My First MVA - Part 1

Disclaimer: If my postings seem naive and unseasoned, it is because I am indeed naive and unseasoned when concerned with the world of emergency medicine. I think everyone has “first real call” story, the following account is my first real call. It is a lengthy read, but I think you may find it enjoyable, or at least familiar.

It was my second day of basic clinicals, and I was riding with a rural county EMS service. I was incredibly nervous, but my preceptor had been sent from God. She was very empathetic to my situation, and greeted me with the comforting words of “We were all in your position at one point, just stick close, ask questions, and if you get queasy, feel free to head back to the rig.” Nervousness fading, now I am just trying to not get too excited and blurt out questions in front of patients.

By the second half of my second day, I was comfortable with the crew I was working with, I had figured out most of my boundaries, and was on my way to what I hope was a decent impression. The last thing in the world I wanted was to be a run of the mill, brainless, lazy, nuisance that I am sure basic students can be.

We get toned out for a MVA. Cool. I am thinking maybe this will be an interesting call and I can get a chance to see about what we learn in the classroom, and watch seasoned medics do their thing.

As the student, I sit in the back of the ambulance facing backward as we approach the scene. I see a fire engine, then another that have parked and are already on scene. My heart sinks a tad as I realize that I may not have an opportunity to help because these guys know what they are doing and will probably step in. I try and clear my mind and prepare to stay out of the way and do what I am told. I hear the intermediate up front say “oooh, looks like a good one.”

I step out of the back of the ambulance and my general reaction is summed up by “holy shit!” There is a deformed truck shooting flames about 6 feet high about 30 feet in front of me. The gas tank explodes. Jokingly, I say to my intermediate preceptor “scene is not safe.” He laughs then says “get the trauma bag, and meet me over there.” He then points to where firemen have extricated the driver and passenger of the burning truck.

I jump in to the back of the ambulance and grab the trauma bag, and as I am leaving some guy who looks, walks, and talks like a zombie appeared at the back door and says “my friend needs help.” I am thinking, okay shit, this guy needs help of a medic, I can’t find my medic preceptor, and my intermediate preceptor is with another patient. I have him sit down, look him over for any obvious life threats, and then ask where his buddy is as I wave over the approaching ambulance. He points to the other vehicle in the crash, another truck that has obviously hit head on with the burning one. A medic takes charge of this particular guy, and I race off with the bag to find my intermediate preceptor.

As I am running past the non-flaming vehicle I hear my name shouted out. My medic preceptor needs the bag I was taking to the intermediate. I think to myself, she is the in-charge, do what she says and explain it to the other guy later. I get to her and she has me pull out the BVM, then asks me if I am comfortable jumping through the shattered back window of the truck and stabilizing the spine of the man entrapped inside. The window was not quite big enough for the firefighter in full turnout gear, so I jumped in and was immediately surprised by what I saw. Lots of blood, open facial fractures, serious lacerations to the head, obvious mid-femur fracture, and agonal respirations. I hear my medic tell the patient’s friend to talk to him, try and get him to respond. He has a wide eyed look, and she tells him that his buddy might die, and he needs all the help he can get. Surreal.

The smell. This was something I had not thought about before. In school we are focused on pictures in books, and our eyes are somewhat prepared for scenes like this. Never had I thought to myself “hrmm, I wonder what a multi-system trauma victim smells like?” Well, now I know…it was kind of like a really musky sweaty iron scent intermixed with occasional whiffs of the dudes cologne.

Okay, now I am holding a very bloody c-spine, I have manipulated a collar onto him, and am trying to get through to him and get him to respond somehow. They always tell you in class about holding c-spine, don’t let go, etc, and it seems pretty basic. What they neglect to tell you is that in some cases you will be holding c-spine in some god-awful contorted position, balancing your lack of movement with his head so that medics can breathe for him, all the while trying to avoid having your leg pinched by the jaws-of-life. I would say that I was having “fun” by this point, but the harsh reality was that this man was circling the drain. So, fun is not the right word, I was focused and excited.

They get him extracted and we get him in the back of the ambulance. It was at this point that I noticed not one, but two helicopters had landed. How the hell did I miss that?? There are now 5 people in the back of our ambulance and I am in a seat handing out whatever people are asking for, and I am really nervous at this point because I don’t know where/what everything is. There are some points where I have to swallow my pride and just say “I don’t know what/where that is.” It is embarrassing, and I make a mental note to go through the ambulance top to bottom and try to memorize locations and names later. (This probably should have been obvious, but it is only my second day on one.)

I am in absolute awe watching these medics go to work on this guy all the while casually greeting each other. I actually realize the gravity of what it means to be a paramedic, and for the first time I am really wondering if I have what it takes. It was a symphony, and I felt like the uncultured looky-lou, a tourist.

To be Continued…