Medical Preparedness – Why Me?

It had been a long day and a long drive up to the mountain. My wife and I had just started pitching our tent by lantern light when our friend came running to our site. She said “Bryan grab your bag there’s an emergency, my neighbor just accidentally shot himself.” I dropped what I was doing as we rushed to my truck to grab my trauma bag. I asked her what happened and she said that her neighbors wife called saying her husband had just shot himself and that’s all she knew. Her husband, John told me he’d lead me down to their homestead. Trauma Bag in hand we took off into the darkness.
As I headed down the hill with John towards his neighbors property I started shifting into gear and started mentally rehearsing my training to get into the right mind set and stave off any panic or doubts in my mind. I knew that I was the only help available and if I choked or panicked things could go quickly from bad to worse in an instant. I took a deep breath as I entered the injured mans homestead and prepared for the worst.
The first rule of thumb whenever coming onto the scene of a medical emergency, especially one involving a weapon is making sure that the scene is safe. Before I approached the injured man to assess him and start treatment the first thing I did was to ask the mans wife where was the gun and was it secured. I didn’t want to get accidentally hurt. After getting confirmation it was secure I approached the injured man. As I was approaching I asked his wife what had happened. She said she wasn’t sure but his pistol had discharged striking him in the face. I reassured her that I was here to help and proceeded to start assessing my patient.
As my light shined upon the injured man sitting in his camp chair slumped over I saw a lot of blood all over him and the ground around him. I could also hear him trying to breath and with every breath he gurgled. I knew his air way was compromised and I had to act quickly. I opened my trauma bag and donned a pair of gloves. As I sat him up I got my first look at his injuries. The bullet had struck him in the jaw and there was an entrance wound. I immediately looked for an exit wound and found one in his forehead above his nose. As I shined my light into his mouth I saw the bullet had broken his lower jaw, broken several teeth, partially severed his tongue, and that the mess of bone, tongue, and teeth was clogging his airway. I quickly reached my gloved fingers into his mouth and gently cleared his airway. I immediately noticed an improvement in his breathing and decided to keep him sitting up so any blood would run down his throat and not clog his airway. I then took some gauze and started applying direct pressure to the entrance wound that was oozing blood.
John came over and told me the paramedics were on their way but it would be quite awhile for them to get up the mountain. I told him based on where we were we needed to get the injured man up the hill to the road as it would be impossible to get a stretcher to him. I told John we would have to carry him up the hill between us so we could keep him upright and his airway opened. I threw my bag on my shoulder and we proceeded to carry him up the hill. I looked at his wife and told her to bring the sleeping bag that I saw so we could keep him warm and that we could use it as a litter if he went unconscious.
As we trudged up the hill I kept reassuring the injured man that he was going to be ok and that I was going to take care of him. We finally reached the top of the hill and I found a good place where I could continue to treat him. Me and John got him setting down and I sat behind him where I could lean him against me and I could keep him setting up and maintain his airway. My biggest fear was that he would lose consciousness and that I would lose the airway. Having a broken jaw and a fractured skull I knew I could not use either of the airways I had in my bag. The nasal pharyngeal airways I had I couldn’t put in because of the broken skull and with the broken jaw and damage to the inside of the mouth a oropharyngeal airway wouldn’t work either. I made the decision that if he lost consciousness and I lost the airway I would have to do an emergency cricothyrotomy to get an airway. I mentally started rehearsing the steps of what I’d need to do.
I continued to reassure the injured man and keep the airway open. I also told him to keep squeezing my leg. This would let me know he was still conscious and would not do further damage if he tried to talk. I pulled out a roll of gauze and applied direct pressure to the entrance wound as it was bleeding the heaviest and I continued to keep reassuring the man that he was going to be ok. His breathing began to get shallow and he began to shiver. I immediately knew he was starting to slip into shock and I had to act quickly. I told his wife to cover him with the sleeping bag I’d asked her to grab so we could keep him warm. I also had her loosen his belt and bootlaces.
He suddenly stopped squeezing my leg and he didn’t respond when I spoke to him. I immediately went to check his pulse and check his airway. His pulse was weak but still present. I checked his airway and the remains of his tongue had slid back and was blocking his airway. I used my fingers to sweep his tongue out of the way and tilted his head back to help open the airway more. I felt him gasp for air and he moaned when I called his name. He started squeezing my leg again and I sighed in relief.
I looked at the person who had called 911 and asked them to get a status of the ambulance as I knew I was going to need suction to keep his airway clear as it was becoming increasingly difficult to keep it open. She got off the phone and told me the ambulance was still about thirty minutes out but the first responders and sheriff were only a few miles away. As he coughed and blood sprayed all over me for the third or fourth time I started going through the steps to do the emergency cric and also started going over the steps in my mind to do CPR. I steeled my mind and prepared myself for what I might have to do.
For the next several minutes I continued clearing his airway and reassuring him that he was going to make it. Suddenly the sheriffs deputy arrived on scene and he notified me that the first responders were right behind him coming up the mountain. After a few more agonizing minutes they arrived in their truck. They immediately jumped out and rushed to help. I quickly told them what had happened, what I had done, and the info I knew. I also told them I needed suction and I needed it quickly. They rushed over with the mechanical suction and started to assemble it. It wouldn’t work. One of the first responders started to check it over as the other ran over to grab the manual suction.
He showed back up with it and I told the injured man what we were going to do. I had the first responder suction and clear his airway. The injured man immediately began to start breathing easier. I then decided we’d start bandaging the wounds. We made sure that the bandages were snug but not tight enough to impeded air flow and that we still could get suction in to clear the air way.
We got word that the ambulance couldn’t make it up the mountain and we’d have to bring him down. We decide to lay him on a spine board and secure him to it so we could load him in the back of the sheriffs pickup. As a team we got him on the longboard well I maintained the airway. We quickly loaded him onto the truck and then unstrapped him and put him back into a sitting position to keep his airway open. As I held him up and we drove down the mountain I kept talking to him and having the first responders suction him every time I could hear him start to gurgle. After a jolting fifteen minute drive down the mountain we arrived at the ambulance and transferred him to it and they sped off to the landed helicopter to medevac him to the hospital. I said a quick prayer to God that he had placed me there on that mountain and that I had the skills and equipment to save this mans life.
As I look back on this last weekend when this occurred a few things come to mind. The first was I was the only one with any real first aid knowledge on the scene, if I hadn’t have been there this man would have died. Second, to keep myself calm I did a few things. First off I committed to helping this man and committed to my life saving actions. Dealing with massive trauma is not for the feint of heart and requires commitment. I also rehearsed mentally what I had done in the past and training I had gone through. Knowing what steps I needed to take and how to do them also kept me calm. Lastly, I kept the patient and those with us calm by clear leadership and taking charge of the situation. It is easy to panic when no one is in charge or providing leadership.
Friends you never know when you will find yourself in a position where another individual’s life is in your hands. I’d like to share some advice with you to inspire and encourage you.

If your reading this you properly spend a lot of time preparing. Don’t forget to prepare your mind. As a good friend of mine stated  “knowledge weighs nothing.” It’s a great addition to your bug-out bag. And if you know what to do, it’s much easier to stay calm. Here are some ways to prepare your mind for a crisis:
Read – Reading the medical articles on my site is a good start. Maybe you’re interested in some medical subjects more than others. Then read some good books about them. Make sure you check your source as people will put anything out there.
Watch videos – The Web has some on just about any subject. The more ways you learn something, the more it will stick with you. But, again, know the source.
Memorize – Not a lot, but some things you should know like the back of your hand. That’s what we medics do. We can’t possibly remember everything we read, But memorizing the first steps to do in different types of emergencies helps you tremendously. For most wounds, that would be “stop the bleeding with pressure.” For neck or head injuries, or trauma you didn’t see occur, it would be stabilize the neck until you can rule out an injury there.
Get hands on training – There’s no substitute. Take classes on CPR, first-aid, etc. Most are a lot more fun than you’d think. You’re in a group of similar people who don’t know any more than you or they wouldn’t be there. And any instructors worth their salt know this and want to educate you.
Learn with family and friends – I’ve always said it’s great I know CPR, but little good that’s going to do me if I’m the one needing it. Also, you’ll feel much better in an emergency if you have someone with you who’s had some training. You’ll have the help, and the two of you can remind each other of things. It’s a good trust building exercise as well.

Just DO IT!
Take charge – Assume you’re the most knowledgeable person on the scene because there’s a good chance you are. Assume if you don’t take the lead no one else will. There’s a good chance of that also. The world’s full of followers and few leaders. In these emergency situations the choice of which to be is yours. And your choice to become a leader could easily save a life. If there happens to be someone more skilled, like an EMT, paramedic, nurse, or doctor on the scene, then do what you can to help them.
Direct – People tend to stand back, but many are more than willing to help if they’re shown what to do. Pick out somebody, look at them, and say, “You, help me move this person. You, call 911,” or, “go for help,” etc.”
Remember that doing something purposeful helps you calm down. If I’m watching someone get bandaged, I may get a little queasy. But if I’m doing the bandaging, I have no problem with the worst of wounds. I’m focusing on the task at hand.
Do what you’ve memorized – I was recently reading about an audience member having a seizure during a play. One of the actors came down, saw she wasn’t breathing, and did mouth-to-mouth respirations. He was touted as a hero, and rightly so. But the paramedic in me was thinking, I wonder if this woman really needed mouth-to-mouth or, like many people after a seizure, only needed her airway cleared by being placed on her side. But the practical side of me thought, hey, in the end it doesn’t matter. She’s alive. The actor did what he knew, what he had memorized to do, for someone not breathing. And it worked. After you’ve done the first steps you’ve memorized, step back mentally, if not physically, and think. Try to recall some of what else you’ve learned. What you’ve read or seen or done. Throw in a little common sense, and you may just save a life.

Death Happens
Even if you do everything perfectly, some people are not going to make it. It happens all the time to medical personnel and is one of the hardest parts of being in that field. How to cope with that is another article. Actually another lifetime. But, in the end, you can take heart in knowing, under the circumstances, you tried and did your best. And that’s all you can do.

I hope this article has given you some insight as into what to do to keep calm in a medical emergency. Remember PREPARE & JUST DO IT!



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