He or she was crying, adding to the muted sounds of distress coming from within the vehicle, but that child, too, was clearly breathing adequately.
Tori couldn’t see any further into the rear of the minibus. So far she had counted four patients, two of whom were seriously injured. How many more people were trapped in the back of the van? And there was yet another vehicle involved in this crash.
‘I’ll be back in a minute!’ Tori tapped on the intact windscreen of the van and the child in the front stared in wide-eyed terror. ‘You’ll be all right, sweetheart. Just hang on for a bit. I’ll be back.’
This was so hard, leaving the child with such inadequate reassurance and then disappearing from view. This never happened when she was on duty as a triage nurse in the emergency department of the Royal North Shore hospital where she worked. Patients came in neatly packaged on stretchers, with an ambulance officer who could tell her how seriously injured they were. Details of the worst cases would have been radioed through en route, in fact, and the trauma room would have been set up with a whole medical team ready to receive the injured.
This was the front line. A place Tori had never been. Thank goodness she had attended that introductory Urban Search and Rescue course last year. Even the most basic procedures for dealing with a multi-casualty incident were helpful and still fresh enough to be pulled from her brain despite the horror of the situation.
She had to see as many of the people involved as she could. A thirty-second evaluation to determine priority of treatment. Airway, breathing and circulation. Disruption to any of those three were the immediately life-threatening scenarios.
For the purposes of triage, she could take the few seconds needed to open an airway and determine whether someone was breathing, and if they were bleeding badly she could apply a pressure bandage of some sort, but that was about it. She had to find out how many victims there were and what condition they were all in.
If there was any immediate and obvious danger to the victims, she would have to try and move them regardless of their injuries, but Tori couldn’t see anything too alarming. There were no power lines down, the remaining logs on the back of the truck didn’t look like they were going to roll off and she thought the puddle of fluid on the road was water from a crushed radiator rather than fuel with its inherent fire risk.
The children she had seen in the van were breathing well enough to be able to cry. The woman had been conscious enough to be moving. Another glance towards the cab of the logging truck showed the driver to be in exactly the same position as the last time Tori had looked, but even if he was slumped enough to be occluding his airway, there was no way Tori could get into the cab to help.
She could get to the final vehicle involved. A middle-aged man was unconscious in the passenger seat, still held by his safety belt, his head slumped forward. The passenger door was too damaged to open and the driver’s side airbag had deployed and now lay dangling from the steering-wheel like a pricked balloon. A woman sat violently shaking in front of it—a horrible, keening moan issuing from her lips.
Tori was trying to open the back door of this car when another vehicle screeched to a halt. And then another.
‘Has someone called for an ambulance?’
‘They’re on their way.’ Tori eyed the solidly built young man with relief. ‘Could you help me get this door open, please?’
The first attempt failed. Then the man put his foot against the back of the car as he wrenched at the handle. The door opened slowly to the halfway point with a groan and rasp of uncooperative metal.
‘What can I do?’ A woman rushed up to the car.
Tori had to think fast. She had been about to climb into the back seat of this car and position the man’s head to open his airway and protect his cervical spine, but that would immobilise her and there could be others that needed the expertise she had until the ambulance crew arrived.
‘Climb into the back seat,’ she told the woman. ‘I want you to put a hand on each side of this man’s head and tilt it backwards until it’s upright against the headrest.’
‘You can’t do that!’ The young man who had opened the door sounded horrified. ‘I’ve done a first-aid course. You can’t move his neck.. he might have broken it.’
‘At the moment, he’s blocking off his airway,’ Tori explained. ‘He’ll die within minutes if it’s not opened.’
The woman had squeezed into the back seat. She reached for the victim’s head. ‘Like this?’ she asked anxiously.
‘That’s great,’ Tori confirmed. She could see the man’s chest through the window and it was expanding. ‘He’s breathing properly now. You’ll need to stay like that and hold his head in that neutral position until the ambulance gets here and he can get a collar put on to protect his neck. OK? Can you do that?’
The woman nodded but cast a nervous look towards the driver of the car, who was still moaning incoherently. She seemed unaware of the activity around her and was fumbling with the catch of her safety belt but seemed unable to open it. Tori couldn’t see any sign of major bleeding.
‘Talk to her,’ she instructed the head-holder. ‘Try and reassure her as much as you can and encourage her to stay as still as possible. Help should arrive very soon. And I’ll be back as quickly as I can.’
She straightened to meet the challenging gaze of the young man.
‘Where are you going?’ he demanded.
‘There are people in that van. I need to triage them— check how badly injured they are.’
The man frowned. ‘What, are you a doctor or something?’
‘I’m an emergency department nurse.’ Tori could see a look of relief washing over his face and hoped it was justified. She had just put herself in charge of this situation. Taken control of the scene. This person was ready to help rather than argue. ‘My name’s Tori,’ she continued. ‘What’s yours?’
‘Roger.’
‘Come with me, Roger,’ Tori said. ‘We might be able to break a window or something and get the children out of that bus.’
More vehicles were stopping now. In fact, blocked traffic was starting to build up and Tori shouted to a new arrival to watch that people didn’t block access for emergency service vehicles. To her surprise, the man turned immediately to do as she’d requested and her confidence, as she and Roger approached the van, increased steadily.
There was no easy way to gain access to the interior of this vehicle. The log lay over both the bottom of the front passenger door and across the side opening door in the back section. The rear of the van had been crushed by the weight of the log.
Tori caught the gaze of the white-faced child as she approached the minibus again. She had been away for only a matter of minutes and the girl, who looked to be about eight or nine years old, had clearly calmed down enough to watch for her return. Maybe the reassurance Tori had given hadn’t been so inadequate after all.
‘We could break the windscreen,’ Roger suggested. ‘And lift the kid out that way.’
Tori peered through the glass, shaking her head. ‘The glass would go all over the driver and she looks injured enough as it is.’
The
