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‘Got it.’ Mikki was already halfway into her overalls. ‘Hey, Tama?’
‘What?’ Both the tone and the eye contact were reluctant.
Her smile was almost shy. ‘Thanks.’
His only response was a grunt as he jammed his helmet over his head. What was it about this princess? How could just a smile—and not even a real one at that—stir some odd sensation in his gut?
He couldn’t identify the sensation but it made him feel…bigger somehow. Important. Powerful, even.
Confusing, that’s what it was all right.
And Tama James did not like feeling confused.
This was so exciting!
Mikki would have hugged herself with the sheer thrill of it all but imagine if Tama saw that? He’d already caught her stroking her new overalls like some dreamy bride mooning over her confection of a frock.
She kept herself very, very still in her seat, thankful no one could see what was happening inside. The way her heart lifted to her mouth to mirror the helicopter rising into the air and then beat a tattoo against her ribs as they took off into a clear, blue sky. The way her stomach swooped and clenched when they hit some turbulence.
Don’t be sick, she begged silently. Please!
‘You all right?’ Tama was giving her a suspicious look. Had he guessed her inner turmoil and the very real possibility that her stomach might not cope?
‘I’m good,’ Mikki assured him. And she was. She had to be!
‘It’s about a twenty-minute ride,’ Tama said, still watching her. ‘There’s two vehicles involved and the fire service is only arriving on scene now so we might arrive to find people still trapped.’
Mikki nodded. Her head felt heavy with the unfamiliar helmet and her nod was probably over-eager. She became still again. This was her first opportunity to show Tama what she was capable of professionally and she was determined not to mess it up.
‘Take a look around in the back here.’
They had their helmet radios on a different channel to the one Josh and Steve were using as they discussed navigation. Tama’s voice, inside the helmet, was so clear and close it was disturbingly intimate. As though he had his mouth right beside her ear, his lips close enough to touch her skin.
And that gave Mikki a shiver to add to the strange physical sensations this ride was already clocking up.
‘We haven’t had a chance to go through the gear in here.’ Tama’s voice continued to caress her ear. ‘Might be a good idea if you at least knew where the basics were.’
She was ready for the weight of the helmet this time. Her nod was carefully controlled.
‘You can talk, you know,’ Tama said drily. ‘You’ve got a mike as well as earphones in there.’
‘OK.’
‘See where the portable oxygen is?’
‘Yes.’
‘There’s adult and child masks, acute and nebuliser, plus a non-rebreather in the pouch.’
‘What’s in that big pack?’
‘It’s called a Thomas pack. It’s got pretty well everything and it’s what we take from the chopper for a job like this. Blood-pressure cuffs and a stethoscope, chest decompression sets, intubation gear, bag mask unit, IV gear, fluids and drugs. We’ll go through it properly when we’re back at base.’
Mikki had a sudden inkling of what this was like from Tama’s viewpoint. She was being allowed out on a job before she really had any idea about resources and protocols. Before he had any idea what her level of skill was. He was probably thinking—quite rightly—that she could be a hindrance rather than any help.
Mikki took a deep breath and tried to quell her rush of nerves but they came back with a vengeance when they slowly circled the scene and came in to land. The view from up high was spectacular but getting the big picture with such clarity made this all seem almost overwhelming.
Traffic was backed up for miles in both directions, with police cars blocking the road well away from the accident site, so that even before Mikki could glimpse what they were heading for, she already had the impression it was major.
More police cars. Fire engines and two ambulances and so many people made up the inner circle and there—in its centre—were two horribly mangled vehicles. A car and a small truck. Mikki could see someone lying on the ground and another sitting with ambulance officers in attendance. And, judging by the cluster of rescue workers, someone else was still trapped in the car.
Multiple patients, potentially critically injured, but it shouldn’t be throwing her into this kind of a spin. She dealt with the aftermath of MVAs all the time in Emergency and she was good at it. They often had more than one victim arrive from a single incident.
But this was very, very different.
These people hadn’t already been triaged and stabilised by competent paramedics. Removed from a scene of carnage to arrive neatly packaged on a stretcher into a department that was well prepared with equipment and personnel. This was frontline stuff with an emotional element Mikki hadn’t expected, thanks to seeing the lines of traffic and the scope of the rescue effort and being there—in real time—to imagine the shock of having one’s life so unexpectedly thrown into chaos.
You know what to do, Mikki reminded herself as the helicopter touched down in a paddock beside the road, far enough away for the rotor wash not to create havoc. It’s basic. Airway, breathing, circulation. Assess each one and deal with it if it’s not adequate before moving on to the next. It may be more difficult and messier out here in the field but the priorities were the same.
And this was exactly where she wanted to be, wasn’t it? Frontline. Dealing with all the complications any kind of environment could create. Relying on her own skills and resources that would be far less than those an emergency department could offer. She wasn’t being thrown into this alone, in any case. She was with someone who was the top of their field. She was here to learn.
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 might be about to lose this challenge.
Tama positioned himself and the patient’s head. He inserted the laryngoscope.
‘Give me some cricoid pressure,’ he instructed seconds later.
Mikki pressed on an Adam’s apple that was actually hard to locate in an already thick neck that had severe swelling going on as well. If things were this hard from the outside, what hope did Tama have of slipping a tube through the airway internally?
Very little, but he managed. Almost instantly, he slipped the tube into place and then straightened to secure it and attach the bag mask to the end of the tube. Mikki picked up the unit as Tama placed his stethoscope on the chest. She squeezed the bag as he listened for lung sounds and then placed the disc below the ribs to exclude air going into the epigastrium.
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