This is a graphic story about an EMS call I led while working. Please read at your own risk. The names of the patient, others involved, and the locations have been protected for privacy purposes.
A few months ago I had a call at work that was one of the most significant of my career so far as a paramedic. The day started out very normal and we didn’t have any unusual calls for a good part of the day. I was working on a race report I had to complete for my last 100-mile race. I had finished the report and asked my partner if we could go to station 1 so I could print it out. Another medic wanted to read my report and I wanted to print out the ones from the Destin 100 and from the Mohican 100 race so that she could read them when she came on shift that evening.
We went down to station 1 and I had just finished printing out my report when we received a call. This happened around 4 o’clock in the afternoon. We were the closest unit when the call came out as a crush injury. We went in route, priority one with lights and sirens to the call. The dispatcher stated that there was an amputation of the arm involved. No other information about the patient or the area was given. Dispatch informed us that flight was available and they went ahead and launched them as we were about 3 to 5 minutes from the call. As we were driving to the call I looked to my right and saw one of the workers sitting there with his head in his hands. I couldn’t tell if he was crying or not but he looked clearly upset. I told my partner that this could possibly be bad and to help me get the patient into the truck as quickly as we could. I told her to grab the blue (first out) bag while I went to see what we had going on with the patient.
I had my gloves on and got out of the truck and saw a guy laying on the sand and dirt down an embankment. This was an area that was being cleared and leveled for a building. There was a big excavator tractor there and our patient was right underneath it. As I got closer I could see other people looking physically worried and concerned and a little scared. I walked up closer to the patient and evaluated what we had. There was a young man that had been involved in this accident and he was the only patient on the scene. As I approached the patient I could see that his left arm was amputated and was hanging on by a small piece of fat. His arm looked completely pulverized and definitely not salvageable. The bones in his left upper arm were all broken and exposed. Large pieces of white bone were sticking out. I walked up closer to the patient and realized that there were more very serious injuries. His right leg had been completely crushed and was still under the large tire of the tractor machine right below his knee. Unfortunately, these two injuries were not the worst of his injuries. One of the units which belong to the fire department has an EMT basic and a paramedic on it. They arrived on scene right before we did. The medic had applied a tourniquet to the left arm before I arrived. As a report on the patient, he told me about the current tourniquet and then lifted up some of the abdominal pads to reveal a full laceration of his abdominal cavity. This meant his stomach was sliced open from the upper left side of his rib area all away to the right hip. His internal organs were spilling out to the right side of his body into the red clay we were in. I could see his intestines just hanging out. Amazingly this guy was still awake and alert. I ran over to my partner and told her that it was very bad and to get a backboard and every piece of abdominal dressing and pads that we had. I also went and grabbed a liter of saline and IV setup while she was getting the blue bag and supplies I requested. I knew I needed to start a line on him as quickly as possible before he went into shock. I went over to him and grabbed his right hand and told him that I was there to help him. I asked him what was hurting him the most and he said that he was feeling very dizzy. He was not aware of the extent of his injuries. He still had his glasses on in his head and was laying back somewhat. I don’t think he could see the damage to his body. We kept everything covered up and tried to keep it as sterile as possible which was impossible considering we were in red clay. I think that not being aware of how serious his injuries were kept him calm.
I got the IV supplies while the fire department was busy stabilizing the tractor and helping me with the patient. I started an 18 gauge needle in his right AC-arm. I started flowing fluids as fast as I could. We got some sheets and the backboard ready for when the tire was lifted off his leg. Once the operator moved the tractor back we were able to package him up as best as possible to get him onto the backboard. For a moment there was a little fear as I was crouched down with my patient under that huge tire and thought how easy it would be for that machine to run over all of us. I was literally holding onto his intestines with my right hand with a sheet onto his body and his hand with my other hand while we were trying to get the backboard underneath him. There was a firefighter working and trying to hold onto his right leg since it was completely crushed with muscle and fat on the side of his leg as his entire leg was about the size of a few pieces of cardboard stacked together. His left arm was so mangled but was still barely attached by a little shred of fat and muscle but we had to keep the arm as close to his body as we could. My main concern was his internal organs coming out of his body. I asked for a big sheet when another coworker who works for the rescue squad showed up on the scene. He gave me the big sheet and I basically just scooped up everything and pushed it as close to his body as I could. We got the backboard underneath the patient and were able to lift him onto it and get the straps on him. We had the stretcher as close as we could at the top of the embankment. Every time we tried to move him he said his left arm hurt and his right hip hurt.
I was amazed that he was not in more pain at this time and actually just in awe that he was conscious. I had never seen injuries so bad especially in someone that was still alive. His leg was so crushed that I could tell it would not be saved. I was afraid to cut off what was left of his pants because I didn’t know if the pants were keeping it all together or not. I held his hand and talked to him. He was amazingly calm throughout the whole thing. He gave me his name and birthday and we talked about how we were both June babies, born in the same month and year ironically. He told me about the two daughters he had and how he and his wife were married a long time. I explained to him what we were doing and that the helicopter was coming. He was excited to be going on a helicopter ride and we talked about how it’s a shame that he won’t remember it. I told him we were going to give him some medication very soon and it was going to cause him not to remember this time frame. I told him that he was an amazing man and my hero for being so brave through such an accident. We had him on the backboard and with everyone’s help from the fire department and the rescue squad we were able to get him up the hill, onto the stretcher, and into our truck. We got into the truck just as the flight crew came in to get a report.
The flight crew arrived as a team of one male and one female. The male came in through the back doors and the female came in from the side door of the ambulance. I was then positioned on the patient’s left side trying to keep his arm from falling and his bandages intact. The crew came in and I explained the injuries that he sustained. I told them about the arm and showed it to them. I told them about his leg and the extent of those injuries. I told them that the main issue was his abdominal cavity and as I lifted up the dressings they both said OMG! Never a good thing when the flight crew says that. The male medic was able to establish another line while the female was at the head of the patient getting ready to intubate him. We established IV access and gave him medication that would make him go unconscious and also not remember what was going on. Before he went to sleep he said something that touched us all. He said to everyone and I quote “if I don’t make it, thank you for everything you did. You did a great job and thank you”. Before he went to sleep I leaned over to him and said: “keep fighting ___(patient name)”.
I was in charge of airway before and after the tube. I knew that I would have to bag him for a very long time and was ok with that. The first time the female flight medic intubated him there were some complications. The tube was not functioning right and they had to actually remove it and put another tube in. They were successful with the second tube and were able to maintain an airway with 100% oxygen saturation with our assistance. We continued to bandage and obtain vital signs on him while the flight crew was getting ready to fly. Me and one other paramedic and the volunteer assisted the flight crew in getting the patient into the helicopter.
This call has kept running through my mind since it happened. Honestly, I have not been able to sleep very well yet. It’s not because I’m upset or guilty that we didn’t do more or should have done something different for him. It’s more that I keep falling asleep and then my brain will not shut off with the images I saw. It was such a horrific sight and I can still see and smell everything about the scene. Seeing his tissue and fat on the ground with all his blood. Seeing his mangled arm hanging there. Seeing his leg completely flat looking like road kill on the road. And then when I was trying to hold his internal organs together. I have never done anything like that before and I can still see the images of it all when I close my eyes to go to bed. Actually, it’s more often that I wake up in the morning earlier than I need to and I can’t go back to sleep because I see these images. I have a lot of compassion and really feel bad for this guy. I had never been affected by a call like I have with this one. He was such a sweet and nice guy especially throughout the whole ordeal and my heart just aches for him. I feel bad for what he’s going to have to go through and battle for the rest of his life. I don’t regret for a second saving his life and being a part of the team that did that. Someone asked me the other day if I should have let him die considering his injuries. Not at all, he needed to live for many reasons. He seems to have a purpose and such a good head on his shoulders. He is very different than any other patient that I’ve had. He has most definitely touched my life and the life of everyone that was involved in that call. I hope that he is able to deal with his injuries and have a fulfilling life from here on out. I think it hits home more because he and I are the same age. I’ve often thought about that and realize that he’s only 25 days younger than I am. I have just never seen someone go through something so horrific and be conscious and alert and then to say things that were so nice. He is an amazing person in so many ways.
Few days later, update:
This evening the volunteer that showed up to help on the machinery call worked a shift with me and we got a late call that took us to The local teams hospital. Same hospital our patient was flown to and was recovering at. We dropped off our patient in the emergency room about 10 o’clock at night. I told him that we should go see if we could find our patient from the industrial accident the other day. He agreed to try so we went and talked to the receptionist. We were still in uniform and we explained to her who we were and who we wanted to see. I still remembered his name and date of birth. She told us what room number he was in so we were thrilled! We went to his room to go and visit, all excited to see him. We explained to the nurse at the nurse’s station who we were and that we would like to visit our former patient real quick. They allowed us to and we went on into the room. Our patient was there but was unconscious and on a ventilator. His wife of 17 years and two other family members were there. We told them who we were and wanted to know how he was doing. He had obviously lost his left arm and right leg below the hip and was connected to lots of IVs and tubes. His wife said that he was doing very well. He had woken up twice and the second time he woke up his heart rate started going very high so they put him back under to keep him stable. They were giving him medication for infection and so far he was doing well. She was very emotional and thanked us for all that we did for him that day. She cried and gave me a hug.
We ended up staying and talking with her for about 20 minutes. We had to get back to our area and go back in service so we couldn’t stay longer. She said that she had gotten a visit from the surgeon and from the flight crew that had helped him. She was impressed that so many people were involved and cared so much about him. She wanted to know what happened that day from my perspective. I told her most of the details that I felt comfortable sharing with her. She seemed happy to have more clarification on what happened. She also told me that the operator of the machine that had accidentally caused the machine to hurt him and was in complete shock. He was not doing well and has still not spoken one word since the accident. When my patient woke up he had told his boss to tell the operator that it was not his fault and that it’s OK. I get goosebumps to know what an incredible person he was and how he responded so well to this major life event. I hope the operator of that machine knows that it was an accident and comes to terms with it eventually. My partner and I were so excited to be able to see our patient and meet his family. All the agencies worked together very well together that day to have such a great outcome for this person and we are all touched so much by this call. This was a call in my career that I will never forget.
Few days later, update:
Today I received an update on our patient . The flight crew had informed one of our other medics to let me know that our patient passed away. I believe his body became overwhelmed with infection and he could not fight it. We were all pulling for him and so hopeful that he would survive. I talked about him every day with the fire department and other people that were on that scene. He was doing so well and was making a remarkable recovery considering the injuries that he sustained. We all thought he was gonna pull through it. I feel bad for his family and hope that they’re able to handle this as well as they can. I feel fortunate that I was on that call and got to meet such an incredible person. It was an amazing experience and I believe I made a difference in being there with him and for him. He definitely did for me.