Administration and Leadership, Communications & Dispatch, Patient Care

EMS Provider Falls from Tree

Issue 9 and Volume 37.

The smoky plume had relentlessly grown with vehemence during the previous five days—culminating in a 65 mile-per-hour-wind-driven fire storm that had consumed 346 homes and taken two lives in less than just an hour one day earlier. My mountain community lies just 10 miles west of the Colorado Springs devastation, and although we shared with our front-range neighbors the collective loss of property, life and scenic beauty, I admit I felt a sense of selfish relief and guilt that the winds had chosen an easterly path away from my domesticated habitat.

Still, the fire was 0% contained while being sporadically fanned by wind patterns the likes no one had ever seen before. And there was still a psychopathic pyromaniac on the loose in our county. Add to that an unprecedented 100-plus degree temperature, single-digit humidity and no precipitation in the foreseeable future. Many of us believed, in spite of the awe-inspiring quantity of firefighting resources being brought to bear, these merciless flames might very well circumvent their way back up the canyon and valley to consume the foundation of Pikes Peak’s purple mountain majesties. I believed our pre-evacuation orders would no longer include the prefix “pre.”

Now I’m not one to say, “I told you so” (ha!), but for years our highland region had been suffering from a brutal drought. “It’s just a matter of time,” I would incessantly preach to any ears that were open to my dire warning (of which receptive auricles belonged only to my dog).

Seeing what medics see in EMS affords us the opportunity to integrate the belief system of, “Of course things can always get worse, and, by God, I want to be there when it happens!” The advantage of this seemingly moronic perspective is that it forces EMS providers to believe there’s a solution to any problem regardless of the probability of a successful outcome. Why else would we want to be there? Simply put, we believe in being hopelessly hopeful.

It is this form of logic that enabled me to endure my neighbor’s ridicule (during the past 20 years) of my efforts to create a fire-free zone around my property. He would watch me diligently work my land as I cleared the forest floor of its dead wood and needles while thinning the pine trees, thus allowing them more personal space to branch out. “What’s the point?” my neighbor would stoically ask. “If a fire rages through here, all will be lost, you silly lumberjack-wanna-be.”

Obviously my neighbor never heard of fire TRIAGE (Trees Readily Ignite Architecturally Grown Entanglements). Just as in EMS, wildland firefighters have triage tags. The black tag for them symbolizes death of a structure by blackened charred embers, and without adequate fire mitigation around one’s home, an owner might as well TRIAGE (Try Running Immediately Away Grudgingly East). Firefighters will not take a stand to save such acreage, especially if there’s fuel lying near or above the residence.

This is why just one day after so many homes were lost in Colorado Springs, I was determined to eliminate the last remaining low-lying branch menacingly clawing its way toward my house. But when I say low-lying branch, this particular abominable limb hovered well over 20 feet above the ground. Her tentacle branchioles (capillary branches) spread ominously toward the gutters of my second story. She had to come down, and it was to be my last act of fire mitigation should the final order to evacuate come down.

For the record, I will arrogantly admit that I wasn’t too concerned about the task at hand. I considered myself quite handy with a chain saw and axe after having resided in these thar woods all these years. When December clouds annually shroud our home’s passive solar heating system—no problem. We had wood. The fragrant smoke from the chimney billowed in carcinogenic testimony to my ability to cut, haul and split wood. “I am a lumberjack! Arrrrgh!” (OK, so I’m a pirate lumberjack.)

With the surface area now secured, the metal clips began to clatter their way up past each step with each pull of the rope. Each subsequent clank would represent an additional foot of separation of me from the earth’s surface. By the sixth clank, I realized I would be lucky if the extension ladder could even reach the base of the tree limb. No matter. My fully extended body and 20″ chain saw guide bar would more than make up for the gap in distance. Cumbersome? Yes. But I’d done it thousand times before without incident. No harm, no foul, right? Riiiiiight.

Copious amounts of sawdust rained down on my head as the guide bar sliced easily through the tree limb like a hot knife through butter. I applauded myself for my foresight in replacing the dull chain with a new one to reduce arm fatigue from having to hold a 35-pound chain saw above my head. Take a back seat Paul Bunyan, for I am the master. Blinded by the showering confetti of wood particles, I suddenly heard a crack. Not a little crack, mind you, but a loud, whopping pre-emptive, oh-crap crack!

It’s wise to constantly monitor one’s progress while cutting down timber. The tree will talk to you as the grain is objectively being weakened. It’s considered standard practice to give pause and reassess the act of cutting before the wood is completely severed from its rooted ties to itself. But I had cut too deep, too rapidly, and the goggles I had negligently left on the ground wouldn’t provide me the visual acuity necessary to foresee the misdirection this gigantic sap-laden pendulum was about to take toward my delicate frame.

It’s kind of funny what goes through one’s mind when something irrevocably bad is about to unhinge your gravitational homeostasis. For me, I was thinking of Looney Toons, the Road Runner’s nemesis—Wile E. Coyote. He was, after all, the master of the whistling astrophysical plummet routine, and I’m pretty sure I had his exact same resigned, deadpan expression as the reality of the situation sank into me … literally.

But unlike Wile E., whose scripted character is supposed to be more humiliated than harmed by his failures, I began to contemplate all the potential prospects in store for my fragile anatomical parts as the partially avulsed limb vengefully eradicated me like an annoying tick from its main body. For I knew it wasn’t the falling that was going to hurt, but the landing that was going to be a bitch.

It’s true what they say: Time stands still at moments like these (sans bladder). Here are just a few of my thoughts as I began my reentry into the atmosphere:

1. This is going to hurt.
2. When was my last BM (breath mint)?
3. Is that squirrel laughing at me?
4. This is going to hurt.
5. What EMS shift is on today, and did I piss off any of the crew members responding recently?
6. This is embarrassing. I hope no one is watching this. No. Wait. I’m unaided. I hope somebody is watching this.
7.  Where is the chain saw?
8.  This is going to hurt.
9.  Think like a cat. Land like a cat. Think like a cat. Land like a cat.
10.  Look! A butterfly! (ADD still intact).
11.  This is going to … Arrrrrrrrrrrrgh!

Hmmmmmm. Interesting. No loss of consciousness, I think, but (gasp) I can’t catch my breath. Take in a lungful. Yah, nope! That ain’t happening. How am I lying? Left lateral recumbent, which explains the left-sided thoracic pain. I note lateral neck tightness as I attempt to survey myself for external bleeding. Sweet! No blood anywhere. What did I land on? Phew! Just missed that severed aspen tree spike. No ground, roots-only, soft needle-laden soil. The chain saw is still running, but where is it? Still no signs of mid-line C-spine point tenderness to palp. Feeling for a strong radial pulse. Ouch! Left wrist slightly deformed. At least I’m right handed. Where did that butterfly go? Why am I tachycardic? Am I hemorrhaging internally? Could be a spleen from landing on my left side. No, wait. Of course you’re tachycardic you epi-rush-dumb-ass. Why else would your hands be trembling? Besides, the peripheral skin is pink, warm and dry with good capillary refill. No abdominal pain. How are the legs? WTF? That doesn’t feel right. Hip fracture possibly, but on the right side? Coup contrecoup maybe? Please don’t let it be the pelvis. Cell phone! Where’s my cell phone?

“9-1-1. What is your emergency?”

“I fell out of a tree.”

“Who fell out of a tree?”

“I fell out of a tree.”

“What tree?”

“My tree.”

“You fell out of your tree?”

“Yes, my tree!”

“Which tree is it?”

“The tree I am under!”

I’m sure there was a lot more pertinent dialogue to the conversation with the 9-1-1 operator, but I don’t recall a lot of the details, except for a few shining moments—especially when the dispatcher asked me to please hold. Please hold? Seriously?

Time may have stood still for me during my nosedive into the abyss, but for the Ute Pass Regional Ambulance District (UPRAD) EMS providers who would respond to me on this day, my timing couldn’t have been worse. During the exact moment of my reckless act, an already taxed UPRAD was preparing for the immediate fire evacuation of the town’s chronically sick and immobile citizens by either recruited buses or ambulances. On top of that, a rollover accident with multiple patients being ejected was concurrently being dispatched, along with my call. Thus, through no fault of her own, the 9-1-1 dispatcher had to put me on hold while she valiantly attempted to bring all the available resources to bear amid the chaos.

Still on hold, and having already completed my initial primary survey, I began to contemplate a more thorough self-exam, upon which I discovered not only my health insurance card, but also a Subway sandwich gift card that still had five dollars worth of credit on it. Suddenly, I saw my loyal dog Koosko sitting just above me on the slope. “Lassie,” I bemoaned through my aching thorax. “Go get help girl! Find help.” I was delighted and surprised to see Koosko, sensing my situation, take off like a bolt of lightning toward the road. I closed my eyes in quiet satisfaction, knowing help was on the way. Minutes later, I felt a light, hollow thud hit my chest, followed by heavy panting. My dog had returned to his master. Not with help mind you, but with his saliva-soaked tennis ball.

Resigned to the fact that it is what it is and that it may take a while before 9-1-1 gets back with me, I feebly lobbed the ball maybe five feet down the hill. Like a good dog, he fetched and returned the ball each time I threw it, despite his obvious air of discontent with my less-than-stellar effort.
As I lay quietly under the tree, despite the continuous, soothing idling rumble of the chain saw’s engine, my mind was far from quiet. I was now scared. Any thread of arrogance that embodied my earlier interpretation of myself was now gone. I knew my body was not that of a young man anymore and that my brain could only mobilize just so many neurons when it came to interpreting any damage. I knew there could possibly be more underlying issues my endorphins were masking at the moment, despite my stable vital signs. Still, I was hopeful my injuries were limited to musculoskeletal in nature as my faithful dog continued to drop his slimy orb on my contused chest.

I didn’t hear the sirens while I continued to reassess my C-spine in a half sit-up position, but I did hear a voice yelling, “EMS.” Moments later, the feel of gloved latex firmly fixating itself bi-laterally along my temporal lobes was simultaneously met by an upside down, sun-blinded view of paramedic Chris Erickson saying, “Don’t move, Steve!” His voice was both commanding and compassionate; his facial expression read “What the hell were you thinking?”

“I’ve cleared my C-spine,” I began but was quickly cut off.

“You know the drill,” Chris said.

“But I …”

I heard, “Shut up, Berry!” as the non-rebreather mask was instantaneously placed over my nose and mouth as if to emphasize the point. And with that, I can honestly say I let go. I let go of the control and put all my trust into my prehospital care providers—my comrades, my brothers, my stupid dog. Chris is one of the best paramedics I’ve ever had the pleasure of knowing, and his EMT partner Travis Daniels, although new to the field of EMS, has more street sense than most medics I’ve known.

“Launch the bird,” Chris tersely ordered.

“Damn! Really?” I contested.

Again, I was cut off, not by his voice, but by his charismatic furrowed eyebrows.

“He’s one of ours,” Chris emphatically told the Northeast Teller County firefighters arriving on scene. He wanted a helicopter, and he wanted it now.

Once the C-collar was applied, my view of the world became stiflingly one dimensional ,with occasional faces, arms, hands, splints, stethoscopes, a blood pressure cuff, straps and tennis ball making brief and sporadic appearances across my 20″ by 20″ transversal viewing plane.

I knew the pinch (ouch!) on my forearm indicated pain management was forthcoming, but instead a second pinch in the same general vicinity soon followed.

“Chris? Oh, Chriiiis? Did you just happen to miss the line on your first attempt?” I satirically inquired in a falsetto voice.

“You moved,” he voiced meekly. I couldn’t help but laugh, despite my unsolicited situation, for three reasons. One: I had ropes for veins without a tourniquet. Two: Chris is a master at venous access. Three: He used the ole pathetic, “You moved” line.

“This was almost all worth it just to witness this implausible moment,” I continued in my attempt to rib him just as my ribs were ribbing me.

“No matter,” he grinned. “You won’t remember this short-term memory moment anyway.” And with that, I was given a fluid challenge of 100 mcg of fentanyl, soon followed by 2 mg of Versed.

Chris was right about my inability to recall much of what transpired following my IV inoculation of happy meds. Brief moments of EMS procedural applications, well wishes, sounds of sirens and rotor blades, along with loading and unloading from ground to ambulance, ambulance to helicopter and helicopter to hospital helipad felt like only minutes rather than the hour it probably required to transport me from scene to ED. Nonetheless, there were some moments of clarity that I know can only enhance my patient care and compassion in the future:

Pay attention to the mechanics of trauma triage. Chris quickly understood the risk for injury from such a vertical deceleration scenario, including the assessment of height, impact surface area, body orientation, age of patient, circumstances of fall, secondary collisions and anticipated weight distribution. I was very lucky to still be among the living, and Chris stayed the course despite my paramedic-induced martyred invincibility.

Introduce your face often to spinal immobilized patients and explain all procedures that are about to or are being performed outside their visual periphery. And keep patients posted often as to their current geographic locality during transport.

Provide your patient updates often as to what you suspect isn’t anatomically correct, but also tell them what’s functioning correctly.

A reassuring touch speaks volumes. Although my EMS peers joked with me often during my ordeal, Chris and Travis made it clear they cared deeply about my well-being by simply gripping my hand occasionally.

Be polite. Repeatedly incorporate the words please, thank you and I’m sorry as part of your patient dialogue.

Never throw the tennis ball farther than that of the disabled pet’s owner current ability, lest the dog turn traitor to a different master.

I also took a lesson on humility that I hope to incorporate into my line of work. I broke many safety rules the day of my fall from sapling grace. I knew better, and yet I cut corners and made a conscious decision to take on a substantial and unjustifiable risk. Did my years of experience carving up wooded landscapes allow me more latitude to drift, simply because nothing bad had happened years earlier? Maybe there’s a tendency to ignore or miss the warnings that don’t conform to what’s actually familiar. It’s easy to draw the line after the accident, but you don’t have to be in one to become a victim.

There’s a reason airline pilots follow a detailed, by-the-numbers transcript of preflight safety procedures that they check off each time they climb into the cockpit, regardless of their years of winged experience. I plan on being more diligent in regard to the check-off list of EMS preventable foreseeables. Events will line up a certain way despite the best intentions to prevent a problem, but eventually something will go wrong. Let’s not add to that probability by drifting simply because we’re currently in a safe place.

Shortly after my (insistent) discharge from the hospital (sorry floor nurses, but your venous access technique really sucked), I had the opportunity to attend the Woodland Park community post-Fourth of July Symphony in the Park celebration—an annual event our family has never missed since the birth of our children. The community had a special reason to celebrate this year as our town was just days earlier spared the ravages of the Waldo Canyon fire. Although the annual fireworks were obviously prohibited, the symphonic orchestra instead introduced our local firefighters to the stage. A well-deserved, five-minute standing ovation ensued.

As I struggled to stand with my acutely recuperating fractured forearm, wrist, ribs, sacrum, pelvis and various other leaking appendages, I noted the UPRAD ambulance and its crew standing by for the event far off stage, just up the ridge. My applause made no sound as I attempted to clap with my casted forearm in their direction—a fitting silent tribute that I suppose EMS has always unfairly had to shoulder since its true beginnings. Standing in the shadows, these crews provided fire rehabilitation and evacuated the local hospital of its residents along with countless other sick and bedridden patients. Through all this, they still had to be there for the 9-1-1 call I needed on that day. Thank you EMS, from a grateful patient and his golden retriever. Oh, look! A butterfly!

Until next time, be safe … and this time I really do mean it.