Confidence was available after all. She had Tama by her side. Mikki gathered all she could find as she followed him towards the car. Josh peeled off, after a brief, almost non-verbal communication with his senior partner, to go to the ambulance officers attending the people already out of the vehicles. Two more ambulance officers were right beside the car. The rear door had been cut away and a woman perched on the back seat, holding the driver’s head in a position that would keep his airway open and protect his neck.
Another straightened from where the front door had also been cut away.
‘He’s unresponsive,’ the paramedic informed Tama. ‘They’ve only just pulled the truck clear and got these doors off for us so I haven’t even completed my assessment, sorry.’
Tama leaned in. ‘Hey, mate,’ he called. ‘Can you hear me? Can you open your eyes?’ His fingers were on the man’s wrist, and then his neck. ‘Carotid pulse,’ he said aloud. ‘No radial. BP’s well down.’
‘He’s bleeding heavily,’ the paramedic noted. ‘His leg’s trapped under the dash.’
A fireman moved in from the crumpled bonnet of the car. ‘We’re about to do a dash roll. You’ll be able to get him out then.’
Mikki had to move as a thick hose was pulled past her feet, a piece of equipment attached to its end that looked like a modified pneumatic drill. She was trying to concentrate on the continuing communication between Tama and the road-based paramedic but this was no emergency department handover.
The pneumatic gear the fire service were using was loud enough to mean people had to shout to communicate and everyone seemed to have urgent tasks that other people were being ordered to carry out. The woman on the ground a short distance away was screaming and a new, approaching siren added to the cacophony.
It smelt of hot metal and petrol and blood and everything looked deformed and sharp. Dangerous.
‘Can you move?’ A fireman requested curtly. He was holding the heavy-looking cutting gear. ‘I need to get in here.’
‘Give us a minute,’ Tama ordered. ‘I want to get an IV in and some oxygen on before we do anything more.’ He slid the Thomas pack off his back and, magically, enough clear space opened beside him to allow the pack to be opened out. ‘Mikki? You want to get the IV in?’
‘Sure.’
She hoped she sounded sure. An eagerness to show Tama what she could do—please him, even—bubbled inside her, and he’d handed her what should be an easy way to begin. Apart from having to step around the crumpled driver’s door on the ground, access wasn’t a problem. The paramedic unhooked a pair of shears from his belt and cut through the jersey and shirt covering her patient’s arm. Mikki slid a tourniquet on and pulled it tight.
Tama leaned past to slip an oxygen mask over the man’s face, then he hooked the stethoscope hanging around his neck into his ears and leaned in to listen to the man’s chest. The paramedic was waiting his turn to get close, a stiff neck collar in his hands.
‘Chest and neck injuries,’ Tama informed Mikki succinctly. ‘I’m not happy with his airway but an OP will have to do until we get him out. BP’s well down so I want to get fluids started stat.’
Mikki just nodded, concentrating on gaining access to a forearm vein with the wide-bore cannula she held. It wasn’t easy. Their patient was a very large man and she was having to go on touch rather than a visual target. To her relief, blood flowed into the chamber instantly. She advanced the needle a little further, slid the cannula home and withdrew the mechanism.
‘Got a luer plug?’
‘Here.’ The paramedic had a dressing and tape ready to secure the line as well and then a giving set and bag of fluids appeared with commendable swiftness, but if Mikki had expected any praise for succeeding in her task, she would have been disappointed. Not that there was time to think of it because things were moving very rapidly now.
Josh joined them.
‘Truck driver’s only got minor injuries and the female passenger from the car is stable. They’re both being transported by road. Where are we here?’
They were at the point of being able to move their patient. Mikki stood back, letting the more experienced and stronger men put on an impressive display of peeling back crumpled metal and then using a body splint and backboard to turn and slide the victim free with minimal disruption to his spinal alignment.
The unconscious driver was on a stretcher within a very short period of time, moved clear of the wreckage, but securing him in the helicopter was still some way off, it appeared. The man’s breathing was deteriorating and Tama clearly wanted to try and stabilise his condition prior to transport. He opened pockets of the Thomas pack and took out a large, tightly rolled package.
Mikki was using the stethoscope as Tama untied the package and opened it up to reveal an intubation kit. She nodded her agreement.
‘He’s got some bleeding going on in his trachea,’ she said. ‘And I don’t like this swelling in his neck. If we don’t secure his airway now, we might lose it completely.’
‘Absolutely.’ Tama was holding up a pair of gloves that looked far too small for his hands. ‘Go for it, Doc.’
Mikki couldn’t help her jaw dropping in astonishment.
Technically, she had higher qualifications than either of the paramedic air rescue crew. She had intubated dozens of people in emergency departments and Theatre but these guys had the huge advantage of experience in working under precisely these conditions.
Rescue crews were still busy around them. It was noisy and dirty and … foreign. And this was an obese patient who could be difficult to intubate even under ideal circumstances. Tama was throwing her in the deep end here but she had breezed through that cannulation, hadn’t she?
She could do this, too.
Except it was harder than she had feared. With blood in the airway and bright sunlight negating the effect of the laryngoscope’s light, it was impossible.
‘I can’t see a thing,’ Mikki had to admit.
‘Here. I’ll shade you.’ Tama loomed close over Mikki and the man’s head, blocking the light from falling directly on them.
Mikki still couldn’t visualise the vocal cords. It was hard to keep a note of desperation from her voice.
‘I need suction.’
‘It’s here.’ Tama managed to slip the handle of the suction unit inside their patient’s mouth without dislodging the laryngoscope Mikki held in place. She reached for an ET tube.
‘Here goes,’ she muttered hopefully.
Her first attempt failed.
‘Oxygen saturation is dropping.’ Josh was right beside her. ‘I’ll bag mask him for a sec.’
Mikki sat back on her heels, looking for a replacement tube in the kit. She caught Tama’s steady gaze. ‘Maybe you should do this,’ she suggested. Or Josh could. Except that Josh was now responding to a signal from a fire officer. It looked as though one of the rescue workers had injured himself.
‘Have another go,’ Tama directed.
So she did and again it proved impossible.
‘The trachea’s swelling,’ she said in despair. ‘I can’t get this past the cords even with a guide wire.’
‘I’ll have a go.’
They swapped places. Tama handed her the bag-mask unit and she held the mask over the man’s face, squeezing the bag to try and get a high concentration of oxygen into the man’s lungs. She could feel it becoming more difficult as the airway closed further. Tama was pulling on gloves. As he picked up the laryngoscope, Mikki could hear the deterioration in the man’s breathing. A nasty stridor that suggested they