Saturday morning, July 20, 2013 diary Got to bed at 0030 this morning, but was called to see a patient at 0230. When I got back to sleep, they didn’t call me again until 0600, so I got more sleep than in the recent past. I keep telling myself that there is no reason to get angry or frustrated (same thing) at these circumstances of life, because everything that happens to me is the Lord’s Will. If He wants me up in the middle of the night, He will take care of me afterwards. He knows how much sleep I need. After sending my Fb evangelistic birthday messages, checking email accounts, and doing a quick scan for viruses, I put on my white tee shirt and bright orange shorts for traveling in the heat, and was prepared to depart at 0833. I was registered for an 8A-1P CME conference at the Wynfrey, but it was questionable if I would be able to make any of it. As I passed through downtown Dadeville and neared Hwy 280, Dr. Schuster, the ER Director for Lake Martin Community Hospital (LMCH), pulled up behind me, honked twice, and motioned for me to pull over. I did so, and we both got out. He kidded me, saying I had run a stop light back there, and he was making a citizen’s arrest. I put my hands on the car, and with a smile, told him to frisk me. All he wanted was to confirm I would continue working Tuesday and Friday nights in the LMCH ER in August. I said I would. I had already said and sent that to him in an email, but he perhaps had not seen it. That brief delay led to perfect timing for something God had in mind down the road. It was a hot sunny Saturday morning. Highway 280 is a nice four lane, with a wide V-shaped median and a central drainage ditch. Once before, at night in the rain, I had seen a car right out my left window leave the pavement, enter the median airborne at high speed, and wildly bounce around straddling the ditch. I watched in my rearview mirror in amazement as he steered back up onto the side of the median without flipping or apparent damage. That left me shaking. As I approached Sylacauga in fairly heavy traffic, I suddenly saw a flash of something ahead which appeared to be metallic go from left to right. Whatever it was, it raced across the divided four lane Highway 280 just 50 meters ahead of me. At first I thought maybe it was a large bird. Then I thought that it was perhaps it was a car trying to cross quickly in front of the oncoming traffic, which had scooted onto a crossing road off to the right. That was unusual, since I travel this road quite a lot and was unaware of a crossing road there. I was going to take a look to my right as I passed the spot to see the road which I didn’t recall, but the cars ahead seemed to be slowing and bunching up, so I had to pay attention to them. Then several cars pulled over, and people were jumping out. I didn’t see any road off to the right, only a very steep embankment. That must have meant a car had gone off the road right ahead of me. Being an ER doc and immediately on the scene, I thought it would be a good idea for me to take a look at the situation, so I pulled over and stopped. I walked back toward where the people were congregating. Down the steep hillside, about a 40 foot drop-off from the highway, I saw a large overturned vehicle which had impacted and rolled against a tree. I started down the hillside in my white tee shirt and bright orange shorts, about third in line. As we have been trained, I yelled back for someone to call 911. They shouted back that they were already on their way. The hillside was steep, rocky, overgrown with vegetation, and quite slippery. The others were falling on their bottoms, but I kept my balance OK even though my shoe soles were slick. Some of those trying to go down the hill stopped and turned back. The closer I approached the vehicle, the fewer people there were with me. Airborne never quits. I wondered what I would find when I got down to it. I wondered if the driver was dead, decapitated or crushed. I have seen all sorts of injuries in the Combat Zone, in various ERs, and elsewhere, but normally they only bring live people to me. If the victims are otherwise, they don’t bring them to the ER; they take them to a morgue. When I got close enough I could see the vehicle was an SUV. Looking through the open rear tailgate window, I could see that its windshield had a big central shattered area. I figured someone’s head must have hit it, since the damage was too extensive for the vehicle to be driven in that condition. I began searching for the victim or victims. No one was visible in the car, and there were no sounds anywhere. That wasn’t a good sign. The car had to have been occupied. Then I heard a moan from the right side of the overturned vehicle. By then I was the only one down there. I picked my way through the heavy underbrush around the back of the car, to the right, and all I could see were a lot of clothing items scattered all around which had been thrown from the car. I heard another moan and a voice coming from underneath the tree branches, weeds, damaged auto parts, and clothing items. As I got closer I could see an upside down and twisted human form. The legs were angled to the right, the torso was bent backwards and rotated, what should have been the head was pointed downhill and under limbs and brush, and the neck was twisted at an odd angle. The head, neck, and left arm were trapped under a several inch diameter tree limb which had been pushed over and down by the body of the car and couldn’t be moved. It was a male. He began complaining of pain in his head and back, and said his left leg was broken. At least he was now conscious and breathing, and his brain was functioning. The ATLS ABCs (Advanced Trauma Life Support - Airway, Breathing, Cardiac assessments) were intact. I took his pulse in his exposed right arm. It was about 110 and regular. The sirens of multiple approaching emergency vehicles came from the highway above. Although I could not see any normal features of his head under the tree limb and brush, I could see there was blood on what must have been his head. I asked him repeatedly if there had been anyone else in the car with him. The first two times he said he didn’t know. I couldn’t see anyone else around, and heard no sounds except from him. There were lots of clothing items strewn around, indicating a family must have been involved at some point. The fellow was heavy. I tried to reposition his legs to straighten out his torso, in hopes of getting his neck straightened out. He resisted that due to his pain, so I left him in the original position for the moment. I called for a chain saw, since I didn’t want to forcibly pull on his head and neck and make matters worse. I was told the fire department was on its way with their rescue equipment. As his mental status cleared, he told me twice he was alone in the car. He asked me to check for his wallet which had his insurance card, and wanted his pants pulled up. I couldn’t find his wallet, and his pants weren’t all the way off. I cinched his jeans around his thighs with his strong leather belt to keep them in place and to give us something to hold onto to lift him. There was no evidence that he had been wearing a seatbelt. He denied drinking today, but said some “spray can” did this to him. We hear all sorts of unusual stories in medicine. Soon a fire medic arrived, and called for a neck collar, backboard, and basket. Some sturdy flat yellow nylon webbing was brought down to us, like that we used in Special Forces for deploying parachutes when exiting the aircraft. The yellow webbing was tied around his chest to give us something by which to pull and lift him better. When this was in place the now three of us on the scene heaved the fellow around to straighten him out some. I was concerned that some of the sharp broken limbs under and around the man might cause a puncture wound. With some help on the tow line from above, and another fireman, the three of us straightened the fellow out enough that when we pulled on him, his head came free from underneath the tree limb. Then he was able to pull his own left arm out from under it. All his body parts were connected, thank the Lord. I didn’t notice any unstable bones or complex skin penetrating fractures, but our job was to get him safely extricated rather than trying to do an ATLS primary survey down in that hole. Someone hollered down asking whether there were any fluid leaks from the auto. I said no. Perhaps that concern was what had kept the majority of the folks out of the area. I shortly heard the familiar sounds of an incoming medivac helicopter overhead. I’m always glad when those sounds don’t portend my having to jump out of them. We lifted the fellow around enough in several short moves to get his head turned uphill. The neck collar was put on, and then the three of us lifted him onto the backboard which was laid in the basket. I was at the foot, and it was my job to get the footboard in place so he wouldn’t slide off when the basket was pulled up the hill. Even that was not easy; I had to ask them to pull him up on the basket so the footboard could be untwisted enough to get it into position. I also had to untangle his legs and the equipment from a heavy vine to get them freed up before they could begin the pull. My experience with vines made me know that that one was strong as any rope and would have to be dealt with before he could be moved. A little vine is like sin. It is dainty and pretty at first, but it will gradually wrap itself around you, grow quietly day and night, until it finally binds and kills the strongest person. The fellow was complaining about something, and the firemedic told him that he was lucky to be alive. I said that he was blessed. We Christians do not believe in luck and do not use that term, but we rather believe in God being in complete control of every circumstance and outcome. There was a new white softback book with a spiritual title lying on the ground nearby. I thought this might be something he would want to read if he survived. I tucked the book under his body on the backboard. Other than his bloodied and torn up clothing, he would have no other personal possession with him from this point on. With him cinched in the basket, the EMS personnel at the top of the hill drug him up, basket and all. I looked around for the guy’s wallet, but did not find it. I started to climb into the back of the wrecked car to look for his wallet, but a policewoman said the vehicle was unstable and they would handle it. I noticed they had tied a heavy yellow nylon cord to the trailer hitch on the rear bumper of the vehicle, which apparently led to something secure up on top of the hill out of sight, apparently to stabilize it. I used the nylon rope to pull myself up to the top. The ascent with that rope was much easier than the descent had been without it. As I went up, on my right I passed a full sized pine tree, growing up from the hillside, with a large area of its bark and wood knocked off way up in the air, at least twenty feet above ground level, about level with the highway above. When the vehicle left the road at a high rate of speed, it had first impacted that tree in mid air, glanced off of it to the right, rotated clockwise 100 degrees, and finally crashed down the hill into another tree where it had come to rest. When I got back up to the top, paramedics were using standard ATLS protocol, but were having some difficulty in getting IVs in both arms as they prepped him for medevac. I heard a medic tell the man that he had a bad cut on his ear, and mentioned that he had indention on his head. I saw that there was flattening of his right frontal area, possibly representing a depressed skull fracture. He was in the Golden Hour after major trauma, the time window of best salvage. He would be flown to a trauma center in time. I thought of all the lab, x-ray, and CT scan studies I’d have to order on him if he came to our ER; it would be just about everything. Hwy 280 traffic was closed in both directions, since the near side was filled with fire vehicles and police cars, and the helicopter had landed on the highway on the far side of the median. I saw a heavy tow truck getting into position. He was going to have quite a challenge getting that rather large vehicle back up the steep hill. The fellow was still awake and breathing, so I excused myself and left the scene. Back at my car I drank some water which I always carry to rehydrate, and washed off some dirt and debris. I had pretty much avoided contact with the patient’s blood, and had only a few scratches and scrapes of my own. Since I was headed away from both of the blocked traffic points on the highway, I drove off with no traffic interference whatever. Total elapsed time for this life event was only 30 minutes.
Posted on: Sun, 21 Jul 2013 22:08:02 +0000
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