Burning Flight

"What's coming in?" I ask the charge nurse, an older guy named Paul.
"Hrmm? Pediatric burn victim. Face and hands." He's clearly preoccupied as we rush to clear out the trauma room and set up a burn dressing kit.
Confused I ask. "They couldn't get through over C Med?" Paul had just gotten off the phone.
"Not an ambulance, kid's father's bringing him in."
I nod as I prep a laryngoscope and a few pedi tubes. Burns are tough to intubate as is but if it should close up the airway is gone and you have to cut your patient. Cutting is never the preferred option and its especially unpopular when the patient is a burn victim because of all of the scarring and partially charred flesh that could always flake off and occlude an airway.
We break out tubs of sterile water, sterile dressings cool packs and a ton of fluids for IV infusion. Luckily one of the docs, Rifino is a former flight physician for Worcester's UMASS Lifeflight, a sort of flying ambulance staffed by a doc, a nurse and usually an EMT or paramedic in addition to a pilot. He's on his personal cell phone running around the code room talking to the Lifeflight dispatcher, pulling ranking and calling in favors to get us a bird. As it stands the on duty crew is about an hour out, doing a critical care transfer from Metheun Hospital to the Brigham in Boston.
As I spike a bag of Lactated Ringers I listen to him cajole and work his magic. "Look, Charlene its Jimmy. Yeah the doc from the bird way back in the day. Listen, you know me, I don't wanna tie up a bird with bullshit. I need a crew here, we have a pedi burn coming in......I know he's not here yet but I'm not gonna play games and.....No, I want to stabilize him here and fly him to Shriners...........Face and head thats why. Yeah, two hours? Not gonna cut it. I got no problem calling Boston Medflight and I mean, shit, we're nice and close to Hartford. Well put a rush on this. I appreciate it....thanks." And like that we have a bird in bound after it's transfer run.
When the father finally got to the ED it was thankfully, anti climactic. The kid was in a bad way, eight years old and his entire face is covered in blisters but he can breath with no difficulty and his lungs are clear and equal. His scalp is pretty singed and as I am applying sterile dressings I take to kidding with him, telling about Kojack.
For the rest of the night he is known as Kojack. Once we establish that his airway is infact patent, remarkably its devoid of burns, he's allowed to suck on ice chips. Starting an IV on him was a bitch, his arms were all moosh from the flames. We ended up starting an IO, a needle litterally drilled into his tibia.
While I am cutting off his charred close, I catch a wicked whiff of gasoline. "Hey Kojack," I ask while Paul the trauma nurse rolls his eyes and Rifino kicks all non essentials out of the room. "How did all this happen?"
His voice is clear, another good sign as any kind of hoarseness would be indicative of airway burns. "We were having a bonfire. I threw a can of gas on it and it exploded."
"Oh, shit man thats awful." I say and continue. "You're too young but when my father and I burn stuff in the back yard we like to have some beers. Tell ya what," I pop another bag of ringers into the now empty line. "When you're old enough you come by my father's place, we'll all have a few and I'll show you the right way to have a fire." He laughes and I have an unsettling flashback to the pedi code I worked earlier, silently hoping that he stays as stable as he is.
Burn patients, especially pediatrics, can decompensate really fast. The body can lose a lot of fluid through the wounds, they can go hypothermic and thus sour very quickly. While its important to cool the burns, the body temperature can be dropped as well which can lead to very untoward consequences.
The radio in my back pocket, a cheapo little two way that all in house paramedic techs have to wear, starts to come to life. "Be advised we have lights in the sky." Its one of the hospital police officers out in the parking lot referring to the incoming bird.
I snort through my nose and turn to Rifino. "That was quick." He grins and says its nice to have connections.
Kojack starts to get nervous so I ask. "Whats up, bud?"
He says hes never been in a helicopter before and that hes scared. "O don't worry, these guys are pros. They fly all over the place. Hey, doc," I call over to Rifino. "Our little buddy here is nervous, come over and tell him about how you used to fly and all that." Rifino comes over and starts telling the kid all about the chopper and about what to expect while I explain to the father that because of the burns and the potential for badness, we are going to medevac his son to Boston. Numbly, clearly drained, he agrees and asks if he can fly too. "Dunno, gonna have to ask the flight crew." I tell him as my radio chirps out that the bird has landed.
Two guys in flight suits and an incredibly tiny woman end up coming into the trauma room. The flight nurse is a guy with a graying beard and a MiniMaglite with the LED replacement bulb that I had wanted to buy but had been to cheap to. They check the kid out, take report and tell the father that he can fly with them.
The cool night air, tinged with moist fog feels good as we push our little patient out to the helicopter. The pilot who moonlights as a firefighter paramedic shows me how they revamped the back end of the chopper to allow us to go closer to the tail rotor than before. I jokingly hand the father a plastic bag and tell him. "If you feel the urge to purge, there's two very important places not to do it. One is on your son because he is very suseptible to infection." On cue the pilot chimes in "And the second is on me because I will kick your ass out of my bird regardless of height." The father stares dumbly for a minute then laughes and tells us we are a bunch of clowns.
We retreat to a comfortable distance as the bird takes off and I see a Worcester medic truck with lights going screaming down the boulevard. My radio blares, vibrating against my ass. "Available tech on the air?" Rolling my eyes I key the unit and tell them I am available. "Good, get in here and prep for a possible MI."
A myocardial infarction, our goal is to get any MI patients upstairs to the cath lab within thrity minutes. My personal goal is under ten. Soon after a foley, a 12 lead and a couple of nitros, some morphine and an elevator ride Worcester's enormously fat patient who was indeed having an MI is on the table at the cath lab.
"No mas," I tell the charge nurse. "I'm going on break, I need a sandwich."