the perfect call ...

september, 1992.

today is my 42nd birthday. my wife and i are spending a leisurely indian summer day preparing for a family birthday party tonight. right now we're at the grocery store, in the parking lot, loading groceries into the department's staff car. it's not that unusual that i would have a staff car on my day off. i occasionally go on calls when i'm not dispatched for qa purposes, or to assist with the overhead on the bigger incidents.

it's hard to believe that fall and winter will soon be here. today is warm and sunny -- shorts and t-shirt weather -- and i notice, with just the hint of a slight smile, that there are plenty of ladies taking advantage of today's sun.

as i'm closing the trunk after loading the last bag of groceries my pager shrieks to life: "car/pedestrian accident, subject down, not moving, unconscious, breathing not verified." the address given by dispatch is about midway between me and our outlying station. we slide into our seats, buckle up, i hit the emergency lights and siren, and put myself in route.

it's an easy drive, not too far off the highway. traffic is light. we're making good time. i call dispatch and ask for an update. i'm given the same information as before, but this time she adds that our patient is a 10-year-old boy. i have dispatch put airlift on standby and make sure that in addition to the engine, rescue, and ambulance that was originally dispatched, a medic unit is also responding. disptach assures me they are and that we also have an additional engine responding.

my gut is starting to churn. this could be a difficult call for everybody.

i arrive ahead of the engine and ambulance, driving past the incident and parking just behind the vehicle and patient to block the road and give the crew a safe working area. this is a dangerous piece of road with a long downward hill and a blind corner above that. the ambulance and engine are coming from the opposite direction. i tell the ambulance to pull past the incident and decide to have the engine block both lanes of travel behind us. there will be a lot of work to do here and we'll need all the road to do it.

as i drive slowly past the incident i see that the car has significant front end damage and that the driver is still in the car, holding onto the steering wheel with both her hands. she looks young and very scared. i tell her i'll have somebody taking care of her as soon as we determine the needs of the boy. our primary patient, the 10-year-old, is lying mostly beneath the rear bumper, legs sticking out, not moving.

i give a quick short report to dispatch and request that they fly airlift to our location. they should be here in under 20 minutes.

the ambulance crew arrives with their equipment, slides the boy carefully but quickly out from beneath the car onto a backboard and determines that he has a pulse and is breathing. the engine crew has blocked the road behind us, set up flares to warn oncoming traffic, and is now also with us.

the trauma exam reveals that the boy has significant head and facial injuries, lacerations, avulsions, abrasions, bruising, and a possible fractured arm. he beings to regain consciousness, but also becomes combative -- not necessarily a good indicator. a witness tells us the boy was hit, thrown over the car, somehow caught on the rear bumper, and dragged approximately 50 feet. from the mechanism we all suspect he has significant internal injuries as well.

the incoming engine company notifies me that they are about a mile out and asks for an assignment. i tell them to find a place for airlift to land and give them the job of command of the landing zone. it's their job to find a safe and suitable landing area, establish communications with the helicopter pilot, and then report weather and landing zone situations. today is extremely clear, there will be no weather issues, but we are in a fairly heavily wooded area and most likely they will end up using somebody's yard or field for the landing zone.

the emt's on the ambulance are doing an extremely good job, as are the emt's from the first engine. we train hard at keeping our skills intact. and the taxpayer's have given us good equipment to work with. this is teamwork and there is little need for discussion or direction as to what needs to be done. our patient is on a backboard, with full cervical spine precautions taken. his wounds are exposed and treated. i can hear the siren from the medic unit arriving and i give them a quick short report as they pull up to the scene.

i step back and survey the incident. we now have plenty of hands on scene and work is going well. i assign an emt to take care of the driver. a landing zone has been established and i hear the airlift pilot talking with the landing zone engine company officer. the medics are dropping a tube in the boy's trachea to keep him breathing and prepare him for the flight to harborview, our state's trauma center.

as i turn i notice my wife talking with a woman in the driveway behind us. she's pale, shaking, and sobbing. this is obviously the boy's mother. shit! i should have seen her earlier and taken care of her too. i know how frightened she must be. emergency medicine is not pretty. she should have been told what we found and what we were doing. i promise myself i will do a better job next time.

my wife doesn't really know what i do either, or what emergency medicine and firefighting is all about. this is the first time she has been on a bad call with me. but she's been doing a great job with mom.

i introduce myself to mom and tell her that her son has some very serious injuries and that the best place for him will be at harborview hospital. we will be flying him there in a helicopter. before we finish the conversation we feel the beating of the helicopter's blades and then see the helicopter hovering overhead. they land about a half mile from us and the medic unit leaves to meet up with them to transfer the patient to the flight nurses for the trip to seattle.

mom tells me that her son asked if they could bake cookies together. she told him that first he needed to check the mail then they could bake. our witness told me that as the boy stepped away from the mailbox to cross the road, he looked in his direction but not the other, and started to run across the road, with the mail in his hand, back to the house. he never saw the car coming down the hill. and it was too late for the young driver to react and stop in time to avoid hitting the boy.

i asked mom if she was able to get someone to drive her to harborview -- she was too shook up to drive herself. she told me her husband was at the husky game and there was no way to get to the hospital. my wife suggested we drive her there. and so we do.

on the way to the hospital she tells me a lot about her son, how he's doing in school, sports, his brother, and again about baking cookies. she's crying quietly, and i search for comforting words -- few are found. i stay in touch with dispatch and advise them of our trip to harborview and that dad is at husky stadium and ask if they can find a way to contact him so that he can meet us at the hospital.

traffic is light on i-5, and we make it to harborview in good time. thankfully so, i've run out of words.

as we walk into the emergency department, dad is there! dispatch was able to call the stadium and have him paged. i cannot imagine how horrible it must be to hear your name over the stadium speakers, asking you to come immediately to the office for important news. you know it can't be good news -- they wouldn't page you because you just won the lottery.

their son spends little time in the emergency department getting an exam, blood draws, x-rays, and scans before being sent to the operating room. harborview is quick and efficient. there are more docs, nurses and techs working on him here than we had on-scene. a doc comes out of the er and tells them what injuries they found, what they've done, what they are going to do, and what they expect to happen. i listen in. i feel good about his outcome. we leave quietly, allowing mom and dad their needed moments together.

in the months that follow the boy makes good, but slow, progress. it takes a long time to heal that many wounds. mom and him stop by the station occasionally to say hello and thank us for what we did. months later he is still in a wheelchair, but his neuro and motor function are returning to normal and soon he'll be up and walking on his own. i think that there will always be slight defecits from the accident, but nothing traumatic enough to slow him down.

in the years that follow i lose touch with him and his parents, but i think often about how perfectly everything went that day for him. we had a witness that called 911 immediately and gave a good report and a valid address. the fire department was on-scene quickly and gave great basic life support care, followed by the medics with advanced life support. after a quick transport by airlift to harborview, he saw some of the best doctors available. and after his treatment at the hospital he received expert physical therapy. and love from his parents and family.

perfect. that is how it is supposed to work.

january, 2001.

i'm on shift today as battalion chief. it's just after midnight. we're bolted from our sleep by our pagers. one-car motor vehicle accident. vehicle on its top. utility pole sheared. occupant trapped, unconscious and not responding. the address is just a half mile from our outlying station. i know the crew will be there quickly, going to work and giving me a good short report.

i'm on the road, asking dispatch for an update. they don't have any more information than that given earlier. i have them put airlift on standby.

the rescue and ambulance from the outlying station arrive and give their short report: pickup on its top, pole sheared abut 4 feet from the ground. major damage to pickup. driver of vehicle pinned beneath pickup. no pulse, no respirations. major trauma to driver.

i arrive and establish command, giving directions to the incoming units before stepping out of the command car. when i open the door to get out it hits me -- the feeling of death in the air.

it's like the taste of a bad penney. chewing on aluminum. staring into the sun. biting odors. it fills my senses -- smell, taste, feel. i don't know where it comes from or how long i've had this horrible super power. but i know i'm not alone -- many others in the emergency services have the same feeling.

for a moment i'm stunned. my adrenal gland goes into hyperdrive. i can feel my pulse and breathing quicken and my brain goes prehistoric, telling my body to flight or fight. i concentrate on the tasks at hand and bring myself to action.

i have the ambulance crew re-check for a pulse. there is none. and by the injuries i can see i know there will be no attempted resuscitation of our patient. he is doa -- dead on arrival.

i cancel airlift and the medic unit and have the incoming fire engine block the road well away from the scene. i want to keep everybody away that doesn't need to be here. this is not a pretty sight. the police will be arriving soon and will want information to begin their investigation.

looking around i see a car-load of kids standing by the road near the overturned pickup. i walk over to them and ask what they know. they tell me the pickup was passing them, lost control, and rolled into the ditch, striking and severing the pole, throwing the driver from the pickup and trapping him beneath it.

they know who he is and tell me his name.

for a moment i can't breath. my eyes blur. i'm unsteady and want to sit down. i don't want to be here -- but i do want to be here.

this is the same boy who was hit by the car after getting his mail in 1992. the one we airlifted out. who, with his mother, visited us at the station to thank us and show us his recovery progress. our perfect call.

i steady myself against the ambulance and have the crew check for a pulse again. i so want there to be one. but i know there won't. there can't be. not with those injuries.

i survey the scene again, making sure we're doing everything we possibly can. i see a car stopping near the scene. it's his mom and dad. one of the kids drove to their house and told them about the accident. they live nearby. i don't want them here. nobody should see this.

they park where they can see the pickup but can't see their son lying beneath it. i run through the mess of people, vehicles, and debris on the road and meet them as they are getting out of their car. i remember how poorly i handled the call years ago and how i promised it would not happen again. they look worried -- no, it's not worry, it's terror. "what is happening?" they ask. but i think i know that they know exactly what is happening.

i explain to them what we found and what we are doing, but that it doesn't look good. he has no pulse and he isn't breathing. and we can't get him out from under the pickup quickly. i have to tell them the truth. lying wouldn't do anybody any good. they ask if we've done everything -- if we could check him just one more time. i send a firefighter to check his pulse again. but we know what the answer will be. they hear the firefighter's reply as he radio's back to me.

i ask them to go back home. to wait. i will be there just as soon as possible. and i will bring our chaplain to help with phone calls and arrangements. there is nothing they can do here. there is nothing we can do here.