“Ambulance 79, take the response, along with Ladder 2 and Sin City Medics. Report of a man fallen from the roof.”
It looked like it would be one of those days. My partner and I were 10 minutes into our shift, and we hadn’t finished checking out the rig. Coffee (or in my case iced tea) was now at least 90 minutes in the future. We saddled up and headed out across town to be met by our first obstacle, a split street.
We could see the ladder company pulling up at the scene, but between us and them was the pedestrian mall of a high-school campus. As it was summer, the area was deserted; however, it has a small flight of stairs in the middle. I didn’t doubt A79’s ability to descend a flight of four steps, but the mechanic would have me drawn and quartered if he found out.
We hung a left, adding four blocks to the route, then pulled into the block immediately behind the arriving paramedics. One look at the house told us this one could be interesting. What had been a two-story house now ended at the top of the first floor. There was no roof to fall from. Workmen were framing a whole new second story. There was construction paraphernalia strewn about and a demolition dumpster in the driveway. There was no sign of the patient, but the firefighters were already inside.
The interesting scene continued inside the house. Directly above the entryway was a four foot square hole, with sky and bits of flapping plastic visible. The staircase began directly below the hole, heading up to the flat deck and space beyond. It had a heavy wooden railing, with a decorative newel cap the size of a large melon, which was broken off and lying on the floor.
The floor. Wow. The floor consisted of random planks and pieces of plywood nailed to the floor joists, covering most (but not all) of the first floor. At least I hope they were nailed in place.
One of the stations in our state EMT exam involves c-spine immobilization. A patient/volunteer sits in a folding chair and we must secure his spine, without moving him, using a short spine board or Kendrick Extrication Device (KED). The technique is supposed to be used to safely remove a spine injury patient from a crashed car or other tight space. We laugh that only in the exam will you ever immobilize a patient sitting in a folding chair in the middle of a room, with plenty of space to work on all sides.
Our patient sat on a folding chair in the middle of the of the room, with plenty of space to work on all sides.
He was holding his left side and screaming in pain whenever he moved or even breathed. In between screams he threatened the life of the Tyvek guy.
Remember the bits of plastic hanging over the front door? Our patient had arrived for work this morning with his Dunkin Donuts ‘Great One’ in hand, trooped up the stairs with his tools, turned the corner, and stepped right into the unmarked, plastic covered hole. Gravity did what it always does, returning him to the first floor in the most expedient manner. Along the way he struck his chest on the railing, breaking off the newel cap and flailing at least three ribs in the process.
Not only did this resemble the state exam, but the KED was the perfect tool for the job. It allowed us to immobilize both his spine and his flail chest at the same time. Then the fun began. Protocol requires us to secure the injured fall patient to a long spine board, but this patient wouldn’t tolerate the pain. When we tried to complete the immobilization he screamed, swore, and tried to come up swinging. I can’t say I blamed him.
In the end we secured him as well as possible in light of his pain and potential injuries. We used the KED, placed him on the stretcher partially laid back, secured his head and torso to an inverted short spine board, and let him bend his knees to relieve the pain. I confess I was happy the medics would be explaining this one to the trauma team and not me.
We all loaded up into the Sin City medic unit, and off we went to Big City Trauma Center. At 0730 on a Tuesday morning. What fun!
When we rolled into the trauma room with our patient trussed up like a Christmas goose, the doctor leading the team puffed up and raised one finger to begin shouting at us, “What the. . .”
The Sin City medic, one of the nicest guys I know, curtly shut him down. “Shut up! There’s a reason for all this!” He went on to explain the patient’s injuries and circumstances.
The bosses at the construction site were justifiably worried about OSHA investigating the incident. If I were them I’d be more worried about our patient’s reaction when he returned to work.
And by the way, Big City Trauma Center has great iced tea.