Extreme Medical Services: Medical Care On The Fringes Of Humanity Read online

  “What happened?” Dean asked as he swallowed hard and knelt down next to the moaning patient.

  “Bystanders said that someone just walked up to this woman and doused her with some kind of fluid from a can then flicked a match at her.” The first firefighter said. “Could have been lighter fluid or gasoline. An arson investigator will be able to tell us when he’s done with his investigation. Her clothes caught fire quickly, and she started screaming and trying to pat out the flames. Another bystander knocked her to the ground and had her roll around to smother the flames and someone else grabbed a fire extinguisher from that coffee shop and used it on her. The fire was out when we arrived. We were just starting patient care when you guys got here.”

  Dean was staring at the patient, unsure where to start first when Brynne came up to stand next to him. Her gasp told Dean that she had just seen the extent of the patient’s burns. He looked up at her. He was out of his element here. He shouldn’t have been but this was more than he could handle on his own.

  Brynne looked down at him and must have seen the look in his eyes. “One step at a time, Dean. Just take it one step at a time.” She knelt down on the other side of the patient and started talking to her. “Hello, my name is Brynne, I’m here to help you. Can you tell me your name?”

  The woman turned her charred face toward the soothing voice next to her. Her mouth opened and she croaked out “Vanessa.”

  “Okay, Vanessa,” Brynne said, “my partner, Dean and I are going to do some things to make you feel a little better. Then we’re going to take you to the hospital, all right?”

  “All right,” Vanessa rasped. “It hurts so bad.”

  Dean looked at her right arm and saw that the burns were less severe there. “Brynne, I think I can get IV access on this side.”

  “Okay go for it, but if you can’t get it, we’re better off going straight to an intraosseous infusion route,” Brynne said.

  “Understood.” Dean began gathering his supplies to start an IV. The firefighters were well trained. As soon as they heard what the paramedics intended to do, one of them came over and started prepping a bag of normal saline for the infusion, attaching the IV tubing and flushing out the air. Dean looked at the arm and knew he wasn’t going to be able to clean the skin very well around the IV site but he made a few passes with the alcohol preps he had pulled out. He selected an 18 gauge needle which was the largest he thought he could get in the vein he’d identified. He removed the safety cover and started to insert it gently into the area. He was rewarded almost instantly with a flash of blood in the chamber at the top of the IV catheter assembly.

  Dean looked up at the firefighter standing next to him holding the IV fluid bag and took the end of the IV tubing. He carefully attached the IV tubing in its place. He opened the rolling valve wide open and saw the fluid flowing through the drip chamber, then taped down the tubing and catheter so it wouldn’t dislodge.

  He left the fluid flowing wide. Extensive burns caused a fluid shift within the body and Vanessa was going to need a lot of fluids over the next twenty-four hours. He judged that she had second and third degree burns over sixty to seventy percent of her body.

  Brynne had hooked up the blood pressure cuff and had gotten a set of vitals. She was in the process of hooking up the heart monitor leads so Dean thought about what he could do next. Vanessa’s groans reminded him that pain management was next on the list. He got out the morphine. He wasn’t going to have enough morphine on hand to deal with this patient’s pain adequately, but he could at least get started. “Brynne, I’ve got IV access and I’m going to start pushing some morphine, okay?”

  “You do that,” Brynne confirmed. “I need to get ready to secure her airway. She sounds like she has some airway burns.” She looked up at the firefighters and said, “Could one of you call dispatch and tell them that we’ll need a paramedic supervisor with supplemental pain meds to this location. Also, have them notify ECMC burn unit that we have a patient with approximate 70 percent burn surface area coming in.”

  The engine’s lieutenant nodded and turned away, speaking into the microphone attached to his shoulder. Dean double-checked the dose of morphine in the syringe. He attached the syringe hub to the IV tubing and slowly started pushing the drug into the patient. “Vanessa, this is Dean, Brynne’s partner. I’m giving you some pain medication now. Hopefully it will take the edge off the pain you’re feeling.”

  As he slowly depressed the plunger, he looked down at the patient’s charred face, watching for a reaction. He saw a flash of silver around her neck and a pendant of a pentagram on a chain. It looked like it was partially seared into her neck. He got Brynne’s attention and she looked down to where he was gesturing. He thought it was a holy symbol for a Wiccan. He mouthed the word “Wicca” to Brynne. She nodded in agreement. It didn’t change anything from a treatment perspective, but it would be pertinent information based on the warning email they had received from headquarters earlier. He glanced around to see if he could spot the police he knew were nearby. Maybe they should know. Then he froze as he saw Zach standing there. He made eye contact with Dean, shook his head no and then backed away into the crowd. Brynne’s voice shook him back.

  “Dean, what are you doing? We’ve got work to do, stay with me.” She said. “We need to get ready to RSI her. I’m afraid that airway is going to close up.” Brynne referred to the practice of rapid sequence intubation where a series of drugs were administered to a patient, sedating them so they could have a breathing tube inserted even though they were conscious. Dean helped Brynne draw up the meds and got the bag valve mask ready to breathe for Vanessa when the paralytics started working.

  They had the tube successfully in place when the shift supervisor pulled up in his chase car. Brynne motioned for one of the firefighters to take over compressing the breathing bag every eight seconds and stood up to talk to the assistant chief walking towards them.

  “Hi, Ari,” Brynne said. “I just RSI’d her. She’s burned pretty severely. I’d estimate the burn area to be around seventy percent. Dean got the IV and has already pushed ten milligrams of morphine. We’ll probably need more at some point.”

  “That’s all right Brynne,” Ari said. “I heard the call and was heading over anyway. What happened?”

  “Someone apparently doused her in lighter fluid or gasoline or something like that and set her on fire while she was walking down the street,” Brynne said. “Police and fire were on scene when we arrived. Do you think that it has something to do with the alert we got this evening about attacks on Unusuals? She’s wearing a Wiccan holy symbol. It could be nothing, but I’d rather be safe than sorry.”

  “I’ll tell the police watch commander about your suspicions,” Ari said. “If this is the beginning of some sort of trend, we need to have a coordinated response between the agencies, especially since it might be Unusual related.”

  Dean called out to Brynne, “I think we’re ready to get her packaged and loaded into the ambulance.”

  “Be right there,” Brynne said. “One last thing, Chief. I think I saw my ex-partner Zach in the crowd but when I looked up again, he was gone. I don’t think he noticed that I saw him, but I thought you should know that he was here.”

  “Let’s hope that was just a coincidence or that you were mistaken,” Ari said. “The last thing we need is to have one of our own doing this sort of thing. We’ve worked too hard to gain their trust to have it all blown by a whack job who should never have been assigned to Station U to begin with.”

  “Let’s get the patient squared away at the hospital and I’ll take care of coordinating the investigation with the police. I’ll also call the local coven and tell them that one of their own may have been injured. They might be able to supplement the medical care in some way.”

  Brynne nodded, and the two of them separated as the chief headed over to the police sergeant on the scene and she turned back to help Dean get Vanessa ready to transport. He and the firefighters had the
situation pretty well in hand. She checked the vitals on the monitor and re-evaluated how Vanessa was doing with the intubation and meds.

  “Dean,” Brynne said. “Since I had to RSI her, you’re going to have to drive the rig. Are you up for it?”

  “I can do it,” he said trying not to grin. “We’re going right to the ECMC Burn Unit?”

  “Yes, you’ll have to call ahead and tell them we’re on the way,” Brynne said. “I’ll bring one of the firefighters along to assist with ventilating the patient. Just take your time and get us there in one piece. Safety before speed, right?”

  “Right.” Dean responded. He could barely contain his excitement. Brynne was right, though. When driving, he had the ultimate responsibility to get the patient and his crew to the hospital in one piece.

  The two firefighters had brought the stretcher from the ambulance and positioned it by Vanessa. With Brynne and Dean’s help, they carefully lifted her up and onto it. Brynne took a moment to check and make sure the breathing tube was in place after moving the patient. She checked the in-line capnography reading and listened to the patient’s lungs before nodding to them to keep moving.

  The team slowly rolled the burned patient over to the back of the ambulance and loaded her inside. Dean held the door open while Brynne climbed inside. She turned and looked at him. “Remember, Dean, slow and steady wins the race.”

  “I got it, boss,” Dean said. He slapped the closed back doors of the ambulance and walked around to the driver’s side. His phone buzzed in his shirt pocket, and he absent-mindedly checked the text message as he climbed up and sat down behind the wheel. And then he froze.

  The text message read: Dean, I know you saw me. Don’t tell Brynne I was there. I’ll explain later. You need to know the whole story before you make up your mind. There’s a reason this all happened. Remember you are a part of this now. - Z

  Dean felt stunned. Somehow he’d gotten mixed up in something that was rapidly turning into a disaster that he didn’t know how to extricate himself from. He knew one thing for sure. He couldn’t go to Brynne with his suspicions because Zach might implicate him in some way and then he’d lose the job of a lifetime. He couldn’t risk that. He put the phone back in his pocket after deleting the message with a swipe of his thumb and shifted the ambulance into gear as he carefully pulled out onto the street and headed off to the hospital. He hoped he would figure a way out of this mess before anyone else found out about it. He decided as he neared the hospital that he needed to talk to Mike Farver about it. He’d know what to do.

  Zach watched the ambulance drive away with the witch in the back. He was pretty sure they had gotten the job done on her. Not even that bitch, Brynne Garvey, would be able to bring her back from the brink of death. The thing that worried him the most was whether Dean would keep his mouth shut about seeing him at the scene. It could bring up some inconvenient attention at a time when the Cause didn’t need it. He was willing to sacrifice himself if that was what it took, but he didn’t want to do so without a good reason. He thought there was still time to get to Dean, and to get him to keep quiet, one way or another.

  He turned and walked around the corner and down the block, away from the crime scene and pulled out his phone, selecting another number to text. He tapped as he walked, choosing his words carefully. Even though it was a burner phone, he didn’t want a search warrant of the account to turn up anything incriminating. The leadership in Elk City had a lot of resources in their bag of tricks, and that didn’t even take into account the things those freaks in the monster community could do. He sent that message off and kept walking for a few more minutes until a large black SUV pulled up next to him. He looked around and then climbed up into the passenger seat. Mike Farver looked at him from behind the wheel.

  “Well?” Mike said.

  “I don’t think she’ll live, but we might have to take some steps to follow-up at the hospital,” Zach said as they drove off. “There’s another problem, though. The new guy saw me in the crowd. I sent him a text to keep it a secret until I could explain myself, but I’m not sure if it worked or not.”

  “I hoped that he would have been on our side by now with everything he’s seen,” Mike said. “I picked him for this job specifically because I thought he could be our man inside after you botched the job. Now you tell me you got noticed and that the witch isn’t dead?”

  “There’s still time to fix it, Mike,” Zach said. “I’ll make it right, I swear.”

  “I know you will because you know the consequences of failure,” Mike said with a deadly tone. “I don’t have to tell you what the others would think if you can’t hold up your end of the bargain?” Zach didn’t answer, just stared straight ahead as the older paramedic drove off into the darkness. “No worries, Zach. Perhaps I need to have another impromptu meal with Dean and see if I can find out what he knows. Then we can decide how to handle him.”

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  Want to know what happens next?

  Book 2 - The Paramedic’s Angel

  Book 3 - The Paramedic’s Choice

  Book 4 - The Paramedic’s Hunter

  Available now at Amazon.com

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  About the Author

  Jamie Davis, RN, NRP, B.A., A.S., host of the Nursing Show (NursingShow.com) is a nationally recognized medical educator who began educating new emergency responders as a training officer for his local EMS program. As a media producer, he has been recognized for the MedicCast Podcast (MedicCast.com/blog), a weekly program for emergency medical providers like EMTs and paramedics, and the Nursing Show, a similar program for nurses and nursing students. His programs and resources have been downloaded over 4 million times by listeners and viewers.

  Jamie speaks nationally on health care, technology, and education and is an advocate for integrating podcasting and media creation in schools at all levels. He has spoken at the Podcast and New Media Expo, been a featured faculty member of the Podcast Secrets course, and has been invited to speak and MC at medical conferences and expos around the world. In addition to his traveling speaker opportunities, Jamie is also an adjunct instructor in the health careers department at Cecil College where he teaches a variety of courses to future nurses and paramedics.

  Jamie is also the managing director of the ProMed Network (ProMedNetwork.com), a collection of the best and brightest independent medical podcasters and new media creators currently available online. The network now comprises over 30 independently produced programs for medical and health care professionals at all levels. These trusted resources for high quality medical education and information reach over 500,000 downloads to medical professionals every month.