This is What it’s Like

Three times in my career, I’ve treated small children who were accidentally backed over by the family car. These kids are so small, so mobile, and very quick – in a heartbeat they are where they shouldn’t be.   It’s made me very cautious when backing my car around my kids. Usually, I just bring them into the car with me – that way I know where they are.

The first kid I saw that had been backed over was in a retail parking lot. His mom had run into the store really quick and the kids took the opportunity to get into mischief. First the three-year-old boy got out of the car, then, coincidentally, his older sister took the car out of gear. Upon our arrival, we found the boy lying in the parking lot, crying. As I bent down to assess him, he began projectile vomiting – which is a terrible sign for someone with a head injury.

We quickly packaged and transported him to the closest trauma center. I never did hear whether he survived, but I sometimes think of the guilt the mother and sister must feel for that incident.

I was working on the helicopter the last time I treated a kid who’d been backed over by the family car. This was a four year-old boy in a nearby rural community. We landed the helicopter in the middle of a residential intersection, about 40 yards from the incident. Firefighters and paramedics were already treating the boy.

Like many emergency scenes in rural communities, everyone seemed to know each other – plus, there was a lot of chaos. CPR was being performed, but there was no IV access and he had not yet been immobilized. I inserted an intraosseous needle into his lower leg while the flight nurse, intubated the boy. We moved him to a backboard and then into the helicopter.

On this particular, warm Summer day, we were in our older helicopter, the BO-105 – which is an amazing machine, but a lot smaller than most EMS helicopters today. Because of its size, it’s impossible to take along extra personnel, and makes it more difficult to work on critical patients. This means we had to work together as a team, to cooperatively take care of this boy – who was most likely not going to survive.

At one point I found myself doing chest compressions with one hand, and squeezing the bag-valve device that was breathing for him. To do this, I had removed my safety harness and was up on my knees. I took a quick glance out the window, to see where we were, and discovered the helicopter was actually making a sharp turn.

Looking out the side window, I was looking right at the ground – 800 feet below me. And I was leaning against the door – without my safety harness fastened. In the midst of trying to save this boy, I had a quick vision of the flimsy aircraft door popping open and me falling to my death. I didn’t like that scenario. But fortunately our pilot was so good that our g-forces were towards the floor of the helicopter, not sideways!

That’s what it’s like to work here…

As I continued to do CPR on this boy, the flight nurse was preparing to give him blood. She plugged it into the IO and pressurized the bag. Unfortunately, the tubing popped off of the connector and blood began to spurt all around – mostly all over me.

We landed at trauma center and delivered this pulseless boy to the team. If he had survived, he’d be 24 this year.

I gathered our gear and proceeded to our fifth-floor office to clean the equipment and myself. Both the flight RN and I were exhausted, dejected, and sad. No one likes to lose a patient, especially a child.  We worked hard to save this kid.

Meanwhile, my colleagues were interviewing potential new flight paramedics upstairs. As I was walking down the hall, the interview team asked the interviewee if he had any questions. He asked what it was like to work in air medicine. The interview team saw me outside the office and called me in. I had no idea what was going on.

In I stepped, my uniform shirt was covered in blood and blood was dripping from the MAST suit that we used to try to control our child patient’s shock. I had blood on my sunglasses, in my hair, and on my face. I stood in the office with a dazed look – and five faces looked back at me with equally morbid looks. I turned and left.

As I walked down the hallway, I heard them telling this potential flight medic, “That’s what it’s like to work here.”