Hanging by a thread

As the shift came to an end tones dropped. Surprisingly, it was our unit that was called to service. Dispatch advised a vehicle had run off the road on the interstate, but the dispatcher stated that she had just come on shift and was unfamiliar if maybe this was an abandoned vehicle that had crashed the night before. We went en route, assuming that someone had consumed a few too many, wrecked, then taken off on foot. We see that a lot- if they don't get caught behind the wheel, then leaving the scene of an accident is a lesser charge than DUI. We had to go north then turn around to get to the advised location, and as we crossed the freeway the radio traffic had a new sense of urgency. Dispatch advised "there is a subject still in the vehicle. Possible 48". (Possibly dead). We arrive and find this:

Can you see the car? He hit the tree on the right, knocking it down, then hit the one that has fallen towards the camera angle, snapping it in half as well. I have never seen a car hit a full grown tree hard enough to knock down not one but two of them. Trees just don't give. If you missed the car, look very closely at the center of the far left side and you can see a smidgen of the tire and undercarriage. When he wrecked his truck, he landed on the passenger side down an embankment and went undetected for 6-8 hours.

Our patient was a 23 year old male. He was pinned by his pelvis in the driver's seat, but his head and torso was hanging upside down. See the firefighter peeking down near the ground in the above photo? He is checking out the patient's head. His forehead was actually outside the vehicle, and because of the positioning we could not simply cut the roof and fold it down to get him out. Being the smallest medic (and the first one in full turnout gear) I grabbed IV supplies and oxygen and climbed into the back of the truck through the broken rear window. My helmet kept getting stuck, but after a few tries I squeezed and contorted myself into the tight space. I attempted to establish an IV on him. He was out cold. His truck was unrecognizable. He was breathing about six times a minute. He was covered in blood and his legs were twisted into an unnatural arrangement that made me nauseated at first sight. I pulled one of his arms free and searched the crook of his elbow for a vein. He still had a faint pulse. His arm was so bloody it kept sliding out of my grasp, like one of those water filled practical joke sausage things that always slide out of your hands. On the third try I finally got bloody flashback in the IV tubing. I taped it down like mad and attempted to get to his airway to at least put oxygen on him. Around me, the crew was breaking glass and cutting metal, trying to peel the vehicle out from around him. Someone handed me a sheet to try to protect him from falling glass, but I had no way of getting it over him. Each time glass rained down on me, I tried to curl over him to at least keep big chunks out of his airway.

One of my guys handed me the cutters. He couldn't cut one of the posts from his angle, so from the inside of the vehicle I had to turn and cut the side of the car, then pass the tools back out to him. I heard the helicopter approaching and land on the freeway. After almost an hour, our patient was finally able to be freed from the vehicle. Because of how his head had landed, we had to put him completely upside down and turn him onto the backboard feet first, face down till we could get him completely clear of the vehicle. Only then did I get a good look at him. He had two softball-sized, smurf blue bruises on his eyes. Blood seeped from his ears and mouth. His hair was matted with dried blood. He was unconscious throughout the entire ordeal. The flight crew took over patient care and loaded him up for transport to our level 1 trauma center. Later I got an update that he had gone straight to the OR from the helicopter, but had crashed once there. At last check he was still alive, but hanging by a thread.

We went back to the junkyard the next shift to get a better look at his vehicle. I was astounded that he hadn't died instantly. He had hit the first tree, then gone airborne and hit the second tree about 15' off the ground (looking closely you can see where it snapped in this pic).

The tree left about a 3' intrusion to his driver door. What astonished me is that normally when someone hits something with the side panel of their vehicle, it will dent the entire panel. He hit with such force that the indention appears perfectly round, as if his vehicle melted around the tree. Note the steering wheel folded in half and moved to the center as well. Imagine the tremendous force needed to do that!!!

And a couple more pics for perspective. What a wreck!!!