*Names have been changed and details omitted for confidentiality*
I’d been in Emergency Medical Services for around six or seven years when I responded to a call that changed the course of my life.
I was working in Consort, a small community in East Central Alberta, when we received a call for a two-vehicle motor vehicle collision near the crossroads of two fairly well traveled highways. It was a late summer or early fall morning, with clear skies and a warm sun.
My partner Lee and I rolled our ambulance out of the bay under five minutes after receiving the call, and we headed to the accident scene. The scene was around twenty minutes out of town under normal driving conditions. Considering the call, we were going significantly quicker than those, running “hot,” meaning with lights and siren.
I was driving. As we responded Lee and talked through our initial steps on the scene. We decided that we would split up on arrival. He would go check the occupants of one vehicle, I would go check the occupants of the other.
Even with the several years of experience I’d had in EMS up to that point in my life, I was unprepared for what we drove into.
We approached the scene from the East, snaking our way past stopped vehicles that had been delayed due to the collision.
To my left was the jack-knifed big rig. Further down the road on the right was a dark colored pick-up truck that had been converted into a portable welding rig. In between the two vehicles, stretching at least a couple 250 feet was a debris field between the two. Previously, the only time I’d ever seen debris like I witnessed on this scene had been in the movies.
Seeing what we had in front of us, we immediately called STARS (Shock Trauma Air Rescue Society) to attend the scene, because if any of these patients were going to survive, I knew the air ambulance would be required.
After I called dispatch that we were on the scene and requesting STARS, my partner and I went to work. He grabbed the med bag and went to the welding truck down the road, and I headed to the big rig.
A big rig, such as a mac truck or Freightliner, are heavily constructed vehicle designed to carry heavy loads. The truck in front of me, which started with its engine in front of it, had hit so hard that the engine had broken free of its mounting brackets and shifted sideways, exposing the fire wall.
I approached the vehicle cautiously, being mindful of spilled fuel and the potential for fire. I climbed up the side of the truck and into the exposed engine bay and up the firewall to get to the driver of the big rig.
When I looked in the cab of the truck it was immediately apparent to me that the driver had not been wearing his seatbelt; the forces of the crash had pulled him out of the driver seat and jammed him in between the passenger seat and the passenger door. Seeing as the passenger side front window of the big rig had popped out, I reached in to check the driver for signs of life.
Due to the awkward position I was in hanging onto the truck by the firewall, and the awkward position of the driver, I didn’t do the best assessment I’ve ever done, but due to lack of access I did what I could. I even climbed to the ground and attempted to gain access by way of the passenger door, to no avail. It was jammed shut.
At this point in time, I made an incredibly difficult decision. Due to the fact that there was no obvious signs of life such as no obvious breathing, no reaction to touch, and an extreme mechanism of injury, coupled with the lack of access to the patient, I felt that I had no choice but to triage the patient as a category black, meaning he wasn’t viable. I walked away to join my partner. The entire process took no more than 3-4 minutes.
I crossed the debris field to where my partner was with the driver of the pick-up truck. The good news is he was alone in the vehicle. The amazing thing is, he still had a pulse and some respirations when Lee had gotten to him. We had a viable patient. While Lee conducted assessments, started an IV line I updated our dispatch that we had one black and one red on scene.
A red triage level is a level that means there is significant risk to life, and that the patient needs to be transported stat. I hung up with dispatch, and Aleem had me start assisting the patient with his breathing by way of a bag-valve-mask (BVM). As its name implies, a BVM is a tool that medical professionals use to blow air into a patient’s lungs, similar in force and volume to a breath. Using room air, the BVM can push air containing approximately 21 per cent oxygen into the lungs. Attached to oxygen, the BVM can give the patient close to 100 per cent oxygen, which in a trauma situation is not a bad thing.
I took the BVM and started helping the patient breath, trying to time my bag squeezes with his breath. Our second ambulance and the fire rescue team showed up about the time I started bagging the patient. By this point in time, I don’t think our on-scene time had crossed the 10-minute threshold yet.
The first squeeze of the bag into the patient is a sound that I still here from time to time. It seared itself into my mind on this day. The reason I remember it so well is, on the first squeeze, I heard air escaping from the patient through his forehead. He had fractured his sinus cavities and had a small opening in his forehead allowing the air to escape. Fortunately, he wasn’t bleeding too badly from it.
With the arrival of fire rescue, our other ambulance, and eventually the police, the scene began turning into some level of organized chaos. The firefighters began working on extricating the patient. The other EMS crew joined Lee and I, with their EMT helping Lee with the monitor, running the IV, etc. The EMR crew who was on the call joined me, and we began taking turns assisting the patient with breathing. I also took on the role of communications officer, coordinating between the police, fire rescue, and our dispatch.
Breathing for the patient was a challenge because his truck had a center console that we had to lean over, and with the truck being on the side of the road facing Eastbound, the slight incline added just that bit of an extra challenge. I remember my abdominal muscles hurt like hell after the call.
After nearly 30 minutes on scene and about two minutes before we were ready to extract him from the wreckage, we lost his pulse and breathing. We had the fire department up-tempo the extraction, and we started CPR. When I had the opportunity, I contacted dispatch with an update for STARS, and to my surprise, the helicopter was patched into my phone so we could speak directly.
They thanked me for the update and assured me that they were less than ten minutes out. They said to keep working the patient until they arrived. I updated fire that STARS was approaching the scene, and a section of highway just west of our position was cleared as a landing zone for the helicopter.
We had the patient extricated and moved into the back of the ambulance, where we continued to work on him. When STARS landed, the flight medic exited the helicopter, and crossed the 200 feet to the ambulance, where she entered and took over, as the highest trained medical professional on site.
She assessed the patient, took our report, and based on mechanism of injury, length of extraction and down time, declared the patient to be a black triage as well, and had us stop resuscitation.
We were deflated. We had a potential victory and it had been snapped away from us.
With the body being in the back of the other crew’s ambulance, we collected our gear, and cleared the scene to go clean the truck, and ourselves, up a bit. Our entire scene time was just over an hour. It was an hour that changed my life.
In the time immediately following the call, I was okay. We returned to our base, restocked our equipment, and went back in service, then went to go get ourselves cleaned up.
The thing is, I wasn’t okay. Deep down something had shifted. I began having nightmares, and my rest became difficult, my anxiety increased, and my depression began creeping back to the surface, though I didn’t know it yet.
We did our job. We did our best. Unfortunately neither was good enough, resulting in the double fatality we responded to.
I still hear the noise of the air escaping the one patients sinuses. I still flashback to seeing the driver of the big rig jammed the way he was between the passenger seat and the door. I close my eyes and see it like it was yesterday.
This call wasn’t the only one to affect me. in the year and a half between this call and my leaving EMS there were others that stick with me as well. Those I’ll get to later.
Thanks for reading this far, and learning more about what makes me tick.