It was probably appropriate that the first day the new crew had the hospital to ourselves we'd get a group of casualties like we did yesterday. The old crew, who in reality had handed us the reigns almost two weeks ago, had officially departed yesterday morning at 5:30 am for Kuwait.
By about 10am we received a "9-line" - the message telling us there are incoming casualties. The 9 lines have critical information, type and mechanism of injury, nationality, and so on, but the most important piece of information is the degree of injury and number wounded. An "Alpha" is worst - life, limb, or eyesight is at risk. "Bravo"and"Charlie" - of course important - don't merit as much sphincter tone. "Alpha" gets everyone to their stations right quick.
We had three Alphas inbound, one with CPR in progress. That's not good, obviously. Another IED blast, by now sounding like a broken record. If CPR is in progress, the casualty likely becomes a "right turn." That means as soon as the injured person gets offloaded from the ambulance and enters the trauma bay, the gurney takes an immediate right turn into the first operating room. Crazy stuff then happens. The chest usually gets "cracked" (officially an 'open thoracotomy') so that open cardiac massage can be performed. For those unfamiliar with medicine, you may recall that Princess Diana had open cardiac massage, performed by a French surgeon after her fateful car crash. Like Princess Di, cardiac massage means the person is as close to death as he or she can be, necessitating this last ditch effort to perfuse vital organs like the brain and heart itself.
Our first Alpha made a right turn and I made my way into the OR. I had been told that I might be able to put central lines into these critical patients if the surgeons were busy doing their miracle work. This day I could get no closer than about 3 feet. The first thing I noticed was that I had a bird's eye view of the patient's heart unnaturally open to the atmosphere, pumping away like mad. A clamp had been placed on the aorta just downstream of the heart. I noticed what was left of the patient's legs - bone and flesh in an unnatural order, all blood, dirt and mess. A boot, foot still inside it, hung awkwardly off the OR table. I noticed that one of the surgeons had managed to place a central line. I was no longer needed in this room. I went back into the trauma bay to find the other two Alphas.
The surgeons ultimately succeeded in resuscitating the patient whose heart I had been fixated on. He made it to my ICU after about 3 hours, got more blood, and departed for higher echelons of care via C-130 by 6:30pm that day.
First day by ourselves... many more to follow.
ROLE 3 entrance at sunset - not where the traumas come in
Tim, are you the guy making the call to move the patients on up the line, or onto a transport plane, or to keep him stable in the ICU, or whatever? I was pretty impressed that man was stable enough to be moved to another hospital so quickly after the trauma.
ReplyDeleteI get involved in stabilizing the trauma patients in the trauma bay, to a small degree. Then I take the handoff from the surgeons after "damage control surgery," and continue post-op resuscitation until they are stable enough to be sent uprange. Hope that makes sense! TQ
ReplyDeleteSounds good to me. Hope they're feeding you enough.
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