First responders had to free her from between the car and the concrete balustrade of the courthouse.” Her voice remained monotone, a habit she practiced when she worked with patients to keep from alarming them. “She was unconscious on scene, but she’s been coming around since we’ve been en route, and she’s in a lot of pain. She has an obvious open tib-fib fracture, badly mangled leg, no pulse on the foot. Vitals initially on scene, heart rate 115, BP 90 over 60, respiratory rate rapid, with slight improvement following a liter bag of normal saline wide open. She’s received 700 cc’s so far. A lot of bleeding on scene from right lower extremity, but we managed to control it some after we placed the splint.”
“What about the other patient?” Lukas gestured toward the cot still in the van.
“That’s Arthur Collins, the husband,” Connie said. “He has a deep scalp laceration, and it looks like he may have a dislocated or broken right shoulder. He lost a lot of blood from the scalp, but it’s been controlled by direct pressure.”
Lukas reached forward to check Alma more thoroughly while he continued to talk to Connie. “What else is coming?”
“Two more are on their way in the BLS ambulance, and one’s coming in by private car.”
Lukas placed his hands over the sides of Alma’s hips and gave a gentle but firm squeeze. There was no reaction of pain. Good. He would get a film on it, but if she didn’t have a pelvic fracture, it would be a lot easier for her. As Connie continued with the report, Lukas helped her rush the patient through the doors and into the first trauma room, leaving the EMT and E.R. tech to handle Alma’s injured husband.
“Judy, get a chopper on standby,” he called over his shoulder as he and Connie transferred Alma to the exam bed. “And let Lab know we’ve got stat blood work for them.” He turned to Lauren, who had come in behind them. “Start another IV, and draw blood for a stat trauma panel.”
Alma’s pupils reacted briskly, and her breathing, though a little fast, was even. Her eyes remained open after he checked them. She moaned again, and Lukas bent toward her. “Mrs. Collins, I’m Dr. Bower, the E.R. physician here.” Because Connie’s businesslike manner could sometimes make a patient feel cut off from human support, he injected even more tenderness than usual into his own voice. “Can you hear me?”
Physical pain etched itself in the lines of the woman’s face. Her eyes filled with tears. “Yes…Hurts bad…Can you help me?”
“Yes. I’m sorry, but I need to do a quick check and ask you some questions. Do you have any drug allergies?”
She attempted to shake her head.
“Please don’t move your head or neck until we know how badly you’re hurt. Just tell me yes or no.”
“No.” Her voice shook with the effort to control her reactions.
“Good. I know your right leg hurts. Do you have pain anywhere else?”
“My head.” Her chin quivered. “I think I hit my head.”
“Were you knocked out?”
“I think so. Arthur?” She stretched out the fingers of her right hand as if to free herself, but she was constricted by the backboard. “Where’s Arthur? Is he okay?”
“I haven’t checked him, but he seems to be doing okay. Do you hurt anywhere else?”
“I can’t tell.” She grimaced. “My leg hurts so bad. Please!”
Lukas turned to find Lauren securing the second IV tube with tape. “Get me a pressure, and if that’s okay, give Mrs. Collins 2 milligrams of morphine, slow IV push. And add 12.5 milligrams of Phenergan. I don’t want to risk the morphine nauseating her.” He looked at the open tib-fib fracture just below the knee, then moved down to look at Alma’s right foot. He still didn’t like what he saw. It was cool to the touch, white, and when he checked for a pulse on top of the foot, he found none. The capillary refill was very sluggish. He had to get this woman to a vascular surgeon fast if he wanted to save her leg.
Lord, guide me. Touch her through me. Give her the comfort I can’t.
He stepped to the hallway and called, “Judy, launch that chopper, then order me a c-spine, chest, pelvis and right tib-fib and ankle X-rays. Have you heard from Dr. Richmond yet?”
“Yes, she’ll be here shortly. She said she had to finish with a really sick patient.”
Lauren straightened from Alma’s bedside. “Dr. Bower, the pressure’s good. Want me to do the morphine?”
“Yes. Run the second IV at 200 cc’s per hour. I want her kidneys well hydrated to prevent damage. I’ll be back in a moment. I need to go check on her husband.” He called out to Claudia to help him and stepped into the next room, where the techs and Connie were transferring Arthur from cot to bed.
Arthur, too, was on a long spine board, with a c-collar and head blocks to keep him as immobile as possible. Blood had seeped through the gauze and Ace bandage the attendants had used to stop the bleeding from an obvious scalp laceration.
Claudia, chunky and motherly and expert with patients, stepped into the room behind Lukas and immediately began her assessment while Lukas talked to the attendants.
“Connie, you said there was a lot of blood loss. How much would you estimate?”
“At least a unit, maybe two,” came the paramedic’s monotone again. “The first responders said he wasn’t answering their questions, but when we arrived he was alert and oriented and asking about his wife. He grew very agitated when he saw her leg. His pressure was a little low, but it came up with a fluid bolus.”
Claudia turned from her assessment and nodded. “BP’s 122 over 79, heart rate’s 110.”
Lukas nodded. Not bad. “Okay, get me a second IV.” He stepped to the head of the bed and introduced himself to Arthur Collins.
“How’s Alma?” the man asked. “My wife…she looks so bad. She’s—”
“She’s very worried about you,” Lukas said. “We’ve given her morphine to help control her pain, and we’re running tests now to assess her injuries. How about you, Mr. Collins? Where do you hurt?”
The man closed his eyes for a moment, as if trying to focus for a few seconds on his own symptoms. “Call me Arthur. We’re Arthur and Alma. My right shoulder and my scalp took a beating, but please take care of Alma first. Her leg looks so bad, Dr. Bower. Can you help her?”
“We’re going to fly her to Springfield for vascular and orthopedic surgeons to take care of her. I’ve already ordered an Air Care helicopter.” Lukas took out his penlight. “I’m going to check your pupils right now.” He shone the light into the man’s worried eyes. “Are you having any trouble with blurred vision?”
“No.”
“Nausea or vomiting?”
“No. When will the helicopter be here?”
Lukas turned off the light and put it in his pocket. “Shouldn’t be too long, less than thirty minutes. Arthur, it’s very important that I know if you’re having any nausea. We have you strapped down and on your back,
