‘Roger,’ he said finally. ‘We’ll get airborne as soon as we’ve refuelled.’
‘Another job?’ The question was redundant. Stupid, in fact, but Mikki couldn’t help asking it. Knowing that Tama would look in her direction when he answered. Wanting him to notice her.
The smile was a bonus she hadn’t expected. ‘Tractor rollover,’ he told her. ‘Forty-two-year-old farmer.’
‘Is he trapped?’
‘No, and the ground was reasonably soft by the sound of things, but he’s got chest injuries and the local ambulance crew is concerned about his breathing.’
‘How far?’
Josh was using his finger to trace lines on one of the large wall maps. ‘Here. Fifteen- to twenty-minute flight, tops.’
‘And it’s not a winch job.’ Tama actually sounded quite cheerful about the fact. ‘You good to go, Mouse?’
‘Absolutely.’
Finally. The frustration of the last few days evaporated and Mikki was left with a sense that the enforced time on station had actually been a blessing in disguise. She was familiar with the gear and the protocols. Far more at ease with these men. Confident, even.
It felt so right to be keeping step with Tama despite having to take much longer strides to stay by his side. Perfectly normal to climb into her seat, fasten her safety straps—lap belt first and then shoulder straps—and then glance up to be rewarded with an approving nod. This time, she actually felt like part of the team and that impression only strengthened when they arrived at the scene.
‘This is John.’ The local ambulance officer introduced them to their patient. ‘He lost control of the tractor on that hill and it rolled. He was caught under it and then thrown clear when it rolled again.’
The tractor was lying on its side, half in a ditch, close to where the ambulance was parked.
‘Steering … wheel …’ John groaned. ‘Got … me …’
‘Don’t try and talk, mate.’ Tama had his hand on John’s wrist, both to assess his pulse and convey reassurance through touch. ‘We’re going to look after you and get you to hospital, OK?’
John gave a single nod and then closed his eyes.
‘I couldn’t get a line in.’ The ambulance officer sounded apologetic as he noticed Josh pulling supplies from the pack. ‘His blood pressure was well down by the time I arrived. He’s pretty flat.’
‘You single-crewed?’ Tama asked.
‘Yes.’ The ambulance officer was obviously relieved to have a crew with higher qualifications to take over. ‘His airway was clear when I got here and there were no obvious signs of any neck injury. Breathing seemed OK, too. He said it hurt but his oxygen saturation was ninety-eight per cent.’
‘Down to ninety-five now.’ Josh dropped a tourniquet beside John’s arm and handed a stethoscope to Mikki as though it was part of a practised team routine.
Mikki fitted the earpieces.
‘What’s his blood pressure now?’ she queried.
‘It’s been a few minutes since I took it. It was eighty-five over sixty.’
‘Narrow pulse pressure,’ Tama commented. ‘We’re just going to have a look at your chest, John.’
The farmer didn’t open his eyes. He seemed to be concentrating on drawing breath. Rapid, shallow breaths that looked laboured.
‘Flail chest,’ Mikki noted, as Tama pulled aside the woollen shirt and cut John’s singlet with a pair of shears he pulled from a pouch on his overalls.
She watched for a moment longer, assessing the section of rib cage that was being sucked in the opposite direction to the rest of his ribs. There were multiple fractures there and the list of potential damage that might accompany them was long.
‘Have a listen,’ Tama invited, moving to make room for Mikki to crouch closer to their patient. ‘I’m going to check his belly.’
The injured part of the chest was on the left side. Low enough to make an internal injury to the spleen a distinct possibility, along with bleeding that could well be contributing to low blood pressure.
Josh was attempting to gain IV access and Tama’s hands were palpating John’s abdomen but Mikki focussed on what she was hearing with her stethoscope. Or not hearing.
‘Breath sounds well down on the left side,’ she reported. ‘And heart sounds are muffled.’
‘I can’t find a vein,’ Josh said. ‘You want to try, Tama?’
‘In a sec.’ Tama was holding Mikki’s gaze. ‘What are you thinking?’
There was respect in that gaze. A willingness to let her make decisions about treating a man who was critically injured. Mikki didn’t want control, however. She wanted teamwork.
‘Narrow pulse pressure,’ she said, instead of offering a diagnosis. ‘Tachycardia. His jugular veins are distended, see?’
Tama glanced at the bulging veins in John’s neck and nodded curtly. ‘Tamponade?’
Mikki tapped the chest wall. ‘Could be a tension pneumothorax. Or a combination of both.’
‘Chest decompression or a pericardiocentesis?’
Mikki touched John’s neck. ‘No tracheal deviation.’ Her gaze travelled to a face partially covered by an oxygen mask. ‘He’s going blue. What’s the oxygen saturation now?’
‘Ninety per cent.’
‘John? Can you hear me?’ Mikki rubbed his collar-bone. ‘Can you open your eyes?’
There was no response.
The farmer was in shock and deteriorating fast. If air was entering the chest outside the lungs because of trauma to the ribs, it could be compressing his heart and lung and would be fatal if that air wasn’t removed. If he was bleeding around his heart as a result of the crush injury, that vital organ would cease to function and he would die very quickly.
‘What would you do first?’ she asked Tama.
‘Your call,’ he responded quietly. He wasn’t testing her. She could see that he was weighing up exactly the same considerations she was. If one procedure didn’t help, they would have to try another anyway. What was paramount was making a decision and getting on with it.
‘Pericardiocentesis,’ Mikki decided swiftly. ‘Followed by a chest decompression if it’s needed.’
‘You happy to do it?’
Mikki nodded. ‘I’d like a monitor on.’
There was a narrow space around the heart where blood could create enough pressure to stop it functioning. A space that was easy to miss with the point of a needle. Not going far enough would mean not removing the blood. Going too far would mean pushing a needle into cardiac tissue and potentially creating further complications.
Tama put the leads of the monitor on. Josh pulled out the kit she needed. Mikki put on a fresh pair on gloves and didn’t allow her thoughts to go anywhere near the idea of failure, even though this was technically a lot more difficult than an intubation.
‘Keep an eye on the trace, please,’ she asked Tama. ‘I’m going in slowly and I want to know if you see any changes in rhythm.’
Their patient was unconscious. He didn’t feel the needle entering his chest just under his breastbone. Mikki angled the needle at forty-five degrees,