Meghan’s first shift back had been busy. Following their call about the nail, they had been called twice to transfer people back to nursing facilities, transported an asthmatic, and treated a patient with hypoglycemia who refused transport after being treated.

Jerry backed the ambulance into the bay after their latest call. Shutting off the engine, he looked over at Meghan. “You look tired. Managing okay?”

She yawned. “I’m beat, but hanging in there. We’ve been busy today.”

Jerry nodded wryly. “The nursing home transfers have gotten worse over the last several months. It used to be an occasional thing – now it seems like it’s multiple runs each shift.” He hopped out of his side of the rig and headed for the building. Meghan caught up with him at the door.

“I think I’m going to try for a nap,” she said, yawning again.

“Good idea. Think I’ll lay down too, actually.” He waved as he headed to the call room he had commandeered for the shift.

Meghan made it to her call room, set her radio down on the nightstand, removed her boots, and shimmied out of her work pants, leaving on the running shorts she wore underneath for modesty. Sighing, she snuggled under the covers and quickly fell asleep.

She woke to Jerry knocking on her door. “Hey, squirt. You decent?”

She threw off the covers and made her way to the door. “What’s up?”

Jerry leaned against the doorframe. “It’s 5:30. I’m hungry. Wanna go grab something for dinner?”

“Sounds like a plan to me. Let me get dressed. Where do you want to go?” Meghan pulled on her pants and started zipping on her boots.

“Dunno. I’m pretty open.”

“Hmmm. What about –“ The tones went off.

Medic 21, respond to the northbound onramp for Highway 137, crossroad Peterson Avenue, for a multivehicle collision. Northbound onramp for Highway 137, crossroad Peterson Avenue. Time out: 1743.

“Well, there goes dinner plans!” Meghan cued her radio. “Medic 21 to Dispatch, responding.”

Meghan and Jerry hurried out to the ambulance and got in. Meghan triggered the bay door, and Jerry started up the ambulance. They pulled out, turned on the lights and siren, and headed towards the scene of the collision. The wreck was near the bottom of the onramp, and it was a tight squeeze to get past the line of vehicles there. Jerry parked in front of the first involved vehicle, turning off the siren but leaving the lights going for safety.

Meghan had already pulled on her florescent safety vest and grabbed the trauma bag. She approached the nearest cop. “What do we have?”

“Three cars and a semi, plus another fender-bender close to the top of the onramp that you passed getting down here. Fire’s enroute. Best I can tell, this first car had to slow down to merge into traffic, got bumped by the semi. Car behind the semi tried to slow down, but got rammed from behind by the fourth vehicle, sending him into the back of the semi,” the officer explained as he walked Meghan towards the third vehicle, which was crunched into the back of the semi.

“Occupants of vehicles one, two, and four have been out of their vehicles and walking around, but the driver in vehicle three is still in there. Complaining of some pain, and the driver’s door won’t budge.”

Meghan nodded at the officer’s report. She cued her radio. “EMS 21 to dispatch. I need 2 more ambulances to this scene, and can you give me an ETA on Fire? Sounds like a possible entrapment.” She looked at the car and how it had crumpled. “Good save by the Mansfield bar.” The cop nodded.

Meghan rounded the last two cars and came up to the front passenger door. It took a bit of pulling, but she managed to wrestle the door open. She climbed in. “Sir? Can you hear me?”

The driver groaned. “Yeah. Are ya’ gonna get me outta here? I hurt.”

“Sure thing. My name is Meghan, and I’m a paramedic. I’m going to take good care of you. Where do you hurt?”

“My neck hurts, and my chest, and my right leg. Thought earlier I’d broken my nose, but that doesn’t hurt now.”

Meghan nodded. “We’re going to get you taken care of. What’s your name?” She started rummaging in her bag for a c-collar, easing it into place around his neck as she talked with him.

“My name’s Harold. Harold Becker.”

“Nice to meet you, Harold. Sorry about the circumstances, though. Do you remember what happened? I’m going to put this collar around your neck to help you hold it still.”

“I was heading home. I teach at the college,” he added. “The semi slammed on his brakes, and I tried to slow down too, but the idiot behind me rammed into my backside and tossed me into this semi’s behind.”

“Really? What do you teach?” Meghan asked. “I teach EMS classes at the community college.”

“Mathematics. I have classes in Physics, Calculus, and Geometry this semester.” Harold coughed and groaned, his hand resting on his chest.

“Easy, Harold. I’ve got you. I’m going to feel down your leg, see if I can tell what’s causing the pain there.” She ducked down lower in the seat and felt along the limb. She quickly discovered an open tib-fib fracture. “Your leg’s broken.”

She heard sirens in the distance, getting closer. “Hopefully those sirens are the fire department, Harold. They’ll get your door open and help me get you out of here and to the hospital. Let’s get your blood pressure.” She wrapped a cuff around his right arm and took his vital signs. She shook her head minutely at the readings as she jotted them down on her glove. His blood pressure was low – she needed to get him extricated and into the ambulance.

The sirens were indeed a fire crew; the captain made his way to Meghan’s open door. “What do you need?”

Meghan exited the vehicle and stood in the open doorway. “This is Harold. He’s complaining of neck pain, chest pain, has an open tib-fib on the right. The driver’s door won’t budge. We need to get him extricated, on a backboard, and splint his leg. I’m worried about internal bleeding, but I can’t do a full assessment with him in the car like this.”

“Sounds like a job for the JAWS. I saw your partner assessing the walking wounded. I’ll send someone to get the backboard and cot. Be right back.” The captain headed back towards his truck, relaying instructions over the radio.

Meghan climbed back in the car. “Harold? I just talked with the Captain. They’re going to use the Jaws of Life to pop your door open so we can get you out of here. They’re going to get the equipment now.”

“Thank you. I’m ready to get out of this metal box.” He coughed again, still clutching his chest.

Meghan frowned, put her stethoscope in her ears. “I’m going to listen to your chest, Harold. Take a few deep breaths for me.” She listened intently while he breathed as best he could, then told him to take it easy.

Jerry tapped her on the shoulder. “I’ve got AMA forms on the other drivers. How’s he doing?”

Meghan climbed back out of the car. “Not great. Complaining of neck, chest, right leg pain. His BP’s low, tachycardic pulse. He’s struggling to breathe more, decreased lung sounds on the right, and an open tib-fib on the right. They’re going to have to use the JAWS to get him extricated. What’s our ETA from here?”

Jerry thought for a moment. “Upwards of 20 minutes. Are you thinking of LifeFlighting him from here?”

Meghan nodded. “Extrication is going to take a bit, and I’m worried that he’s going to go downhill before we could get him to the ER.”

Jerry nodded. “Well, if you want it, you’d better get to requesting it.”

Meghan thought for a moment more. “Yeah, I think that’s going to be in his best interests. I’m suspecting he may be working on a pneumothorax. I’ll call in the request. Find me an officer and have him report to me, please. And I need backboard, cot, and splints. Also set up 2 lines of Lactated Ringers, one with blood tubing.”

“Will do. Be back in a couple.” Jerry headed towards the ambulance.

Meghan cued her mike. “EMS 21 to Dispatch.”

Go ahead, EMS 21.

“I’m requesting Life Flight assistance. I have a bad trauma alert at this location.”

There was a pause on the other end, then her radio crackled to life. 10-4, EMS 21. Life Flight 6 is being dispatched to your location. We will coordinate with police at your location to set up an LZ. Dispatch out.

A police officer came running up to Meghan. “Your partner said you needed assistance?”

Meghan nodded. “I just requested a Life Flight helicopter for this patient. Dispatch should be contacting you shortly to set up a landing zone.”

The officer looked at the patient and back at Meghan. “Do you want us to land them here, or do you want a nearby parking lot?”

“I’d prefer here. He’s not doing well, and I don’t want to delay transport any longer than I need to. I think one of his lungs is collapsing.”

“Okay. I’ll start working to shut down traffic so there’ll be a place to land.” He started walking away, talking on his radio.

The Captain approached Meghan. “Did I hear you’ve called for a helicopter?” She nodded. “I’ll coordinate with police to help with the LZ. Here,” he said, as he handed Meghan a helmet and a tarp. “Helmet’s for you. Cover yourself and the patient with the tarp while we use the JAWS. Jerry’s coming with the cot and stuff.”

Meghan placed the helmet on her head and took the tarp from him. She climbed back into the car. “Harold? How are you doing?”

“I’m really hurting, ma’am, and it’s getting hard to breathe.”

Meghan started working the tarp around between Harold and the door. “I know, Harold. Listen, the firemen are about to pop your door open so we can get you out of here. I’m going to cover us up with the tarp so we don’t get hit with any flying glass or stuff. It’ll be loud, but you’ll be safe, and I’m right here with you.” She raised her hand above the tarp and gave a thumbs-up to the crew.

The sound of a generator being started came from outside the vehicle, and soon there was a loud screeching and popping heard as the metal of the driver’s door gave way under the pressure of the JAWS. The door gave way, and hands finished pulling it as wide open as possible. The machinery stopped making noise, and the tarp was pulled away.

“Hi, Mr. Harold. My name’s Tony. I’m a firefighter. We’re going to get you out of your car and onto this backboard. I want you to relax and let us do all the work. Meghan, can you get his seatbelt? Thanks!

“Okay, Mr. Harold. Cross your arms over your chest. We’re going to lay you down and slide you out on this board. We’ve got you, you won’t fall. Meghan is going to hold your leg as still as she can, but it’s probably going to hurt some. On the count of three: one, two, three!”

Strong hands helped shift Harold sideways and then laid him down on the backboard, Meghan holding and guiding his leg as he was slid onto the board and up into position on it. The Backboard was slid back onto the cot and secured. Jerry placed a splint into Meghan’s hands after she cleared the car and helped hold Harold’s leg as she splinted the fractured limb.

The fire captain came close to Meghan as she walked with the cot back towards the ambulance. “Helicopter’s about 3 minutes out. This side of the highway has been closed off for an LZ. Tony will help you get him ready to go. Tony!” The captain pointed first at Tony and then at the ambulance. Tony nodded and entered through the side door of the rig as they loaded the cot into the back.

Jerry started cutting clothes as Tony began starting IVs. Meghan performed a quick trauma assessment and got a new set of vital signs. “Harold? How are you doing?” she asked as she placed an oxygen mask over his nose and mouth.

“I’m hurting bad. Hard to breathe.” She could see the panic in his eyes.

“Harold, you’ve got some pretty good injuries, and I think you’ve got a lung that’s collapsing. We’re going to send you by helicopter to the hospital, and they’ll get you all fixed up. They’ll be here in just a couple of minutes. Now, does anything else hurt from what you have already told me?”

“My belly. Kinda low, where the seatbelt was.” He coughed again.

Meghan frowned. She crawled over the bench seat around Tony and palpated Harold’s abdomen. She could see the additional pain caused by her palpation, but it was still soft. “I’ll make sure the paramedics on the helicopter know, Harold. Harold? Stay awake for me, Harold!”

He was on the verge of losing consciousness, and was fighting to breathe.

“Damn!” Meghan shoved her stethoscope back into her ears, listening to breath sounds again. A knock sounded on the back of the ambulance doors, and they opened, revealing the flight medics. She motioned them in as she removed her stethoscope. “Tension pneumothorax. He’s not moving air on the right side.”

“Let’s intubate and do a needle decompression.” The medic moved around Tony and came up by Harold’s chest. Meghan was digging through supplies and pulled out alcohol prep pads and a decompression needle. She passed these to the medic and grabbed the intubation kit. As the medic decompressed Harold’s chest, Meghan snapped open the laryngoscope, inserted it in Harold’s mouth, and passed an endotracheal tube down his airway after the second flight medic injected medication into his IV to sedate and temporarily paralyze him.

Confirming that he was now breathing better, the flight crew did a quick trauma exam and received report from Meghan about Harold’s condition. They secured him to the backboard, tossed a sheet over him, and hooked him up to their monitors. “Okay, let’s get him loaded!”

The cot was removed from the ambulance and Harold’s backboard transferred from it to the cot from the helicopter that waited just outside. Harold was buckled to the cot and quickly whisked off to the helicopter. Within minutes they took off towards the hospital.

Meghan watched them go, then turned back to the ambulance. She sighed; the back of the rig was trashed. “What a mess!”

Tony nodded, stripping off his gloves. “Good call, flying him to the ER.”

“Thanks. Twenty plus minutes by ground was too long. Flying will have him there in five.” She stripped off her own gloves and tossed them in the trash can. “Thanks for the help.”

“You’re welcome.” Tony saw one of the firemen coming towards them, holding his arm. “Uh, oh. I think you’ve got another patient. What’s wrong Ben? Come around the side door.” Tony grabbed a second pair of gloves and yanked them on.

Meghan grabbed gloves herself and some gauze pads as Tony raised the head of the cot and dropped a side rail. Ben sank onto the cot and held out his arm as Meghan slapped the pads over the gash in his arm that was dripping blood on the floor. “Thought I saw something around one of the vehicles and stuck my hand out to investigate. Wound up cutting myself on some metal. Ouch!”

Meghan peeled back the gauze to take a better look at the wound. “Not too bad, but it’s going to need stitches. How’s the pain?” she asked, covering the wound again.

“Maybe a 3 outta 10. I’ll let them medicate me at the ER – it’s not that bad.” He watched Tony toss a towel down on the floor and put another in his lap to help catch the errant blood. Jerry wrapped a cuff around Ben’s uninjured arm, put a pulse ox probe on a finger, and turn on the monitor.

“Looking good, Ben. Let’s get you to the ER to get that stitched,” Jerry remarked. He headed for the cab, while Tony stripped off his gloves and headed out the ambulance doors.

“I’ll make sure Cap knows where you disappeared off to,” Tony told Ben.

“No worries – Cap sent me this way. He already knows. The guys will drop by the ER to pick me up once they’ve been cleared from the scene,” Ben replied.

Tony nodded, and shut the ambulance doors. “Ready to go?” Jerry hollered back.

“Yeah, let’s go,” Meghan replied. Jerry pulled out carefully onto the highway and headed for County Med.

Meghan called report, and started working on her paperwork for both Ben and Harold. She had Ben’s completed by the time they reached the ER.

Jerry pulled into the ambulance bay and shut off the engine. Climbing out of the cab and making his way around the rig, he opened the side door and stepped up into the back of the truck. Meghan was in the process of removing the monitoring equipment from Ben. She had bandaged up his arm before starting work on her charting, and it was neatly wrapped in white bandaging.

“How are you doing, Ben? Want to walk or ride in?”

Ben snorted. “I’m walking. Arm’s throbbing in time to my heartbeat, but bleeding is under control.” He stood up from the cot and followed Jerry out the side door and into the ER. Meghan followed behind, carrying the Toughbook.

Jerry got Ben settled in an open room and waited with him for a nurse to come in. Meghan, meanwhile, made her way to the nearby vending machines and bought a candy bar and a Code Red Mountain Dew. She had just made it back to the nurses’ desk when Bob stopped her. They watched as a gurney was hurried down the hall towards the elevators leading up to the OR. She glimpsed the patient on the gurney. “Mr. Harold is headed to surgery?”

Bob nodded. “I’m assuming you took care of him on scene?”

She nodded in return. “How is he doing?”

Bob shook his head. “Hemopneumothorax, free fluid in his abdomen on ultrasound. And the open tib-fib. They’ve already given him 2 liters of blood and a pack of platelets.” He looked more closely at Meghan. “I think you need to sit down. Now.”

Jerry exited the room Ben was in, having given report. “Squirt, you’re looking rather pale. Feeling okay?”

“I’m fine,” she protested.

Mitch saw the small group and came over. “Hi, Meghan, Jerry. Everything okay? You’re looking pale, there, Meghan. Bob, find a room for her, will you?”

Meghan wasn’t happy, but she followed Bob to a curtain area and sat on the edge of the bed. She allowed them to hook her up to telemetry and take her vitals. Meghan’s mood was palpable in the small area, and Bob and Jerry decided to give Meghan and Mitch space; they headed back to the nurses’ station under the pretext of getting Mr. Harold’s information for the reports.

“You’re a little low, Meghan.”

“I’m fine.”

“You don’t look like you’re fine,” Mitch countered.

“Mitch, you know as well as I do that we don’t need to treat 98/62. I’ve just gotten off scene of a bad wreck with a crashing patient, and now my adrenaline is crashing. I want my pick-me-up, some dinner, and a chance to finish up my reports.” She crossed her arms and looked hard at him.

“What’s your pick-me-up?” he asked. She held up the soda and the candy bar. Mitch made a face. “I’d rather you were going after coffee instead of the soda, but I understand wanting the caffeine.”

“Well, I can go and get a cup of coffee and save the soda for later.”

“Actually… I think I just drained the pot prior to that trauma patient coming in.” Mitch said guiltily.

“Mitch.” Meghan sighed. She pulled off the blood pressure cuff and the pulse ox and shut off the alarm on the telemetry unit. “Listen. I’m a touch low. I know that. But I’m okay. Have I lied to you or kept from you that I was feeling bad?”

Mitch shook his head no. “No, you haven’t. You’ve been forthcoming when you need help.”

She laid a hand on his arm. “Then trust me. I’m okay. Brandi’s making me do vital signs after each call. It’s annoying, but it is keeping an eye on things. I need to be able to go about work without everyone panicking over nothing. I’ll let you know if there’s an issue. Otherwise, please trust me.”

He nodded; she was right. “Okay. Guess I should let you go get some food. Rest if you can, though. Hopefully you’ll get a –“

“Don’t say it!” she warned. “Don’t jinx our night!”

He chuckled. “Back to work, medic girl.”

She gave him a mock salute and headed out of the curtained area. She walked up to Jerry. “Did you get Harold’s info?”

He tapped the Toughbook. “It’s all here and loaded. You just need to finish up your narrative. Hungry?”

“Definitely,” she declared. “I don’t care where we go; just find us someplace close.”

“Okay, Jack in the Box it is,” he deadpanned.

“On second thought, I do care where we go,” she retorted. She headed for the exit. Jerry scooped up the Toughbook, waved goodbye, and followed her.