SAR: “Where’s the medic?!?!”
Me: “I’m right here!”
SAR: “Okay I need you on this side, and two carabiners through the two loops there.”
I grabbed two carabiners from the blue mat and clipped them onto my harness as I wrestled into a backpack loaded with medical equipment along with an O2 tank. I shoved on a pair of extra large leather gloves on top of my already gloved hand. I had my helmet on, my safety glasses, I’m all geared up and ready to go. I’m wondering what I’m getting myself into as I looked down the slope. The first hill didn’t look too bad, but then it ends at a trail and there’s another lip that I can’t see the other side to. It just drops off, and all I hear is water running below.
SAR: “Are you ready?”
I have no idea what I’m doing!
SAR: “Okay good, here’s my radio, don’t lose it!”
I got to the edge of the steep embankment and leaned on the ropes as I looked at the belay system my friends had set up. My life is now in their hands. Literally.
Me: “Secured and ready to go!”
I leaned back till the ropes were taught and started walking down the muddy embankment. The O2 tank wasn’t tied onto my pack properly and waved back and forth challenging my balance. I got to the lip of the trail and had to really tug to get the rope going.
Pt’s Friend: “God! What took so long! Where were you??”
Me: “We were getting our equipment ready to haul your friend up. What happened?”
Pt’s Friend: “We were just hiking and picking shrooms. He tried to get some off the edge and fell down there.”
He pointed down the second embankment which was even steeper than the first, littered with rocks, branches, mud and some stubborn weed. His friend laid on his back on the rocks next to the river.
Me: “How did he fall down?”
Pt’s Friend: “He tumbled, like head over heels.”
I worked the ropes and got myself into position to get lowered down the second slope.
Me: “Did he take any of the shrooms?”
Pt’s Friend: “No.”
Me: “Is he on any medications or allergic to anything?”
Pt’s Friend: “No.”
Me: “Does he have any medical history I should know of?”
Pt’s Friend: “No.”
Me: “Okay you stay here, I’m gonna head down.”
The rain was falling, I was slipping on the rocks and digging my feet into the mud. As I walked down the slope backwards leaning on my line.
Me: “Hi there! Don’t move, stay still! I’ll be right down.”
When I finally got down to the bottom. I unclipped myself and radioed up to Control that I’m off ropes and attending to the patient. I put my backpack down and assessed my patient. He was a definite spinal just based on the mechanism, but I asked anyways.
Me: “Did you hit your head on the way down?”
Pt: “No….I don’t remember. I don’t think so.”
Me: “I need you to hold steady and not move okay.”
I could really use a second hand here. I have a spinal patient and I’m by myself. I have no sandbags, there’s nothing there to steady his head. It was frustrating. The patient’s airway is clear and his breathing was adequate. He was complaining of his leg. I found no other injuries, until I got to his leg which was bent a little funny. I cut his pants open and found an open fracture which was gushing out blood. I quickly bandaged and controlled the bleed, fighting the rain and soil to keep the dressings clean, then checked his pulse on his feet. He had no pulse on that injured side.
Just wonderful. That’s what I need right now.
I got a NRB (non-rebreather) out and set the oxygen to 15Lpm.
Me: “Here’s some oxygen, it might help with the pain.”
I grabbed the radio from my pack.
Me: “Control from Medic1.”
Medic1 go ahead.
Me: “Update on patient status: Have a spinal patient with good breathing and circulation but an open fracture left mid third femur, no pulse distal to injury. Unstable.”
What would you like to be sent down?
I could use a hot mocha.
It was raining, my patient was cold, I’m on a muddy embankment with jagged rocks and very little space to work and a river right next to us. I was slipping as I assessed the patient, and I’m all by myself. I’d like to not be here in this situation right now.
Me: “I need another crew to bring down the basket and clamshell with a blanket. Is helicopter or ALS (Advanced Life Support) crew available?”
Another team has been sent down with the basket stretcher and clamshell. Blanket, ALS and helicopter is unavailable.
Me: “Is a BLS (Basic Life Support) unit available for standby and Fire?”
I guess it’s just me and my team. Juuuuust excellent!
I checked my patient’s skin and he’s pale cool and obviously wet from the rain.
Me: “Is the oxygen helping at all?”
Pt: “Yeah a little bit.”
Me: “Good. We’re getting another crew down here with a stretcher to bring you up the slope okay. Right now I have to re-align your leg. This is going to hurt, but I’m going to have to do this to get you out of here.”
So I took his leg and moved it back into alignment much to his complaint. I strapped his legs together with zap straps as my two other attendants clambered down with the basket stretcher. I had to prepare my patient for transport.
Pt: “I can’t feel my hands and legs.”
Me: “Can you squeeze my fingers?”
Me: “Okay. Can you wiggle your toes?”
Me: “We’re gonna get you out of here real soon.”
Shoot I shoulda put on the collar earlier.
I did think about stabilizing his head earlier on, but had nothing to really steady his head so I went for the life over limb train of thought, and for some odd reason I didn’t think about using a collar. A collar will still allow for some movement, but at least it would’ve restrained him a bit more. I’m so used to practicing putting on the collar after my RBS/at the end of my Primary Assessment right before transport in class. But the situation here was different, my partner wasn’t here.
I wanted to smack myself. Well I can’t go back in time and we’re transporting him now. So I grabbed the collar out of the jump kit and collared him with the help of my partner who came down as the second crew. I looked at the terrain. It didn’t look good. I’m going to have to roll him onto his injured leg to get the clamshell in because were too many rocks on the other side. It’s also safer, so if anything went wrong with the move, he wouldn’t slide into the river.
I got everybody to position themselves for the roll. I sat at the patient’s head, digging my feet into the mud, and teetering myself in between two rocks as I dug my bum into the mud to get into a good position. I held my patient’s head in the modified trap grip (a type of grip used to support a spinal patient’s head to prevent movement) for the roll.
Me: “We’re going to roll you onto your side so we can get you onto our stretcher alright? Okay is everybody ready? On the count of three I’m going to roll him to my left and then you’ll slide the clamshell in. One, two, three.”
We got the patient to his side, slid the clamshell under him and rolled him back onto the device. Because we were on a slope, our patient threatened to slide downhill on our board. Thankfully we had someone at the foot end to prevent that. As my driver and third attendant buckled the patient onto the device. I was thinking how best to place the patient into the basket stretcher.
Me: “Control from Medic1”
Go ahead Medic1.
Me: “We’re preparing to leave.”
Things just never run smooth when you want it to. The clamshell wasn’t fitting properly into the basket stretcher. We had to muscle it in. And even stomp on the clamshell to get it to sit down properly. It’s not professional, but you do what you gotta do. I mean, no one there looked professional, covered in mud and all.
We positioned ourselves tripod, two beside the basket stretcher and I brought up the rear end. We tied ourselves onto the load and belay line.
Partner: “Control from Medic1.”
Partner: “We’re roped in and ready to go.”
This was the toughest part, going back UP the hill. We lifted the stretcher and leaned back on the ropes as the haul team helped pull us up the slopes. We stopped at least a dozen times as we slipped and lost our balance on the wet rocks and unstable muddy slope. It felt like 45min before we got back up to the very top. We were all panting and sweating, wet and muddy. It felt good though. We made it!
I have to say, that was one of the best days ever. It was very challenging and I learned a lot. There were so many things to think about down there by myself in the mud, rain, with a patient who’s unstable and having to coordinate and think about resources, how to get him out, to communicate and reassure my patient and treat him at the same time. It’s nice to be pitched into a realistic environment and not just another “JI” day in a classroom.
I didn’t feel like the call went well, but it was a very good learning experience. Perhaps the biggest lesson was learning what do when I’m by myself with a spinal patient. I should have placed the collar on way earlier in my assessments and to remember to be flexible.
I’ve been told later by my teacher that one thing that works well is to be very assertive and say, “Don’t move! If you move, you will DIE or be a quadriplegic. So stay still!” Because like he said, spinal patients will swerve their head left and right and to see what is going on. It may seem mean to threaten, but it’ll make them think twice before moving their head around. In the practice scenario above, if I placed that collar on earlier, he wouldn’t have lost sensation in his arms and legs. That’s something I’m never going to forget.
The rope rescue course was amazing. I wish we had more opportunities like this to practice outdoors, it makes the situation more realistic. However, it does take a lot of time to run one call, so not everybody gets a chance to be the attendant. Therefore when the opportunity presents itself, don’t hesitate and volunteer! In our group only two people got to practice attending. However, the course incorporates everybody so everybody gains experience in one way or the other, whether it is setting up the rope system, rigging up mechanical advantage, working on the haul team, partaking as the stretcher bearers, learning to use the belay system and manning the prusik knots etc.
The course was also a good eye-opener to personally experience the difficulty of extricating a person. I gained a new appreciation for all those who volunteer their time in SAR. It also sparked my interest in possibly joining SAR and taking courses in swift water rescue in the future. Special thanks to the Chilliwack SAR crew who made the day an amazing experience.
For those who are heading into Primary Care Paramedic program at JI, patient extrication day is definitely a day to look forward to 😀