That day had been normal like so many others, I was 'attending', which means I was the Paramedic in charge of patient care and treatment. We had completed a few calls, coffee was running through the veins, the sun was out...a good day so far. We had just cleared the hospital when a call came through on our computerized information system located in the cab of our ambulance. 'Code 3' for the high fall. I scrolled through the information gathered about the call, address, reference coding, and short detailing notes. It stated that somebody had fallen from the 17th floor of an upscale condo and the patient was on the pool deck located on the 3rd floor, a fall of 14 stories or about 140-150 feet. As I read out the information to my partner we both looked at each other and said " he'll be code 4 for sure" a reference meaning the patient will be dead. Nobody survives a fall like that.
We arrived on scene just after Police and were quickly ushered into a locked off elevator with all our gear crammed in...full well expecting not to use any. As we came out onto the 3rd floor and through the outside doors to the open air pool deck a mother and young child walk by with horror on their face, testament to the carnage we were about to see. As we rounded the corner I saw the contorted naked body of what I figured was a 20 something male. Just above where he was folded around a wooden sitting bench was the metal railing fence upon which he landed on (see included picture which gives you some gravity of the mechanism of impact) from some 13 stories above. He was motionless and lying on his right side, his left leg was contorted up in line with his upper body, his right leg going down. I could see both arms had open fractures as I neared the the body, blood and tissue oozed from his abdominal cavity. His head was covered in disheveled mess of long black hair, I poked my fingers though his mane to find a carotid pulse. Up until then I had fully expected that he would be dead, to fall more than 140 feet and impale abdomen across a metal fence is to be expectant of certain death. 'da dump..da dump..da dump..' as I felt a steady pulse across my gloved fingers. I looked at my partner and with dumbfound calmness said " he's got a pulse". Just as I said this I saw him open his eyes and look forward, he let out a low powerless moan. I motioned for our clamshell device which is like a plastic backboard that comes apart in the middle to scoop up spinal caution patients.
Suddenly everything changed about this call, my mindset went from ' ah that sucks .. he died' to ' ah shit..let's get to work'. The Fire dept guys had just arrived and together with my partner we set about extracting his crumpled body from the wooden bench and getting him into a position that we could scoop him up with the clamshell. Based on mechanism I knew he could go into cardiac arrest at any moment and also it was highly likely that he would not survive to the operating table, which is what he needed...immediately.
Even though his left leg was going in the wrong direction it was making a pressure point on the eviscerated trauma going on in about his pelvis and lower abdomen. I knew that once this pressure point was removed and the leg brought down into its natural position that he would bleed out in a gushing mess, but really what options did I have, he needed to go and it had to be asap. Everything was ready, clamshell in place, we had him with a cervical neck collar on, oxygen high flow with BVM(bag valve mask) at the ready, the stretcher lined up for a quick departure to the elevator. I designated the pressure point to my partner as we brought his leg down and brought his body into a position where we could get him on the clamshell. Within seconds he was loaded and moving off to the elevator, blood was coming from his abdominal cavity at a steady rate even though we had trauma dressings and my partner had most of his hand sunk into his lower abdomen. I kept a steady watch on his carotid pulse seemingly expecting him to go into arrest at any moment. I had called for one of our Critical Care Paramedics to assist and give enhanced patient care while on route to Vancouver's major trauma receiving hospital. We 'notified' the hospital of our incoming trauma patient. He was intubated, large bore IV's running and his chest darted enroute. Two minutes from arriving at the hospital emergency doors he went into cardiac arrest. We unloaded him from our vehicle and commenced continuous CPR, I road the stretchers lower bar as we calmly moved into the ER trauma room, 'one and two and three..' I quietly said within my brain. A whole slew of emergency doctors and nurses let us transfer our patient over and we gave an accurate story about what we knew, what we had done, and what we observed.
We continued through about another 3 to 4 minutes of CPR while the the ER physician went through his mental checklist, monitor, abdo ultrasound. "Stop CPR!" the doctor called out " ...and thank you everybody" as he looked at us all, he then noted the time to the nurse who was scribing the notes.
And so it was done and we set about cleaning up an absurd amount of blood , feces, and other body fluids. The ambulance was a mess with shit everywhere. In silence for awhile my partner and I did our own thing, each of us reflecting on what had just happened. While we were cleaning up all our gear the Police who were on the call arrived, I asked if they had a name and date of birth so that I could note it on my paper work. As it turned out he was 20 years old that day, his birthday. His younger brother was in having a shower when he climbed over his 17th floor balcony and lept off. Why? we will likely never know.
The rest of the shift rolled on mercilessly, we took time though to go have another coffee and find humour in the tragic call we had just done. Making sense of it all is the best we can do, even if it doesn't make sense sometimes.
Tragic!
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