Being an EMT

This is a true story.

Shortly before 0748 on 1/4/05 I was waiting on the inbound platform at the [redacted] commuter rail stop in [redacted], facing away from the platform and chatting with fellow commuter [redacted]. As the 0748 train arrived and slowed through the platform area [redacted] gasped and flinched and moved away from me. Since I’d had my back to the train as it arrived I hadn’t seen or heard anything unusual, and I spun towards the train but only saw other people scattering and shielding their eyes. At first I thought the train had kicked up some debris into people’s faces, but when I turned back to [redacted] and asked what had happened he told me a man had been hit by the train. I asked him to call 911 immediately.

I ran up the platform looking under the train until I found the victim. I recognized him right away as a man I’d been seeing at the [redacted] stop for years: middle-aged, a grey mustache, frequently in a [redacted] cap. He was lying supine in the gravel between the concrete platform and the nearest rail and I saw that his left leg had been raggedly amputated halfway between his knee and ankle. His calf muscle and some tissue was all that remained of his lower leg.

He made a gurgling, snoring noise and I climbed down under the train so I could open his airway. I tried a jaw thrust but his snoring didn’t decrease, so I had to tilt his head back and lift his chin. It worked; his breath sounds improved.

I continued to survey him from my position at his head. The bleeding from his stump was dark and oozing—venous in character rather than arterial—and I saw no evidence of bleeding or other trauma anywhere else on his clothes. I did see possible deformity to his right ankle but it may have just been the position of his leg. His color was grey and his pupils were equal and sluggish. While I didn’t shake him (being mindful of the possibility of spinal injury) I did shout “Sir, sir?” into his ear. He blinked but didn’t speak.

A conductor asked me who I was and what I was doing to help. I told him I was an EMT and asked him to get 911 on the phone so I could relay information to rescuers.

A woman volunteered to help me. I instructed her to take control of the victim’s airway and I showed her how to do it. As we were transferring control I moved my hands to the back of the victim’s skull and found it to be sticky with blood, although I felt no softness, crepitus, swelling, or other signs of skull fracture.

I crawled from the victim’s head to his left side and immediately applied pressure to the femoral artery in his left groin. I noticed the bleeding from his stump lessen. In a few moments another bystander I knew from the train named [redacted] offered to help, and at the same time a woman offered us a pair of latex gloves. I told [redacted] to put on the gloves and I gave him instructions on how to take up pressure on the femoral artery. As [redacted] took pressure the victim’s breathing slowed and I told the woman at his head to look, listen, and feel for breath sounds.

I think this was when someone told me a bystander had gone up [redacted] Ave. to the firehall to get help.

I returned to the victim’s head and checked the victim’s breathing for myself. He was barely breathing and I was getting ready to assist him with mouth-to-mouth, but he started gurgling loudly and I realized the problem was that his airway was becoming obstructed again. I looked in his mouth and saw a buildup of yellowish matter in the back of his throat. I was reluctant to roll him but knew I had to get his airway clear, and I instructed the woman and [redacted] to prepare for it. As we were setting up for the roll, though, the victim’s breath sounds improved and I cancelled the maneuver.

More bystanders offered help. I asked them to search underneath the train for the victim’s missing foot. I told them they didn’t have to touch it but needed to find it for EMS. They searched but couldn’t locate it. One theorized that it might be under the victim.

I heard sirens. At about the same time a bystander informed us that the victim is epileptic, and [redacted]told me he could see a med-alert bracelet on the victim’s wrist. He also pointed out what looked like a deep bruise on one of the victim’s hands.

A couple of people offered me their belts, thinking I’d want to use them as tourniquets, but I declined. I thought [redacted] was doing a good job controlling the bleeding—it was relatively slight, in relation to the severity of the injury, and still oozing and venous in character—and I didn’t want to compound the damage to the victim’s leg. If I’d seen spurting blood or if high arterial pressure had become ineffective, I’d have used a more aggressive technique.

I continued surveying the victim and trying to get a verbal response from him. His eyes were growing heavy-lidded and I kept calling out to him. I opened his eyelids with my fingers and tried to assess his pupils for reaction by shading and unshading them. His pupil response was sluggish and he remained unresponsive to my voice, though his eyes did dart from side to side a couple of times.

I looked up to see EMS workers arriving. I’m pretty sure less than ten minutes had elapsed since the accident. I’m not sure who arrived first, [redacted] Fire or [redacted] EMS. I communicated the situation to a paramedic who slid in beside me, up on the platform.

I asked the paramedic for an OPA and he gave it to me, but when I tried to seat it in the victim’s airway he gagged it back out.

The paramedic handed me a c-collar and I started putting it on the victim. I started working on this and the medic climbed down next to me and asked to take over. I helped his team roll the victim onto a long board and strap him down. They put him on 02 with a non-rebreather.

I noticed the victim blink several times as the paramedics and firefighters lifted him out from under the train and onto a stretcher. They rolled him to the ambulance. [redacted] and the woman who had helped with the airway and an eyewitness and I stayed behind for a few minutes to answer questions from police.