, said, “There’s a small pneumothorax, but it’s not causing any problems yet. We’ll keep the trauma dressing on and let the air leak from the one open corner. Who’s taking her?”

By this time it was shift change, and the new charge medic was Doug. I turned to him and said, “If you send a night crew, you’ll be down a truck for two or three hours. How about I go on the transfer and we can ask Dick if he’ll stay later to cover the ambulance?”

“That’s good with me,” Doug replied, “but are you sure you want to do that? It’ll add two or three hours to your already long day.”

“Yes, I’m sure. There’s something about this kiddo that makes me need to see her safe on the transfer. Maybe it’s because she’s so close to my granddaughters’ ages. Anyway, I want to take her up.”

“All right, let’s check with Dick.”

Just then Dick walked by. “Dick,” I asked him, “can you stay over and cover the ambulance, and I’ll go on the transfer?” True to form, he agreed immediately.

With that settled, plans were put in place to cover the ambulances, and we packaged Emily for the transfer to the trauma center.

The crew for the trip was Jim driving and Tim in the back with me. Mom sat up front, and Jim kept up a running conversation with her the whole trip. I know this kept her anxiety under control—thank you, Jim!

In the back Tim and I attended to Emily. We monitored her vitals and, just as important, kept her quiet and calm. She had been given medication for her pain that helped keep her comfortable.

On arrival at the trauma center, we went straight to the emergency trauma area and were met by the trauma team. I gave report to the surgeon and his team and gave them the paperwork and x-rays. Within five minutes Emily was on her way to the operating room.

We said good-bye to Emily’s mom and started for home.

Epilogue

Three weeks later I headed to the trauma center with my wife to visit Emily. She had been in my thoughts almost every day. I’m not sure why, but I kept thinking about my own two girls at Emily’s age, as well as my precious granddaughters. Every once in a while, a call happens that really hits close to the heart. This was one of those calls for me.

We found Emily and her family outside on the patio. She was sitting in a wheelchair, connected to an IV pump. She looked tired and frail. I spoke with her for a short while. She didn’t seem to remember anything about the accident or the trip in the ambulance. Her family had been filling in the blanks for her. In time, I’m sure she’ll start to remember things on her own.

I spent the better part of the hour talking to Emily’s family after Emily had gone back to her room. I learned she was the only girl in a set of triplets and that the family was on a camping trip as a last vacation before school started. Mom shared that in the operating room, the surgeon found a piece of pine branch, six inches long and an inch in diameter, embedded in Emily’s chest. It had nicked her left lung and was just a centimeter away from her heart. Emily was doing pretty well, her mom said, and was scheduled to be transferred to a hospital closer to home.

Two days after I saw Emily, she was moved to a hospital closer to her home two states away. I haven’t heard how she’s done since my visit, but I think of her often and have a feeling everything is working out well for her.

Just intuition.

Mike Kennard, EMT-P, has been in EMS for 33 years. He currently works as a paramedic at Frisbie Memorial Hospital in Rochester, NH, and is a program coordinator for the New Hampshire Bureau of EMS. Contact Mike at grumpy1medic@gmail.com.

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