Illustration by Lenny Miller/Coffee or Die.
The trees had lost most of their leaves and the bright moon shined overhead on a brisk autumn evening. It was Halloween night, and Minneapolis’ nightlife was buzzing with celebrations.
Becky (last name withheld at her request) and her partner were clearing from the emergency department after bringing in a patient for treatment. They updated their dispatch that they were finished transferring care to the hospital staff, making them available for any new 911 calls. It had already been a busy night — a typical Halloween for those in emergency medicine.
“There was no time to really sit and eat a meal or anything,” Becky said. “It was kind of like pee while you could, while your partner was giving the report to the nurse. And then next time you got in the truck and cleared, you got another call.”
Indeed, the next call came in almost immediately — a code three: traffic accident.
The call was close to the hospital but they didn’t know the number of patients involved or how serious the injuries were, so they turned on their lights and sirens and sped toward the scene of the crash. Seconds often make the difference between life and death.
When they arrived, they didn’t initially see any signs of an accident. They searched but the area was dimly lit, making visibility difficult.
Before long, a bystander from a nearby business approached. He was the one who called 911. But the only information he could provide was that he had heard a loud crash. The search continued.
Finally, the vehicle was found on its side in a group of trees with a large amount of debris from the vehicle around it. Firefighters and police officers arrived at the scene shortly after.
As Becky approached the vehicle, the only thing she could hear was the faint sound of the freeway a couple of miles away. Then she saw a pair of legs and the lower half of a man’s torso sticking out from under the vehicle.
“It was almost like — you know when in ‘The Wizard of Oz,’ when the house landed on the witch? Kind of like that,” Becky said.
The patient was not moving his legs, so her initial thought was that he was dead. However, when she got closer to the vehicle, she could hear faint, incoherent yelling. The responders went to work immediately.
The firefighters on scene started tackling how to extract the patient. Normally they would prop the vehicle to roll away from the patient, but due to the position of the patient directly underneath, they were concerned that maneuver would further injure the patient.
While the firefighters were establishing their plan, Becky and her partner were trying to figure out how to get inside the vehicle to properly assess the upper half of their patient. After several attempts, they were unable to gain access due to the damage to and position of the vehicle, but at least they could see him.
Then she saw a pair of legs and the lower half of a man’s torso sticking out from under the vehicle.
Becky and her partner established that the patient was in a low spot under the vehicle, so the full weight was not on him. They saw that the patient’s legs had normal skin color and — outside of minor lacerations and abrasions — his legs appeared to be in good shape, indicating good blood flow to his legs. His blood pressure reading was even within normal range. But his yells and screams indicated he was in severe pain, so they continued to work as fast as they could.
Due to the velocity of the impact, his shoes had actually been blown off his feet. This presented an opportunity though: Becky and her partner removed his socks and placed tourniquets on both legs in an attempt to find a suitable vein for an IV.
“All of a sudden chainsaws started up above our heads,” Becky said. She looked up and saw that the firefighters were cutting tree limbs away from the vehicle to allow better access. She and her partner were told that they were in a safe position but to not move.
Becky finished inserting the IV in his foot, and fluids were started — including medication to manage the pain. Shortly after, a firefighter grew concerned that the patient had transitioned into cardiac arrest because he wasn’t screaming anymore. But Becky reassured him that she could see his abdominal wall moving regularly, indicating that his breathing was steady.
After approximately 45 minutes on scene, the firefighters extracted the patient by using airbags placed under the vehicle, which lifted it just enough to slide the patient onto a backboard. The responders placed a cervical collar to stabilize his neck and immediately moved him onto the stretcher. The most complicated aspect of the call was over, now it was time to get him to a higher level of care.
With trauma patients, a paramedic’s goal is to be in and out as quickly as possible because the patient ultimately needs a trauma surgeon, and time is tissue, as they say. But complicated extractions like these take time, and a trauma surgeon isn’t much good if a paramedic can’t deliver the patient to them alive.
Becky and her partner had been working together for years, so everything was set up in the ambulance ahead of time. When you work with the same partner enough, you know what they want and need, leading to assessments and treatments that are performed like a symphony inside the ambulance.
Becky hopped in the back of the ambulance with a firefighter, and her partner hit the road with the lights and sirens running hot. While en route to the hospital, Becky continued to look over the patient to ensure nothing was missed. A 12 Lead EKG was started, as well as a second large-bore IV so that they could continue administering fluids.
The firefighter assisted her with continual suctioning of the mouth due to the large amount of ongoing bleeding. Fortunately, the patient remained stable the whole way back to the hospital, which was surprising considering the severity of the injuries that he had endured.
After arriving at the emergency department, Becky and her team wheeled the patient into the stabilization room where she was met by the full Emergency Department (ED) team. Trauma and Emergency Medicine physicians, nurses, respiratory therapy, and ED techs had all been waiting for their arrival. On this particular night, Becky’s boss, the medical director, was also the receiving Emergency Medicine physician taking the report.
It’s one thing for a seasoned paramedic to give a report to a receiving hospital team, but it’s entirely different when you are giving the report to your boss. One might think that it would be no problem for someone who just got done rescuing someone literally being crushed by a rolled vehicle, but such is the perspective of a paramedic.
The physician announced loudly, “Everyone be quiet and listen to the paramedic.”
The room went silent.
The silence in the midst of chaos was unnerving. But Becky gathered herself and with a calm, cool, and collected demeanor, she delivered the report seamlessly. As the ED team took over care of the patient, Becky and her partner wheeled the stretcher and all their equipment back to the ambulance. They needed to clean up the blood and sanitize before their next call inevitably came in.
The work of a paramedic is relentless in intensity and volume — especially on Halloween. But ultimately, they press on day after day, night after night, constantly running toward the sound of distress. Constantly running to intercept the reaper, no matter the physical or mental cost.
Editors Note: A previous version of this article described how the paramedics were able to get to the patient inside the vehicle. The article has been updated to reflect that they were unable to gain entry.
Joshua Skovlund is a former staff writer for Coffee or Die. He has covered the 75th anniversary of D-Day in France, multinational military exercises in Germany, and civil unrest during the 2020 riots in Minneapolis. Born and raised in small-town South Dakota, he grew up playing football and soccer before serving as a forward observer in the US Army. After leaving the service, he worked as a personal trainer while earning his paramedic license. After five years as in paramedicine, he transitioned to a career in multimedia journalism. Joshua is married with two children. His creative outlets include Skovlund Photography and Concentrated Emotion.
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