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When It All Goes Wrong, Paul Marquardt On Trauma Response

Paul Marquardt is a new addition to the DSC crew, he’ll be making his reporting debut for us later this month. He has though been around the tracks for some time as a (ridiculously enthusiastic) fan and, as you’ll read below, on occasion as a professional EMT – Emergency Medical Technician.

The article below was prepared by Paul some time ago as an example of what he could do as a writer. At his specific request though it is presented here as a tribute to Dr John Hinds, “a legend in trauma response” who was killed on Saturday in an accident at the Skerries 100 Road Race near Dublin.

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Dr Hinds was one of an elite group of ‘Flying Doctors’ who provided fast medical response to the Irish road racing scene.

Ahhhhh, sitting in my ambulance. Engine switched off, doors open, hat brim pulled down over my face. Hour 14 of my 16 hour shift. Always love pulling a shift on Sunday at the track.

The sounds of the cars racing past us, engine notes filling the end-of-weekend air. Nothing does a better job of landing you smoothly at Sunday night to prepare for the coming week than an afternoon of racing.

Suddenly, I hear nothing. Hearing nothing at a race track is not a good thing. Abrupt silence around a racing track is a bad omen. My trusted partner Tyler and I both perk up in our seats. It’s usually nothing. Just a lack of racing on the track as one group finishes their running and another is about to start, but a quiet race track is like a night club when they’ve turned the lights on and are ushering people to the doors, it is not a comfortable sight to see or hear.

Then suddenly our CAD (computer-assisted dispatch) lights up on our dash. Tyler and I’s eyes are drawn to it immediately. We look at the dispatch notes, “645 (our ambulance call-sign) we’ll have you for a Code 3 (emergency lights and sirens) response, Turn 9, single vehicle accident, driver still in car, no fire at this time.” Tyler and I just went from relaxing to full on attack mode. Tyler fires over the radio, “645 copies, en route code 3.” Dispatch comes back with a time stamp, “13:45”, to let us know they heard us and are tracking our progress.

Sirens start, lights on. Tyler and I go through the same conversation we do on every critical call. I ask him, “okay what’s the game plan?” Tyler will say, “let’s get on scene, consult with the safety team and see where we are with getting the helmet off and the driver out of the car.”

The red flag has been thrown over the practice session. No other cars are on track. We drive the ambulance on to the circuit and head down to the crash. We can see a race car, or what was left of one, on the left hand side of the track, all but the driver’s monocoque completely destroyed. The driver is waving his hands in panic, and his head his moving. Tyler pulls the ambulance up to the scene and we can hear everything now. “600 from 645, you can show us on scene.” Dispatch comes back right away, “645 from 600, copy that. Advise if we need to start Air.” Dispatch is waiting on us to push the button on starting the helicopter response team. Dispatch has most likely alerted the flight crew but have told them to standby for further instructions.

Now there is no more silence. I hear firefighters shouting, fans screaming, the track announcer trying to keep “the peace” while we do our jobs. I hop out of the ambulance, and I’m instantly sweating. I’m wearing steel-toed combat boots, dark blue EMS pants with more pockets than you’d ever know what to do with. My left pant leg has trauma shears, two hemostats, stetheoscope and tourniquet. My right pant leg has an extra set of trauma shears, and a giant wad of medical gloves. My upper body has an Under Armour shirt to wick away sweat, a polyester button up shirt that is my uniform with my patches on either anterior deltoid, and over that, a kevlar bullet-proof vest. Needless to say, it gets hot wearing my uniform.

I reach into my pants leg and put on my gloves. Never walk into any scene, of any kind without gloves on. Tyler and I are now walking towards the crash. We never run. Walk fast, Walk briskly, but as a general rule, EMS does not run. If we fall and get hurt, then it only takes that much longer for us to get more help to then help you.

A firefighter walks up to me, “Okay guys: the car went head first into the retaining wall, bounced back off the wall and spun onto the track as you find it. No secondary impact to the car. Driver never lost consciousness. Impact was over 100 mph. Driver is complaining of lower leg pain, back pain, and neck pain.” While I’m taking the verbal report from the responding firefighter, Tyler has already donned his gloves and walked directly over to the car and is crouched on his knees, speaking with the driver.

Tyler looks back at me and in the corner of my eye, I see him give me the thumbs up. That means we are ‘looking good’.

In EMS, when you arrive on any scene, something Paramedics and EMT’s try to determine is whether this is a “Load and Go” or a “Stay and Play” situation. By that we mean is this patient so critical that we need to get them moved into our ambulance and to the hospital as soon as possible, or can we take our time, be a little more methodical and a little less reactionary. Both methods have their merits and are completely decided upon by the nature of the injury and crash that we are dealing with.

Tyler giving me the thumbs up means we are good to “Stay and Play.” All the while the firefighter is finishing his report. I begin to walk over to the damaged car. I lean down and do something I always do, “Hi, I’m Paul and I’m with the ambulance service. What can we do for you today?” Some might say that asking a question like that, at a time like this, would be foolish. But, knowing that Tyler has assessed the driver as stable and in no immediate life threat, speaking to any patient in an introductory and calm manner helps establish trust and rapport, something critical in delivering excellent patient care.

The driver looks up at me, his eyes huge, sweaty and nervous, “I’m in a lot of pain guys. Leg hurts and my back hurts.” I look back at him, lean down to the opening in his helmet, “Okay, where does your back hurt? Upper back? Lower back?” The driver responds, “lower back only. My neck doesn’t hurt and neither does my head. Just my lower back.” Clearly this driver knows how to help us out. “Okay bud, we are going to get you out of the car, in the ambulance and we’ll get you some pain medication, okay? Make you more comfortable and have you on your way in no time.” The driver looks up at me and you can see his nervous eyes calm themselves as he hears my game plan. Just knowing the plan gives a patient a lot of calm.

Tyler at this point has walked away from the scene to get some silence and keys up his radio. “600 from 645, you can advise Air to stay on standby but not foreseeing any need for flight on this call.” Dispatch, always at the ready, “Copy 645, Advise further if necessary.”

I wave over to the fire fighters and advise them that we need to get the driver out of the car, with spinal precautions being taken. Medically I can’t determine if this driver has hurt himself or not. I don’t know if he’s okay to walk. Protecting the spine and back is crucial in a trauma incident of this type. The firefighters grab equipment to safely remove the drivers helmet. Special care is taken to keeping the driver’s cervical spine and neck as stable and still as possible while the driver’s helmet is removed by the response team.

After the helmet is removed, it’s set aside for inspection. A lot can be determined about a possible head injury by the state of the helmet. After the driver’s head and neck has been exposed, a cervical collar will be placed on the driver to help maintain a neutral and in-line position of his neck. At this point my partner Tyler has gone back to the ambulance and grabbed our stretcher. He will have also grabbed the trauma bag with supplies to start IV therapy on the driver if necessary, along with our 12-lead monitor so we can get a good look at his heart if his condition changes.

After a serious trauma accident, any movement of the body can be detrimental to the patient’s condition. As they sit in the car, they might present to you okay. They could be talking, and feel relatively okay. However, it’s possible that by simply removing the driver from the car we could finish a fracture process in a bone, cause more bleeding and internal vascular damage. A trauma victims condition is dynamic at all times. Constantly changing. You assess a driver’s condition, and then re-assess it, and then re-asses it again. Constantly.

Tyler walks back over and as I assist the amazing firefighters with their extrication process, Tyler gets ready to finally get a set of vitals on the driver. If the crash had been worse, we’d be more focused on getting a baseline set of vitals, but with the driver responding appropriately to questions, and being totally alert, we are safe to presume his condition is okay for the immediate time being. The primary concern at this time is getting him out of the car deliberately and carefully.

Many race cars have a feature that allow safety teams to lift the entire seat insert right out of the car, allowing the integrity of the spine to not change during extrication. This car is no different. I watch in amazement as the rescue professionals literally pull the driver out of his damaged car while still sitting in his seat. Then, the driver is transferred to a backboard (long plastic board that you lay on your back) to help maintain spinal integrity when you’re out of the hospital. At this time, we can really evaluate the patient’s condition. The driver’s overalls are removed carefully to expose his body, so we can ensure that there is no bleeding. While I do a blood sweep with my hands, feeling for any wet spots, broken bones or signs of physical trauma to the driver’s body, Tyler is getting a baseline set of vitals. A who’s who of how our patient is doing right now. “Paul, blood pressure is 137 over 95, Pulse 95, Respiration rate at 21.” “Copy that,Tyler.” In other words, this driver is doing incredibly well. Blood pressure is a little high, but we can attribute that to his complaint of leg pain, and the fact that he just crashed a million dollar race car, head on, into a cement retaining wall at unabated speed. Trust me, your blood pressure would be high as well. His heart rate is completely normal per the situation and his respiration rate is as calm as when you’re sitting at Christmas Dinner.

I don’t let anybody see it, but I’ve mentally taken a huge sigh of relief. Just because the driver says he feels great doesn’t mean he necessarily is. But, these vitals point us to a happy ending for this Emergency 911 call. The driver, as the calm and cool heroes they are, is making jokes and conversation with the responders, to ease and distract from his pain and lighten the mood. You can see him trying to get his arm high enough above the crowd of first responders to give the thumbs up to the rest of the world that is watching on TV screens around the world. We move the driver onto the stretcher and wheel him over to the ambulance.

Firefighters, Law Enforcement and even a corner worker or two help protect the driver’s privacy by holding up huge white sheets (often times taken from our ambulance or the fire crew’s trucks) to protect the world’s view from seeing the driver in duress. Even a driver in great condition can look very scary to cameras with no concept of what’s being done treatment wise. We get the driver to our ambulance, load him in and the doors shut behind us. A short drive to the hospital and a team of doctors and nurses await our patient. “645 from 600, we will be transporting one patient, routine, to Mass General Hospital.”

Paul Marquardt