Radclyffe - Crossroads

When she reached the roof, Jett was beside the big EC145 Eurocopter with a clipboard in her hand, completing her preflight check. She shot Linda a thumbs-up and climbed into the cockpit. The rear double doors slid open, and Linda stepped aboard, settled into the pull-down seat behind Jett, and strapped in. The engine roared to life and the overhead rotors turned, caught, and whirled. The belly of the chopper trembled like a beast on a chain, hungry for freedom. Linda peered out the open bay doors and watched a short, thickset man with a bullet-shaped, shaved head and a taller brunette in hospital greens sprint across the tarmac. Not yet noon and heat shimmered off the black surface like fingers of fire. Dave Burns, the nurse anesthetist on flight call, and Sammie Chu, the senior trauma fellow, clambered aboard at the same time.

“Hiya, what we got?” Sammie asked in her deep alto, the Texas twang still evident in her voice despite six years at PMC. She took the other half of the double seat next to Linda and pulled on her helmet.

“Motorcycle victim.” Linda passed Sammie the field report.

“Hello, summer,” Dave said and dropped into a jump seat across from Linda and Sammie.

Jett’s voice came over the comm channel. “Flight crew, make ready. Wheels up in twenty seconds.”

“All clear,” Linda said into the mic in her helmet.

Everyone settled back, the doors closed, and the chopper lifted off.

Linda watched out the window as Jett made a lazy circle over the hospital and then arrowed northeast toward Route 309, the site of many of their vehicular call-outs, especially during the summer season. Eighteen minutes later, the crash scene came into view—a clot of vehicles blocking the northbound lanes. Fire trucks, police cruisers, and ambulances had all converged in a ring across the three-lane. A pickup truck was canted onto the median, its front end crushed, the hood popped open and steam billowing out as firefighters coated it in flame-retardant foam. Some distance away, dark skid marks snaked up the highway to where a big touring motorcycle lay on its side. A blue tarp covered a shapeless mound twenty feet farther down the road. A clump of people gathered nearby, presumably tending to the survivor.

A state trooper waved a flashlight, directing Jett to a makeshift landing site on the highway, and the helicopter descended, touching down with the barest of jolts despite the winds that had picked up as they’d flown.

“Clear,” Jett signaled over the radio channel.

Linda released her safety belt and grabbed the med kit. Sammie and Dave grabbed their gear boxes, and they all climbed out and raced toward the circle of emergency responders.

Several people moved aside and Linda and Dave knelt by the patient. Sammie talked to a middle-aged man in a paramedic uniform a few feet away. The girl on the ground was slight, maybe five-one, a hundred pounds if that, dressed in jeans and a yellow, scoop-neck T-shirt—not exactly biker gear—and the lightweight clothes hadn’t offered her much protection. Her left shoulder was raw with road rash and her arm was clearly fractured just above the wrist. Fortunately, her helmet, a minimal affair with no face or chin protection, was still in place. An open fracture of her left femur was obvious from the inch of bone protruding mid-thigh through a ragged rent in her torn jeans. The EMTs had already started an intravenous line in her right arm and splinted the fractured leg. Linda checked her vital signs while Dave assessed her airway.

“She’s nonresponsive to verbal commands,” Dave said, “and she’s not moving much air.”

Sammie squatted across from Linda and pressed a stethoscope to the girl’s chest. “The truck changed lanes and didn’t see them. Reports are this girl and the driver were ejected from the bike on impact.”

“Was she ever responsive?” Linda asked, documenting the first set of vitals on her notepad.

“Unconscious when the EMTs got to her.” Sammie frowned and moved her stethoscope an inch to the left. “Breath sounds are decreased on the left.”

Linda said, “Her pressure’s been all over the place, but it’s steadily tailing down.”

“What’s hanging in the IV?”

“Normal saline.”

“Run it wide open.” Sammie draped the stethoscope around her neck and looked at Dave. “How’s the pulse ox?”

“Crappy. 72 and drifting lower.”

While Dave and Sammie conferred, Linda checked the positioning of the splint on the girl’s leg and moved down to assess the pulses in her foot. The foot was mottled, faintly purple, and cold. “We’ve got no blood flow here, Sam.”

“Looks like several broken ribs, possibly a hemopneumothorax too.” Sammie grimaced. “Dave, you’re going to need to tube her.”

“You have to take this helmet off,” Dave said. “I can’t get to her airway this way.”

“All right.” Sammie duck-walked around the girl’s prone body until she was leaning over her head from above. “Linda—stabilize her neck while we get this helmet off.”

“Right.” Linda bent over and held the girl’s shoulders and neck in line with her spine while Dave and Sammie eased off the helmet. The position was awkward, and a muscle twinged in her lower back. She ignored it, concentrating on preventing the girl’s neck from flexing. If her cervical vertebrae were unstable, too much motion could crush her spinal cord.

“Okay. Linda—hand me the C-collar,” Sammie said.

Linda passed the molded plastic neck support to Sammie and straightened, trying to massage the cramped muscle in her back with the heel of her hand.

“You okay?” Sammie asked.

“Fine.”

“I’m gonna have to get that tube in now,” Dave said. “Pulse ox is 68. There’s a number seven right on top in my box, Linds.”

“I’ve got it.” Linda pulled the curved plastic tube from Dave’s kit and held it by Dave’s left hand as he opened the girl’s mouth and inserted the laryngoscope. She said to the first responders still crowded around, “Anyone got suction?”

“Here.” The EMT who’d briefed Sammie passed a thin, flexible catheter to Dave.

“Thanks.” Dave cleared saliva and blood from the girl’s throat. “E-T tube?”

“Here you go.” Linda positioned it in Dave’s hand so he could slide it down the trachea.

He took it without shifting his focus from the oropharynx and eased the tube alongside the blade of the laryngoscope, past the base of the tongue, and into the trachea. Linda quickly checked for breath sounds. “Nothing on the left, Sammie.”

“Yeah—I hear that,” Sammie said, also listening for breath sounds. “She’s got tracheal shift to the right. That left lung is down. Linda, open up a cut down tray and get me a number thirty chest tube.”

Linda’s pulse jumped. This was bad. The girl was too unstable to even get into the chopper, and the longer they were in the field, the worse her chances became. Quickly swiveling around on her knees, Linda reached for the surgical field trauma kit. The muscle in her lower back cramped again, harder, and she caught her breath, battling a wave of nausea. Ignoring the pulling sensation, she lifted the instrument pack from the bottom of the trauma box, extracted the two-foot-long chest tube, and tore open the clear protective wrapper. After folding open the outer layers of the sterile cut down tray, she pulled on a pair of surgical gloves, snapped the blade onto the handle of the scalpel, and waited for Sammie to ask for it. When Sammie did, she passed it, handle first, across the girl’s chest, and Sammie made a two-inch incision between the fourth and fifth ribs in the anterior costal line.

“Kelly,” Sammie said.

Linda slapped the oversized hemostat into Sammie’s palm and got the chest tube ready.