ER Doc: "Wear a helmet, it saves lives"

I had an experience this weekend that may be of interest to those of you I worked with in the ER. It’s a bit of a long story but bear with me. 

Kathy and I were out for a weekend adventure and were crossing Beartooth Pass atop the Beartooth Plateau which straddles the Montana Wyoming border. We were coming down the Wyoming side when we came upon a motorcycle accident that had happened just a few minutes before. We stopped to see if we could help. 

Lying in the middle of the northbound lane were the two riders, husband and wife. She had a helmet on, he did not. She was confused, intermittently combative, complaining of severe back pain and trouble breathing. Her helmet had scrapes along its right side. She was pale and I didn’t like how she looked. Her husband had facial injuries and palpably broken ribs. He was unclear on what had happened but otherwise seemed to be the more stable of the two. Someone was already providing cervical spine and back stabilization.

Within minutes, perhaps a dozen people had stopped to help. Some directed traffic, some held a blanket to provide shade. We quickly sorted out our resources. Among us are a firefighter/EMT, his EMT significant other, a former certified nursing assistant, a woman who had witnessed the accident, an honest to god cowboy and me, a very retired ER doc. We establish a makeshift ER. We are at about 10,000 feet elevation, out of cell range, and at least 50 miles over the pass from the nearest small hospital that is across the state line in Montana. Our floor is the northbound lane of Highway 212, the blanket held over our heads is our ceiling. Our medical gear consists of a bottle of water, some now bloody paper towels, a small stack of Handi-Wipes and assorted small blankets and pillows. As an ER doc, I was used to having millions of dollars of medical equipment at my disposal. What we have here is worth maybe a buck.

A construction crew working nearby radios for help. They tell us it took 3 hours for the ambulance to reach this location for a previous motorcycle accident. I talk to Dispatch and request a helicopter. They are working on it but in our location, they are not optimistic. They could not estimate an ETA for the ambulance. It is going to be a long wait. We settle in, sitting and kneeling in a small circle around the two victims who lay on their backs, at an angle to each other, in the road where they had landed.

After about half an hour, a Forest Service Ranger arrives. He is the first emergency responder we have seen. He has a small medical kit in the back of his truck that he had previously “borrowed” from Border Patrol. We rummage through it and find a blood pressure cuff, a $2 stethoscope, a disposable cervical collar, a bunch of bandages and a very large “Emergency Candle”. None of us know what the candle is for and the bandages are of no use for the internal injuries we are dealing with. I am not encouraged when I check vitals. The wife’s systolic BP is somewhere between 80 and 100. She is still confused and says she has to vomit. We briefly review log rolling procedures and decide whose side we will roll her toward. I draw the short straw. The husband is stable and I quit worrying about him so much. 

Another hour goes by before the next emergency responder arrives. This is the Under Sheriff from Cody, Wyoming, about 75 miles southeast of us, on the other side of Dead Indian Pass. He has no medical gear and has no information about either ambulance or helicopter. He secures the victims personal belongings including the pistols and knives both are carrying. 

We wait. The husband is uncomfortable and wants to move around. We tell him he can only move his chest to breathe. He says it only hurts when he laughs. I tell him I have a stack of bad jokes I can tell if he doesn’t hold still. He laughs, groans, holds still and doesn’t ask to move again.

Our surroundings here are spectacular, high in the Beartooth Mountains. It’s sunny and warm, a beautiful summer day. We watch thunderstorms build over the mountains to our west. The cowboy has a tarp in his truck. We can use it if it rains. It rains for hours later that night.

We continue to sit on the highway. It has been almost two hours now. The wife asks for water, we find lip balm and smear it on her lips. Someone soaks the Handi-Wipes in the snowmelt running in the ditch and tries to cool our patients, both of whom are still partially clad in leathers. The EMT and CNA continue to hold cervical stabilization as they have done from the start. Neither wants relief. The cowboy manually splints the husband’s broken ribs and helps hold him still. No one complains. We reassess, we reassure, we hold their hands, we apply lip balm, we swat mosquitoes, we pass around a bottle of bug spray and we wait. 

I like our volunteer “ER crew” a lot. Calm, caring people who are all committed to doing what they can on that highway for as long as it takes until proper help arrives. I wouldn’t trade any of them for all the gawkers who slowly drive by, some coming to a complete stop to stare at our little group. We tell them, move along, we don’t need your help here. We have lip balm and Handi-Wipes, what more could you possibly have to offer? Scores of motorcyclist roll by, few wearing helmets, looking good in bandanas more important than staying alive in a lid.

At two hours, the Wyoming Highway Patrol arrives. They take pictures, measure skid marks, record names. They think there is a helicopter waiting 15 miles down the pass and several thousand feet lower in elevation. They have no news on the ambulance. I don’t even ask if they have a medical kit. A small fire truck pulls up. They help direct traffic.

Some minutes later, someone spots an ambulance snaking its way across the plateau to our west, siren wailing. We are into our third hour of sitting on that highway. So much for the Golden Hour of trauma care. Both lanes of the highway are now closed. 

The ambulance arrives, an EMT Basic unit dispatched out of Yellowstone National Park some 80 miles to our west. Three young EMTs emerge, looking concerned. They have gear we lack, Nitrile gloves, trauma shears and back boards. They don’t carry IVs. They leave their oxygen in the rig. They dismiss us, ask us to stand back and gravitate toward the blood on the man’s face. We direct them elsewhere. They start cutting off clothes. They do their assessments and we help them secure the patients to the back boards. We finally load our patients into the ambulance and send them on their way. Even with a helicopter, it will be at least an hour before they reach a hospital but at that point, I think both will survive.

The makeshift ER and its crew melt away. I suspect we will never see each other again. I have only caught a couple of their names, Heather is one and Steve, the cowboy, the other. I don’t know where they’re from. They had all done a wonderful job.

Is there a take home message here? I don’t know, wear a helmet, it saves lives. The wife may well have died if she hadn’t worn one. I have no interest in sitting helplessly by on a beautiful summer day and watching that happen. Sometimes just providing shade and shelter is the most important thing there is. Sometimes it’s the people you work with that matter the most, not the stuff they have or the equipment they carry. Sometimes, even in an emergency, staying calm, making people laugh, and applying lip balm is the best you can do. Hopefully that best will be good enough.

 

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