Monday, September 12, 2005

As the Special Response Team (SRT) circled through the woods to a favorable location to approach the house, Dr. Mitchell waited nervously by the command post. Although he routinely trained these type of entries with the team, as the doc he was relegated to hang with the team commander in the converted motor home used by the Sheriff's Office as a command post.

He was nervous because the team, his friends, were about to attempt entry at a residence where there was a man with at least one rifle and one handgun and two hostages. As was all too often the case, the hostages were his own wife and child, a two year old boy.

The gunman hadn't made any demands and was well known to the department as a heroin junkie. He had served several jail sentences for possession.

Dr. Mitchell mentally reviewed the afternoon leading to this point. He had been at home on a rare day off, working on his newest hobby, furniture building. He wasn't very good at it, but he loved working with his hands. His wife politely allowed him to place his furniture creations, resembling some type of modern impressionist art, around the house. He didn't even notice that the house never seemed to get full, almost like these pieces were disappearing.

While in the workroom, his Nextel buzzed. Sgt Robinson. "Doc, we've got a call-out. Some hype with a gun is threatening to kill his wife and kid. He's well-known to us, but hasn't ever done anything like this before."

Running upstairs, the doc quickly changed into his bullet-proof vest and fatigues. Pulling on his tactical holster with his Glock 22, he called out to his wife, letting her know he was leaving.

He threw his tactical medical bag into the trunk of his car and jumped into the driver's seat. He was proud of his bag, having spent seized drug money to buy and equip it. He just hoped he never had to use it, but that is what he prepared and trained for.

On the way to the scene, lights flashing, he mentally prepared. He ran through scenarios, using imagery to review what equipment he had and what he would have available from EMS. He had also convinced the team members to carry certain supplies on their tactical vests.

Snapping back to the present, he watched as the team advanced behind the tactical shield, approaching the front door. No one had heard from inside the house for almost an hour, prompting the scene commander to order the tactical entry.

As the team knocked the front door off its hinges, the night lit up with sound, smoke and light as they threw flash bangs. Suddenly, multiple shots rang out, shouts came over the tactical radios and Dr. Mitchell heard his name called.

The hostage taker had barricaded in the bedroom. The team leader was unsure if they had hit him with any of their shots, but a team member was down. The doper had fired off several random shots with a handgun and one had ricocheted from the ceiling, hitting the officer in the neck.

If the scene had been controlled, Dr. Mitchell would have entered with EMS. However, this was far from a controlled scene and the EMS and rescue squad members were unavailable for assistance. He had to make his own tactical entry.

As the team was clearing the remainder of the house, two team members came out with the shield and escorted Deputy Doc, as he was known, into the living room. What he found looked as horrible as anything he would see in the ER. John Hilliard was lieing on the floor with stridorous respirations and a neck that looked enormous, even for the weight-lifter he was.

Dr. Mitchell dropped to the ground. "OK, ABC's," he muttered. The airway was definitely in danger from the expanding neck hematoma that was obvious as soon as he pulled the ballistic collar off the vest. Only a bullet coming at a down angle could have gotten past the vest and collar like this.

"Well, let's see if they got their money's worth," he thought as he pulled open the airway kit in his bag. One quick look into the hypopharynx revealed the futility of trying to intubate this way. "What a mess!" he exclaimed as he looked at the destroyed upper airway. It was obvious that the bullet had crossed the neck and there was no way he was going to be able to perform a standard intubation through this hamburger.



After pouring Betadine across the anterior neck, he isolated his landmarks and incised the front of the trachea. After creating the opening, he slid the business end of an endotracheal tube into the opening. He cut the tube shorter with bandage scissors and reinserted the adapter. Hooking up the ambu bag, a team-mate was able to provide respiratory assistance.

"All clear," came the call from the team leader. During the period of quiet before the entry, the moron doper had shot up and was now passed out.

As the paramedics packaged Hilliard for the flight to the hospital, Dr. Mitchell got to intubate the shooter as well. As angry as he was, protecting this asshole's life was the job, just as was saving his friend. Sonofabitch.