Emergency Response (6 page)

“I have a problem with intensive care trained nurses who can’t work unless they have machines beeping at them all the time. It drives most city nurses crazy and they never stay. I cannot believe the agency would employ someone with no emergency experience. It’s just typical. We can never get staff out here so they take anyone. It’s like if you have a pulse you’ll be good enough.”

Mackenzie was livid. She planted her hands on her hips and glared at him. “I think you’re making a huge assumption about me and my nursing abilities.”

He shrugged. “We’ll see.”

His phone rang then and the sound cut through the room like the shattering of glass. Mackenzie jumped. He turned away from her to take the call and when he turned back, she saw a very different look in his eyes. Pure adrenaline.

“Find something to wear, Mack. There’s been an accident which means we’re about to find out what kind of nurse you
really
are.”

He was gone before she had the chance to tell him she did
not
like to be called Mack.

Fear coursed through Mackenzie’s veins. Apparently she was about to find out what it felt like to be dumped into the deep end without a life jacket.

“What have we got coming in, Doc?” Debbie asked, trotting after him, trying to keep up with his long strides.

“Rollover,” he said. “We’ll need all hands on deck.”

“Why are they coming here? Para is set up better for trauma than we are.”

Mackenzie had done her homework. Paraburdoo, known to the locals as “Para,” was the nearest town to Iron Ridge.

Doc shrugged. “We’re closest to the scene.”

“Do we know anything? How many injured?” Debbie asked, looking at him expectantly, wanting more details. Her voice had risen a couple of notches.

Mackenzie stood rooted to the spot in the middle of the room, totally forgotten by the others. Doc turned on the ventilator and checked the oxygen and suction. While he rushed around, he called out what details he knew.

“Nineteen-year-old male driving home with a group of mates just after seven o’clock on that long stretch of road between Paraburdoo and Tom Price. The person in the car behind him saw him drifting toward the center of the road. He swerved a number of times, corrected, then over-corrected, causing his car to spin before it rolled six times and landed on its roof, ejecting the driver through the front windscreen. Bloody idiot wasn’t wearing a seatbelt. He was unconscious but still breathing when the driver of the other car pulled up. He managed to drag the other five occupants from the car before it burst into flames. Flippin’ hero he is. The other kids have apparently escaped injury, but the driver’s not so lucky. We’ll know more soon.” Debbie headed out the door and Doc yelled after her. “Can you find Mack some scrubs?”

In the distance, Mackenzie heard the faint wail of an ambulance siren. Debbie handed her an oversized pair of pale blue theater scrubs and Mackenzie ducked behind a curtain to pull them on, not caring if anyone saw her stripped down to her underwear. No point being concerned about modesty. Or fashion. Her hands shook as she rolled up the cuffs of the pants and tied the drawstring around her waist.

The sound of the siren intensified and her knees quivered. She yanked a pair of bright blue latex-free gloves from the container on the wall and cursed under her breath when her damp fingers refused to go where they should. Debbie and Doc were oblivious, intent on getting ready for their patient. It was the wrong time to ask them what they wanted her to do – she would have to work it out for herself.

Doc turned to Mackenzie. “We don’t have the luxury of a trauma team like you have in the city. We’re it. I’m the team leader and you follow my directions. Understand?” He barked the question at her and she nodded. “Think of me as the conductor of the orchestra and don’t do anything without either telling me what you’re doing or checking with me first.”

“So what
do
you want me to do?” she asked.

“Can you focus on airway?”

Mackenzie nodded again, not trusting herself to speak. Sure, in the intensive care unit back in Sydney they’d had their share of emergencies and she knew what to do, but usually the environment was a little more controlled. At least when her patient crashed in ICU she usually knew the reason. Often it was because they were septic or had a bleed following surgery. Trauma was something she knew nothing about. Uncertainty coursed through her. Maybe she wasn’t as equipped for this job as she’d thought when she’d accepted the position.

“Is that a yes?” Doc demanded. “I can’t keep looking up to see if you’ve heard me. If I ask you a question, Mack, you answer. Out loud. Got it?”

“Yes,” she hastily replied, hoping he didn’t hear the tremor in her voice.

“He’ll probably need to be airlifted out anyway, but we’ll stabilize him here first. When I know what’s going on I’ll call the RFDS. Assuming they’re not already in the air somewhere else, it takes around forty-five minutes for them to get here from Port Hedland, but you might as well double that timeframe. Our job is to keep him alive until the cavalry arrive,” Doc explained.

Two women burst through the doors.

“You called, we came,” the younger of the two said as she bounced into the room, yanking gloves from the box on the wall and pulling them on her hands. Everything about her cheerful expression exuded a youthful energy. She had scraped her blonde hair into a messy ponytail as if she had dressed on the way to the hospital. She glanced sideways at Mackenzie and then looked at Doc with arched eyebrows.

“Mack. My replacement,” was all he said by way of explanation.

“What have we got coming in, Doc? Car accident?” the other woman called out. She had a strong New Zealand accent. In contrast to the younger woman, at that moment she wore a deep frown and a face full of worry. Bright red hair hung in tight curls around her face. She grabbed a yellow disposable gown and slotted her arms into the sleeves before pulling on gloves.

“Yeah, MVA,” Doc answered. “Rollover, five minutes down the road. A carload. Bloody morons. Bet they were going too fast. Probably been drinking too.” He shook his head. “And of course the driver wasn’t wearing a seatbelt.”

The lights of the St John Ambulance truck flashed through the glass doors, lighting the room with throbbing color. The screaming siren cut off any further discussion. The moment of truth had arrived.

“I’m Amy.” The young woman smiled in Mackenzie’s direction. “I’m one of the other nurses here. What was your name again?”

Mackenzie returned the friendly smile with one of her own. She was only going to have one chance to make a good first impression. “Mackenzie Jones.”

Someone mercifully silenced the siren, but the lights remained on, pulsating, painting everyone’s faces first red, then blue.

“Welcome to the Outback,” the other woman said with a smile as she scraped her red curls up and out of the way of her heavily freckled face. “I remember when I first arrived six months ago it felt like I’d landed on another planet.”

Mackenzie nodded, glad both nurses were being so friendly. She had expected the opposite.

The doors burst open and a paramedic and two St John Ambulance volunteers in their dark green overalls wheeled the patient into the room.

“By the way, I’m Charlotte.”

My roommate!

“There’s nothing like being thrown straight into the middle of things, is there? Are you ED trained?”

“No. ICU.”

“You’ll be fine. Just remember no question is a dumb question.” Charlotte tipped her head in Doc’s direction and gave a small wink. “And the other thing to remember is his bark is far worse than his bite.”

Mackenzie exhaled slowly, smiling genuinely as she warmed to the likeable woman. She didn’t have time to dwell on the possibilities of friendship though. They had a job to do.

It was difficult to see much of the young man beneath all the equipment piled on the stretcher and laid between his legs. A shiny space blanket covered his torso and all Mackenzie could see was his head. Wrapped around his neck was a white plastic collar, and when she got closer, she saw his face was covered with splattered blood and there was a sprinkling of glass through his dirty blond hair. His mouth hung open, reminding Mackenzie of a dead fish. She noted the plastic guedal airway, blood, missing teeth. The paramedic delivering oxygen via an orange bag-valve-mask looked at Mackenzie expectantly. She took over from him. This was familiar territory.

“Let’s get him transferred onto the bed and get an LMA in,” Doc said. “Are you ready?” he asked Mackenzie.

“Yes.” Her legs were like jelly and she was sure if she stopped moving someone would hear her knees knocking. She hastily pulled herself together. She knew what she was doing. Sure, it wasn’t the orderly intensive care unit environment she was used to, but she’d seen plenty of emergency situations in the unit when things didn’t go according to plan.

The others swooped like seagulls and transferred the man from the ambulance stretcher to the slightly wider resus bed. Seconds later, Mackenzie inserted the laryngeal mask airway, pleased at how easily it slid into the man’s throat. She attached the bag-valve-mask and rhythmically squeezed oxygen into the man’s lungs.

“Airway secure,” she called out. If the airway wasn’t controlled, there was no point in assessing the patient’s breathing or circulation. Worrying about his actual injuries would come last.

As Mackenzie concentrated on the man’s airway, the others worked around her. No one said much as they all listened to the brief handover from Dave, the paramedic. Debbie cut off the injured man’s clothing with large scissors and Amy attached ECG leads to his chest before returning to documenting the proceedings. Charlotte inserted a second IV cannula and hung a bag of IV fluids. Doc stood back watching, but when Mackenzie spoke, he bent over the patient and placed his stethoscope on the man’s chest. He listened carefully and then leaned closer, tilting his head to observe the rise and fall of the man’s chest.

“Equal air entry,” he said, wrapping the stethoscope back around his neck. “Chest is clear. How are you going with access?”

“Eighteen gauge cubital fossa is in,” Charlotte said. “I’ve drawn off bloods and hung a bag of normal saline. It’s running stat.”

“Did you take bloods for a venous gas too?”

“Yes,” Charlotte said.

“Mack, what are his vitals?”

As she continued to squeeze oxygen into the man’s lungs Mackenzie called out the latest blood pressure, heart rate and respiratory rate. She remained at the head of the bed, unsure what else she should be doing. A scratchy voice interrupted her thoughts and she turned in surprise to see a man’s face appear on a small television screen on the wall.

Debbie saw her confused look. “VC,” she said. “Video conference.”

“And who’s that?”

“The RFDS doctor. Craig. He’s a top bloke. Better than the local doctor here. Wait till you meet
him
.” Debbie rolled her eyes before angling the screen so they could all see it better.

“Richard’s been working in the Pilbara for almost two years,” Amy said, “but he’s only just started to accept that we actually know what we’re doing.”

“We call him Dick, not Richard,” Charlotte added.

“That’s because he is,” Debbie stated. “Don’t worry, Mackenzie, you won’t have much to do with him, but just remember you’re employed by the agency to work at the hospital. Sometimes you’ll have to remind him you’re not his personal nurse.”

“Let’s get him sedated and then can we get x-rays?” Craig’s voice came clearly through the speaker. He gave orders for the medication doses and Amy drew them up, showing them to Mackenzie for confirmation. Midazolam and Fentanyl. Mackenzie nodded and watched as Amy put the syringes in the drivers and pressed buttons on the pump to allow the fluid to flow into the man’s veins. She was back in familiar territory again.

“Radiologist is on his way, Craig,” Doc said. “Lucky he’s in town overnight.”

“No worries, Doc. Have you done your secondary survey?”

“On it now.”

“I’ll stand by,” Craig said.

“Let’s get him rolled,” Doc commanded. “Mack, let Dave bag him while you hold his head.”

Mackenzie held the man’s head between her forearms, bracing her fingers against his shoulders. “On three,” she said when everyone was in position. “One, two,
three
.”

They rolled the man on his side and Charlotte reached in and yanked the remaining clothes out from beneath his body, cutting the material as she went. Doc began his assessment, running his fingers from the back of the man’s head, down to his feet, looking for any signs of bleeding or obvious injuries or deformities. He listened to his chest and when he was satisfied, they rolled him back. Along with cuts and abrasions, he had a number of deep lacerations that required suturing, but nothing appeared life-threatening. As they checked his limbs and skin, the radiologist arrived and slid hard boards under the bed. They waited nearly twenty minutes for her to take the x-rays, and another five before Craig’s face appeared back on the screen.

“Can’t rule out a possible fracture at C-five. And looks like he’s got a fractured right femur too. He’s a mess. Probably got a stack of internal injuries I can’t see. Wheels up here in twenty minutes. Good job, Doc. Everyone.”

“Right, we need to get a naso-gastric tube and catheter in. Mack can you do that?” Doc spoke after the screen faded to black.

“Yes.”

Amy pointed to a cupboard and Mackenzie opened it to find well-stocked shelves. She gathered the equipment she needed. First, she inserted the naso-gastric tube down the man’s nose into his stomach and secured it firmly to his nose with tape. While she did that, Charlotte inserted the urinary catheter. Blood-stained urine began filling the bag.

Doc frowned. “Someone tell me his vital signs again. And what’s his temp?”

“BP’s dropped,” Amy called out.

“Sats are fine. No worries with his airway and breathing,” Dave added.

“Get Craig back online and get an order for Norad,” Doc said. “While we’re waiting, let’s go from the top again.”

Mackenzie checked the man’s pupils with a small torch. They were equal and reacting. She then inspected his nose and ears – there was no discharge. His face seemed to be straight from what she could tell, although his nose may have been broken. Doc listened again to the man’s chest then palpated his abdomen gently, frowning as he listened intently with his stethoscope in his ears.

“Debbie, someone needs to call this kid’s parents.”

“I’ll get one of the St John guys to track them down,” Debbie said. She pointed to the young man’s clothes in the corner. “Can one of you guys check through his pockets and see if you can find a phone or wallet,” she instructed. They did as they were told, finding what they were looking for and left to contact the police. It was their job to notify his next of kin.

*

It was almost ninety long minutes later before they had the call to say the plane’s arrival was imminent. They loaded their patient back onto the wheeled stretcher and into the ambulance and made the ten-minute drive out to the airport in eight minutes. Doc and Mackenzie went with Dave in the truck while Debbie, Charlotte and Amy stayed behind to begin their assessment of the other passengers from the car. Dave and the St John Ambulance volunteers had done a basic triage on the scene and ascertained none of them had life-threatening injuries, but had brought them to the hospital anyway.