The Golden Hour

The collective strength of strangers after a horrifying accident

Wilder Schmaltz

I'm riding shotgun in the ambulance, navigating us to a vehicle vs. pedestrian call we've just been tapped on. I'm picturing all the possibilities in my head. I'm picturing all the things we'll have to do when we get there. There'll be a quick triage to find out how many total are injured (pedestrians, plus or minus passengers, driver). Police and Fire will establish a blockade with their vehicles and orange cones to prevent other vehicles from driving into the scene and clipping one of us. We'll have reflective vests on and we'll still have to watch our six. There'll be backboards and neck collars to apply. We'll park our ambulance at a defensive angle that allows for a quick egress to the hospital. But right now, we're still just trying to get there.

I tell my partner, Mark, to turn left on Farmington.

He says, “I got it. I know where this is, man,” and toggles the siren to a warble tone while approaching the intersection.

And he does know where this is. I know he does. He's been doing this ambulance thing for years now, maybe decades. I'm the newer guy. I've seen a lot of things in my first two years, but there's still a lot I haven't seen. Some things you hope you never see.

Dispatch comes over the radio and says Life Flight's on standby. If this patient is in a bad way, flying to the hospital rather than going by ground will save a few precious minutes of the golden hour. The golden hour is a euphemism to describe your best sixty-minute chance of surviving a life-threatening injury, if you get to a surgeon in time.

There's radio static inside the cab of our ambulance. Dispatch says, “The pedestrian is possibly trapped under the vehicle.”

I think of the size of an SUV compared to a person. I think of all the possible external and internal injuries that correlate with different parts of a body being trapped. A person's spleen can rupture and bleed out from being punched hard enough in the left rib cage. A severed femoral artery can cause a grown man to bleed out in less than two minutes. There are a lot of car parts that can impale a person.

When the dispatcher speaks again, there's a difference in her voice. Dispatchers are trained to remain calm. And she would probably sound calm to anybody else. But after hearing her tap hundreds of calls I know something's off. She lilts. The lilt in her voice hits the hardest when she says, “The patient is a pediatric male.”

In drug dosing, a pediatric is anything from infancy to adult weight. In legal matters, the range extends to eighteen years of age. In my mind I'm praying that our patient is closer to the adult size. For just a second I picture one of my sons under an SUV—TJ is twelve, Taber is six—and I immediately suppress the vision. Thoughts like that aren't helpful; not while getting to a call, not while treating your patient, not while going to bed at night. Not ever, really.

I look over at Mark, who's driving with complete purpose and focus. His eyes are swiveling from the side mirrors to the windshield, scanning everything on the street in front of us, looking for anything that might T-bone us from the sides. Suddenly, Mark puts the brakes on, and I jerk forward as he maneuvers around the left side of a yellow Volkswagen that's come to a skidding stop directly in front of us. This happens more than you might think—people just freaking out when they hear sirens. I kind of get it. But there's a reason why there's a question on your driver's test about what to do when an emergency vehicle is approaching; it's so you don't slam on your brakes and anchor it right in front of one. But Mark's still so focused on his driving that he doesn't even say anything. Not “Learn to drive, buddy,” or “Really? Really?!” with one of his palms up, flabbergasted. He just swerves around the Volkswagen without even blinking. I'm impressed. This is what zen and the art of ambulance driving looks like. Mark is a master, and these streets are just concrete rivers, and we're flawlessly following the path of least resistance.

I go back to mentally forecasting the scene. I'm still wondering if it's a leg, or an arm, or a skull trapped under that SUV. If it's a torso. We know it's a kid. A lot of things change when you're working on kids. For one thing, kids' heads are proportionally bigger than adult heads. If I were Rain Man, or a mathematician or something, and I ran the numbers, there would probably be a higher chance of the kid's head being under that SUV than an adult's. I don't run the numbers. I don't know how to do that. I don't want to know how.

Another thing about kids is how long they can compensate, and how quickly they can abruptly decompensate. An adult's vital signs usually trend downward gradually to a less life-sustaining condition, so you can chart the decline and take actions. But a kid can go from looking great to being almost dead in the blink of an eye.

I'm hoping it's not the kid's head or torso. I'm hoping that he just looks trapped. I'm hoping this isn't really bad.

You never really know how bad most calls are going to be until you get there. Most “car into building” calls we go on are just people who accidentally put their car into drive instead of reverse when leaving the convenience store, or the liquor store, or the dry cleaners; they're low impact and minimal injury. Most “unresponsive” patients are actually awake and talking to you when you arrive. A lot of them even try to talk their way out of going to the hospital. But you have to be prepared for it to be bad.

We start to see congested traffic in front of us, so we know we're close. There are two lanes of traffic in each direction. It's a main street, not a side street; the possibility of higher speeds is greater here. There's a crowd of bystanders on the sidewalk, many with their hands to their mouths. There's an SUV with a broken-off passenger side mirror; the front passenger door has a small human-sized dent in it. The SUV is upright in the middle of the road, standing perpendicular to the flow of traffic. The vehicle is empty. There is a boy lying on the ground, face up, in front of the vehicle. He is surrounded by people who are forming a half circle in the street. These people have done what cop cars and fire trucks and orange cones do. They're protecting the patient with their bodies.

I key the radio mic and say, “Medic 5-4's arrived.”

Mark and I get out of the ambulance. Both of us grab our kits and together we make our way to the patient.

“Who was in the car?” Mark asks a man standing by the SUV as I kneel at the boy's head.

I see a man standing next to it raise his hand.

I hear Mark say, “Are you injured?”

I don't hear what the man says. I kneel next to the boy. He looks a little smaller than my older son. The boy looks up at me, and I tell him I'm going to hold his head still for him. I tell him to try not to move it.

I say, “What's your name?” and he tells me.

“How old are you?”

“Ten.”

His eyes are big and scared and glistening with tears. He wiggles all of his fingers and toes when I ask him to. The boy says his back and stomach and legs hurt. Mark palpates the kid's belly and the boy winces. We don't find a lot of external injuries on him besides some knee abrasions, but it's what we can't see that's most concerning to us. It's the way the boy winces when Mark presses on his stomach. We need to keep an eye out for abdominal and flank bruises forming, and altered mentation, and decreasing blood pressure, and any other signs of internal bleeding.

I turn to a man with a moustache who's standing close to me and ask him, “Did you see the accident?”

The man nods and says in a Spanish accent, “Sí…Yes. This boy ran into the street for his pelota, for his ball, and that car tried to stop. The car, it skidded sideways, and then tipped over onto him.”

“That car,” I say, nodding my head toward the damaged SUV, “was on this boy?”

“Sí,” the man says.

“How is it not anymore?” I say.

The man spreads his arms out toward the crowd around us. “We lifted it off of him,” he says, raising his shoulders as if to say, “Of course we did,” as if to say, “What else would we do?”

For a brief second I think of how much bigger an SUV is than a human. I think of how much smaller a child is than an adult. I think of how much can be achieved when people are moved toward action.

“Is he going to be all right?” the man says.

“I hope so.”

I look down at the kid. “You're doing great, buddy,” I say. “We're going to have to get you on this hard board, but all of this is just to help you. OK?”

He nods his head between my palms. And I wince a little because it'd be better if he held his head still.

“Try not to move your head, buddy,” I say. I leave out the OK? this time. The boy keeps looking at me, and then his eyes start getting tired.

“Hey, buddy,” I say, and he opens his eyes again. I do this every time his eyes start to close. We package him onto the backboard and load him into the ambulance.

We rendezvous with Life Flight at a nearby school football field. Mark and I and two firefighters approach the helicopter from the side, ducking down, with one person on each corner of the stretcher—the wheels bumping over the grass. We load the boy into the bird with its blades spinning above us.

I hear the flight medic yell, “Hey, buddy!” to the kid and see his eyes open again.
Once the boy's secure, we take our empty stretcher back to the fence line. We watch the helicopter ascend in a cloud of swirling dust. The dust settles and the helicopter becomes a dot in the sky, getting smaller and smaller. It's so much quieter without the sound of the rotors.

I turn to Mark and say, “Those people put that SUV back on its tires. They pulled it up off that kid.”

“Yeah,” he says.

“That's fucking cool,” I say.

“Yeah,” he says.

“Yeah,” I say.

I look at the ground for a second. I don't tell Mark I want to call home to talk to my kids. I don't tell him that those people have restored my faith in humanity.
I wonder how much an SUV weighs.

“Hey,” I say. “You think he'll be all right?”

Mark's been doing this longer than me. He can probably predict better. He knows more, has seen more. He's all zen in traffic mayhem and seems unfazed by everything.

“You know,” Mark says, nodding, “he just might be.” But there's a lilt in Mark's voice that I just barely catch.

Comments

1 comments have been posted.

Thank you for sharing this piece. Well done.

Jen | December 2016 | Portland

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