Great! Traffic at noon on a Thursday.
I had just spent 30 hours on call as the senior resident in the Intensive Care Unit (ICU) at my hospital, and all I wanted was to go home and sleep. But instead I had the pleasure of standstill traffic, irritated motorists and trying to drink my cold, stale coffee without spilling it.
Looking to the left, I witnessed two police officers running toward a construction site where a large crane appeared to have fallen across the entire southbound side of the freeway, partially crushing an SUV. Having clinical experience in both the prehospital and hospital realm as an EMT and current emergency medicine resident physician, I pulled my vehicle over and went to assist. Had I seen fire engines and ambulances on scene, I would most likely have driven by; however, this accident had just occurred and I suspected it would be awhile before additional help would arrive.
The crushed vehicle was empty. The passenger was standing outside, trembling with fear, frantic, tears streaming down her face. Instantly, I was launched back to my prehospital days of working on a 9-1-1 response ambulance. Her injuries were minor a few cuts and bruises; no airway, breathing or circulatory concerns from a triage standpoint.
I told her to stay still until further help arrived. I asked a police officer to assist with calming her down, and I headed toward the clearly anxious construction workers who were crowded around the crane operator s cab. We re going to get you out, desperately screamed one of the workers.
The crane s cab had been crushed, trapping the operator inside. The scene was a disaster, glass fragments blanketed the dirt, large wood planks were randomly scattered about, and fellow construction workers were urgently trying to free their colleague. Fortunately, the crane was stabilized by the highway, and seemed unlikely to move further. With this in mind, I jumped up on the apparatus and proceeded cautiously to the patient. He was screaming, Please get me out of here.
Glancing into the cab, I noticed that the patient s left leg was severely crushed, his chest compressed, and he was bleeding from his left hand. I knew there was no way we could safely extricate this individual without cutting through parts of the metal cab. Fortunately, I saw no direct evidence of significant bleeding, the patient s airway was intact, and his breathing was not labored. For now he was stable. Although time was paramount, we would have to wait for the fire and EMS response teams.
As more police officers arrived, barricades were made and the scene was cleared of all unnecessary bystanders and cars. In basic EMT training, we learn that scene safety is of greatest importance and we rely significantly on the skill of police officers to accomplish this crucial goal.
With the scene secure, the fire engines began to arrive. Soon a swarm of firefighters, clad in their smoky yellow turnouts, wearing helmets and goggles, and carrying a variety of extrication and safety equipment, converged onto the crane. I had gone from primary health-care provider on scene to a bystander who was requested by the paramedics to standby in case further assistance was required.
Over the next hour, I witnessed a well-organized and obviously well-prepared group, under the leadership of the captain, stabilize the crane using all available resources (i.e. police officers, firefighters and construction workers) and safely cut away the crushed metal that was preventing safe extrication of the patient.
Through all the commotion, the EMS personnel were able to provide quality patient care under these incredibly difficult circumstances. The nature of the accident required cervical spine precautions, aggressive intravenous fluids, and further medications and treatment secondary to the prolonged entrapment and presumed crush injuries sustained. These interventions were initiated while the patient was still entrapped.
With so many personnel on scene, I was amazed at the efficiency and safety of the extrication. Personally, I believe this success was directly related to the teamwork and effective leadership during the incident.
As a previous EMT, I understand what s involved in delivering patient care in the field. Prolonged extrications, risk to their own lives and initiating medical care in extremely difficult conditions are just a few reasons why hospital-based emergency medicine clinicians should be thankful for our prehospital colleagues the true life-savers.
Watching the patient being wheeled toward the medical helicopter, surrounded by concerned firefighters and EMS providers, I was overwhelmed with pride. Despite my extreme fatigue from the grueling night in the ICU, I was proud to witness the teamwork of emergency medicine at its best. All personnel from the firefighters, EMTs, paramedics, technicians, nurses and physicians play integral roles in delivering quality patient care, and we should consider ourselves fortunate to be part of such a well-functioning, collaborative system here in the United States.
Andrew W. Seefeld, M.D., is a resident physician in the Department of Emergency Medicine at UCLA and Olive View Medical Centers. Previously he worked as an EMT-D with UCLA EMS for three years. Contact him at firstname.lastname@example.org.