scene.
‘We’re still cutting the vehicle free,’ a policeman told them. ‘The road train driver’s been removed. He’s in that ambulance over there.’ He pointed, before adding, ‘You might take a look at him. He’s in a bad way.’
Blake nodded to Kate, who headed for the ambulance, disconcerted but somehow not surprised when Angus followed her.
An ambo was using a bag mask ventilator on the driver, while his fellow attendant stuck ECG leads to the man.
‘GCS?’ Kate asked, referring to the Glasgow Coma Scale that measured how responsive their patient was.
‘Fourteen when we got here, but he’s in and out of consciousness.’
‘Coupcontrecoup injury,’ Kate murmured to herself as her mind pictured the scenario. The powerful rig powering through the night, then the car right there. The driver would have slammed on his brakes, and his body, held in place by a seat belt, would have stopped abruptly. But his head?
She knelt and spoke to the patient, glad to hear a response. She introduced herself and Angus, learning the patient’s name was Mike.
All good so far.
‘Can you remember what happened, Mike?’ she asked.
‘The car came flying towards the crossing, I tried to stop.’
Kate nodded, but wondered just how quickly he had stopped and whether the deceleration had caused his brain to jolt forward into the front of the skull then virtually bounce back to hit the rear.
The action could result in a serious brain injury but scanning it here would be a waste of time when it would have to be done more precisely at the hospital—and as soon as possible.
‘Are you in any pain?’
‘Gut hurts, and headache. The guys gave me something.’
Which probably explained why he was woozy.
‘His blood pressure is dropping,’ the paramedic said, nodding towards the monitor.
Kate checked the fluid line already feeding into a vein in the man’s hand, then took in the abrasions to his neck and chest.
‘Seat-belt syndrome,’ she said to Angus, pointing out how deep the indentations were. ‘With a shoulder-lap seat belt the shoulder strap took the brunt of the force. That could cause damage to the carotid. Could you check his distal pulse?’
She studied the monitor for a moment. Blood oximetry was fine, and when Angus felt a pulse in Mike’s wrist, she was reassured that any loss of blood was not life-threatening.
Yet.
She examined his chest, and felt the ribs under the seat belt, but there was no palpable damage.
‘Would the big rig slow for the crossing, do you know?’ she asked the ambos.
They both shook their heads, but one said, ‘I wouldn’t think so. The place is usually deserted at night.’
‘So a high-speed collision, rapid deceleration, possible internal injuries including damage to carotid artery.’ She checked the fluid line again then poked her head outside the ambulance.
Paul was standing nearby.
‘Possible internal bleeding from damage to the carotid. Can we lift him immediately?’ she asked.
Blake, who was over to one side, watching as the car was extricated, came across, took in the information the monitor was now offering and hesitated.
‘It’s unlikely anyone in the car survived, but if they did, he or she will be seriously injured and will need immediate transport. We can work on them on the flight. Can you hold him a little longer?’
Kate nodded.
‘We’ll need to keep up the fluids and open up a bigger port in case he needs a rapid infusion,’ she said to Angus as Blake hurried away.
‘IO?’ Angus suggested, but Kate already had the intraosseus pack in her hand and was holding the drill that would insert a needle into the bone marrow, while the ambo, who’d kept up with the exchange, was cutting their patient’s shirt and opening it up.
‘Here, let me,’ Angus said, taking the drill from her as she used a sterile wipe to clean the site on the man’s unaffected shoulder, at the head of the humerus. ‘We use this more often than not in field situations,’ Angus assured her, ‘and I promise I’ve never once drilled right through the bone.’
Kate had to smile. It was always a worry, although the devices they used now for IO infusion were very sophisticated. With this access, they could deliver anticoagulant drugs to ward off a possible stroke and add high-volume drugs should the patient go into cardiac arrest.
Kate administered a local anaesthetic and watched as Angus drilled, then inserted a wide-bore cannula.
Working together, they set up a fluid line to keep the port open, and, while Angus watched for any change in their patient’s condition, Kate continued her examination. The seat belt had left abrasions across the driver’s chest and lap, and the depth and severity of them told her how violent the impact had been. Once in hospital, there’d be scans that would show the extent of the damage to the chest and abdomen.
Yet, even with possibly serious injuries, he was luckier than the people in the car. It had been dislodged from under the prime mover, and the damage told a grim story even before the firies started cutting out the bodies. Two people, driver and passenger, and neither had survived, which dampened the spirits of the SDR crew as they flew home with the rig driver.
Kate did the handover in one of the resus rooms in the ED, hoping they’d got the man to the hospital quickly enough to be saved, although she couldn’t help wondering whether, if they’d flown him out earlier, his chances would have been better.
‘You only do what you can,’ came a voice from behind her as she left the hospital.
She knew before she turned that it was Angus.
‘I’ll walk you home,’ he said, and because she was tired, not to mention doubtful about the outcome for her patient, she was hardly gracious.
‘It’s two blocks and broad daylight, I don’t need to be walked home.’
‘Ah, but my hotel is just across the road from your apartment building, and I might have been suggesting it because I needed to be walked home, only asking you to walk me home might have seemed a bit unmanly.’
Worried as she was, Kate had to smile. She turned to face him, taking in his height and breadth, and the aura of strength that hung around him, contrasting sharply with the gentleness in his dark eyes.
‘Unmanly?’ she echoed. ‘That’s not an assumption many people would make!’
He held out his arm, crooked at the elbow.
‘So, shall we walk each other home?’ he said, and somewhere deep inside a little bit of the Kate she used to be began to unfurl, like the petal on a tight rosebud. She slipped
