A majority of us who work in EMS have, at some point, hurt ourselves on the job. Some are sobering, life-altering accidents, while others are the more humorous ones that we love to tell about.
For me, it was the time I fell out of my ambulance and landed on the concrete floor of the bay. Fortunately, I was okay, just a little dazed, and didn’t need treatment. But I’ve wondered several times what it could have been like if I hadn’t been all right. So here’s a story of what could have been.
Names have been changed to protect the ornery!
I had just switched from working in the city to working in a rural station. I was tired of sitting in a parking lot every shift for 12 hours and then being held over another 2-3 hours because of short staffing issues. So I switched stations. Rural shifts were 24 hours, but you had a base station to stay at when you weren’t on a call, and the pace was generally slower.
Thanks to the new location, I had a new partner: Steve. Steve was a big man, 6’3”, 280 lbs, with wire-rimmed glasses and buzz-cut brown hair. He could intimidate a rude patient with a glance. But I learned that he was more of a gentle giant… with a wicked sense of humor!
Steve had been an EMT for several years, and it showed in the quality of his work. He was good! He had attempted paramedic school before, but it’s hard to balance medic school with a full-time job, so he had dropped out. He was such a big help for me, and I appreciated it, believe me!
I had two main supervisors at this station: Shannon and Mike. Mike had transferred to this station about a month before I did. I knew of him from the city, but hadn’t worked under him. He had a reputation of being difficult to work under, and I was frankly scared of the man at the time. I later realized that he was quite fond of me as an employee, but that didn’t help things at the beginning.
The base I worked at was essentially a large house with an attached garage capable of housing two large ambulances. There was a door that opened straight from the base house into the bay, with a short landing and several steps down to the bay floor. The bay itself was cinder block walls and a concrete floor, with shelving along the back for storage of supplies and inventory.
These were the days before everything became computerized. The hospitals were just starting to use computers for patient records, but everyone else were still using paper reports to keep records. We had three forms to fill out for each patient, I remember: a patient report, a HIPAA form, and then an additional sheet for continued narration if needed.
A typical shift started out like this: I would bring my bedding, clothes, toiletries, projects, etc. into the base and find an empty bedroom to dump them into. This would be my room for the shift. Then I’d go and greet the outgoing shift. We would chat about what was new in our world, what kinds of calls they’d had that day, etc. Then we would make our way to the ambulances.
There are many different styles and configurations of ambulances out there. This particular station used an ambulance that was built on a FreightLiner chassis. Essentially, it was a patient compartment mounted on a semi cab. Very tall, and much taller than me! There were about 4 steps to get into this thing, and I remember that they were all directly over and flush with each other. I’m not sure, but I think the actual cab was 5 feet off the ground!
We check our ambulances (affectionately referred to as “trucks”) at the start of every shift. Inventory is extremely important, as is cleanliness of the truck. We want to have everything ready to go when the tones go off for a call. This includes making sure the cab is ready with a large torchlight, maps of the service area, and patient report sheets kept in a large plastic clipboard. We also kept track of mileage and checked the oil and fuel levels.
I had worked at this new station for maybe a week when it happened. I had started my shift off as I normally did – dropping my stuff off in a room for the day, chewing the fat with the off-duty crew. I said my goodbyes and headed to start truck checks. I was standing just on the edge of the “floor” of the cab, checking on patient forms. My partner, Steve, was busy checking the engine with the hood up. Satisfied we were well-stocked, I stepped out of the cab, aiming for the first step. I missed the step and fell backwards, landing with a loud thud on the concrete floor, landing straight on my back.
Dazed, I remember Steve poking his head over the hood. “Are you okay?” He rushed to my side as I lay there. “Megan, are you okay? Can you hear me?” I could only moan.
I felt his hands on either side of my head, holding my neck still and keeping my c-spine stable. “Megan, I want you to hold still. I’ve got you,” he reassured. I was pretty much out of it at this time; I lay there moaning, not responding to my surroundings or the questions and prodding that was coming.
“Mike! Mike! I need your help now!” Steve shouted through the connecting doorway. He wished he could get to his radio, which was in the truck on the other side of the door.
Mike appeared at the doorway and stopped, shocked. He rushed down the stairs. “Oh my goodness! What happened?” He stopped beside her. “Megan! Megan, can you hear me?” He was only met with groans. He rushed to the back of the ambulance and yanked out a c-collar, backboard, and straps. Setting these down beside her, he grabbed the Thomas pack from the truck. “What happened, Steve?” he asked, as he started digging in the pack for a blood pressure cuff and stethoscope. He donned a pair of gloves and started taking vital signs.
“She was checking the cab and fell. I don’t know if she hit her head or not. I was checking the oil when I heard a loud thud and saw her lying on the floor. You’d better notify dispatch, Mike.” Steve was justifiably worried.
Mike nodded, and radioed the situation to Dispatch, putting the unit out of service. He then turned his attention back to Megan. Behind the scenes, the dispatcher notified the county fire department, requesting their assistance at the station.
“Blood pressure is 92/56, pulse 136 and thready. Respirations are…” Mike started.
“Resps are 22 and shallow. Her eyes are glassy, and she’s not responding verbally. I’m not noticing anything coming from her ears or mouth,” Steve responded, giving what little info he could, considering he was still holding her neck stable.
Mike nodded, and reached to carefully feel the back of her head and neck. “I’m not feeling anything abnormal here.” He reached for the c-collar and carefully applied it to her neck. He then started a quick head-to-toe assessment. He didn’t find anything immediately injured with her lying face-up.
They heard the sound of a large truck pulling up outside the building, plus the hiss of air brakes, followed by a double horn honk. Mike quickly hit the button to open the bay door and returned to his patient. Four firefighters followed him into the building.
Chad, the captain of the crew, motioned to Megan. “What’ve you got? What happened?” He motioned to the backboard, and a couple of the men went to get the straps and board ready, while the fourth man (Will) set about shutting the hood of the ambulance and getting it ready to go.
“She fell out of the cab and landed on her back. She’s not really responding to us. We need to get her backboarded and to the ER.”
Chad nodded. “Bret, Mitch, give us a hand with that backboard.” They pulled the board up close to Megan’s side, and carefully logrolled her onto her side. Mike carefully felt her spine and back, pulled the board up to her back, and they rolled her back onto the board. Mitch and Bret started securing the straps to the board.
Will had pulled the stretcher out of the back of the ambulance at this point. The backboard was carefully lifted and set on the stretcher, and it was wheeled around to the back of the truck and secured inside. Mike hopped into the ambulance, and Chad passed him the Thomas pack. “Do you need someone to ride along with you?” he asked.
Mike thought for a second, but shook his head. “No, I think I’ve got this covered. Thanks for the help.”
“No problem. Good luck!” Chad shut the doors and thumped on the back twice. Steve had by this time started the engine so that the truck would be ready to go. He entered the side door of the ambulance.
Mike had already turned on the compartment lights and was dragging down a couple of sheets. “I need to get these clothes off her, start an IV, and get her on the monitor. Could you put some oxygen on for her?”
Steve nodded, and pulled down a nasal cannula, which he hooked up to run at 3 liters O2. He then took patches and placed her on the cardiac monitor. He pulled out the supplies for the IV and set those up.
During this, Mike was busy cutting clothes off Megan. It was necessary to expose her, as injuries can often hide themselves under clothing. He was careful to be as discreet as possible, keeping her covered as much as possible, but making quick work of it as well.
Mike hadn’t found anything obvious so far with his exam, but was extremely aware that he needed to get her to the hospital. “Steve, let’s go. I can start the IV en route.”
Steve nodded and headed out of the side door and up to the cab. He radioed dispatch that they were headed to the hospital, and pulled out of the drive. He turned on the lights and the siren and started driving towards the city, 12 miles away.
Mike started first one large-bore IV, then a second one. Megan still wasn’t responding well to him, but she was no longer moaning. Rather, she was crying. He kept talking to her, trying to get her to respond to him, reassuring her she’d be okay. He finished cutting her clothes off, keeping her covered with sheets. Her now-naked body lay under the sheets, strapped to the backboard with her clothing in pieces underneath her. Mike discreetly checked the lead placements for the EKG, and listened to her heart and lungs. She sounded slightly congested due to the cold she had, but nothing that sounded like she was having breathing difficulties.
He checked her vital signs again. Her blood pressure was still low, around 86/palp. He increased the drip rate of the IVs, and continued to monitor her condition.
Steve pulled into the ambulance bay at the hospital, shutting off the lights and siren. He hurried to the back of the truck, where Mike had everything unhooked and ready to go. They pulled the stretcher out of the back and wheeled her into the ER. They wheeled her into Trauma 1, where the team was waiting.
The backboard was moved from the stretcher to the gurney, and suddenly people were everywhere. Techs were drawing blood, hooking up oxygen, and preparing to take x-rays. The doctor was beginning his own examination while listening to Mike give his report on what happened.
The doctor started removing the straps from the backboard. A tech held c-spine as Megan’s head was untaped. Efficiently, Megan was logrolled onto her side, the backboard and clothing removed from behind/under her, and x-ray boards positioned in their place. The doctor was carefully running her spine under his fingers. He stopped at an area of bruising on her upper thoracic spine. “Meg,” he said, talking to the x-ray tech, “be sure to get a clear picture here. I think this is where she impacted the floor.”
Megan was logrolled back onto her back. X-rays were taken, the boards removed, and the doctor continued his exam. A nurse inserted a Foley catheter while another tech brought over a small ultrasound machine. The doctor looked at her abdomen via ultrasound to make sure there were no areas of internal bleeding. A nasogastric tube was inserted.
The doctor was concerned about Megan’s level of responsiveness. He ordered a CT scan of her head and thoracic spine. It wasn’t until he had the results back that he diagnosed what was wrong.
Steve and Mike had had to return to duty after dropping Megan off, but they had gotten another call soon after returning to base, so were back at the hospital with that patient a couple hours after bringing Megan in.
Mike spotted the doctor and approached him. “Hey, Dr. Blake. How’s Megan?”
Dr. Blake nodded at Mike. “She’s still in Trauma 1. I just got the results of her cat scan. Let’s go in so I can show you.” He led Mike and Steve into Megan’s room. Megan had been cleaned up by now, and was in a hospital gown and covered by warm blankets. She still had a C-collar on, and a myriad of wires and tubes were connected to her. Her eyes were closed and she didn’t respond to their entrance. Mike glanced at the telemetry screen above her bed that softly beeped reassuringly.
“She’s resting comfortably at the moment. We’ve given her some pain meds, and are working to keep her blood pressure more stable. Let me show you her films.” He motioned to a light box on the wall. He studied and sorted films for a moment, and popped two into the clips, turning the boxes on. “Here’s where I think the point of impact with the floor was. She has a hairline fracture to this vertebra, and another here to this one. I haven’t noticed any neurological diminishment so far, but I’ll know more when she wakes up.”
“Has she woken up at all?” asked Steve.
“No, she was still very out of it, only moaning and crying before we gave her some Demerol. Her head CT scan came out clear, so I’m thinking that it’s a combination of shock and a bad concussion. She has a nice bruise on the back of her head.” Dr. Blake nodded.
Mike sighed heavily. “So what’s the game plan for her?”
“We’re going to get her into a brace that she’ll probably be in for a couple of months while those fractures heal. I have a neurology consult put in for the concussion. I’m just waiting on a Neuro ICU bed to come available. I’ll have the nurse call you when she gets moved, so you’ll know the room number.”
Mike nodded. “Thanks doc. If she wakes up, tell her we were here?”
Dr. Blake nodded. “We’ll take good care of her. Don’t worry.”
Megan woke up feeling like she had been beaten up. Her head pounded in time with her heartbeat, reflected in the beeping of the monitors hooked up to her. Her back hurt, and she felt like she couldn’t move due to all the wires and braces. Her fingers found the call button, and soon a nurse was at her side.
“Where am I?” Megan asked.
“You’re in the Neuro ICU. Today is Wednesday. You’ve been here two days. Are you in any pain?” The nurse busied herself with checking the catheter and adjusting the pillows and blankets on the bed.
“My head and back are pounding. What happened to me?”
“You had an accident at work. Let me see if I can get the doctor in here with some pain meds, okay?” The nurse left the room and returned with Dr. Blake.
“Hello there, Sleeping Beauty! How are you feeling?” He leaned on the bedrail as he looked at her.
“Not feeling so beautiful. I’ve got a headache that’s keeping time with that cardiac monitor. And my back hurts. And I can’t move!” Megan tried to shift, but couldn’t seem to do it.
“Sharon, go ahead and give her some more Demerol. Megan, you have a brace on your neck and back due to two vertebral fractures. Plus we’ve got you wired and tubed about as many places as possible. Do you remember what happened?”
Megan tried to shake her head, but remembered the brace. “No. I remember seeing my partner asking if I was okay, but even that’s fuzzy. What happened?”
“From what the medics told me, you fell out of the cab of your ambulance and landed on the concrete floor. You have hairline fractures on T-4 and T-5, and a pretty bad concussion. I’d say you’re pretty lucky, considering.” The nurse came in with the Demerol and administered it through her IV line. “Since you’re awake, why don’t we see about a quick exam, and then maybe try to help you find a slightly more comfortable position?”
Megan agreed, and proceeded to be poked and prodded. Dr. Blake and Sharon helped her to readjust her position in the bed, sitting up some. “Well, I think that I’d like to keep you in ICU for one more night, and then get you to a regular room tomorrow.”
“How long will I be in the hospital, and what happens then?” Megan asked.
“You’ll be our guest for a few more days, mainly because of the concussion. I’d like to send you to an inpatient rehab facility to work with you, get you back on your feet after this back injury. I’m waiting for Dr. Warner with ortho to get back with me about how he wants to handle the fractures so we can get your rehab plan drawn up.
Story to be continued later!