Sometimes it's really hard

Warning: Graphic description of traffic accident victim

Two years ago this week a 22 year old died in a senseless traffic accident. He made all the mistakes that a typical kid his age would make, only he didn't get to live to laugh about it later. He wasn't wearing a seat belt, he had been drinking and he was speeding. A combination that too many times rips apart the lives of people who care about you.

I was working that night. I don't remember if it had been busy or what we were doing when our pagers went off. Just that after midnight on a Saturday night getting dispatched to a motor vehicle accident isn't that unusual. It was a cold and damp night. While we were en route we were told that it was a one vehicle accident and to use caution due to wires being down at the scene.

We saw the debris field long before we got on scene. It was spread across four lanes of traffic and wires were down across two of the lanes. As we pulled up we could see someone laying in the center of the road and could hear a woman screaming. A young woman was leaning over the figure in the street and about 20 feet away we could see what was left of a dark colored two door car.

Another ambulance had been dispatched with us and pulled up right behind us. We both approached the patients in the street. The other crew took the female, who told us there was no one else involved and our crew stayed to work the obviously young man dying in the street. It was bad, in fact we didn't even think he was alive. The metallic smell of blood was strong and a wide river of it was running down the road from his head. Gray matter (what we call the brain) was visible and his scalp was almost completely separated from his skull. He had no discernible pulse and he was breathing about 5 times a minute, what is known as agonal respiration's or literally your last breath. He had obviously been thrown from the vehicle and had additional injures that were consistent with having the vehicle strike him during the roll over.

When you have a patient like this, who appears DOA, protocol requires you to attach your EKG monitor for verification of asystole (flat line or no electrical cardiac activity), contact medical command and make a death pronouncement on scene.

Even when faced with injuries this severe we know that the human body is an amazing machine and we've seen people survive so much worse. Until we have confirmation we treat everyone as if they are alive. While I provide artificial respiration my partner wastes no time attaching the monitor. We are both left momentarily stunned to see that he had cardiac activity. His heart is still beating, he's alive. Collar, back board and on the litter we are moving fast.

Most people have heard of the golden hour. We have the golden 10 minutes. That's how long we have to assess, package, begin treatment and get en route to the hospital for a trauma victim.

Loaded in the ambulance one of the fireman sticks his head in the back asking us if we need a hand, are you kidding, get your butt in here. He takes over breathing for the kid while my partner gets ready to intubate him (put a tube in his throat to keep his airway open). I am cutting off his clothes so we can fully assess all his injuries. Take a set of initial vitals, we are almost ready to go. The tubes in and the medic is putting in the first of two IV's.

Just as I'm ready to get up front to drive a cop sticks his head in the back of the ambulance and tosses the kids wallet at me. I toss the wallet on the bench seat and the cop says, "Hey, this is John Smith" (obviously not his real name folks) Everyone but the medic pauses. Not only is this kid a member of the local fire company and a good friend of the fireman keeping him breathing but I have known his mother for 20 years.

Almost as an exclamation point on the moment explosions break out and bright blue and green flashes light up the sky. Transformers are blowing all around us. We are out of there.

At the trauma center things move even faster. If you've never witnessed a trauma team in action it's truly amazing. Fifteen people each with a job and everyone working at once to save a life. I'm still in the trauma room and my cell phone rings, I give it a quick glance and it's his mother. I'm sure the hospital has called her by now so it's not coincidence that she's calling, but the hospital doesn't give much information out over the phone. I can't answer this. But how can I ignore it. I take the easy way out and hand my phone to his fireman friend. I hear him struggling to talk to her. It is one of the most painful conversations I have ever heard.

Twenty four hours later this young man was taken off life support. It is a decision I can never imagine having to make. He had signed his organ donor status on his drivers license so now many lives have been saved or improved by his death.

I have worked in emergency services for 30 years. Many times people thank me for the job we do and many wonder out loud how we can do it. It's only after calls like this that I agree with them.