01 Alpha please head in to the multi-vehicle MVI (motor vehicle incident), IC (Incident commander) is on site.
Me and my partner rolled in our cot along with our spineboard, jump kit, sandbags, blanket and O2. The IC directed us to a bronze jeep where a motorcyclist was struck. There were five vehicles involved. As we strolled to the jeep, I was not expecting to find our pt stuck under the vehicle with his legs sticking out from under the hood.
Ohhh this is just wonderful.
We made sure the vehicle was turned off, and the vehicle was cribbed. The driver of the jeep was still in the vehicle and looks to be unconscious. My partner went to investigate how to extricate the patient under the jeep as I triaged the driver.
“Hi there! Can you hear me? We’re paramedics, here to help you.”
She opened her eyes when I spoke to her.
Her respiration was less than 30, I checked her radial pulse which were present.
“Can you squeeze my hands?”
She does. Based on the RPM (Respiration, Pulse, Mental status) triage assessment, she’s a yellow.
“We’re going to take care of the motorcyclist first okay, you wait here.”
So I went back to my partner, because it’s clear the motorcyclist who got run over is in more serious condition. The motorcyclist, who was lying on his belly, still had his helmet on and his helmet was about 2cm from the jeep’s undercarriage.
Partner: “Can you immobilize his head while I try to pull him out?”
Me: “Yeah I can try.”
I crawled under the jeep from the passenger door. Space was tight, I didn’t like being underneath a vehicle, I imagined it crushing down on me. I cringed at the thought. I crawled in further until I was in the middle of the undercarriage.
“Hello? Can you hear me? If you can, don’t move, I’m just going to stabilize your head.”
I grabbed onto my patient’s motorcycle helmet. As I lay there underneath the damp vehicle, I could feel something cold seep up my pant leg…I didn’t have time to think about it.
Partner: “Are you ready?”
Me: “Yeah, lets try going slow, one foot at a time.”
Partner: “Okay sure, on your count.”
I was in an awkward position.
Me: “Okay, one, two, three.”
My partner pulled on my patient’s legs. We didn’t even move a foot when I yelled for her to stop.
Me: “This isn’t going to work.”
My body was all twisted, and I can only go so far under the jeep. I crawled back out. My pants were soaked with water. Someone brilliant suggested we use a clamshell. I thought that was an awesome idea. It’ll support the patient much better than what we were trying to do, and we can just pull the whole stretcher out with the patient on it. The clamshell, also known as the Robertson Orthopedic Stretcher (ROS), is a great device where you can separate the stretcher in half and slide it under the patient on either side then clip it together at the head and foot end. I went out to our ambulance to grab the clamshell.
Me: “Okay, lets give this a shot.”
We unclipped the clamshell in two, I gave the left side to my partner as she slid it in from the front of the vehicle. I went back to the passenger side with the right side of the board. I was about to crawl under when I noticed another paramedic crew had started helping the driver of the jeep. I took a moment to tell them I’d be under the vehicle and for them to be careful (probably a stupid move in hindsight, should of had them hold off for a bit). Once again, I crawled on the moist floor into the dark underside of the jeep. I slid the clamshell beside the patient, and snapped the head end together while my partner clicked the foot end together. I placed two sandbags beside my pt’s head to stabilize it. Suddenly I felt the whole jeep carriage drop a good 1.5″ before it recoiled back up. Which meant my head was just 1″ from being hit by the undercarriage. If anything was scary, THAT was scary. The image of me getting crushed quickly resurfaced with menace. I quickly crawled out from under the vehicle.
Partner: “His helmet’s stuck under the undercarriage, we can’t get him out.”
I thought my head was about to be stuck under the undercarriage! And without a helmet! The sudden drop of the vehicle had to do with the movement of the other crew working inside the vehicle to extricate the driver.
Me: “Hey, is it possible for you to get out of the vehicle so we can extricate our patient first? The extra weight is pinning our patient’s helmet. (Not to mention nearly my head!)”
Second crew: “How about we get our patient out first?”
Me: “How long will that take?”
Second crew: “We just gotta slide her out, it’d be faster if you give us a hand.”
Me: “Okay sure.”
It only took 30 seconds to get the driver out, now it’s time to get our motorcyclist out. Despite having the driver and the other crew’s weight lifted off the vehicle, the clamshell underneath our patient added an extra 1.5cm. We still couldn’t pull him out. This was getting frustrating. Luckily we had an awesome firefighter who helped us by applying some upward pressure to the jeep’s frame. That was enough to give us the few precious centimeters of clearance to pull the motorcyclist out.
We quickly unclipped the clamshell and removed our pt’s helmet while taking spinal precautions. He was unresponsive, we inserted an OPA (oralpharyngeal airway), got him on O2, exposed and quickly assessed his injuries, stabilized his fractured legs, collared him and got him onto a spineboard and stretcher then wheeled him out to the ambulance.
I never want to crawl under a vehicle ever again *knocks on wood*. I wonder how mechanics do it on a daily basis.