Impact 4/4

Driving home I see the text message from my wife telling me that she couldn’t stay awake any longer and is going to bed. I got held over by three hours tonight and it’s well past midnight before I make it home.

I give my wife a kiss and pet the dogs who are asleep in their monogrammed dog beds on my wife’s side of our bed.  Sleepy eyes look up from the pillow, “How was your day?”

“Busy, I’ll tell you about it tomorrow love, go back to sleep. I love you.”

I spend an hour in the hot tub – cool wind in the trees and stars overhead – tying to let the adrenaline dissipate from my system and introspectively looking for answers while listening to the lonely call of an owl sitting in a nearby tree.

Don goes to the middle east, putting his life on the line for his country, while getting shot at by the Iraqi version of bangers in their very real killing fields. In an effort to help his fellow serviceman even more he starts medical training and gets shot at by local bangers – the very people whose freedoms he swore to protect – in the domestic version of the killing fields.

Of all people to shoot at, why shoot at EMS? We are the best chance a banger has when they get shot. We are their ONLY advocate and our single purpose is to make sure they don’t die – a job that we have become quite proficient at over the years. In the summer months of this year 204 people were shot in the urban city that comprises most of my county. Of those 204 people only 11 people died. That’s a survival rate of 95%.

In the world of modern medicine we are able to keep the elderly alive long past their bodies’ ability to function – giving their families just a little more time with grandma and grandpa. That same modern medicine seems to also be keeping the violent offenders alive through multiple life threatening altercations and solidifying their personal self image of indestructibility – thereby prolonging and intensifying the violent behavior. In the dark ages a ruffian would have died from infection following a minor cut in a knife fight. Yet today I have many patients with multiple laceration and GSW scars that tell the tale of escalating violence – and by extrapolation an escalation of PTSD, dissociative violent behavior, depression, and many other mental afflictions. It’s possible that the ability of the physical body to cope with trauma has out-paced the mind’s ability to cope with the effects of the same trauma.

As I lay in bed – wife and dogs sleeping peacefully near me – I wonder if my mind has the same limitations to cope with the trauma that I bear witness to – and occasionally participate in – on a daily basis.

One week later Jim tells me that the victim in the GSW that we worked was a friend of his neighbor. He was attending a Quinceañera party – the celebration of a Latina’s fifteenth birthday where she transitions from childhood to being considered an adult. He had a perforated right lung and ruptured pancreas as the bullet had a straight trajectory in a downward angle from right mid-axially, bouncing off of the left iliac arch. He spent three days in the ICU under sedation. Upon waking up he told the nurses that he wants to meet with Jim and I to thank us for saving his life. That should be interesting.

His shooter was arrested one day later and is expected to be charged with assault with a firearm and attempted murder. The motive for the shooting was a gang initiation test to shoot a random person.

The suspect that shot up our ambulance is still unknown…

Impact 3/4

Thwack…..Thwack..Thwack.

“Drive!” I tell Jim to get us out of here now after hearing the metallic impact noises to the back of the rig. The dark streets of the killing fields become a blur as Jim accelerates away from the shooter and adrenaline floods my system while narrowing my field of view to a small tunnel with a blurry periphery – it’s the definition of “fight or flight” response.

I’ve slumped down in my seat a bit, unconsciously lowering my profile in the rig and putting more metal between me and the outside world.

“Anyone hit?” Communication is truncated to just specifics as Jim chirps the siren through a few stop signs and gets us out of the area. “I’m good,” comes the answer from Don behind me – the closest one of us to the shooter. Jim is the definition of concentration as he deftly maneuvers the rig through the hood, “Good.”

I pick up the radio, “Medic-40, priority traffic.” I really hope I’m keeping my voice calm.

“Medic-40, go.” The stoic dispatcher comes back quickly.

“Medic-40, we’ve taken shots to the rig. Relocating now, Code-4, non-injury. Shots fired at our previous staging area with four suspects heading east.”

“Medic-40, copy that, sending PD now, go with suspect descriptions.”

“Medic-40, four suspects, African-American, ages 15-18, one in a white hoodie, three in black hoodies. One black hoodie has white skeleton bones on the front and back.” I think I just described half the population of my mostly urban county.

I help Jim navigate to the well lit commuter train parking lot, hoping it’s a little safer than our last location. I heard our supervisor requesting our location from dispatch who has been watching us on the GPS and gives him our new location.

As we get out of the rig to check the damage, police cars start to show up. City PD, county sheriff officers, and the commuter train officers followed by our supervisor. Descriptions of the suspects are given again and the officers race off to canvas the area. I doubt they’ll find the shooter as all of the suspects were wearing the uniform of the hood: sagging jeans, black hoodie pulled over the head. You can never pin a crime on one person when everyone dresses the same.

An inspection of the back of the rig shows three impact points to the metal. They are small circular impacts that chipped the paint and dented the metal but didn’t go through. Given the distance of the shooter we’re assuming it was a small caliber pistol. Fortunately bangers are notorious for shooting with the gangsta-sidewise grip and usually can’t hit anything. In this case they did hit us and that’s really messing with my head. There was a time when everyone in the hood had an unwritten rule: no kids and no ambulances. It seems that rule is no longer in place – we saw that memorial to the kid today and we just got shot at.

I’ve had my body armor on since the last GSW we went to so I guess I was somewhat protected but it’s really just random happenstance that I was wearing it at the time when I got shot at. Yes, I have good instincts, and take every precaution. But honestly this could have happened anytime of the day or night. The rule of thumb for staging is to be 6-10 blocks away without a clean line of sight to the scene – and that’s exactly what we did. But it’s hard when we’re in the middle of the killing fields and there’s twenty blocks of unsafe hood in every direction. I doubt the shooter had any connection to the assault we were staging for. I suspect it was just a random, spur-of-the-moment crime of opportunity. Like so many things in EMS I I’ll probably never know the reason for this act or even the final outcome. As usual I just showed up for the exciting middle part – however unwilling that participation may have been.

The end result of all this excitement is an hour spent filling out paperwork and making police reports.


Impact 2/4

After missing out on an interesting call we’re still posting near the killing fields when we get a call for a GSW about twenty blocks from the one that went out only fifteen minutes ago. Finally, something interesting!

It’s dark now and Jim is navigating through the hood with our strobes illuminating graffiti covered fences as I map out the call location on my iPad. Given the close proximity and time-frame to the last GSW it’s reasonable to suspect that this may be an extension of that scene or possibly a retaliation by affiliates of the victim. Either way it means the vibe in the hood has changed and this is a very dangerous time to be traveling the streets. I pull my ballistic vest out of my bag and strap in the velcro attachments as I’m giving directions to Jim. It’s not something I wear all the time but it seems appropriate right now.

When we’re maybe fifteen blocks from the scene the dispatcher tells us that we’re clear to enter and police have secured the scene. Making the last turn to the street we see the fire engine and six police cars that were parked in a hurry. I tell Jim and Don to get the gurney as I want to get to the patient quickly – this is going to be a stat call and I want to be able to visualize any wounds before the patient gets bandaged up or put on a back board.

Walking up to the scene an officer meets me and accompanies me to the victim. We have to push past a crowd of people who look as though they were having an outdoor barbecue with party tents and folding tables and chairs. I can see the firefighters kneeling in the grass with officers holding back the onlookers. Secure scene my ass! There are way too many random people standing around just feet from my victim – and me.

I’m happy to see Darren, my neighbor, who’s the lieutenant on the fire engine that beat us to the scene by thirty seconds. “Hey KC, good to see ya. We’ve got a twenty year old male, single GSW under the right armpit, no exit wound. We’re working on getting him boarded now.” I thank him as I head over to check out the patient.

Darren’s crew is as dialed in as they come for this kind of call. They have the patient stripped to his boxers, the oxygen mask has already been applied, and they are about to slide the back board under him as I kneel down at his head. A quick greeting to the patient tells me that he’s alert for now and that his airway is good. I give a quick listen to lung sounds to confirm that he’s moving air and feel for a radial pulse which tells me he still has a decent blood pressure. All good so far.

I inspect the wound, which is just where Darren said it would be, and I start looking for additional wounds or an exit wound. As I run my hands down the ribs on the opposite side from the GSW I feel a lump under the skin that moves around when I push it. Fuck me! That’s the bullet! It entered under the right armpit, mid-axillary, and is now resting right next to the left floating rib. That’s directly through the kill zone!

There are basically three possibilities: straight trajectory through the torso; ricochet trajectory bouncing off of bones to end up on the other side; or the luge option where the bullet entered at such an angle that it skated to the other side following the ribs in a circumferential trajectory and bypassed the internal organs. I really hope it’s the last option.

We have him loaded in the ambulance and start transporting in an incredible four minutes and thirty seconds. I brought Darren’s fire-medic with me and I have Don in the back with me. Treatment is fast and methodical from two medics that have done this many times: bilateral sixteen gauge IVs, Asherman chest seal over the wound to reduce the chance of a sucking chest wound producing a collapsed lung, keep re-assessing and go find a trauma surgeon.

After all of the basics are covered I turn it into a teaching case for Don. In an ambulance, traveling with lights and sirens, bumping down the road, I’m walking Don through everything we did and having him re-assess. I have him take a blood pressure in the most challenging of environments using all of the tricks I’ve shown him today. I quiz him on the anatomy that is in danger given the different possibilities of bullet trajectory. I have him feel the abdomen that is now filling with blood and appreciate the rigid distention that only comes from internal bleeding. He then feels the bullet under the skin as I guide his hands and I watch Don’s eyes get big and round. And finally I point to the trends that we’ve been watching over the last six minutes; skin signs going shocky, heart rate increasing by fifteen percent, blood pressure dropping by ten percent, respiration increasing, oxygen saturation dropping. I’m explaining shock and compensation as I roll into the trauma bay filled with this year’s new crop of doc-lings and the rest of the trauma team.

If you wish to make an impact for one year, plant corn; if you wish to make an impact for a generation, plant a tree; if you wish to make an impact for eternity, educate a child.

Anonymous

Impact 1/4

im·pact

1 : the striking of one body against another

2 : the violent interaction of individuals or groups entering into combat

3 : to have an effect upon; a positive impact upon the community

Words can never adequately convey the incredible impact of our attitudes towards life. The longer I live the more convinced I become that life is ten percent what happens to us and ninety percent how we respond to it. 

Charles R. Swindoll, 1934

We’ve been staging for the assault in progress for almost a half hour and all three of us are starting to get a little tired of just sitting in one place as we wait for PD to secure the scene so that we can safely enter. Normally we would be parked behind the fire engine, as they stage with us, yet this call came in as a Code-2 so we’re running it solo. The police are stretched pretty thin right now as they’re working on the aftermath of two shooting scenes within twenty blocks of us.

My military EMT ride-along is in the back and I have a float EMT partner as Kevin and I got split up today by scheduling. After the excruciatingly slow pace of the day we finally got an interesting call an hour ago – for a GSW that occurred about 20 blocks from our current scene. We rocked that call to perfection and I’m going over the specifics with my ride-along as we sit waiting for a secure scene.

Four young men in the hooded sweatshirt/baggy pants uniform of the hood walk past the rig and down the dark street behind us. One of the black hooded sweatshirts has the white bones of a skeleton on the front – the harbinger of death. My partner is keeping an eye on them in the side mirror when one of them raises his hand pointing at us from fifty feet away.

Thwack…..Thwack..Thwack – three metallic impact noises come from the back of the rig. Don, my ride-along, yells over to us, “Oh shit! They’re shooting at us!!!”

While checking out my narcotics, computer, and miscellaneous equipment from the deployment coordinator I’m told that I have a military ride-along today and head off to the lounge to pick him up for his training day in the hood. He’s an energetic man in his late twenties named Don. I spend a few minutes getting him familiar with the rig and explaining expectations for the day as Jim, my EMT parter for today, shows up.

As usual we seem to have a heavy dose of “third man syndrome” today as it’s very slow and I’m only getting the absolute mundane calls – a fall from a ladder with minor injuries, the febrile seizure, the sixteen year old girl with a tummy ache consistent with menstrual cramping, and an old man who had a seizure in a skilled nursing facility. I do my best to involve Don in everything but there’s really not that much to do on these calls and we have over an hour of posting between each one so we get a chance to talk all day.

Don tells me he’s been in the Army for six years with a tour in Iraq and one in Afghanistan. He switched from infantry to a medical focus and is getting his EMT certification so he can feel like he’s helping his fellow servicemen on future deployments.

Jim and I tell him about calls that we’ve been on and talk about treatments and patient presentations. We pass the time by quizzing Don on how he would do assessments and treat fictitious patients.

We’re finishing up a call and hear another unit get dispatched to a GSW (gun shot wound) with possibly two patients on scene. It’s too far away for us to jump the call from the other unit but the dispatcher sends us to a post that’s near the scene. If there happen to be two patients then I’m sure we’ll be sent in for the second patient so maybe our luck is turning for the day.

I explain to Don how we call this area the killing fields as it’s a flat, 60 by 40 block area of the county where a lot of assaults and gang violence take place. I point out a street memorial – stacks of stuffed animals surrounded by candles and flowers – for the three year old child that was the unintended victim of a recent drive-by shooting. Then we pass by the street where the four officers were killed a few years ago by a banger with an assault rifle. Don’s having a difficult time believing this is happening right here in America. He’s a combat veteran who is no stranger to violence but he didn’t know it existed to this degree in the forgotten urban wasteland of my mostly urban county.

He tells us of his experiences in Iraq where his convoy was often shot at while driving from one base the the next and how IEDs (improvised explosive devices) were a constant source of annoyance and often death.

I hear the unit that responded to the GSW start transporting Code-3 to the trauma center without having called for an additional unit. It appears that there was only one patient and our “third man syndrome” is still in full effect.