Today was my first day back from an 11 day vacation. I had a bad feeling all night last night and had a hard time getting moving this morning. BUt I got my son off to school, got dressed and went to work. The morning was pretty uneventful....quiet actually for a Monday. But I still had that nagging bad feeling. We took our first call at about 11. A dialysis patient who's electrolytes go wonky pretty easy. He actually called for an ambulance before he was really bad...sure enough his K was off.
So we get back to station, get lunch watch some TV and the phone rings..."need you central until I get another crew freed up". So we get in the rig and head central. We get told that we can 5-4 station 2. On the way back, dispatch calls...."Head for Millerton, on Bailey Creek Road, about a mile up from 549, for a motorcycle into a barbed wire fence". Keep in mind that PA has no helmet law.
So on the way out there Im thinkin...ok this might not be so bad. But that bad feeling was ever present. We get on scene and in front of the firetruck is a Harley on its side. No driver in sight. Then I look and see firemen kneeling on the road on the left side of a large tree. So I get out, ask what they need and they say "just need some help to get him up this bank." So I grab the backboard and as he is coming up, feet first, I'm looking at him. His right leg is slightly askew but there are no obvious injuries. They get him up the bank and set the board on the ground and I start my survey. He has an abrasion around his eye, maybe from sunglasses and an abrasion on his forehead, over the right eye. His left arm is doing funny things...multiple fractures of the humerous and a radius/ulna fracture. Chest is clear, right arm is clear, belly is soft and non tender, pelvis is stable, lower extremities are clear. He is gazing to the left and he is combative. C-collar is placed and I leave the fireman to strap him to the backboard. I spy the helmet in the field about 30 yards from where they brought him up from. Unknown how long he had been there or who finally came along and saw the bike in the road. PA State Trooper shows up as I am telling my partner to haul ass.
So I do my thing as best I could...he is covered in dirt, pale, diaphoretic and wont leave his right hand tucked into the spider strap. I ask for another set of hands while enroute. Meanwhile I am tryng to get the left arm splinted, and he is pulling the O2 off with his right hand. Monitor shows he is tachy..rate of 150ish, get a pressure...its high too. He is also tachypnic. Pupils are equal and reactive but he is still gazing to the left. Redo the trauma assessment which remains negative. (No he doesnt have his pants or shirt anymore) Stop to pick up my extra set of hands and get an 18 in his right AC and run ringers KVO. His pressure is till high and his pulse is falling but still in the 130's. So I call in to the ED...they give me a room and notify of any changes.
We get him there and the team is there and after helping get him over to the bed, I stand back and tell the nurse who didnt hear the radio report, what I thought had happened. Next thing I know the Doc is doing RSI and he is on a vent. Once that happened, his pressure started to come down and there was all kind of running. I finish my paperwork, ask if there is anything else they need and out the door I go.
This is about 13:45.
At 1630, the phone rings. Its dispatch. I need to call the ER and talk to Missy. My patient died. I was floored! So I call the ED and ask for Missy...she gets on the phone and says that the family was asking what happened, was there any officers there. So I gave her my best guess at what may have happened and tell her that there was a state trooper there, but I didnt talk to him or get a name....I was kinda busy. I asked her what had happened. She tells me that they sent him to CT for the Head injury....he didnt have one., No bleed, no bruise no nothing. But he decompensated further, so they sent him back for a full body CT and found a huge pelvic fracture. I told her that I had checked his pelvis and it was stable. I checked his belly and it was fine. She told me that they missed it too and only really started to try to get to the bottom of why he was crashing with the CT of his whole body. She said he could have been eviscerated inside and bled out....she didnt know for sure. Just that the fracture was big.
I've been going over and over it in my head...did I miss it?? Did the right leg kind of bowed in to the left leg mean something, kind of like an inner rotation hip fracture? Was that the clue?? My pelvic exam revealed a solid result.....what did I miss dammit!!? I can beat myself up until the cows come home but it doesnt change the fact that he is dead. I cant change that...I wish I could...for his family.
In going over my assessment in my head...I didnt miss anything. I cant treat what I cant see. But I still feel awful and I cant shake the feeling. This is the 4th fatal accident that I have been on in the last 3 months...when does it end?? When does God say...enough is enough. Or will it end with me saying...I cant take anymore. I'm not making a difference...I just....cant do this anymore. I just cant.