Call of the Quarter

    On October 22. 2001, the Glasgow Life Saving and First Aid Crew, along with the Glasgow Fire Department were toned out for a motor vehicle accident along Shop Hill Road.  EMT-ST Robert Hickman, EMT’s Shane Watts, Larry Mayo, and Junior Member Sommer Rogers were among the first on the scene.  On assessment, they found the patient, a 25-year-old male, trapped in his car at the foot of a 50-foot embankment.   The vehicle ran off the road and slid down the embankment.  The car he was in rolled over several times and came to a rest lying on it’s top. 

On reaching the patient, it was found that the patient was unconscious.  He presented with snoring respirations and a strong pulse.  Due to the mechanism of injury, Hickman immediately called Rockbridge EOC to summon Life-Guard 10.  The patient was unconscious, had multiple injuries, and a possible head trauma.  The call was made to Life-Guard 10, however, they were busy with another assignment.  Another call was made, this time to Life-Flight 3.  Based in Lynchburg, Med-Flight 3 is staffed by the Virginia State Police.  As it turned out, this call was their first in Rockbridge County, as they only recently went online.  In the meantime, EMT Roger Funkhouser and Trainee Chris Flint arrived with the crash truck.  EMT-ST Hickman, Funkhouser, Mayo, and Flint, along with members of the Glasgow Fire Department set to readying the extrication equipment.  EMT Watts remained with the patient, stabilizing C-Spine and maintaining the airway.  NREMT Paramedic Danny Smith and EMT-ST John Ellington responded to the call for ALS assistance and were enroute from Stonewall Jackson Hospital to the scene in Medic 3.

            While EMT Shane Watts was assessing the patient and stabilizing the C-Spine, the squad and fire department members began the task of cutting him out.  The extrication effort took almost an hour.  During this time, the patient became somewhat arousable and combative.  This was due to the suspected head injury.   On assessing the extrication, the patient was upside-down with one leg trapped under the dashboard.  The roof was crushed, allowing limited access into the driver compartment.  During the extrication process, it was discovered that a dog was trapped underneath the patient.  The dog presented a unique hazard to the rescuers.  The dog attempted to bite anyone who came near him.  To free the dog, the patient had to be lifted upward.  Once the dog was freed, it appeared that he had a crush injury to his right leg.  A bystander took the dog and returned him to the patient’s mother.

            Upon arrival of Medic 3 from Stonewall Jackson Hospital, Smith and Ellington asked Hickman and Watts what the vitals were and any changes to the patient.  Within minutes after their arrival, the patient was successfully extricated from the vehicle.  He became increasingly combative and was attempting to strike his rescuers.  The patient was fully packaged on a long spine board with C-collar support and spider straps.  He had difficulty breathing because of blunt force trauma to his thoracic cavity.  He was bleeding from his mouth.  He had no obvious external injuries, however, he had small bumps and abrasions along his arms and legs. 

            Once placed in the ambulance, Watts began to bag the patient.  The patient’s breathing was becoming more shallow and rapid.  Smith and Ellington placed two large-bore IV’s of normal saline in both arms.  Suction was used to clear the patient’s airway.  The patient began to vomit up blood with a brownish fluid.  Due to the patient’s mental status and his combativeness, Smith called medical control to obtain permission to administer Versed to intubate the patient.  Medical Control granted permission to administer the Versed.

            While attempting to intubate the patient, a focused trauma assessment was performed.  The patient’s chest was tender to touch with a pain stimulus.  The patient’s stomach was somewhat distended.  His breath sounds were diminished, and he had no obvious head trauma. 

            Members of the fire department established a landing zone at the Natural Bridge Learning Center.  Med-Flight 3 landed at the LZ and was escorted to the ambulance to assess the patient.  The Versed was not as effective as hoped in calming down the patient.  He continued to fight with the rescuers.  With the vomit and fluids coming from his mouth, intubation was difficult.  Med-Flight 3 medics advised that they would perform a rapid-sequence intubation (RSI).  RSI is performed by administering more Versed and succinylcholine (SUX), which is a paralytic agent.  While performing the RSI, the Med-Flight medics were still unable to intubate because of the fluids in the mouth.  Fears of aspiration of vomitus were beginning to enter everyone’s minds.  The medics then tried to place a laryngeal mask airway (LMA), which is not a common airway device in the field.  Attempts to use the LMA were met with success.  The patient now had a patent airway.  The patient was then fully assessed and placed into the helicopter for transport to Carilion Roanoke Memorial Hospital, which is a level one trauma center.

--  Written by:  William Wheeler

Photos from this call