Author Beware: The Right Patient Placement

Coming across inaccurate medical scenarios in books is common for me so to have one raise my ire enough to blog about it generally means a pretty big eye roll was involved when I read the passage.

Scenario: An elderly male dressed in sweats is found wandering the streets of New York in a confused state.

The author's solution: The police take him to a nursing home.

Well, yea, just--- no.

If police find an elderly male, let alone any confused individual, wandering the streets without any ID the first place that person is going is straight to the ER likely via ambulance.

The reason? One, is to make sure nothing medically is wrong. Chronic diseases such as dementia and Alzheimer's are not the only reason the elderly people become confused. Something as simple as an electrolyte imbalance could be the cause. In any new onset confused state, other minor and major medical conditions need to be ruled out first. What might some of those be? Electrolyte imbalance. Brain Tumor. Stroke. Head Injury. Brain Bleed.

Secondly, there is not a nursing home in the United States that will take in an elderly person unknown to them without a medical evaluation first. Plus, do you know all that's involved for nursing home admissions? A lot.

In this instance, if the patient is deemed to not have anything clearly medical (that could be fixed or treated) causing his confusion, then the hospital would involve the police and likely social services for placement.

But no drive by drop-offs at the nursing home.

Author Beware: Provider Scope of Practice (EMS)

Here I am, happily reading along one of my favorite mainstream suspense authors, when a glaring medical mistake takes me right out of the story. Bummer! Now I'm wondering how long it would have taken this well known author to make one phone call to determine if this situation was plausible or not.

The scenario: The hero in our story is injured but doesn't want to be transported by EMS to the hospital. He's got other important things to do-- like catch a killer. Awesome. EMS has him sign a release form and he's on his way BUT the EMS team has given him an oral dose of a narcotic and two to take in the future when the pain comes back.

Did you hear that? That was steam billowing out of my ears.

This is a very common mistake authors make-- issues that deal with scope of practice. I've blogged about it several times. This post has links to several others that just deal with scope of practice.

In simple terms, scope of practice is what a health care provider can and cannot do. EVERY licensed health care provider (a nursing assistant, a nurse, an EMT, a paramedic, a physician, a physical therapist, a pharmacist) has a scope of practice that is governed by their licensing board-- whoever that might be. These governing boards determine the rules of practice. If the licensee does something outside of these rules they can be brought up on disciplinary action and even potentially lose their license. Scope of practice rules can vary from state to state.

In short-- it's bad to operate outside your scope of practice.

For instance, this document gives a pretty detailed overview of the medical treatments different EMS professionals can do.

The first problem with the author's scenario is that EMS professionals do not carry oral narcotics to give to patients. Only IV and those that can be administered nasally.

The second problem is that EMS professionals not only operate under scope of practice laws but also medical protocols which outline the things they can do in the field and under what conditions. In fact, here's a whole document that lists the EMS protocols for one hospital in Colorado that would give a nice overview for what likely happens in the US. There will be differences state to state but you could reasonably generalize from this.

Essentially, a paramedic giving a patient (who is refusing medical treatment) three doses of an oral narcotic (which he doesn't carry) is a serious violation of his scope of practice. Only a few medical roles can prescribe oral narcotics and dispensing oral narcotics is the role of a pharmacist.

Authors should take scope of practice as seriously as medical professionals do because though your book might be fiction-- the public will take it as fact.

Murdering a Television Scene

The ABC drama, How to Get Away with Murder, is a series not for the faint of heart. The show centers around defense attorney Annalise Keating (great acting by Viola Davis by the way) and how murder victims keep popping up around her where she may or may not be involved.

The second season opens with an intense scene where Annalise has been shot in the chest and subsequent episodes deal with the events leading up to this one scene. Just who shot her and why did it happen?

Of course, this is a great time to do some medical analysis of her EMS rescue. What's follows is a conversation between two medics who are taking her to the hospital.

Medic One: Starting a 16 Gauge IV. Lungs are clear. Need another blood set for a second IV and a BVM. Blood pressure 70/palp. Pulse is thready.

Medic Two: Feels tachycardic. I'm seeing some JVD. Might have to do a needle thoracostomy. Need to get ETT right away. Diminished respirations. Chest is clear. Equal breath sounds but respiratory effort decreasing.

Just what does all this medical mumbo jumbo mean and is it medically accurate? Well, kind of.

When dealing with a trauma patient, getting IV access is paramount. Usually two lines of a large bore gauge is necessary. A 16 Gauge is a large size. And working to get two lines in is accurate.

What does BP 70/palp mean? Likely, you're used two seeing two numbers in regards to blood pressures. Something like 120/72. The top number is what's referred to as your systolic number-- or the pressure inside your arteries when your heart is contracting. The bottom number, or your diastolic number, is the pressure in your arteries when the heart is relaxing. To get both numbers, you have to be able to listen to the blood pressure by using a BP cuff and stethoscope at an artery point-- usually at the antecubital space (the crook of your arm.) The first time you hear the heart beat-- that's the first number. The moment you can't hear it anymore-- that's the bottom number.

In EMS, active resuscitation scenes are really loud and it's hard to hear. There is  technique where you feel for the blood pressure but you only get one number-- the systolic one. In this technique, you feel where the radial pulse is (at your wrist) and pump the cuff up until you can't feel it anymore. As you let the air out of the BP cuff, you record the number where you first feel the pulse. In this case 70-- which is low. But, that's why there is only one number and the "palp" denotes it was felt or palpated.

Pulse being thready-- means it feels thin and weak. Also appropriate for someone experiencing blood loss related to a gunshot wound. As does what the second medic begins to say-- feels tachycardic which means the patient's heart rate is increasing-- which is also a sign of blood loss.

The main medical inaccuracy with this scene is the procedure one medic says they might need to do-- a needle thoracostomy. Just what is that?

A needle thoracostomy is done to pull air from the chest that has caused a lung to deflate-- here from a gunshot wound to the chest. It is a rescue measure-- meaning it will buy you some time until the patient can get a chest tube placed in a hospital setting.

But note what the medics say over and over-- her breath sounds are equal. These comments denote that her lungs are filling as they should. If one lung was "down" or deflated from the gunshot wound-- the breath sounds should be unequal. Generally, you can't hear breath sounds on the side of the chest where the lung is deflated-- or there is very little air moving on that side.

The writer has also picked the wrong procedure. When one medic comments-- "I'm seeing some JVD."-- this usually denotes an obstruction somewhere in the chest (like a deflated lung or blood collecting around the heart) and blood is having difficulty flowing as it should and so the blood is backing up into the veins. JVD= Jugular Venous Distention and is when the jugular vein is easily seen at the side of your neck because it is filling up with blood.

Since the medics state her breath sounds are "clear and equal" then we know the problem is not with her lungs but could be with her heart.

The rescue procedure for blood collecting around the heart is called "pericardiocentesis".

Again, Hollywood, I am available for medical consultation. Let's rescue our characters using the right procedures.

If you're interested in seeing a video on needle decompression (the first) and/or pericardiocentesis (the second)-- then watch the videos below. They aren't gory.

Author Question: Hockey and Head Injuries

Elaine asks:

A hockey player gets knocked down in a fight and hits his head (with his helmet in place) on the ice. Could he be unconscious? I know the trainer would come out on the ice and possibly a doctor, but if he is unconscious, I’m assuming they’d call for the stretcher and put him in the ambulance as a precaution.

I was going to have him regain consciousness in the ambulance on the way to the hospital, but wonder what would the paramedics/EMT (which/who would it be) be doing in the ambulance? What would they do if he “came to”? And what would happen when they reached the hospital?

Jordyn Says:

Yes, it would be possible for a hockey player to be knocked unconscious with a fall on the ice even with his helmet on. If he stays unconscious, then he's going to need to be transported to a hospital. Baseline treatment would be C-spine precautions (C-collar, back board), supplemental oxygen even if he is breathing adequately on his own, and likely an IV.

If he wakes up in the ambulance, they'll first orient him to what happened. "Hey Mike, my name's Roy and I'm a paramedic taking care of you. You took quite a hit on the ice and you were knocked out. To be safe, we put a c-collar on you and put you on a backboard to protect your back. We're on the way to Swedish Medical Center to get you checked out."

Then they'll assess him. Can he move everything? Can he feel everything? Does he know his middle name? Does he know the month? Does he remember any part of the accident? Does he know what city he's in?

At the hosptial in the adult world-- you're more likely to get a CT of the head for this type of injury. So upon arrival to the ER-- the nurse would check his vital signs, do a neuro exam (as described above), and make sure the IV is patent.

The doctor will likely order plain x-rays of his neck and spine and a CT of his head. If all that checks out-- he would probably be discharged home.

Trauma Call/Domestic Violence: Dianna T. Benson, EMT

I am pleased to welcome back award-winning novelist Dianna T. Benson. I love how she writes these scenes fictionally but conveys a host of medical details along with it. 

Welcome back, Dianna!

“EMS 6, Stabbing, TAC Channel 12”

     Responding to a domestic disturbance call, my partner and I park our ambulance in front of an upscale home over a million dollars. Not atypical – EMS is too often called out to the rich on domestic violence.

     “Did you know the power company turns off this zip code for lack of pay more than any other in the state?” I ask my new partner.

     “Yep. Idiots living beyond their means. No wonder they’re so stressed out and hurt each other.”

     At the front door, we join a fire crew, as three cops enter the house, all three with weapons drawn.

     “Scene isn’t safe?” I ask.

     “Not sure,” the last cop answers then trails his two buddies.

     The fire crew of four hangs back with me and my partner.  

     “Was the door unlocked?”

     “Yup,” one of the firefighters answers me.

     After five long and boring minutes of standing around on the lawn in the dark of night, I radio in to dispatch. “EMS 6. Standing by outside residence. Any updates from PD on scene?”

     “Yes. Scene is secure. PD is with victim.”

     “Copy that.” I roll the front of our loaded stretcher into the house.

     In the family room, I find one officer bent over a body, the other two talking with an agitated man.

     I kneel at the woman’s other side. She’s supine on the carpet, her lapped hands pressed to her lower abdomen and covered in blood.

     “Ma’am?” I touch her shoulder in comfort.

     My patient blinks at me then flutters her eyes closed.

     “Can you tell me your name?”

     “Judy,” she whispered in a pained voice.

     I brush my hand over hers. “Judy, are you hurt anywhere other than here?”

     “Don’t know,” she mumbles.

     “Judy?” I stare into her eyes, mascara smudged underneath them. “Can you move your arms down at your sides?”

     She does.

     My partner hands me trauma scissors, a stack of 5X9 sterile gauze pads, and an occlusive dressing. As I rip open the gauze packages, my partner hooks up the patient to our cardiac monitor and focuses on assessing and monitoring vital signs.  

     “How can I help?” one of the firefighters asks me.

     “Perform a rapid trauma assessment.”

     “You got it.” He starts at the head.

     With the trauma scissors, I cut Judy’s shirt, exposing the wound. Noting no debris other than blood, I cover the gushing horizontal wound—thin but long—with one sterile gauze pad after another, and apply direct pressure with my palms. “Did a knife do this, Judy?”

     “He did.”

     “With a knife?”

     “Steak knife.”

     “I see nothing else,” the firefighter informs me at the patient’s feet.

     I nod. “Thanks.”

     I glance at the monitor screen for Judy’s vital signs. Her heart rhythm is normal, but her blood pressure is too low, pulse too high, indicating she’s headed to shock due to blood loss. My guess is she’s bleeding internally, the knife blade sliced an organ or two, maybe the abdominal aorta. Regardless of what’s injury, she needs a surgical team.

     I look at my partner. “We gotta go. Now.” 

       

     “Give me the switchblade,” one of the cops says, alarm in his tone. “Sir, you’re just making things worse for yourself.”  

     “Past time to go,” I whisper to my partner, a rush of panic clogging my throat.

     “No kidding,” he whispers back, wide-eyed.

     “Get out of here,” one of the cops says to us.

     “What’d you say to them?” the agitated man shouts.

     “You don’t want a murder charge, do you? The EMS crew needs to get her to the hospital.”

     The cops deal with the perpetrator, as my partner readies the stretcher. I blanket the dozen or so bloody gauze pads with a towel.

     Inside the moving ambulance, I raise the foot of the stretcher to treat for shock. I cover Judy’s mouth and nose with a non-rebreather oxygen mask and turn on the O2 to 15 lpm. Since none of her organs eviscerated, I do not apply an occlusive dressing. Instead, I add additional 5X9s and a fresh towel and instruct the one firefighter who joined us en route to press his hands over it for direct pressure. I insert an IV saline bolus and consider administering morphine or fentanyl for pain.

  

     “More cops dispatched to scene,” my partner yells back from the driver’s seat. “Guy stabbed one of the cops and fled the scene on foot.”

     I look down at my patient. She doesn’t indicate she heard those disturbing words.

  

     “We’re ten minutes out,” my partner yells back at me.

     I pick up the radio. “Wake Med ED, this is EMS 6.”

     “Go ahead EMS 6.”

     “We are enroute with a thirty-eight year old female. Left lower quadrant adnominal stab wound. No evisceration. BP 82 over 56. Heart rate 173. Non-rebreather at 15 liters per minute. Legs elevated for shock treatment. Place OR on stand by. ETA 10 minutes.”

     “See you in 10. Wake Med out.”

     “EMS 6 out.”  

**********************************************************************

Dianna Torscher Benson is a 2014 Selah Award Winner, a 2011 Genesis Winner, a 2011 Genesis double Semi-Finalist, a 2010 Daphne de Maurier Finalist, and a 2007 Golden Palm Finalist. In 2012, she signed a nine-book contract with Ellechor Publishing House. She’s the author of The Hidden Son, her debut novel. Final Trimester is her second release. After majoring in communications and a ten-year career as a travel agent, Dianna left the travel industry to earn her EMS degree. An EMT and a Haz-Mat and FEMA Operative since 2005, she loves the adrenaline rush of responding to medical emergencies and helping people in need. Dianna lives in North Carolina with her husband and their three children. You can connect with Dianna via her website.

 

   

          

Dianna T. Benson: A Son's Tale of Traumatic Brain Injury

The term concussion is well known. The medical field refers to a concussion as a TBI – Traumatic Brain Injury. Contact sports are one of the top causes of a TBI, another are MVCs – Motor Vehicle Collisions.

My teenaged son has endured four concussions. The first two as a goalie for the Junior Hurricanes and the third in a MVC. The first one took him out of school for a month and hockey for three months. The second, a year later, was more mild, which is unusual. Typically, a patient suffers a more severe TBI the second time. In the MVC, a classmate was driving them to school when another car struck them. This third TBI ended my son’s hockey career, preventing him from attending the Junior Hockey draft in Canada Spring of 2013.

The problem wasn’t simply that this was his third concussion, although that in itself is a strong reason to end a contact sport career. With this third TBI, a neurologist evaluated him versus just the concussion clinic MDs who’d treated him with the first two. Not only was it his third TBI, but his symptoms were extremely severe, which didn’t make sense to me – the details of the MVC didn’t suggest such injuries for my son: 1) None of the others involved in the crash suffered any injuries 2) No air bags deployed 3) Vehicle damage was minor. As an EMT for nearly a decade, I wondered about underlining health conditions in my son. I also considered he had not fully recovered from the first two concussions and was in denial about his symptoms in order to play hockey.

Sure enough, the neurologist diagnosed my son with hyper-mobile joints (something I already knew but wasn’t aware of the danger with contact sports.) The MD also diagnosed him with mild CP (cerebral palsy), a diagnosis that made sense to me since my son was born in respiratory arrest and was non-verbal and had spasticity until over age two. Both diagnosis are a recipe for injury, especially in contact sports. The MD gently told my son he was done playing goalie forever – it was devastating and crushed him. Understanding his hockey career was over, he admitted he’d ignored symptoms because he had a shot to play Junior Hockey, college hockey, and possibly professional hockey. A life-long athletic competitor myself, I completely understood the denial that led him to ignore his body.

Hyper-mobile joints, while creating an incredibly athletic body, are highly susceptible to any musculoskeletal injury in that individual. For my son, after two TBIs in a contact sport, his hyper-mobile neck was easily and severely whip-lashed in the MVC, jostling his brain fiercely, causing all his concussion symptoms to return and more heightened than ever.

Ten months after the car accident, the fourth TBI occurred December 2013 just days after the neurologist cleared my son to return to his life minus contact sports. The neurologist gave my son the green light to snowboard. That December day on the mountain, my son didn’t even hit his head and he sustained no head trauma – simply snowboarding jostled his brain enough to cause another TBI.   

Even though he’s extremely athletic, my son’s body shouldn’t do what it can to do. The risk of permanent brain damage and partial or full paralysis is too high for him-- something he now understands. I described it to him as this: When Cam Ward (the goalie for the NHL team Carolina Hurricanes) is playing goalie, his body is naturally like a SUV of protection in a MVC. Whereas, for my son, his body is like a motorcycle in a MVC – no protection.

Until Spring 2015, my son is restricted from doing anything with speed, wheels, height or repetition (basically everything fun.) This next year his brain will heal, then little by little he can attempt things (no contact sports ever, though) to see how his body responds. At 6’7” in height and extremely athletic, he appears a medically sound seventeen-year-old, but inside his body tells a different story. 

    

God works in amazing ways and this is my son’s blessing. Since cerebral palsy only affects motor function, and none of the four TBIs caused him any loss of cognitive abilities, he’s still as annoyingly brilliant as ever and is anxious to head off to college this fall. For now, his goal is to graduate medical school with a degree in neurology and become a neurosurgeon since he feels (understandably so) he can relate to patients’ symptoms with head trauma. 

***********************************************************************

 Dianna Torscher Benson is a 2014 Selah Award Finalist (winners not yet announced), a 2011 Genesis Winner, a 2011 Genesis double Semi-Finalist, a 2010 Daphne de Maurier Finalist, and a 2007 Golden Palm Finalist. In 2012, she signed a nine-book contract with Ellechor Publishing House. She’s the author of The Hidden Son, her debut novel. Final Trimester is her second release.

After majoring in communications and a ten-year career as a travel agent, Dianna left the travel industry to earn her EMS degree. An EMT and a Haz-Mat and FEMA Operative since 2005, she loves the adrenaline rush of responding to medical emergencies and helping people in need.

Dianna lives in North Carolina with her husband and their three children. 

Website: www.diannatbenson.com

Her releases are available wherever books are sold. Below are the links to Final Trimester at the three largest booksellers:

Amazon.com

Barnes and Noble

Books-A-Million

 

Medical Critique: James Patterson's Kill Alex Cross 1/2

I am a James Patterson fan. I've restricted myself lately to the Alex Cross and Michael Bennett novels.

I just finished Kill Alex Cross. You can read my Goodreads review of the novel here.

This post is to discuss the medical aspects of the novel and what I find suspect. Come on, James. Hire me as your medical consultant-- I think-- no I know you can probably afford me.

In this post we'll deal with a male adult that is involved in a motor vehicle collision. The character was driving a van at a high rate of speed and took a header into a bus.

Initial treatment of the victim was good. Jaws of life. C-collar in place. Suspicion of drug use based on dilated pupils-- specifically PCP which is an accurate bodily response.

All good until this line: "The van driver was out on a gurney now, hooked up to a nasogastric tube and IV."

Anyone know what is wrong with this sentence?

Simply put, EMS is never going to put down a nasogastric tube.  Are paramedics trained to do the procedure? Yes. Have they ever in the field? Not that I've seen in twenty years of specialized nursing.

Now-- a flight team on a long transport-- maybe.

An nasogastric tube (or NG tube) runs from your nose to your mouth. It is used to drain/vent secretions and air from the stomach. If the stomach is retaining a lot of these things-- it can impact on the patient's ability to breath. A secondary use is as a feeding tube though there are many more comfortable styles (like a cor pak which is thin and flexible but doesn't drain well.)

All this sounds very good for the patient, right? Why not put one in in the field?

One-- patient priority is different in the field than in the hospital. It's basically secure the airway, breathing and circulation and get on your way . . . fast. Placing an NG would simply slow down scene time and they can be difficult to place.

Impacted Nurse

There are also contraindications to an NG tube placement. One is a basilar skull fracture. We all have bones that line the base of our skull. If these are broken-- there can be a direct conduit from your nose into your brain. Signs of basillar skull fracture are misshapen face, fluids (blood and serous drainage) leaking from the ears and nose. Mid face fractures.

That's what we don't want-- an NG tube in the brain. Yes, it can happen as evidenced by the photo that comes from this article which discusses just such a case.

Really, James, call me. 

Fall Call: Dianna Benson, EMT

I love these posts from author and EMS expert Dianna Benson where she weaves medical detail into a fictional piece. 

Welcome back, Dianna!

I shake my head to full awake from my cat-nap, and gear up for the trauma call less than a minute drive away. Once my partner and I roll on scene, I note the three cop cars arriving.

Additional information regarding the call flashes across our ambulance laptop screen.

Proceed with caution. Law enforcement dispatched.

“What’s the deal?” my partner yells out the driver window at a cop rushing toward the building.

“Another worker pushed the guy.”

“Ah,” I say with a nod. “Attempted homicide.”

“Or homicide, but if the guy’s not already dead, he’s gonna need us.” My partner jumps out of our ambulance.

We grab a C-collar (cervical collar) and a backboard, and toss it onto our stretcher already loaded with EMS equipment and supplies.

“Remember caution?” I remind my partner.

“Yeah, yeah. Guy was pushed not shot or stabbed. Let’s go.”

I really didn’t want to hang back either. Our patient’s life may be over if we wait.

Inside the building, we push through a crowd of gawkers. I notice three cops drawing their guns at a man choke-holding some young woman, her wide eyes glossed-over.

“Let her go,” the cop at the left yells out. “Now.”

I’m hoping the guy follows the demand or we’ll have more than one patient. As I rest my hand on my radio in case I need to request additional EMS crews, I scan the area for an injured man on the ground. I spot our patient on the other side lying supine and lifeless in a pool of blood on the cement, his attacker in the middle and blocking us from our patient. I glance up and see the catwalk and assume our patient was pushed off of the suspended walkway about twenty feet above.  

The guy fell twenty feet? I think to myself.  If he’s alive over there, he’s in critical condition.

“Clear out,” the cop to the right shouts. “Everyone. Out of this room. Now.”

The crowd scampers away. My partner and I hold our position behind the cops. The perpetrator doesn’t have a weapon, so there’s no danger to us.

After a few drawn-out minutes of the cops warning the perp to let the woman go, and our patient remaining lifeless and out of my reach on the ground in the near distance, I somehow dig up my most gentle tone and interject, “Sir, I don’t think you want to hurt her. Do you?”

The perp jerks his head in my direction. Ten seconds tick by with him just staring at me as if pleading me to help him out of this. “Ah…no. No, not really.”

“I didn’t think so. How about letting her go and we’ll talk?” Stop blocking me from my patient. If he’s not already dead, he needs me now. Needed me minutes ago.

 “Talk? Yeah, yeah,” he nods, “I just need to talk.” Chest panting, arms shaking, the perpetrator shoves the woman aside and drops on the ground. All three cops pounce on him and drag his arms behind his back.

I roll the front of the stretcher around the chaos on the ground; my partner pushes from the back. As I pass the perp, I ignore his insistent yells to talk with me since my focus is on my patient.

“Sir?” I say to the lifeless man as we approach him.

No answer. No movement of any kind.

I slide my fingers to his neck and find a thready carotid pulse. His chest is rising and falling in steady rhythm bi-laterally.

My partner holds his head in an in-line spinal stabilization position as I strap the C-collar around his neck. I slip a towel underneath his head for hemorrhage control and feel for trauma. I find an open skull wound, crepitus bone, and flesh.

Two firefighters appear at our side and assist me with log rolling the unconscious patient onto a spine board and strapping his body down. I secure the man’s c-collared head to the backboard with head blocks, straps and tape, allowing my partner to finally release the manual c-spine stabilization.  

“What do you need from me?” some guy asks. “I’m his supervisor.”

“How old is he?”

The manger answers that pertinent question as well as all my others, as I connect my patient to our cardiac monitor. Less than a minute later, I’ve assessed all vital signs and the heart rhythm, as my partner performs a rapid trauma examination. Our patient remains unconscious. I’m thinking internal bleeding is the main cause and he’s headed to hypovolemic shock, and if that’s the case, surgical interventions are vital. No more time to waste on scene.

“Femur fracture,” my partner says.

“Among other things,” I say. “Let’s go.”

All of us lift the backboarded man onto the stretcher, and roll it out to my ambulance.

As one of the firefighters drive, my partner and I attend to our trauma patient in the back with the assistance of another firefighter. Our patient remains unconscious. In order to protect his airway, I slide a lubricated oropharyngeal airway down his throat. With a curved laryngoscope, I lift the epiglottis and gain a visual of the glottic opening and white vocal cords. I drop the orotrachael tube between the cords, down the trachea. I connect a bag valve mask over the tube opening. To keep him oxygenated, I squeeze the football-size bulb every five seconds.  

“Take over bagging,” I say to the firefighter, and he grabs the bag valve mask from my hands.  

I spike an IV bag as my partner slides in an eighteen-gauge IV needle into our patients left arm. Since the patient is unconscious, there’s no point to administer pain meds.

I grab the radio mic. “Wake Med ED, this is EMS 16.”

“Go ahead EMS 16.”

“We are en route with a thirty-three year old male. Trauma patient. Twenty-foot plus fall onto concrete. Unconscious. Intubated. Open head trauma posterior. Fractured femur.  Normal sinus cardiac rhythm. BP 95/52 and falling. 182 heart rate. ETA 5 minutes.

Even if this man’s body survives, his brain will probably never be the same. I swallow the sadness clogging my throat, hoping he doesn’t have any children, and I re-focus on finishing my job on this trauma call.

*************************************************************************

 

Dianna T. Benson is a 2011 Genesis Winner, a 2011 Genesis double Semi-Finalist, a 2010 Daphne de Maurier Finalist, and a 2007 Golden Palm Finalist. In 2012, she signed a nine-book contract with Ellechor Publishing House. Her first book, The Hidden Son, released in print world-wide March 1, 2013. 

After majoring in communications and a ten-year career as a travel agent, Dianna left the travel industry to earn her EMS degree. An EMT and a Haz-Mat and FEMA Operative since 2005, she loves the adrenaline rush of responding to medical emergencies and helping people in need. Her suspense novels about adventurous characters thrown into tremendous circumstances provide readers with a similar kind of rush. Dianna lives in North Carolina with her husband and their three athletic children. Learn more about Dianna at www.diannatbenson.com.