Penetrating Trauma

With the onset of summer, one of our more long standing epidemics is raising its head and demanding it not be forgotten

In the north end of Hartford that means penetrating trauma — the knife and gun club.  In my earlier years in the city, I often worked nights when the trauma numbers were highest,  The last several years my shift was Sunday through Tuesday 5:30-AM-5:30 PM, not really prime hours for trauma.  Lately, I have been working Fridays from 9 AM to 7 PM in a city fly car where I respond to all 911s, often arriving before the ambulance and in many cases, before the fire department first responders.  Along about four on a Friday afternoon, people start to get riled up. 

I am slowly getting back in form.

Transport times are very short in Hartford with two level one trauma centers not two miles apart.  I find traumas challenging, but often unsatisfying.  The challenge is to accomplish as much as you can in as short a time as possible.  The lack of satisfaction is that the call is often over in minutes.

I am 100% in the “bag and drag” school of trauma for those cases where a surgeon is (or likely might be) needed.  Stop an immediate life-threat — bleeding, tension pneumothorax, sucking chest wound, and then haul, doing everything on the move. In cases of gunshot or knife wounds, the damage is internal and there is not much I can do but get them to the hospital.  I used to tell medics I was precepting the priorities in trauma were find the injury, get them on the stretcher, tell your partner to go (safe, but fast), call the hospital with a trauma alert, remove or cut off the patient’s clothes and get the patient’s name, date of birth and social security number, all while trying not to get any blood on yourself.  With any extra time, get an IV, give pain meds if not contraindicated and unload.  On arrival, hand the registrar the name, dob and social security as you pass her, and into the trauma room, where you give a quick report to the trauma team, and then go write your report. 

Your measure of success is not how pretty your patient looks when you come in the trauma room, but the time from when you arrived at the scene to the time you arrive in the trauma room. 

Think of an imaginary stop watch over the trauma bay.  If you break the tape at 6:43:02, that’s better than bringing in a neat looking patient at 12:56:14 

Sometimes I don’t even try for an IV, others I don’t have a blood pressure beyond saying I felt a radial pulse.  

It’s okay. I can’t count the number of times I’ve had IVs pulled and ECG wires cut by overanxious members of the trauma teams.  If I do have time, I will wrap cling around the IV to better secure it, and I often yank the monitor wires myself on arrival at the hospital (unless there is good cause to keep the patient on the monitor for the sixty seconds it takes to get in the trauma room).

You can be sitting in the EMS room, get a call for a shooting down the street, and be back in the EMS room writing your report before ten minutes have passed.  Sometimes it can be so quick, another EMT can get up to use the bathroom and then come back and find you are still there.

“You know you got some blood on your shirt,” he says.

You notice it for the first time.  “Damn, I’m losing my edge.”

“Friday night.  Craziness will be starting soon,” he says.

You answer.  “No doubt.”


Note:  the illustration above is the cover of a great book of photography, The Knife and Gun Club by Eugene Richards.  It is out of print now, but you can get a used copy here:

Knife and Gun Club


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