Saved by the seatbelt (and car seat).

Dispatch spoke quickly. Motor vehicle accident with injuries. And entrapment. Initially another truck was sent, but the caller wasn't positive on their location. Once other people started calling, we were sent. The location was in our zone. It sounded bad. Dump truck versus car, positive entrapment. Two guys from my station were out in the rescue truck, so my partner took the ambulance, I drove the engine. I neared the scene and was struck by the layer of smoke hovering around the tree tops, like our own private low-lying black cloud. My partner had stopped the ambulance seconds before, and was showing me where he wanted the engine parked. I stopped it, put it in pump gear, and ran to get my turnout gear on. The SUV was on it's side, smoking, it's roof collapsed, and entire driver's side caved in, the vehicle was on fire. The acrid smell of hot plastic and burning metal burned my nose. There was a large dump truck up against the bottom of the SUV. One of the guys on scene poked around from the car and yelled "I need patient care!". I tossed my helmet on my head and ran over to assess the driver. She was in the driver's seat, hanging by the seat belt. Her arms dangled in midair, blood ran down her face, down her hanging hair, down her arm. I followed a drop of blood, and noted the pool on the passenger window and roof (the car landed on it's passenger side). I saw the color of her arms. Purple and blotchy. The color of dead. To my surprise she moaned. I tried to get into the vehicle, but one of the guys doing the extrication hollered over the noise "no, I'm about to cut there" so I went in through where the windshield had been as best I could. When my head was inside the car, instead of seeing the patient, I saw the car seat. It was in the back seat, a forward facing toddler seat. Then I saw a little mirror in the seat next to it- the type parents use to look at babies in rear facing car seats. Only there were no kids, no babies. It's never safe to assume, so I spoke to the driver. "Were your kids in the car with you?" She responds. "Yes."

We all glance through the car- there are no children to be seen. No little hands or feet poking out from anywhere, no whimpers, no cries. I ask mom again- "Are you sure your kids were with you- did you drop them off at a sitters?" She stopped to think, and replied "no, my 2 year old stayed with grandma, but the baby was with me. OH GOD WHERE'S THE BABY!?!?!?". A sheriff from another county was on scene, and touched my shoulder. He said in a monotone voice "We have the baby. The baby is fine" It wasn't what he said, but how he said it. I took it to mean he was trying not to freak mom out and there was a dead baby here somewhere. I didn't ask any more about it initially. I did what I could to get mom out. The guys had to cut some on the roof of the car, and spread the metal floorboard to get her foot unstuck, so I pulled the officer out of earshot from mom. Where is this baby? "He's up there, he's fine" he replied, pointing 200 yards up the entrance ramp to the highway. There, standing on the roadway, was a lady holding a baby. Someone had pulled the baby- car seat and all- from the smoldering car. She had held the baby, and he did appear to be ok. A helicopter was on it's way for mom, so I asked for another ambulance for the baby. Appearances are one thing- but if this baby was in the car the dump truck hit, he needed to be transported. Kids are notorious for crashing hard and fast with no warning.

It took us about 15 minutes to free mom from the car. She had two deep lacerations angled across her forehead- perfect angles from the steering wheel. She had hit an artery and the blood kept seeping steadily from her face. Her arm was broken just above her elbow. Her hip and femur were shattered. I didn't detect any internal bleeding or airway problems, and am sure she will make it, but she's going to have a long road to recovery. We loaded her up and began treatment. We tried to slow the bleeding, started fluids, and gave her some morphine. The helicopter landed, and we flew her out. The other ambulance hadn't arrived on scene yet, so I tried to secure the baby on our pedi board, but he was too small for it. The best possible way to secure him was in his car seat. I didn't like doing it, but it was the best choice for him. The infant c-collar was too big for his tiny neck, so we made an old fashioned horseshoe brace out of a towel and secured it around him. It would limit his movement decently. They asked me where I wanted to take him. I made the decision to bypass the closer, smaller hospitals that can treat ear infections and sore throats, and make the 40 something mile trip to the children's hospital downtown. I called them to let them know we were on our way.
The baby miraculously appeared completely unhurt. He was in the back seat, directly behind mom. The driver's side took the impact, and the interior of the car had 2-3 feet of intrusion. The baby's seat had major stress marks from the wreck. Dad showed up on scene, and rode in with the baby. The children's hospital stressed to dad that the car seat had done it's job. They said he would need a new seat to leave the hospital in. Dad explained that he had paid that vehicle off two weeks prior- and had gotten the title yesterday. He said finances were tight, and a new car seat wasn't an option for them that day. I promised dad i would make some phone calls and see what i could do. Our county has a very proactive child safety program, and reduced price car seats are one of the services we offer. I was so very happy that before I had even made it back into county, someone was on their way to take him a new seat from headquarters! It makes me feel so good to be able to help people in more ways that just the immediate emergency needs.

Dad got choked up and started crying. He said "I almost came full circle this morning". My puzzled look must have been obvious, because dad went on to explain that he can trace his family tree all the way back to 1900, and there had never been a male in his family who had lived to see his 16th birthday with a mother alive. The women all died before their sons turned 16. His mother had died when he was 10 in a car accident. His nephew lost both parents the day before he turned 16. His dad's mom had died of cancer when his dad was young. A grandmother died in a freak hunting accident. I guess I still looked puzzled- the baby was 9 months old, and there was a car seat for a 2 year old. Dad spoke up "we also have an 11 year old, and a 15 year old son." I didn't know what to say. Goosebumps arose on my arms. Speechless, I shook dad's hand and asked him to keep us updated on mom's condition. I had to turn and leave- there was nothing else for me to do.