Extreme Medical Services: Medical Care On The Fringes Of Humanity (7 page)

   
“Do you want me to do the vehicle and bag check while you rest up?” Dean asked.

   
“No, I’ll help out,” she said. “I’m supposed to make sure you know what you’re doing and you might miss something we need, though usually Bill and Lynne leave things in good order.” The two of them went into the bay and began going over the ambulance, double checking the supplies in the med bag and all the cabinets. As Brynne had said, all was in good shape.

   
Dean was considering a cup of coffee but the first tones of the day dropped as they were coming back into the squad room. “Medical Box U-301, sick person, 1273 River Road at the community pond picnic area.”
 

Brynne took the driver’s seat and Dean jumped in the passenger side. He was looking forward to when she would let him drive. It was always a thrill to operate an emergency vehicle with lights and sirens. He picked up the microphone as she pulled out. “U-191 responding.”

   
“U-191 Responding, switch to med channel 2,” returned the dispatcher’s voice.

   
Dean switched the radio over to the med channel and keyed the mic. “U-191 on med channel 2.”

   
“U-191,” the dispatcher said, “Respond for an unresponsive adult female found by work crews at community pond. A crewmember will meet you at the parking lot entrance. No additional information at this time.”

   
“U-191 copies,” Dean said. “This is on the other side of town. It almost makes sense to send another unit until we can get there.”

   
Brynne accelerated up the onramp for I-95 northbound. It was the fastest way to the other side of the city. “We can’t be sure what kind of Unusual we’re dealing with. A regular crew would be in over their heads. I hate that we’re the only unit for these calls when we have to drive fifteen minutes to get to the patient. I’ve asked for them to place another Unusuals unit on the other side of town to get better coverage, but they say that there just isn’t the call volume to justify it. Let’s hope we don’t have a cardiac arrest by the time we get there.”

   
They pulled into the parking lot in the park next to the community pond about thirteen minutes after they left the station. True to the dispatch instructions there was a guy in jeans and a t-shirt with muddy work boots and one of those hi-visibility neon orange and yellow vests on. His hard hat was in his hands as he ran his fingers through his hair.

   
He started talking as soon as they got out of the vehicle. “We found her down by the edge of the pond. We’re pretty sure we didn’t hit her with any of the equipment. Eddy was backing up in the Gradall excavator when he saw her in the grass.”

   
“Where is she now?” Brynne asked as she walked around the vehicle.

   
“We didn’t move her,” the guy said. “She’s all the way on the far side of the pond.”

   
“What pond?” Dean asked, looking at the broad, muddy basin in front of them with a small pool of water in the middle. “Where’s the water?”

   
“We’re draining the pond to fix the outlet system,” the worker said. “It’s gotten clogged with debris and we needed to drain most of the water out of it to get to it.”

   
Brynne went to the rear of the ambulance. “Let’s pile the gear on the stretcher and roll it over there. I don’t want to drive the ambulance around there and risk getting stuck.” She opened the two rear doors, released the stretcher from its locking mechanism and pulled it from the back of the unit.

   
Dean came over and started placing the bags on the stretcher. “I’ve got the med bag, BLS bag, oxygen and airway supplies.”

   
Brynne climbed in the back, grabbing the heart monitor off the shelf and the portable suction machine from its charger. She placed them on the top of the stretcher, taking a moment to secure the monitor in place with one of the straps. “Let’s go.”

   
With Brynne at the head of the stretcher and Dean at the foot, the two began rolling the stretcher across the uneven ground around the pond’s banks. They found a group of construction workers clustered around one of the pieces of equipment. Two of them were kneeling next to a woman who looked to be in her early 20’s. She was dressed in what looked like a short pale blue nightgown, thin and slightly see-through.

   
Brynne spoke up, “Who’s in charge here?”

   
“I am, ma’am.” A tall man in his 40’s stepped forward. “I’m Jim, the foreman. Eddy said he didn’t hit her and it doesn’t look like she’s hurt, but we can’t wake her up.”

   
“Okay, Jim,” Brynne said. “I need you to clear most of the guys out of here but you.” She gestured to the big Gradall machine. “The guy who can run this vehicle should stay in case we need to move it.”
 

She and Dean moved over to the woman on the grass. She didn’t look injured from what they could see. Brynne reached into her pocket, pulled out a pair of exam gloves and put them on. “Dean, you get a set of vitals and put the heart monitor on her while I do a head to toe exam.”

   
Brynne knelt down next to the girl, touching her on the shoulder and giving a gentle shake. “Miss, hello, are you alright?” There was no response. She used the knuckles of her hand to rub the woman’s sternum and got a groan in response. The woman’s hand came up and brushed feebly at hers to push it away. “Alert to painful stimuli only,” Brynne reported to Dean. She carefully ran her hands through the woman’s dark hair, gently lifting the head up as she did so. She checked her gloves for blood as she pulled them away. Lifting each eyelid in turn, she shined her penlight in them then moved it away. “Both pupils equal and reactive to light,” she said.

   
Dean hooked up the automated blood pressure cuff and hit the button on the heart monitor to start it inflating. While that ran, he started connecting the leads from the heart monitor to the woman’s arms and legs. Once all four were connected, he looked at the heart monitor’s screen and the lines started bouncing across it. “Sinus tachycardia at 156,” he said aloud. “Blood pressure is,” he paused briefly to look at the monitor as the numbers stopped changing. “Blood pressure is 92 over 48.”
 

   
He picked up her wrist and palpated a pulse with two fingers, watching the monitor screen to match the beats on the screen to what he was feeling under his fingers. Her pulse was difficult to detect, no matter how he moved his fingertips around. “Pulse is weak and thready.” He checked his wristwatch and watched her chest rise and fall. “Respirations, 26 and pulse ox 96.”

   
Brynne continued her head-to-toe check for signs of injury. She checked the back of the neck, the rib cage, sternum, abdomen, and hips in turn. The whole time, she watched both the patient’s face for signs of grimacing in pain and frequently checking her gloves for signs of blood. She moved down to the legs and bare feet, before moving back up to the arms.
 

   
“No sign of injury,” Brynne said. “Let’s roll her. I want to get a look at her back.” Together, they carefully rolled the woman up on her side and scanned her back. There was no sign of bleeding or other injury. The laid her back down in the supine position. “Okay Probie,” she said. “Thoughts?”

   
Dean thought for a moment then picked up her hand and gently pinched the end of her finger at the fingernail, watched the color change and counted in his head. He looked in her mouth at her tongue and pulled her lip out gently, looking at the skin inside. Finally, he pulled up at some skin on her forearm closest to him. It stayed pulled up briefly like a peaked tent.

   
“Severe dehydration is my best guess, boss,” he said. “She’s got signs of shock with altered mental status. Capillary refill time is four seconds. Mucous membranes are dry and skin turgor non-existent with tenting.” He looked around. “My only question is how did she get here? The guys on site swear they never saw her when they first got here. They said she just appeared. Since we’re here, I guess there’s an Unusual connection somehow. You didn’t find any sign of injury or bleeding so we’re not looking at a vamp attack, right?”

   
“You’re right,” Brynne said. “If I were to guess, I think she’s the Naiad tied to this pond.”

   
“The what?” Dean asked.

   
“Naiad, a water fairy,” she answered. “Look at the pond. My guess is when they showed up this morning and started pumping out the pond to clear the drain field, she got caught unawares. Usually she could have, well, detached herself from the pond and not been affected so much.” She looked up at her partner. “So what do we do?”

   
“Okay,” he began. “Her oxygen sats are ok, no O2 needed right now. I’ve got the monitor hooked up. IV access next with a bolus of fluids to get her hydrated. We should also get her back to the unit since it’s hot out here. That might contribute to dehydrating her, plus how she’s dressed, or should I say, undressed is getting too much attention from these guys.”

   
“I agree,” Brynne said, nodding. “But we can’t move her farther from the remaining water in the pond until we get fluids in her. You start the IV. Remember to go large, we need to get fluids in her quickly. I’ll get the IV bag spiked and ready.”

   
Dean got the IV pack out of the side of the med bag that had all the supplies to get a line started. He tied the elastic tourniquet off a few inches above her elbow and then got out a few two by two gauze pads, two alcohol prep swabs and selected an 16 gauge needle to establish the IV access. Turning back to the patient, he gently palpated the antecubital space on the inside of the elbow, feeling for the big veins there.
 

   
“Brynne,” Dean said. “I’m having trouble finding the vein. Maybe she’s too dehydrated?”

   
Brynne came around to his side of the patient and handed him the IV bag. “Finish getting this set up while I take a look.” She knelt down next to the woman’s side and checked her arm, looking and feeling with her fingertips. “There,” she said holding her finger on the spot she found while she picked up one of the alcohol preps, Dean had already ripped open. Lifting her finger up, she swabbed it in a circular motion.
 

   
Dean handed her the 16-gauge needle catheter he’d selected. Keeping one hand holding the arm, she pulled the needle cover off with her teeth, spitting it onto the ground while she pulled the skin tight with her thumb just below the spot she’d found. Advancing the needle in at nearly a forty-five-degree angle at first, she then leveled it out, watching closely for the flash of blood in the chamber. There it was. She advanced a few millimeters more then slid the plastic catheter forward off the needle as it slid back with a click, safely stowing it in the housing. Dean attached the IV tubing from the bag, rolling the valve all the way open to allow full flow of fluid into the vein. Brynne taped off the IV on the patient’s arm to hold it in place then stood up.
 

   
Brynne looked at him. “How much fluid do we give her?”
 

   
“Twenty milliliters per kilo,” he answered. “She’s small so I’d guess forty-five or fifty kilos so nine hundred or a thousand Mls. Pretty much the whole bag.” He nodded toward the bag of normal saline he was holding.
 

   
“Okay, we’ll run about five hundred milliliters in and then check her vitals again,” Brynne said. “Mr. Foreman,” she called to the leader of the construction team.
 

   
He came trotting over. “Yes, ma’am?”

   
“I know this is going to seem strange,” Brynne began, “but can you hold off pumping out the rest of the pond for about fifteen minutes? It’s our protocol when on a construction site that all work stop until we clear the scene.”
 

   
“Uh, I guess so,” he said, taking his hard hat off and scratching his head. “Only 15 minutes? I’ve got a lot to try and get done today and the boss wants us to finish up and get the pond filling again before the end of the day.”

   
“15 minutes,” Brynne said. “A half hour, tops. Just until we get her loaded into the back of the ambulance. We need to get her stabilized first.”

   
“What’s wrong with her?” He asked.

   
“Not sure,” she said. “She’s not awake yet so we’re just treating symptoms. We’ll know more when we get her back in the ambulance.”

   
“Okay,” He said. “Let me know if you need anything else. I’ll go shut the pumps down for a bit and give the guys a break.” He laughed. “It’s not like they’re getting anything done right now anyway with all the excitement.” He walked over to his crew, giving some order and gesturing to the pumps still chugging away on the far side of the pond basin.

   
Given the size of the IV line Brynne had started, it didn’t take long to get half of the liter bag of fluid into the patient. Dean, holding the bag up over his head, knelt down and pressed the button the heart monitor to start another blood pressure reading. The pulse rate had come down to 126 and her respiratory rate was down to 20 possibly showing that her body wasn’t working as hard to get blood around to the various organs and tissues. The blood pressure came back as 104 over 54. All signs were good.
 

   
Dean heard a sound and looked over as the patient’s eyes fluttered open. “Wha- what happened? Who are you?” she asked looking up at him.

   
Her eyes were a deeper shade of blue than Dean had ever seen before. “You’re doing alright,” Dean said, reassuring her. “We got called here when the construction crew found you here next to the community pond in the city park. I think you’re dehydrated so we’ve started an IV and are giving you some fluids. Can you tell me your name?”