“You don’t choose the moment, the moment chooses you. You only get to choose how ready you will be when it does…”

I passed this Fire Academy lesson to my friend Ethan as I stepped onto a plane, returning home from vacation. I offered these words hoping he would find comfort, or at least company, while he wrote a letter to our many friends affected by the Blue House tragedy.

As the plane climbed out of San Jose I began writing down what I remembered from my crisis communication books, along with the great class taught by the King County Chaplains. Lost in sad thoughts, I almost missed the announcement the flight attendants were making: “May I have your attention. If there is a doctor or nurse onboard please ring your flight attendant call button.”

I rang mine and told the nervous looking flight attendant who came over that I was an EMT and happy to help. She asked me to come back where I found a 28 year old man, clutching his face in pain. The flight attendants said “He’s had eye surgery, and I guess he shouldn’t have flown.”

I began putting on my gloves, which I had instinctively grabbed from my bag as I left my seat. As I turned to face the patient a man abruptly stood up and said “I’m an eye surgeon”.

The doctor asked a few quick questions and then just as quickly… poked the patient in the eye. He stared intently for a moment, and told the flight attendants “This plane needs to come down, we need to reduce the pressure or this man will lose his vision in his only good eye”.

One of the flight attendants was communicating with the pilot and a medical dispatcher via a headset. I suggested that the doctor speak, and gave him the quick lesson in simplex communication. “Press, Pause, Speak, ‘Over'”.

While he did this, I asked for the medical bags and began inventorying them, suspecting that the kits were probably similar to an ambulance jump-kit without drugs or needles. I was happy to find that the aircraft “Enhanced Medical Kits” are really well stocked, and told the doctor what drugs and equipment were available to him.

A few minutes later the doctor was performing minor surgery on this man’s eye, with me holding a flashlight, setting up equipment, keeping a log, and whatever else needed to be done.

The pilots brought the plane down to 3,000 feet as the doctor finished de-pressurizing the man’s eye and saving his vision. I picked up the trash, asked the doctor if he wanted vitals or oxygen for the patient, and began writing a report.

In 2004 the FAA required commercial aircraft to carry an Enhanced Emergency Medical Kit, intended for use by medical professionals that might be on the plane. The flight-attendants can’t even open it, and most of the drugs are out of my scope-of-practice as an EMT. It’s a gift from those who have found themselves chosen by the moment… to those who are about to be.

-Jesse

(note: I migrated this post to here from my livejournal on September 22, 2007)

Christmas Eve in Palo Alto by my old fire station on Newell Road made me heartsick for firefighting. I spent most of the evening thinking at the coming expiration of my “5 year become a career firefighter plan” without having actually become a career firefighter.

I didn’t sleep well, and when my girlfriend Regina and I awoke (at 6AM) to drive to Fresno it was no farther from my mind. The drive was quiet, with me lost in thought and she lost in last-minute present wrapping.

The fog was dense on Pacheco Pass, and I was driving very carefully. I saw what looked like a serious accident and began to slow down even more. Several idiots swerved by me, nearly hitting a CHP officer who was setting out flares. Other than the cop, I didn’t see any emergency units on-scene and I could now see there were at least 6 blood covered patients huddled in the cold against the median.

I passed the accident, told Reg that I’d be stopping and found a safe spot to pull off. As I hustled toward the scene I was kicking myself for not carrying gloves on my keychain anymore. I found a guy who looked like an off-duty firefighter… crewcut, jeans, and a tattered CDF t-shirt, identified myself as an EMT and asked him if he needed a hand. He did.

Mr. CDF had already done the initial multi-casualty heavy lifiting by moving “walking wounded” patients to (relative) safety on the median, distributed basic bandages to put on minor wounds, and determined which patients would be the most critical. He must have been on scene for at least 10 minutes by himself.

We stole the first-aid kit from CHP officer’s car and began rifling through it for gloves (which was nearly impossible). This proved to be somewhat of a challenge, as it seems cops who primarily do traffic control don’t put a lot of thought into the utility of their jump-kits. They especially don’t seem to consider off duty and/or wannabe rescuers who might be rifling through their stuff. Regardless, I found a couple of glove kits, tossed one to the CDF guy and went to the car with patients he had identified as “criticals”.

The critical patients were a ~50 year old woman and her ~80 year old mother. I approached the car, introduced myself to the patients, and told them what was happening and what I was about to do.

“My name is J, I’m going to do some first aid until the fire department and ambulances arrive. There’s going to be a lot of commotion, and things will happen quickly, but everything we do is to help you…”

The daughter was pretty banged up with an obvious wrist fracture, some heavy bruising on her chest from where it looked like she had struck the steering wheel. She was complaining of severe pain in her wrist, was feeling dizzy, having difficulty breathing, and saying she felt like she was going to pass out. Grandma was looking much better, had no obvious trauma and was not having any trouble breathing. The Daughter was going to get treated first.

I had just started taking her vitals when the first Fire Engine arrived from about 10 miles away (They had to go through the same fog to get there so it took a while). I got the Captain’s attention, gave him the status for the two patients, and asked him for a better Stethoscope. (The CHP officer’s steth was missing the rubber earpieces, making it useless and uncomfortable) He tossed me a new one from their rig, and I got the vitals on the daughter just as the ambulances began to arrive.

I asked the Captain if he wanted me to start holding C-Spine on the patient, to which he responded “Yeah, if you’re up for being here a while”. I got behind her in the back seat of the car, told her that I was going to hold her head still and that it was important she move as little as possible and not shake her head to answer questions. I found a comfortable position, pulled the sleeves down on my jacket, and took control of her head.

(Almost every time I’ve held C-Spine for any extended duration I’ve managed to assume the most uncomfortable position possible, resulting in every limb going numb or cold. By the time we’re ready to move the patient onto the backboard, I have to be relieved because I’m a paralyzed and thoroughly frozen EMTsickle. After 5 years of doing this, I finally managed to get it right and was comfortable *before* I put my hands on the patient.)

The various responders began to assemble backboards and gurneys near the car as the Captain and one of the Firefighters began splinting the woman’s fractured wrist. Life-flight was on the way to a nearby parking lot (above the dense fog), we had her on high-flow oxygen, and things seemed to be going in the right direction.

I started talking to Grandma, who had insisted that I call her Grandma, and it was obvious that she was turn for the worse. She was starting to struggle a little for breath, and seemed like she was getting shocky. The paramedics had arrived and started treating her. She was going downhill pretty fast, and so a second helicopter was ordered.

We were able to move the daughter onto the backboard and get her transferred into the ambulance. I returned all the gear that I had absconded with and then asked if there was anything else I could do (there were now 3 fire engines on scene, 4 CHP units, 3 ambulances, two turtle doves, and a partridge in a pear tree). Mr. CDF and I were released and we scooted on our merry little way.

I suspect that Grandma had a hemothorax (blood in the lung cavity) and was probably in greater immediate peril than her daughter. I’ll never know how they fared at the hospital, but I did the best I could for both of them with the time and resources available. I hope they ended up with nothing more than a fractured arm for the daughter and rib for Grandma, that they were only a few hours late to open presents with their family, and are thankful for the gift that the accident wasn’t worse (it could have been much worse).

In that answering the call to help those in need I was given a gift too… An opportunity to write my next 5 year plan remembering why I wrote the first one. It was an unexpected gift, but one that I’m immensely grateful for.

Merry Christmas.