The Brotherhood

It's been a strange week or two. Had a buddy in town from CO for some steelhead fishing, and we wound up with the worst windstorm in recent history on the first day. Second day, rivers were all still way too high, so we moseyed up to Forks, WA and watched the not-so-Super Bowl. Mick was an embarassment. That night I awoke to a rapid onset fever, and spent the rest of the trip sick as a dog, dragging out of bed for an hour's worth of fishing at a time followed by a hot shower. Some vacation.

By the end of last week, I was feeling much better, though still pretty wrecked. I lost a boat dolly back in December, and suddenly got a call on Friday from someone who had spotted it. I was preparing to go out in my boat on Saturday to retrieve it, and had a hard time sleeping Friday night. By 3:15AM Saturday morning, I was wide awake. Through the floor, I heard my pager activate downstairs. They toned out about five apparatus for a BLS car accident, unknown if injury. I thought, "what the hell, I'm awake anyway" and headed downstairs. By now, the fire trucks were rolling, but the address was wrong. I drove the general direction of the address, and as I rounded a curve two blocks away, there it was. The police were just arriving, and I could see the fire sirens coming around the bend opposite. Park, out of the car, quickly into bunker gear, and into the fray. It gets graphic from here.

The car was a late model Saab, and had run head-on into a large (3 foot diameter) cedar tree. I quickly grabbed a sawzall, and my captain ran power for me. Setting that aside for a moment, I rounded the car to find the right rear passenger had self-extricated, and was lying in the dirt talking to us. He obviously had bilateral femur fractures, but was in pretty good shape overall. We decided that rapid transport was the priority, and someone went to get a backboard. In the meantime, I slowly became aware of the front passenger. He was packed in like a sardine. The car had hit mainly on the driver's side of the front bumper, but the passenger had about half the steering wheel on his side, and was in such a small space that he couldn't even turn his head. Hearing my old captain from Colorado saying "try before you pry", I lifted the door handle and the door opened. That guy fairly flew out of the car--he was definitely ready to be out of there. He was drunk and almost tripped over his buddy's broken legs about three times. I was amazed that he was standing, and he was saying, "I'm fine, thanks for getting me out. I'm fine." A couple of other firefighters took him away to an aid car, and packaged him for transport. We got the guy on the ground on a backboard, and loaded him into a medic unit. He was also packaged and taken away.

Meantime I had started working on the roof. After breaking out all the remaining windows, I cut through one of the D-posts, while a FF on the cutters was getting the rest of the posts. At the last minute, two of us stabilized the roof while he cut through the remaining A-post by the driver. Off came the roof.

Up front, others had been working on freeing the driver. He was in a bad way; to the man (and woman), every one of us was certain he would expire right there in the driver's seat. The front wheel was even with his seat, and his legs were unrecognizable. His left thigh came out and back in a sort of arch, and his left tib/fib/foot were back behind the seat. We actually had to be careful not to cut his leg when we were cutting away parts of the car behind him. His femur was also protruding about two inches. Normally in a case like this, his legs would have been so hopelessly trapped (under the dash, entangled in the pedals) that there would have been almost no way to get him out in time. But it wasn't his day to die; somehow his legs had gotten thrown upwards and were sort of pretzeled in with his torso and the steering wheel. The guys got the spreaders in there, and managed to push the dash up and away, and suddenly his torso just flopped over into my arms. As I held him, they did one more spread and I could feel movement. We gave a good tug, and out he came. Total extrication time was 32 minutes, which all things considered, was golden. Onto the backboard, and up into the waiting medic unit. This time I wound up in the bus with him, and helped with all sorts of things, from blood pressure to cutting off clothes to pulling traction on his legs as the MAST pants were inflated. We rolled over to the LZ at our main station. There were two helicopters on the ground, the other bird had already taken the third patient to Seattle. The flight nurses came in for their briefing, and then we packaged him on the helicopter's stretcher and put him on board. A few moments later, both helicopters took off. I looked at my patient's helicopter and said, "to better days, man" as he took off, and it was over.

Back across the street at the station, one of the guys was doing decon, which I needed badly. I was covered from head to toe in blood, and somehow, having someone just brush off my boots really made me feel taken care of. I finally had all my gear off and in a plastic bag, and headed back to the scene to get my car.

I was totally in awe of two things: first, how hard they hit, and second, that anyone survived. The police report would later show that they were traveling in excess of 100mph, and after a long skid, hit the tree at 70-80mph. The tree was down a 45-degree embankment, and after impact, the car bounced backwards six feet back up the embankment. You kind of have to see this to really get the full impact, but two tons of metal just doesn't move like that. Also, the car hit the tree directly in front of the driver, and the driver was absolutely pinned in. Though his injuries were severe (more on that later), none of us could believe that he survived.

I headed home, it was 5:30AM. A long hot shower, a shave, and I tried to sleep. Yeah right. I ended up just staring at the ceiling (K was downstairs because I was still coughing a lot). At about 7:30, I went down and snuggled up to her. We ended up talking through the whole scene, lots of tears and grief. At one point I said to her,
"Today I joined the brotherhood."

I am approaching the end of my second year in the fire service, and up to now there has been lots of training, talking, videos and mock scenarios. Though I have been on lots of calls and have worked other MVAs, this was the first time where I wasn't swept aside as the 'probie' who doesn't know what to do yet. When I looked back on this, I was the only person who had direct contact with all three patients, I worked on cutting, packaging, EMS, and so on. It is a great feeling to know that you have actually contributed to saving someone else's life, but it is also an incredibly stressful event. Having the driver flop into my arms couldn't have been more symbolic, and that is a huge responsibility. It makes me realize how much I need to be honing my skills and learning where everything is and how it works. Up to now, this has been a great ego trip, i.e. I have gotten to say I'm a firefighter and EMT, etc. without any of the real stuff that goes along with it. But Saturday, all that changed forever. When called on, I stood and delivered and changed the outcome for these young men.

Monday we had a critical incident stress debriefing, due to the extremely violent nature of the accident. It was my first CISD, and worthwhile. If nothing else, I got to tell a couple of guys how extraordinarily impressed I was with their calm, collected demeanor during the incident. I guess I thought I was done processing this one, but as I blog this, I realize that there are still emotions, etc. and I suppose they'll never be gone altogether.

Update on the patients:

All three were 18 or 19, all were intoxicated, and possibly taking other pharms.

Somehow, somehow, the driver was the one to call 911. Had you seen his arm sticking backwards out of the window, and the 8-inch slot he was packed into, you'd realize how stunning, no, impossible, this is.

Rear passenger had dual femur fractures and a broken pelvis, but is neurologically intact. He just needs time for his bones to heal.

Front passenger (remember the guy who was walking around?) had a broken pelvis and two broken vertabrae. He's in a halo splint. Lucky, lucky.

Driver has dual broken femurs, tib/fibs, ankles, knees, and pelvis. Bruised lung, perforated colon (I think), cardio contusions (bruised heart), etc. They haven't been able to extubate yet, and he's received five units of blood so far and is still oozing somewhere internally. They are still trying to find the bleeding. He responds when pain meds are turned down, and seems to be neurologically intact (gasp). The general feeling is that "he doesn't want to be there". Go figure.

Guess that's it for now. Maybe I'll post updates on these guys later.

Update 4/2/2006: I haven't heard any specifics, but have been told that all three of these guys are "in various stages of reconstructive surgeries and healing". So while I'm sure they'll all have PT, etc. for a long time, they all lived to tell the story.