Monday, September 05, 2005

You never know when you will be called on to do something extraordinary. The other day James Parks, a local ER doc, was driving to the YMCA to exercise. Just another routine day, about 20 minutes on the rower and hitting the weights. The best part was the sauna after the workout.

However, this was not to be just another routine day. As he crested the hill near the airport, he saw something that snapped him out of his daydream. A large tanker truck was angled across his side of the divided four-lane highway and a small car had driven up under it.

Slowing, he pulled onto the shoulder, driving past the small number of cars that had already become trapped behind the wreck. As he moved to the side behind a highway patrol car with its blue lights flashing, a sheriff's deputy approached him and began to instruct him to stay in his car. As James began to explain who he was and offer to help, the deputy recognized him and said, "Thank God you're here! We've got a really bad one!"

Dr. Parks pulled a couple of gloves out of the box in his trunk and began to approach the car. One of the rescue squad handed him a scene coat and a helmet. "You'll need these, doc, there's a gas leak and we're going to have to do an extraction."

The tanker truck was loaded with thousands of gallons of highly flammable gasoline and the car had struck a valve, bending it and causing a leak. There were four people trapped in the car, but the truck driver was OK.

As he walked up, he saw that the driver's side of the car was severely damaged, with the roof compressed so much that only a small space was open through the rear passenger window area. He couldn't see the driver at all, and could see a paramedic extended through the opening in the window. The right side of the car was wedged under the truck.

Just then, the paramedic pulled out of the car and stood up, holding an infant. Turning, she saw Dr. Parks and said, "I had to cut him out of the car seat. I didn't want to, but I wouldn't have been able to get the car seat out the window. We are in a hurry, as the gas leak is concerning."

Looking around the rear of the car, Dr. Parks saw the firefighters trying to stop the leak and scattering an absorbent material (looked like kitty litter) to soak up what was on the ground. If a fire started, everyone in the car would be lost. Obviously, rapid extraction was important.

As the paramedic handed the small boy to a rescue worker, Dr. Parks looked through the opening. He saw a young girl in the rear passenger side seat, crying loudly. A part of the frame of the underside of the truck had broken through her window and had pinned her chest against the seat. He could barely see into the front seat, as the ceiling of the car was compressed down against the upper part of the seats and had bent the frame of the seats. Through the console area, he could see a large woman in the passenger seat, mostly in the foot well. At the top of the seat on the driver's side, he could see part of the upper torso of the driver, completely crushed, almost amputated, by the frame of the seat.

He felt a tap on his back and withdrew. The fire chief, the rescue squad leader and the paramedic were standing there. Another rescue worker stepped in and began working in the rear seat.

"Doc, we've got a real problem," began the fire chief. "It's pretty obvious that the driver is dead. We can't get to the woman in the front seat through the passenger side of the car. With the gas leak, we can't cut through the seat. Access over the seat on the driver's side is blocked by the driver. Even if we get the driver's door open with the jaws of life, we won't be able to move his body out. I think we can get the kid out by cutting the material of her seat. This should give us enough slack to slide her out.

"I'm afraid to cut anything metal. Any spark could set this whole thing off. Any ideas?"

"Can you get the driver's door open?" asked Dr. Parks.

"Yes," the reply came from the rescue team leader. "But the driver's still going to be in the way. With him pinned between the seat and the roof of the car, we still won't be able to get to the front seat passenger."

"We'll have to cut. As horrible as it sounds, we will have to cut through the driver's body to release it. It is almost cut through anyway," observed Dr. Parks. "Right now, we can't be concerned about the dead; if we don't get that woman out, she will die."

The rescue crew came in with a large inflatable bag and placed it on the hood of the car, between the hood and the lower frame of the tanker. Dr. Parks heard the sound of an air compressor and the bag expanded and began to take some of the weight of the truck off the roof of the car. Another rescue worker inserted the pneumatic teeth of the "jaws of life" into a small opening between the driver's door and the pillar post.

With an ear-wrenching groan, the door bent open. The driver's left arm, completely amputated, fell onto the road surface. Wretching, the rescue worker stumbled to the grassy roadside, falling to his knees.

The paramedic reached in through the back window and between the seats and unfolded a sheet across the passenger. A firefighter approached with a large saw, the one they used to cut through timbers in a building. It looked sort of like an electric circular saw, but the blade was much bigger and it was gas powered.

Dr. Parks stepped back and turned away as the firefighter cut through the mid chest of the driver's body. Blood spattered the sheet placed over the passenger as the body came loose.

Immediately, the paramedics, Dr. Parks and the rescue crew jumped in to check the passenger. She was alive, with a weak and thready pulse. The paramedic placed a cervical collar and carefully moved the woman as she positioned a device that allowed for immoblization of the upper back, as there was no way they could extract this woman on a full spine board. She would be immobilized on a full board after removal from the car.

All three living victims from the car were flown to a local trauma center and did well, despite significant injuries. This family was extremely lucky to have a well-trained and equipped local emergency services organization. Unfortunately, they lost their father and husband, but without the interventions and rescue techniques provided, they would have all perished.

I don't think we pay our emergency services personnel nearly enough. These folks are true heroes. Thank you.