When You Least Expect It

"It looks like there was an accident," I hear my friend's son say in a muffled voice from the front seat of the van.
As my friend pulls to the side of the road and stops on the shoulder, I crank my neck and lean around the driver's seat to see what lies ahead. All I can see is the back end of the SUV directly in front of us. I yank open my door and lean out to assess the cause of what has halted our travel. The scene that greets me is the exact opposite of what I was hoping for. There are cars everywhere, some with noticeable damage, others with none. There are also dozens of people milling around of which I have no idea who are helpful passerby or who have actually been in the accident. There is also debris...lots of it. Shattered glass and plastic litter the roadway for at least the next 100 yards along with chunks of fenders and other unidentified objects that have been scattered from the damaged vehicles. I let out a sigh of relief when I see the flashing lights of a sheriff's vehicle already on scene at the far end of the debris field.
For a moment, I tilt my head to the side and silently hope for the distant sound of a responding ambulance. To my dismay, I hear nothing, absolutely nothing. In fact, for an accident scene, it is eerily quiet. My cardinal rule of coming upon any emergency is to let the responding crews do their job without interference from me. On this beautiful, calm, sunny morning, they are well out of earshot.
I suddenly realize that I have been stuttering incoherently and fumbling through my purse in search of my nitrile gloves. I find them right where they have been for the last several months, tucked neatly next to my CPR mask. I cast aside the mask and before I have a chance to talk myself out of it, I check for traffic and bail out of the van without saying a word.

Incoming traffic has completely halted at this point and is backing up quickly. This is not my concern. In fact, with traffic stalled, the scenario is a bit safer for me, especially considering I am now standing amidst the debris field of what is normally a 55-mph road.
Vehicles line both sides of the road and I am overwhelmed on where to start my assessment. I choose a path directly down the middle of the debris, looking for the first person I can find in a damaged vehicle. Something to my left catches my eye as I pass a stopped car and I turn to see a workman in a bright orange safety vest and sporting a hardhat, hovering over something that resembles a crumpled tarp which I assume has been flung from one of the vehicles. It takes me only a millisecond more to realize that he is actually pacing next to a person lying on the ground.
As quickly as the realization hits me, I make my descent into the ditch. In spite of the fact that I am wearing sandals and a skirt, I make a quick scan of the ground for sharp objects or bodily fluids and drop to my knees next to the injured man, situating myself at the back of his head. He is twisted at his waist in such a way that he is lying on his side with his face turned to the ground. I glance quickly at the workman who is silent and still nervously hovering nearby.
"Has this been called in?" I ask, skipping all forms of introduction.
"Yes," he answers breathlessly.
In all fashion of paramedicine, I reach down to touch my patient and quickly spit out, "My name is Amber. I'm a paramedic. What's your name?"
To my surprise, he responds immediately and speaks relatively clear.
I tell him that I am going to stabilize his neck and help keep his airway open. As I grasp his head and neck simultaneously between my hands and slightly lift his face out of the dirt, I become aware of the extent of his injuries. I will spare you all details other than the fact that his face has obviously made a high-speed impact with his steering wheel. I draw a tight breath and realize that he won't be able to maintain his own airway if I leave him here alone. My dilemma suddenly becomes the fact that there are several other people around and in vehicles and I have no idea which of those needs help, possibly more than my victim.
My attention shifts back to the workman. "Do you have medical training?" I nearly shout at him.
He is still pacing nervously. "No," he manages to choke out while shaking his head.
It becomes glaringly obvious that he is traumatized and is not going to be of much assistance.
Inevitably, I make the decision not to leave my victim. There are several other people gathering around the damaged vehicles along with a growing number of law enforcement. They can figure out what to do with anyone else who may be injured.
I ask my patient if he recalls what happened and he states that he was driving along normally when a small sedan crossed the center line and struck him head-on.
"Were you buckled up?" I ask.
"No. My pickup is too old to have seatbelts."
My stomach knots as I glance up and try to judge the distance between him and his severely damaged truck currently. It's at least 50 yards. I ask the dreaded question, "Did you walk here or were you thrown?"
"Neither."
"The truck was on fire so we pulled him out," lends the workman, continuing his efforts of trampling the earth with his nervous footsteps.
I breathe a small sigh of relief after hearing this bit of information. I fire off several other assessment questions ranging from my patient's age to recollections from the accident to any past medical history. In addition to the injuries to his face, he is complaining of excruciating pain in his leg. I make a quick visual scan of his lower extremities and cannot see any major bleeding or anything else unusual. I refuse to release my grip on his head to search for the cause of the pain. Once my assessment has been exhausted, I once again tilt my head and hope to hear the sound of responding sirens. Again, I hear nothing.
I move on to the only thing left to do at this point and try to make small talk with my victim. He is in pain but remains conscious. We talk about his work and his family.
Finally, I hear the wail of approaching sirens. Few things have left me as elated as that sound. A fire truck rolls up on the road and a crew of familiar faces bails out. However, instead of initiating treatment of my victim, one of them simply checks his pulse, breathing, and level of consciousness. Then she slaps a triage tag on his wrist which indicates "delayed transport" and races off with the promise to return. This is standard practice on incidents of this magnitude. In spite of the logic behind it, part of me is screaming for someone to pick my patient off the ground and whisk him away to the much cleaner ER.
We wait for what seems like an eternity longer and again I hear the soothing wail of sirens approaching. A few seconds later, an ambulance pulls up no more than 20 feet from where I am crouched in the ditch. Yet another familiar crew jumps out. All of them immediately descend into the ditch and surround us. Our deliverance has come.
Instead of asking me to step back and let them take over, like I was expecting, they ask me for a brief run-down of our victim's condition. I quickly rattle off what pertinent information I can as the attending medic begins a full physical assessment and begins to remove what of our patient's clothing he can while maintaining his dignity.
At some point, an unidentified first responder that I have never met, pushes in next to me and says he's going to take over spinal stabilization. The attending medic quickly shoves him aside and growls "She's got it."
The over-zealous responder backs away even quicker than he made his appearance. I do not see him again. Amidst the organized chaos, I glance over my shoulder and see another trusted medic and friend, lingering a few feet away. He is the charge medic for the ambulance crew that has finally come to my aid. He gives me an acknowledging nod but makes no effort to take over my position or say anything that will distract from the care of our patient. In spite of the fact that I feel like I am unraveling inside, the oncoming crew is expecting me to stay focused and in charge of our patient's airway and spine.
On any given day, when I am on shift, I am prepared to take charge and dive into the fray that is emergency medicine. However, this day, my day off to be with friends, the last thing I was expecting was to respond to the call of duty and I feel ill-prepared for the scenario in which I now find myself. Henceforth, when the responding ambulance crew arrived, I had anticipated passing the baton and walking away.
Instead, I remain grounded at my post while we dutifully place a neck-stabilizing collar on our patient, roll him onto a backboard and begin strapping him down in preparation transport to the hospital. Within seconds of being flat on his back he begins to complain he cannot breathe. The blood from his shattered face is following the laws of gravity and flowing back into his sinuses and throat. If we don't get it out soon, he will vomit and/or inhale the offending liquid. The charge medic has made his way back to the ambulance and is prepping it for our patient. Without hesitation, I scream at him to grab the portable suction. He is at my side with it almost before I can finish my sentence. With the crisis averted, we finish packaging our patient and haul him up out of the ditch and into the back of the awaiting ambulance.
Our crew shares a few friendly slaps on the shoulder and a couple of them thank me for my help as the ambulance doors slam shut and they pull away.
Once again I find myself standing in the midst of the debris field. I glance around, trying to judge if my assistance is needed anywhere else. While attending to my victim, 2 other ambulances have arrived and a medi-vac helicopter has landed. I conclude that plenty of other on-duty medical staff are on scene and have the situation under control.
I suddenly hear my name being shouted and I whirl around to see that my friends have pulled the van into the road ditch on the opposite side of the road from where I have been crouched for the last 20 minutes. I make my way toward them, while looking myself over to make sure I haven't gotten any blood down the front of me. There are kids in the car and that is the last thing I want them to see. Surprisingly, other than some dirt on my knees, my clothing has survived untainted.
I crawl back into my seat in the van. Everyone is silent and all eyes fixate upon me. At this point, I am debating whether I am clear to leave the scene, and, if so, if it is even logistically possible with the monstrous traffic jam that has formed. Various law enforcement are attempting to reroute traffic but it is extremely difficult, considering all the lanes of this main thoroughfare are completely blocked.
Finally, the 14-year-old girl sitting next to me, breaks the silence in the van. "What happened?" she asks, wide-eyed. I briefly recount to her what I know of how the accident occurred. I specifically leave out all details of the physical condition of anyone involved.
After a few extremely quiet minutes in the van, I make the decision that it is o.k. for us to leave the scene. My friend, carefully steers the van between a few other cars that have been abandoned in the ditch and makes her way onto a gravel side road. Conversation is strained and, in spite of the fact that I am still trying to channel my adrenaline rush, I attempt to chit chat normally about our plans for the day. Apparently everyone else's mind is still focused on the accident because they only briefly respond and the van falls quiet again. Eventually they begin to open up and converse normally and thankfully nothing is mentioned again about the accident.
In spite of the fact that I am trained to handle whatever form of tragedy and chaos that may present itself, my response to it is completely different depending on whether or not I am on shift or simply going about my daily life. When I am in full EMS uniform with my pager strapped to my belt and a fully stocked ambulance at my disposal, I am majoritively prepared for any call that comes in. When I am on my days off and hanging out with friends, I am armed only with a pair of gloves, a CPR mask and a desire to help. In all other ways, I am at the mercy of whatever ambulance crew is actually pounding the streets that day.
That sunny June morning caught me off guard. I keep re-analyzing it. From some strange, third-party viewpoint, I recap every little detail of all that happened. However, looking back, there isn't a thing that I would change. In spite of the fact that I was under no duty to act that day, the inner medic in me could not walk away from those in need. It is what I have trained to do for the last 8 years.
I have received many well-meaning pats on the back and commendations for my actions that day. Although there is some aspect of "warm fuzziness" to it, they are not the reason I do what I do. I do it so that the injured man I saved that day can go home to his wife and know that there really is still some good left in this world. I can only hope that someday, when my friends or family are in need, someone else would do the same for them.