Recoveries... a KnightWATCH story

Chapter 1

         David Longfellow was having a loud day in what he considered a quiet life. Normally, Sundays at Knightsbridge EMS were quiet. Normally. But April 17th was proving the proverbial exception to the rule. It was 10:30 a.m., and David had already run three calls – two of them with lights and siren – since coming on duty at 7:00 a.m. He was used to busy days during the week. A usual Sunday, however, was two or three calls in a 24-hour shift, not the first three hours.

         Sitting at the corner of 81st and Kensington, David, an Emergency Medical Technician, was talking and trading barbs with his partner, Jim Hollis, a Mobile Intensive Care Technician (more popularly known as a Paramedic). Talking, that was, between bites of their fast food breakfast.

         “You know, Jim,” David said, his mouth half-full of Egg McMuffin, “any more mornings like this and I’m heading for a major coronary.

         “Oh? Is the fast pace of our calls getting to you? Or will our lousy excuse of a late breakfast give you that heart attack?”

         “Lousy excuse of a breakfast? Come, come, Cowboy. This is a perfectly healthy breakfast! This fine, wholesome Egg McMuffin contains your bread, egg, cheese and cholesterol groups. The hash brown patty fills your starch and grease requirements. And it must, and I mean MUST, be washed down with EMS Lifeblood.”

         “EMS Lifeblood?”

         “Yes, Jim, EMS Lifeblood.” David held up his Styrofoam cup. “The ever-necessary and blatantly neglected part of the food pyramid… the Mountain-Grown Folgers Group.” The two men looked earnestly at each other, cracked grins and began howling with laughter. The guffaws were interrupted by a series of alert tones over the radio.

         “Knight 27, Knight two-seven,” crackled over the radio. “Start for 45th and Carbondale, Emergent on difficulty breathing.”

         “Ten will get you one,” Jim told David, “it’s the Kreeley Catholic Care Center. They always name that intersection when Kreeley wants us to use the rear entrance.”

         “No bet, Jim. I’ve been sent there too many times. Who’s working on 27 today?”

         “With Mary Randolph out on maternity leave, that’s a good question. But whoever it is, I’ll gladly let them have the call.”

         “Knight 27,” dispatch continued over the radio, “you’re responding to the Kreeley Center, 4621 Beckworth Avenue. This will be in the 300 Wing, room unknown, on a female, age 86, difficulty breathing. Facility is insisting you use the rear entrance.”

         “Twenty-seven, we’re responding emergent from 53rd and Kensington to the Kreeley Center, rear entrance, on difficulty breathing.”

         “Twenty-seven,” replied dispatch, “en route at 10:32, all traumas open.”

         “Am I mistaken, Jim, or was that Kim Martinez on the radio?”

         “You’re not mistaken. My question is, how did they get him to work on the same truck as Bob Mitchell?”

         “Not only that,” David replied, “how did the bosses convince our resident white supremacist bigot to work with a man who is half Japanese and half Mexican?”

         “THAT, my boy, may be one of the biggest mysteries in the universe.”

         “Anyway”, David responded, “we better get ready for the post shuffle.”

         “Don’t you mean the ‘System Status Square Dance’?”

         “Jim,” he chuckled, “I’ve worked with you for over a year and I STILL tend to forget just how ‘country’ you are!” The radio crackled to life –

         “Knight 31, Knight three-one, make your post six-one and Kensington.” Jim picked up the radio microphone as David started driving.

         “Dispatch, Knight 31,” Jim said into the mic. “Departing 81st and Kensington for posting at 61st and Kensington.”

         “At ten-thirty-three hours.”

         “Hey, buddy boy,” Jim told David, “You just might be in luck.”

         “In luck? How?”

         “We just got moved 20 blocks closer to Carrolton Trauma. Which puts you 20 blocks closer to that cute ER nurse you’ve been dreaming about.”

         “What in the world,” David blurted out laughing, “are you talking about?”

         “Not a ‘what’, my boy, a ‘who’. A very attractive ‘who’ named Melinda.” David started blushing beet red, realizing he’d either been found out or had talked too much to the wrong person. “If she’s the person I’m thinking of, you’ve got damn good taste. Now, we’ll have to see what can be done about getting the two of you together.”

         “I think I can handle that on my own, thanks.”

         “Hey,” Jim replied, holding his hands up in mock surrender. “Far be it from me to interfere. Or for my wife to offer advice to a certain EMT when he asks for it.”

         “Oops,” muttered David. “I did talk to Annabelle, didn’t I?”

         “Yes, you did talk to charming and lovely wife, old what’s-her-face. Yeah, that’s her name, Annabelle. Charming lady, I may just have to spend some time with her.” David looked over to see Jim grinning from ear to ear, and started to smile despite his embarrassment.

         “Okay, cowboy, we’ll be 20 blocks closer to Carrolton,” David replied. “However, unless they go on diversion, Kensington General is still our closest facility. So, for the moment, there’s not much chance of you trying to an embarrassing introduction on me.”

         “Moi, David? Would I do something so silly?”

         “In a heartbeat, cowboy. But since Kensington IS closer, I’m safe for the moment. Whew,” David concluded, wiping imaginary sweat from his brow. Secretly, though, David was grateful for the change in location. He was hoping for a run into Carrolton, if at least to get a glimpse of young Melinda. She was blonde, slim, pretty, and something else David admired – intelligent. His first wish – to get a glimpse of her, or bring a patient to her. His hope beyond hope – to actually speak with her beyond the job talk, joke around with her a little, even ask her out for a “get to know you” chat over pie and coffee at Bransteads’s (home of the best pies in the city). In all this secret hoping, though, David was forgetting his own saying about the tricks of fate: “You can often get what you want and even hope for in life. But life will give it to you in ways you won’t enjoy.” In ignoring this saying, David also had no clue it was about to bite him in the ass.

         “Okay,” Jim said to David, “let’s be serious for a moment. You like this girl. But you have no clue if she likes you or not. And you’ll never know unless you take a chance. So unless you want to worship from afar the rest of your life, screw up a little courage and ask her out. It could be a movie, lunch, or even a cup of coffee in the EMS lounge. But until you take a chance, you chicken, you’ll never know what the possibilities may be.”

         “Now wait a minute. I’m no <CLUCK> chicken. I’m just <CLUCK, CLUCK> moving slowly. Why would <CLUCK> you <CLUCK> call me <CLUCK, CLUCK> a chicken? Hey, did it suddenly turn cold, or <CLUCK> is it me?” David stole several quick glances around the front cab of the ambulance. “What are all these <CLUCK> feathers doing on the floor?” He looked at his right arm, then again at the invisible feathers between his feet. “AUUUGHHH!!!! I’m molting!” In the passenger seat, Jim was doubled over with laughter. David chuckled along with him, enjoying the moment. The laughter died an instant later, when an alarm tone rang out of the radio speaker.

         “Knight 31, Knight three-one, Knight 55, Knight five-five, motor vehicle crash, intersection of 58th and Cornwallis, emergent.”

         David picked up his microphone. “Dispatch, Knight three-one, responding emergent from 67th and Kensington.” Jim turned on the lights and siren as David began maneuvering the ambulance through traffic.

         “Dispatch, Knight 55,” rasped from the radio. “We’re en route from 44th and Cornwallis. Advising we will delayed negotiating a construction zone on Cornwallis from 42nd to 49th streets. If there’s a closer unit, you better call them in.”

         “Negative, five-five,” replied the dispatcher. “You and three-one are the two closest available units. You’re responding to 58th and Cornwallis on an MVC. Caller states two cars involved, T-bone collision, number of patients and extent of injuries unknown. Police and fire en route. Time 10:39.”

         “Fifty-five copies all.”

         David keyed his mic. “Three-one copies.”

* * *

         “Okay, Tommy, you just rest easy. The doctor will be in with your X-rays in a few minutes. Now, tell me again what you were doing when you fell? Chasing girls?” Melinda Bradley gave the six-year-old boy a dazzling smile. Joking was one of her ways of calming little kids down and letting them know that things would eventually be okay. As often as not, her comments were aimed at the parents (who were usually more scared than the kids).

         “Chasing girls? Ewwww!!” Little Tommy Prandell’s nose crinkled at the thought. Like many boys his age, he had one word to describe girls – “icky”.

         “Now wait a minute here.” Melinda put an exaggerated pout on her face. “Why do you say that about girls? After all… I’m a girl.”

         “You’re different.”

         “Oh? How so?”

         “You’re pretty.”

         Melinda chuckled as she turned to face Tommy’s mom. “Ma’am, you better watch out. He’s a charmer at age six. Imagine what he’s going to be like at 18.”

         “I’ve been trying to avoid that thought, thank you.” Marjorie Prandell was about to make a statement about Tommy following in his father’s footsteps when a loud spoken <QUACK> came from just outside the exam room. Then a man walked in wearing surgical scrubs, a white lab coat… and a duck’s bill.

         “Quack, quack. Who have we here?”

         “Doc, this is Tommy Prandell. Tommy, Meet Dr. Duck.”

         “Ah, yes, he’s the one who’s quack-rays I’ve been looking at. Nurse, have you found out what happened?”

         “Well, Doctor, I suspect he was girl chasing, even though he won’t admit it.” Melinda pinched his cheek. “After all, what else would a six year old boy do?”

         “Well, Let’s quack,” replied Dr. Don “the Duck” Drake. “Boys that age watch TV. They ride bikes. They even… climb trees?” Tommy began to blush as his “secret” was revealed. Actually, they had already known the cause from the paramedic’s report, but getting the child to acknowledge the consequences of his activity was part of how “Dr. Duck” treated kids. “Well, Tommy,” he said as he placed some x-rays on the viewer, “your tree-quacking days are over for a while. These pictures show us that you’ve got a small break in your left forearm… right there. Now, some friends of mine are going to put a cast on it so it will stay there for several weeks, until it heals. It may hurt a little bit. If it gets too bad, we’ll give you a small shot to help with the pain. But you’ve got to be a big boy and do what my friends quack you, okay?” Tommy nodded yes. “Good. And since you’re such a big boy, I’ve got something for you.” Dr. Drake reached into a coat pocket and pulled out three lollipops. “You can have one now while you wait for my friends to take you to the casting room. The other two wait until you go home. Okay?” Tommy nodded yes, then reached up and squeezed Dr. Drake’s duckbill mask.

         The doctor then walked over to Tommy’s mom. “He’ll probably need to be in a cast for about four weeks,” he said through the duckbill mask. “Then he’ll need to see his pediatrician for new x-rays and follow up care. The casting crew will be here in a few minutes.”

         “Thanks doctor, for everything.” Marjorie Prandell went over to hug her son, being careful not to bump his left arm.

         “Thanks, Duck,” Melinda said in the hallway outside the exam room. “You’re really good with kids. I wish we had a few more like you. You’re going to be a good dad some day.”

         “Yeah, right,” Drake snorted as he took off his mask. “That’s a BIG if. I’m in a job with rotten hours and almost no social life outside of work. Now tell me, what lady in her right mind would put up with that?”

         “You’d be surprised, Don.” Melinda crossed her arms and leaned against the hallway wall. “Some ladies in this world want that kind of driven person.” Melinda felt on safe ground with that statement. She had heard many times around the ER how Don Drake and one of the nurses were a serious item. The only people not to comment, in fact, were Drake and the nurse in question, Paula Pawlush. Many ER staffers called it “The Great Secret That Isn’t.”

         “Anyway, Don, good job. The duck bit seems to put the little kids at ease. Where did you come up with that?”

         “When I was in med school, lo those many eons ago, someone saw my name on a folder. He started calling me ‘Dr. Duck,’ and the nickname stuck. When I was an intern, a little kid came into the ER. Four years old, had fallen, was bawling like crazy. Nobody, doctors, nurses, not even the parents could calm this kid down. I started quacking and got his attention. The next day, I bought a duckbill mask, and the rest, as they say, is history. Now, Melinda, I’ve got a question for you.”

         “Okay.”

         “You just told me to always remember there’s someone out there for me. What about you? Aren’t you looking for that special guy?”

         Melinda turned to her left, putting her back against the wall. “I did find him,” she sighed, her head dropping to her chest. “Back in college. He was mine, I was his. We were engaged…” Though she tried, Melinda could not keep the pain out of her voice. “Engaged…” Drake peered around the side of her head, and saw Melinda’s eyes squinted shut in an effort not to cry. “I… I’m sorry, Duck. We… we were engaged for only seven hours.”

         “Melinda… seven hours?”

         “He died seven hours after proposing to me.” Drake cringed, suddenly remembering that tidbit about Melinda’s past. He put a hand on her shoulder and stepped closer. “Thanks, Duck,” she half-sobbed, “I appreciate the sentiment.” When Melinda looked up, Drake could see a tear welling in her left eye. “Jeremy was a good man. As good as there ever was for me. I’ve had my chance at happiness,” she sighed in personal defeat as she moved away from the wall. “I doubt I’ll find someone as good as Jeremy, so I’m not looking for more.”

         “Okay, Melinda, but remember this,” Drake replied, sounding like a brother giving her advice. “Just as there may be someone out there for me, the same holds true for you. You’re still young and very pretty, so don’t let your grief imprison you.”

         “Thanks, Don. I appreciate all of this.”

         “Even if you refuse to believe it, eh? I can hear it in your voice.” Before she could reply, charge nurse Stephanie Berglund approached them.

         “Okay folks, get ready for the patients to hit the fan. Kensington General’s ER just had a power failure; they’re on total diversion.”

         “Hoo-boy,” Melinda commented, a hint of “here we go again” in her voice. “I better check our supplies. Especially in the trauma rooms.” Melinda walked off before Stephanie could ask about the glum look on her friend’s face. It wasn’t Melinda’s usual reaction; Stephanie knew her friend as the type of ER staffer who got an adrenaline rush from a heavy trauma.

         “Okay, Duck, what’s going on? Melinda rarely gets down in the mouth over another hospital going on diversion.”

         “It’s my fault, Steph. I inadvertently brought up her old fiancé.” Stephanie ruefully shook her head, already knowing how Melinda treated herself in that regard. “Hit me upside the head, Steph. I need to reboot my memory circuits.” She gave him a light tap above his right ear. “Harder, Steph, make it count.”

         “No way in Hell, Don. The last thing I need is for you to be out with a concussion. Especially with ‘Doctor Compassion’ on duty right now.”

         “That’s why I took the little kid in seven. The last thing he needed was to deal with Karl Marx. Just remind me to be careful with Melinda about romances, okay?”

         “Sure thing, Don.” As she walked off, Stephanie told herself that something needed to happen, and soon. Or a certain young nurse was going to be living out a self-fulfilling prophecy of a life all alone.

* * *

         “Dispatch, Knight three-one,” David said into his microphone. “On scene with fire two-two-four.”

         “Copy 31 on scene, time 10:44.”

         Following the directions of a police officer, David edged his ambulance around a parked fire truck. As he came to a stop, David saw a red Ford Mustang convertible had run into the left front fender of a black Chrysler Concorde. The Mustang had been going fast enough to push the Concorde from the right-hand lane across the dry sidewalk and into a telephone pole. The front end of the Mustang was pushed in several feet, crumpled and collapsed as though it were an accordion.

         “Knight 55 to Knight 31, advise approach situation.”

         “Roger, five-five. Accident is blocking both eastbound lanes. Traffic is backed up at least three blocks from the scene. The police are blocking the westbound traffic. You may have to ‘wrong way’ the last few blocks – use caution.”

         “Copy, we’re at 53rd and Cornwallis, should be there momentarily.”

         “10-4.” While David was on the radio, Jim had done a quick check of the injured in both cars. He was ‘triaging’, rating which people were the most hurt and needed help first. Finished, he walked back to David.

         “David, we’ve got two code white, one code red… and one code obvious.” Code White meant the injuries (if any) were minimal and easily treated. Code Gray meant more serious injuries, usually needing a hospital trip, but not life-threatening. Code Red was reserved for critical/life-threatening injuries. And Code Obvious meant the patient was dead, with no chance of being revived.

         “Gotcha,” David said before keying his radio. “Dispatch, Knight three-one.”

         “Go ahead, 31.”

         “Three-one triaging one code red, two code whites and one code obvious. Also, show five-five arriving at this time.”

         “Copy one red, two white, one obvious and 55 on scene at 10:46.”

         “Marcel, Alicia,” Jim yelled to the incoming ambulance crew. “Take the two in the black Chrysler. David and I have this one.”

         David walked over to the Mustang, where Jim and a firefighter were treating the driver. Another firefighter was attempting to drape a sheet over the passenger. He was having trouble, as the passenger was lying through the windshield.

         “Jim, need a KED board?”

         “Negative, David. Just have a backboard ready. As soon as we can get a cervical collar on her, we’re moving her out of here.”

         An alternating two-tone series of beeps rang out over their radios. “Dispatch to all Knights, all Knights, information only. Kensington Emergency closed to all traffic due to power failure. Repeating, Kensington Emergency closed to all traffic due to power failure. Time 10:52.”

         “Jim, did you catch that?”

         “Yeah, David, who’s closest now?”

         “Carrolton’s the quickest, straight shot on I-47. St. Vincent’s is shorter miles, but we’ve got the Cornwallis construction.”

         “Carrolton it is, then. Keep the backboard steady, we’re coming out on three. One… two… three.” Jim and the closest firefighter slowly laid the driver on the long spine board on her side. “Okay, now we scoot out. One… two… three.” Two firefighters moved the driver’s body along the board as Jim kept her head and neck steady. “Okay guys, now rotate her on her back, towards the rear of the car. One… two… three.” Jim and the firefighters slowly turned the driver so she was lying on her back. “One more scoot up and we’re ready to strap. One… two… three. That’s it, let’s get her secured.” Jim and the firefighters quickly applied straps to keep the driver from moving on the backboard. “Okay, let’s load up and get to Carrolton.”

         David, Jim and one of the firefighters put the driver on the ambulance cot, then loaded the cot into the ambulance. “David,” Jim said as they climbed into the back of the ambulance, “get a set of vitals while I start the IVs and oxygen.”

         About a minute later, David told Jim, “blood pressure is 88 over 62, pulse is 124, weak and regular, and respirations are 18 and shallow. Her chest rise looks odd on the lower right side of the ribcage.”

         “Thanks, bud. Get us to Carrolton.”

         “We’re gone.”

         David stripped off his gloves and left the back of the ambulance. Climbing behind the steering wheel, he grabbed his microphone. “Dispatch, Knight three-one.” He started driving before dispatch could reply.

         “Go ahead, 31”

         “Three-one, transporting one code red to Carrolton Memorial, starting miles zero.”

         “Copy one code red to Carrolton. Carrolton Trauma is open. Eleven-oh-four hours.”

         “Cowboy,” David yelled back, “slowing down for the ramp to I-47.”

         “Okay, let me know when we get to Quigley.”

         “Roger that,” David replied as he turned and accelerated up the ramp. “On the highway, we’ve got two miles to Quigley Boulevard.”

         “Close enough, David. Get me a channel”

         “Dispatch,” David said into his mic, “Knight three-one. Need a med channel to Carrolton.”

         “Copy 31, Med six is up and ready.”

         “Three-one, copy med six, thank you.”

         “Got it, David,” Jim yelled from the back. “Thanks!”

         David started accelerating to highway speed, his left hand on the steering wheel. His right hand rested on the siren control, changing sounds as necessary to clear traffic. His eyes moved between the road ahead and his various rearview mirrors, trying to be aware of traffic all around him.

         In the back, Jim picked up a phone-style handset from its cradle on the wall as he dialed in the med channel on his radio. “Carrolton trauma, this is Knight 31, how copy?” Silence on the other end. “Carrolton, this is Knight 31, how copy?”

         “Unit calling, this is Carrolton trauma, go ahead.”

         “Carrolton, Knight 31, how copy?”

         “You’re clear, 31, go ahead.”

         “Thanks, this Medic Jim on 31. We are currently en route to your facility with a female patient, age 28. Patient was an unrestrained driver in two-car T-bone MVA. Be advised that patient's car also had a passenger fatality on scene. Patient is unresponsive at this time. Vitals as follows: BP 88 over 62; Pulse 124, weak and regular; respirations 18 and shallow with paradoxical expansion on lower right rib cage. Have splinted area with two rib-belts and one five-pound sandbag. Patient is receiving oxygen at 15 liters per minute by nonrebreather mask.

         “We have two lines of Lactated Ringers established, both wide open, one into the left forearm, second into the right leg. Possible fracture of right forearm, will splint when report finished. Left leg is shortened with outward rotation. Patient is in cervical collar and spinal package, with previously mentioned treatments for --”

         “HANG ON!” David yelled. A car had come across the grassy median into David’s lane. “BRACE FOR IMPACT!” David swerved to avoid the oncoming car, praying that his mirrors weren’t lying and the lane to his right was open. It wouldn’t matter. As David swerved away, the car moved with him, ensuring an impact.

         The full-size Lincoln Town Car hit the ambulance just left of center, directly in front of David. As they hit, time seemed to slow down for David. He saw the other driver’s airbags deploy. He saw his front end crumple, felt his seat belts hold him back, and saw the passenger airbag deploy in his truck. David then felt the steering wheel and his left arm hit his chest. His airbag never popped out.

         “Jim? JIM!” David tried to yell. “Talk to me, cowboy!” There was no response. With difficulty, he picked up his microphone. “Dispatch… dispatch, Knight three… Knight three-one. 10-33.” David was having trouble breathing, having to gasp every few words.

         “Knight thirty-one, dispatch. You are coming through broken. Confirm 10-33.”

         “Dispatch, Knight three-one… three-one, confirming 10-33. MVC, unit… unit involved. North…” David struggled to breathe. “Northbound Interstate 47… north of… Quigley Boulevard.”

         “Thirty-one, stand by.” An alarm tone came across the radio. “Attention all units, attention all units. All Knights switch to Channel Three. Repeat, all Knights switch to Channel Three. Do not acknowledge. Channel One is now 10-33 for unit-involved MVC. All non-related traffic must clear this channel.” Another alert tone came across the radio. “Knight 31, dispatch. Hold on, David, help’s on the way. Tell us what you can. Don’t worry about call signs.”

         “Copy, dispatch, three-one involved… involved in… head-on MVC.” David let go of the transmit button on the microphone as he struggled for another breath. “Status of patient and paramedic… unknown. No… no response…” David gasped again. “Nothing from the rear of the truck.”

         “David, this is Claudia Morgan.” She was a dispatch supervisor, held only in medium regard by many of the field personnel. A former paramedic, Morgan had partially lost the use of her left arm in a skiing accident. In spite of serious rehabilitation efforts, she was found physically unable to work on a two-person ambulance crew. Transferring to dispatch, she climbed the ladder to supervisor. Some crews thought she held a grudge against them since they were still able to work the streets. Others said any grudges disappeared when push came to shove. “David, we’ve got fire and other Knights en route to you. Tell me what you can of your situation.”

         “Copy, front-front impact. Status of paramedic and patient… unknown,” he gasped. “No response… from the back. No info on… car that… car that hit us. Saw his… airbags deploy. No one has… has exited… the car.”

         “David, are you able to get out and check on others?”

         “Negative. I’m pinned in the driver’s area. Having… having difficulty breathing. Had…” Morgan heard a gasp and chuckle on the radio. “Had a fight with the steering column. Came off… second best…”

         “Did your airbag deploy?”

         “Negative, driver’s airbag mal… malfunctioned. Warn incoming crews.”

         “Copy, David, will do.” David was startled by a sudden thumping on his door. He looked over to see a firefighter in full gear. David had been so intent on his report, he’d not heard their sirens as they approached.

         “Hang on!” the firefighter shouted. “We’re gonna have to cut and pry you out. There’s no fire, but you are leaking fuel.” David heard a commotion in the back of the ambulance.

         “What… what’s going on… back there? Jim? JIM!”

         “Settle down, man. My people are back there. Anything you can tell us will help.”

         “Patient was critical,” David yelled through the closed window. “We were transporting hot when the other car came across the median. Tried… tried to avoid him.” David gasped, trying to get enough air to talk. “Swerved… swerved right with me. Haven’t… haven’t heard anything… from the back.”

         “Okay, my guys are back there checking them out. Soon as we can, we’ll get someone in there with you.” In the distance, several sirens grew louder. “Sounds like your counterparts are on the way.”

         “Dispatch to Knight 31.”

         “Three-one, go… go ahead.”

         “David, trucks 41, 53 and 88 are all on the way. Is fire there yet?”

         “A — affirmative”

         “Okay, David.”

         “David,” a firefighter said as he climbed in the passenger cab door. “It’s Paul Mulvaney from engine 238. I’m gonna do my best to get some vitals and get you packed up to transport.”

         “238? Mulvaney? Great,” David grimaced. “I’m being rescued by ‘3M’. How are Jim and our patient doing?”

         “I don’t know, David. And to be blunt, at the moment I don’t care, because you are my patient. You need to concentrate on getting yourself better. Don’t worry about them. We’re going to have to cut the truck apart in order to get you out. I’m going to place a tarp over you to keep the glass off.”

         “Okay.”

         “Dispatch,” David’s radio crackled, “Knight eighty-eight is on scene.”

         “Copy, 88.”

* * *

         “Ugh… if there’s anything I hate more than stocking the aircraft…” Emily Hargraves had stopped on a landing in the roof access stairway at Knightsbridge Headquarters. Waiting for her partner to catch up, she was leafing through the paperwork on her clipboard. Despite all her wishes, neither she nor anyone else on the Knightsbridge EMS staff could magically will the assorted pages to coalesce into an already-completed patient report form.

         “Now, Emily,” came the cooing Creole tones of her partner, “are you complaining about the charting we need to do? Remember, you volunteered to write up this last run.” Seeing the “don’t remind me” look flash onto the young paramedic’s face, flight nurse André Thibideaux decided to take a different tack. “Hey, think of it this way. At least the coffee here is good and the furniture comfortable.”

         “Meaning?”

         “Meaning we could still be at the ‘EMS Dungeon’ at Rothschild Pavilion.” With a groan at that realization, Emily started down the steps. Along with pilot James “Sulu” Hiroshi, the two of them had just flown a complicated cardiac patient to said hospital. A privately run facility that catered to elite doctors and patients, Rothschild Pavilion provided its patients with facilities that were just sort of lavish. Amenities for anyone not a doctor or patient, however, were Spartan at best. And EMS crews, viewed by the hospital on the same level as janitorial staff, were relegated to a dimly-lit room just off the ER that came with a plastic banquet table, six unpadded metal folding chairs and a coin-operated coffee dispenser. Ambulance and helicopter crews throughout the region referred to the room as “The EMS Dungeon.”

         In need of both fuel and medical supplies, the crew of SkyKnight 2 had collectively decided to make the ten-minute flight over to “The Castle,” the primary headquarters of Knightsbridge EMS. Not only was it quicker to go there for their needs than returning to their base, “The Castle” held the promise of reasonably comfortable surroundings in which to tackle the ever necessary chore of paperwork. Emily and André were on their way to do so while “Sulu” finished pumping “motion lotion” (one of his favorite over-the-air slang terms for jet fuel) into the fuel tank of their Eurocopter EC 145 medical helicopter.

         Three steps from the entrance to the ground floor, the two medicos were stopped in their tracks by garbled traffic over their hand-held radios. André had just pulled his radio off his belt when it emitted a clear, three-tone alarm. “So much for coffee and paperwork,” the African-American Creole said as the two of them started jogging back the way they had come.

         Up on the rooftop helipad, pilot James Hiroshi had just finished reeling the fuel hose back into its cabinet when the alarm sounded. Acknowledging the dispatch over his own radio, he jumped into the pilot’s seat and went through the engine-start sequence with practiced ease. After a few seconds of note writing and using a small calculator on a clipboard, he keyed his radio.

         “Sky Two pilot to medical on channel two. André, you’re up front with me on this one. And if this patient’s heavy, I may have to burn off some extra fuel. Be careful when you get up here; I’ve already got the bird cranked up.” Hearing a garbled reply, he looked up to see the stairwell door opening. Two minutes later, both of his crewmembers were strapped into their seats, and Emily was reading off a pre-takeoff checklist. Another two minutes, and Sulu was on the local Unicom frequency, telling the air control tower and other aircraft in the area he was about to liftoff from headquarters and fly to the southwest.

         “Dispatch, SkyKnight two,” Andre said over a different radio. “Lifting from ‘The Castle’ with three souls and two hours ten minutes of fuel, en route to scene.” After hearing the acknowledgement, he turned to his pilot. “James, I didn’t hear much on my radio. Where exactly are we going?”

         “Scene call at I-47 and Quigley Boulevard,” he said, an edge on his voice.

         “Sounds like MVA time,” Emily commented over the intercom system. She immediately began a mental catalog of the items they might need to pull out of the aircraft.

* * *

         Mulvaney placed a cervical collar around David’s neck and started getting vital signs. In the rear of the ambulance, firefighters Anne Mulholland and Marc Mitscher had unhooked the patient’s IVs from the ceiling and were slowly moving her out through the side door. They had already removed the unconscious Jim Hollis and placed him on a backboard. The crew from 88 took 31’s patient and immediately left the scene.

         As firefighters started removing David’s door from the ambulance, Knights 41 and 53 arrived. 53’s crew of Connie “Mac” MacKenzie and Joel Palco came over to Knight 31.

         “Okay, here’s his vitals,”, Mulvaney said, handing Mac a small sheet of paper through the passenger-side door. “He’s alert and oriented, but he's probably going to need an IV once we pry the steering wheel away.”

         “Paul,” David said, fear creeping into his voice. “Level with me. Are you expecting my blood pressure to drop when you pry me out?”

         “I won’t lie, David. It’s a possibility. Now, I’m backing out of here and one of your paramedics is coming in to start the IV.” Mulvaney and Connie changed places.

         “David, it’s Mac. I think you know the drill.”

         “Let me guess... large-bore needle?”

         “At least an 18 gauge, a 16 if I can get it in.” She quickly wrapped an elastic band around David’s upper arm, then started feeling for good veins. “Joel,” she yelled over he shoulder, “got that bag of LR spiked?”

         “Flushing the line now, Mac.” He had plugged a length of plastic tubing into a bag of IV fluid, and was running the fluid through the tubing to remove air bubbles.

         “Good.”

         “Mac, just to let you know....” David struggled for a big breath. “I’m allergic to Codeine.”

         “I know, David... but thanks. Okay, you’ve got some good veins. I’m going to try a 16.” David clenched his teeth, anticipating the sting of an IV catheter in his arm. “Okay, it’s in. I’ve told you I should be called ‘painless’.“ Reaching behind her, she felt Joel place the bag of IV fluid in her hand, along with the coiled IV tubing. While she hung the IV bag from a coat hook behind David’s head, Mac’s arm hid her look of worry from him. “Okay,” she said as she hooked the other end of the tube to his IV catheter and taped it down, “you’ve got Lactated Ringers running wide open. I have to get out of here so they can rip up the cab. SkyKnight Two is on the way to pick you up.”

         “Wait! What about... about...”

         “88 already moved out with your patient. 41’s looking after Jim, as well as the creep that hit you.”

         “Where... where are...”

         “As far as I know, you’re all going to Carrolton. Now I’m out of here.” Her voice dropped lower as she clutched his hand. “But I’m still here, David.” Despite the sound of ripping metal, David heard the tremor in her voice. She gave his hand another gentle squeeze before climbing out. By this time, firefighters had removed the driver’s door and were starting to pry away the dash. Paul Mulvaney climbed back under the tarp to keep David calm.

         “David, relax. We need to spend a few minutes prying your truck apart.”

         “And we just...” David gasped. “... Just got the thing back...” Another gasp. “... from annual inspection!” David tried to laugh, but ended up gasping several times.

         “And cut out the bad jokes,” Paul replied with a smile on his face. “Just for that, you get the express KED board application.”

         “Wait, you’re talking about a Kendrick Extrication Device... a wrap-around-the-torso upper body splint...” David gasped again. “One of these... done... express?” David tried to laugh, only to gasp from the pain. “Stop joking like that, Paul. It really does... hurt when I laugh.” David had to gasp several times as he said this; it was getting harder for him to breathe. “What... what about... guy who... who hit us?”

         “I don’t know, David. I’ve been too busy over here. If I can find out something before you go, I will.” The metal of the van began to groan in protest as firefighters tried to pry the steering wheel away. “Tommy, bring that ram over here. We gotta push this dashboard up!”

* * *

         Finishing up her mental inventory, Emily began to feel a pall settle over her. It was then she realized that Jim Hiroshi’s usual happy-go-lucky, “let’s have a great trauma” excitement was missing. “Jim, what do you know that we don’t?”

         “Em… one of our trucks is involved.” Both medicos felt a slight shudder in the aircraft as their pilot relayed this bit of information. Emily wrung her hands together as André called dispatch for further information. After hearing the usual items of call description, who they would talk to on the scene and what frequency to use, the radio went silent. André asked for further patient info, only to get a curt “we don’t know anything more” in reply.

         Thinking she was only talking softly enough not to be heard, Emily said, “I don’t like this.”

         “What’s that?”

         “Nothing, Jim.” In her present frame of mind, using the Sulu nickname didn’t seem appropriate to the young paramedic. “Nothing at all.”

         “You think they’re not telling us everything, Em?” Hearing a slight gasp, the pilot continued, “I agree. There’s something they’re not telling us, and I don’t like it. But we’ll find out soon enough.”

         “Why?”

         “We’re less than five minutes from the scene. Keep your eyes open for obstacles. If it’s what I’m afraid of… this is no time to clip a power line.” No one replied; both medicos were sharing the pilot’s fear of having to fly one of their own. After a moment of silence, André spied a collection of emergency lights in the distance. He adjusted several switches, then keyed his radio.

* * *

         As a firefighter brought a piece of equipment over to David’s door, five others set up a landing zone on the interstate. SkyKnight Two approached from downwind and began to circle. “I-47 command,” the firefighters heard on their radios, “this is SkyKnight Two on Tac Two. On approach to Knight 31 scene. Talk to me.”

         “Sky Two,” the radio reply crackled in the helicopter, “this is the landing zone coordinator. We’re not sure if this is a hot or cold pickup. LZ is set to the northeast of the accident, firefighters on the corners. Surface winds are light out of the west. We’re still prying your patient out.”

         “Sky Two copies all.” André let go of his transmit button. “Emily, did you catch all of that?”

         “Yeah, and I don’t like it,” replied the flight paramedic “He needs out of there soon.” She keyed her own mic. “Sky Two to either Knight 53 or Knight 41. Request patient update.”

         “53 to Sky Two. 41 is double-loading two code grays for ground transport. We’ve got your info when ready.”

         “Go ahead, Mac.”

         “Patient is male, age 27, alert and oriented times three, 15 on Glasgow Coma scale. Restrained driver, airbag malfunction. Currently running large-bore IV of Lactated Ringers, IV bag is in a pressure infuser in case we need to force it in. Vitals from fire department to follow. BP is 134 over 66; pulse 88, weak and regular; respirations 26, he's having difficulty breathing, suspect flail chest; pupils equal and reactive to light, with equal movement; skin warm, pale and dry. Suspect injuries to both legs, but have not been able to assess them.”

         “53,” André interrupted, “have you applied oxygen?”

         “Negative, Sky Two. We’ve had occasional sparks from cutting equipment; I don’t want to risk one of them igniting the oxygen.”

         Emily looked out the window of the helicopter and saw Knight 41 pulling out. “Sky Two to 41. Make sure you give those guys on 31 some TLC while we fly the jerk that hit them.”

         “Uhh... Sky Two, this is 53. 41 has the ‘jerk’, as you called him.” Emily looked out the window again, this time seeing all the firefighters clustered around the driver’s door of Knight 31. “Your patient’s is 31’s EMT.”

         “Oh, shit,” Emily said off the air. “André, when we finish this call, kick me in the ass. I’d do it myself, but my foot is too far down my throat.

         “Copy, 53,” André replied on the radio. “Any time frame on his extrication?”

         “They’ve stopped long enough to put a KED board on him, André. Figure another five to 10 minutes until we get him out. Tell Sulu to keep hot iron.”

         “Copy all, 53. James?”

         “Yeah, I heard. Hang on, we’re turning for landing.” After the helicopter landed, Emily and André pulled out their cot and assorted bags and pieces of equipment. As they made their way over to the nearly destroyed front end of Knight 31, Mac and Joel Palco were finishing the KED board application on David.

         “Mac... level... level with me,” David gasped. “How... how bad?”

         “I’ll be straight with you,” she replied. “Your cervical spine looks good. You almost certainly have a right-side flail chest, not sure how many ribs involved. Your left forearm is banged up. I don’t know about your legs, I can’t get to them. Face it, you’re going to be in the body and fender shop for a while.”

         “As least... I’m still... under warranty.” David tried to smile through the pain. A large creak and groan was heard as more of the ambulance was pried away.

         “David,” Mac said, struggling to keep the tremors out of her voice. “I’m not seeing any indications, but I can’t take a chance you’ve had a head injury. You’re going to have to do the extrication without any Morphine or Demerol.”

         “Sounds like... ‘grin and bear it’ time.” Several firefighters got a backboard in position, sliding the head end under David’s butt as much as possible. After several minutes of body rotating, feet-first sliding, and numerous grunts and groans of pain, David was strapped down to the backboard and being carried to the helicopter. On the way, Mac gave Emily an update on David’s condition.

         “All right,” Emily yelled as they got close to the aircraft. “You all probably know this, but KEEP LOW! And don’t go past the big stabilizer fin when we load him in back!” The group walked to the rear of the helicopter’s body, where André had opened the clamshell doors and pulled out a cot. “OKAY, PEOPLE!” Emily had to yell to be heard over the roar of the helicopter’s two jet engines screaming just above their heads. “Gently put him on the cot.” The firefighters did just that, with a minimum of jostling. As she and André strapped David to the cot, Emily told the helpers, “Move out to the sides of the aircraft, around the front, and go back out the way you came in. We’ll load him into the aircraft. Mac, you stay here to secure the doors.” The firefighters walked away as André, Emily and Mac loaded David into the aircraft.

         “Emily,” Mac asked as she tried to climb in behind the flight crew, “do you want me to start a second line?”

         “No room, Mac. We’ll get it.” Mac continued climbing on board. “MAC!” she yelled, putting a hand on her shoulder. “There’s not enough room for you!” Seeing the fear on Mac’s face, she continued, “we’ll take care of him, Connie. Don’t worry.”

         “Go… go for something on his left leg,” Mac replied, referring to where to put in a second IV. “I did a quick check once we got him on the backboard; I don’t think it’s as badly hurt as the right. Here’s all the information I’ve gotten on him.” She handed over a piece of paper, a slight tremble in her hand. Mac then climbed out and closed the rear doors. Emily cut away the left leg of David’s trousers, found a good vein and started an IV while André took a fresh set of vital signs.