Thursday, October 22, 2009

The Race

A shooting? In our first in? The planets must have fallen out of alignment  we joked as we rolled down the road. Although violence is not unheard of in our district, the higher rents of newer housing require that most of our customers have jobs - thus the factors that usually contribute to violence are not as prevalent around "The Healing Place" as they are around many of the other stations in the K.B.F.P.D.

"Whattaya bet it was a BB gun or a paintball gun?" I ask over the headset,  half joking. We pull into the parking lot of a large department store. The sight of a Hispanic male leaning against the bed of his pick up truck, pale and profuse throws my theory out the window. I can tell from my seat that the patient is seriously injured and is in shock. My engineer, who also happens to be a medic, doesn't get as good as a look at him as I do, but can still tell that patient is in bad shape. As a result, he spots the engine in the aisle, leaving just enough room behind the engine for the ambulance.

A deputy is on scene, as is an officer from a neighboring city. The deputy motions for us to approach the patient, the rapid, deliberate manner of his action conveying the urgency of the situation.  

As we approach the patient, I notice a couple of shell casings on the ground, fairly close to him. They look large, at least forty cal. I try not to step on or kick them, as this is likely to be a homicide investigation.

We are surprised that our pt. is still standing. We can see at least two splotches of blood on his shirt, one on his right upper torso, toward his back and one on the right side of his abdomen. He is starting to have trouble breathing, but is able to tell us what happened and is aware of what is going on.

It is now a race against time as I look up and see the deputy getting the crime scene tape and camera out of the trunk of his cruiser. The ambulance arrives as we quickly strip our patient, give him some Ohs, take vitals and complete our assessment. Both crews work together to establish I.V. access, place the pt. on a backboard and load him for transport.

So far, our actions appear to have done little to improve the condition of our patient. He is in need of surgery, the term "Golden Hour" was coined for patients like this. All involved know that the sooner our patient gets to the trauma center, the better his chances for survival are.

The ambulance departs for the hospital, my medic accompanies the patient as the chances of performing CPR seem high. The siren's wail pierces the din of late afternoon traffic, the patients race against time continues.

My engineer hurriedly collects our equipment and tosses it into the rear of the cab. Our race with time is in the critical phase now. I assist him and am closing the cab door as the deputy approaches me and tells me that he doesn't want us to move the rig, until he looks to see if it is in any of the photographs that he has taken. A quick veiw of the camera LCD shows Engine 226 in all of it's glory.

It appears that we have lost our race against time. We are doomed to stay here until the homicide detectives arrive and the I.D. techs complete processing the scene. We have to call the District Commander and advise him that we will likely be tied up for a few hours and that we have personnel out of the district, at the hospital.

Fortunately, our medic is able to catch a ride back to the scene from an ambulance company supervisor, the D.C. does not have to go fetch him. Our medic tells us that the pt. spent about five minutes in the E.R, then was whisked up to surgery.  We later heard that our pt made it through surgery OK, and is expected to recover.

Although E226 lost it's race against time, the patient emerged victorious in his. The stakes for us was a late dinner. For him they were much higher. The important race was won.

Thanks for reading,



  1. Well done - the patient recovered, which is always good.

    Forgive me for asking, however, but I struggle to see (unless you've deliberately omitted something) what the justification is for backboarding this patient. I wasn't there, and I don't want to second-guess you, but I'm trying to understand the differences between UK and US EMS.

    It seems like in the US there is a great tendency to board pretty much all trauma patients. Seems to me (again, basing this only on what I've read), I would have considered managing this patient in a sitting position (bepending on chest injuries), or the trendelenberg position, rather than immobilising him.

    Apologies if this appears critical, once again, I'm just trying to understand differences

  2. The fear of litigation is one primary motivation for placing a great deal of our customers in full spinal precautions.

    However in this case, we felt CPR was likely, due to his crappy presentation. CPR is more effective on the firm surface of a backboard then on a padded gurney. Also, some counties have a protocol that calls for full spinal precautions on any gunshot wounds to the torso, as you really cannot determine where the bullet went or ended up.

    Hope this helps, Thanks for commenting.

  3. One of the other reasons I can think of OTR is two bullets entered this patients torso... a direct route to his spinal column. Bullets like to bounce around once inside, off bones and such. How am I to know the bullet is not sitting in or around the spine and an errant movement causes paralysis? Without an x-ray there is no way to know.

    Thanks for the post Capt. Glad you all made the difference. Do you know what precipitated the shooting??

  4. Thanks both. Your gurneys must be far more padded and comfortable than our trolley beds!

    Knew there'd be a reason!

  5. Great post! Nice job to save the man's life. One other consideration with the backboard that medics have shared with me: easier to carry the patient the distance to the cart and thus to the ambulance.

    I did not know that an emergency vehicle can end up being held as part of a crime scene. I'm trying to remember if I have ever seen it here in KCMO, but all I can recall is when the EV was actually involved; for example, it was shot up, or involved in a crash. Read blogs, learn things!