By Michael Morse
An accident happens, as they often do, and 911 is called.
The EMS crew has been on duty for 18 hours, and has responded to 15 911 calls during this span. Homeless alcoholics, chest pain, falls and a few fender benders before this one — a rollover on Rt. 95 with occupants trapped. A fire crew and an ambulance are dispatched. Five people out the door 30 seconds after the tones hit.
They position the apparatus in the high speed lane and the one next to it, hoping that an 18-wheeler speeding through Providence doesn’t miss the warning lights and create a mass casualty on the highway.
There is a man in the vehicle with life-threatening injuries. Cars speed by, trucks zoom past, a freezing wind picks up highway grit and relentlessly attacks exposed skin as the crew begins extrication.
A few miles away, we have the trauma team getting ready, advised of the incoming trauma by the very same EMS crew that is now battling the elements and fighting time. They have their gowns on, gloved up, eye shields in place, respiratory standing by, three RNs, a few ER Techs, doctors, residents and interns waiting in the wings. They’re waiting, thinking, going over protocols, medications and procedures, checking and rechecking the IV set-ups, intubation equipment, the organ bank has been notified.
Back on the highway, it’s controlled chaos as the crew immobilizes the patient, brushes broken glass from his clothes, controls bleeding, and gets him to the ambulance. The vehicle is leaking all kinds of colorful fluids, most smelling of petroleum. Two of the firefighters remain on the highway to mitigate potential hazards; the third firefighter gets in the driver’s seat of the ambulance and gets rolling toward the ER.
All is quiet at the hospital as they await their patient.
The EMTs arrive with a patient clinging to life. Two IVs have been established, an 8.0 endotrachial tube is in place and secured. The patient has equal lung sounds with good chest rise, his clothes are cut off for the most part, traction splint in place, three sets of vitals and a fairly cohesive report is ready.
Trauma team rolls into the room, and prepare to move the boarded and collared patient from their stretcher to the hospital’s stretcher, all neat with sheets and absorbent pads in place. Security stands by due to the patient‘s combative nature, most likely due to the head bleed from his noggin meeting with the windshield at seventy MPH.
The guy in charge of the EMTs starts to give his fairly cohesive report — a report formulated in his head while en route to the ER, while performing the endotrachial intubation, managing an airway, monitoring vital signs, directing IV placement, holding the combative patient down while his clothes are cut off in the back of an ambulance with no suspension over roads that have survived too many New England winters.
There’s a lot of racket in the trauma room, so the EMT raises his voice a little so all can hear his report. The doctor, an intern actually, maybe her first time in charge of the trauma team shouts, “Quiet!” The EMT in charge stops speaking, thinking to himself, surely she can’t be yelling “quiet” at me.
The doctor in charge says to the EMT, “Start with the ABCs.” The guy in charge of the EMTs starts to recite the information he has gathered from the scene, including the pulsox, the blood pressure, the airway status and the heart rate and rhythm. The doctor stares him down, says “QUIET!” and breaks out her stethoscope. The EMT again begins to give his report, the doctor again stares him down and tells him to “relax.”
Relax?
Is there a more condescending thing to say to somebody who has just spent the last half hour in the field, battling the elements, the broken glass and twisted metal, the combative patient and a multitude of other equally unrelaxing things?
Relax.
I’ll relax when the report is given, the patient is in your care, and the paperwork is signed. Until then, I’ve got a lot on my mind that is keeping me from “relaxing.”
Interns. I guess we all had to start learning somewhere. Life isn’t lived in a classroom.
