A Nurse's Search and Rescue
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Alison Roberts
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10
CHAPTER ONE
‘OH…MY God!’
Victoria Preston had, as usual, timed her journey carefully to avoid the kind of traffic hassles commuters around Auckland, New Zealand were having to face these days.
This scene of total chaos was the last thing she had expected to see on her way to work.
This was no traffic hassle.
This was a disaster!
It must have happened only seconds ago, while Tori had been singing—no, shouting happily—along with the song rattling the windows of her ancient VW Beetle, just before she’d rounded the bend onto the downhill stretch that led to the bridge across the river.
Another car was pulling to a halt on the other side of the bridge, but Tori was officially the first on the scene as she killed the engine on her car and leapt out.
And what a scene!
A logging truck lay twisted across the road, blocking the narrow bridge. The driver’s cab had smashed through the concrete side of the bridge and now hung sideways in mid-air, one giant wheel still spinning slowly. Tori could see the bloodstained, starburst pattern of cracks in the windscreen and a figure slumped over the oversized steering-wheel. The only thing holding the cab above the water, a good twenty metres below, was the twisted coupling holding the cab to a platform now only half-full of huge logs of wood.
The spilt logs had done serious damage to the car the truck must have been trying to avoid hitting as it had come off the one-lane bridge. One had also taken out a minibus, which had presumably been travelling behind the car. The van-style bus lay tipped on an angle to one side, with the weight of a massive tree trunk crushing its side doors.
Tori could see a face in the driver’s compartment of the van. It was the face of a young child and the sound of screaming suddenly cut through the stunned silence that had been the ominous background during the few seconds it had taken Tori to size up the situation and realise the magnitude of this disaster.
‘I’ve called an ambulance.’ The shout from the bridge on the other side of the logging truck was barely audible. ‘How does it look from your side?’
‘Not good.’ Tori was moving towards the minibus. ‘Call the emergency services again. Tell them it’s a multi-casualty incident.’
‘How many people?’
‘Don’t know yet,’ Tori shouted back. ‘I’m about to find out.’
The child in the van was screaming too loudly to hear Tori. She could see a woman in the driver’s seat, her face covered in blood, moving her arms feebly. At least she was moving, which was more than the driver of the logging truck appeared to be. Another child could be seen, huddled in the gap between the two front seats. He or she was crying, adding to the muted sounds of distress coming from within the vehicle, but that child, too, was clearly breathing adequately.
Tori couldn’t see any further into the rear of the minibus. So far she had counted four patients, two of whom were seriously injured. How many more people were trapped in the back of the van? And there was yet another vehicle involved in this crash.
‘I’ll be back in a minute!’ Tori tapped on the intact windscreen of the van and the child in the front stared in wide-eyed terror. ‘You’ll be all right, sweetheart. Just hang on for a bit. I’ll be back.’
This was so hard, leaving the child with such inadequate reassurance and then disappearing from view. This never happened when she was on duty as a triage nurse in the emergency department of the Royal North Shore hospital where she worked. Patients came in neatly packaged on stretchers, with an ambulance officer who could tell her how seriously injured they were. Details of the worst cases would have been radioed through en route, in fact, and the trauma room would have been set up with a whole medical team ready to receive the injured.
This was the front line. A place Tori had never been. Thank goodness she had attended that introductory Urban Search and Rescue course last year. Even the most basic procedures for dealing with a multi-casualty incident were helpful and still fresh enough to be pulled from her brain despite the horror of the situation.
She had to see as many of the people involved as she could. A thirty-second evaluation to determine priority of treatment. Airway, breathing and circulation. Disruption to any of those three were the immediately life-threatening scenarios.
For the purposes of triage, she could take the few seconds needed to open an airway and determine whether someone was breathing, and if they were bleeding badly she could apply a pressure bandage of some sort, but that was about it. She had to find out how many victims there were and what condition they were all in.
If there was any immediate and obvious danger to the victims, she would have to try and move them regardless of their injuries, but Tori couldn’t see anything too alarming. There were no power lines down, the remaining logs on the back of the truck didn’t look like they were going to roll off and she thought the puddle of fluid on the road was water from a crushed radiator rather than fuel with its inherent fire risk.
The children she had seen in the van were breathing well enough to be able to cry. The woman had been conscious enough to be moving. Another glance towards the cab of the logging truck showed the driver to be in exactly the same position as the last time Tori had looked, but even if he was slumped enough to be occluding his airway, there was no way Tori could get into the cab to help.
She could get to the final vehicle involved. A middle-aged man was unconscious in the passenger seat, still held by his safety belt, his head slumped forward. The passenger door was too damaged to open and the driver’s side airbag had deployed and now lay dangling from the steering-wheel like a pricked balloon. A woman sat violently shaking in front of it—a horrible, keening moan issuing from her lips.
Tori was trying to open the back door of this car when another vehicle screeched to a halt. And then another.
‘Has someone called for an ambulance?’
‘They’re on their way.’ Tori eyed the solidly built young man with relief. ‘Could you help me get this door open, please?’
The first attempt failed. Then the man put his foot against the back of the car as he wrenched at the handle. The door opened slowly to the halfway point with a groan and rasp of uncooperative metal.
‘What can I do?’ A woman rushed up to the car.
Tori had to think fast. She had been about to climb into the back seat of this car and position the man’s head to open his airway and protect his cervical spine, but that would immobilise her and there could be others that needed the expertise she had until the ambulance crew arrived.
‘Climb into the back seat,’ she told the woman. ‘I want you to put a hand on each side of this man’s head and tilt it backwards until it’s upright against the headrest.’
‘You can’t do that!’ The young man who had opened the door sounded horrified. ‘I’ve done a first-aid course. You can’t move his neck.. he might have broken it.’
‘At the moment, he’s blocking off his airway,’ Tori explained. ‘He’ll die within minutes if it’s not opened.’
The woman had squeezed into the back seat. She reached for the victim’s head. ‘Like this?’ she asked anxiously.
‘That’s great,’ Tori confirmed. She could see the man’s chest through the window and it was expanding. ‘He’s breathing properly now. You’ll need to stay like that and hold his head in that neutral position until the ambulance gets here and he can get a collar put on to protect his neck. OK? Can you do that?’
The woman nodded but cast a nervous look towards the driver of the car, who was still moaning incoherently. She seemed unaware of the activity around her and was fumbling with the catch of her safety belt but seemed unable to open it. Tori couldn’t see any sign of major bleeding.
‘Talk to her,’ she instructed the head-holder. ‘Try and reassure her as much as you can and encourage her to stay as still as possible. Help should arrive very soon. And I’ll be back as quickly as I can.’
She straightened to meet the challenging gaze of the young man.
‘Where are you going?’ he demanded.
‘There are people in that van. I need to triage them— check how badly injured they are.’
The man frowned. ‘What, are you a doctor or something?’
‘I’m an emergency department nurse.’ Tori could see a look of relief washing over his face and hoped it was justified. She had just put herself in charge of this situation. Taken control of the scene. This person was ready to help rather than argue. ‘My name’s Tori,’ she continued. ‘What’s yours?’
‘Roger.’
‘Come with me, Roger,’ Tori said. ‘We might be able to break a window or something and get the children out of that bus.’
More vehicles were stopping now. In fact, blocked traffic was starting to build up and Tori shouted to a new arrival to watch that people didn’t block access for emergency service vehicles. To her surprise, the man turned immediately to do as she’d requested and her confidence, as she and Roger approached the van, increased steadily.
There was no easy way to gain access to the interior of this vehicle. The log lay over both the bottom of the front passenger door and across the side opening door in the back section. The rear of the van had been crushed by the weight of the log.
Tori caught the gaze of the white-faced child as she approached the minibus again. She had been away for only a matter of minutes and the girl, who looked to be about eight or nine years old, had clearly calmed down enough to watch for her return. Maybe the reassurance Tori had given hadn’t been so inadequate after all.
‘We could break the windscreen,’ Roger suggested. ‘And lift the kid out that way.’
Tori peered through the glass, shaking her head. ‘The glass would go all over the driver and she looks injured enough as it is.’
The woman lying half-crumpled under the steering-wheel appeared to be unconscious but Tori could see some chest-wall movement so she was still breathing. Rapidly. A nasty laceration on the side of her face was still bleeding heavily so urgent medical attention was needed here. The wail of a siren, possibly two, could be heard in the distance now, but Tori wasn’t going to wait for further assistance if there was something she could do to save a life now.
‘What’s your name?’ she called to the girl, still strapped into the front passenger seat despite the 45-degree angle the vehicle was in.
‘Chloe.’ The response was surprisingly audible and it was then that Tori noticed the gap at the top of the side passenger window.
She moved to the side of the van and stood on tiptoe to get her mouth closer to the gap.
‘Are you hurt, Chloe?’
‘My arm hurts.’
Tori could see the distorted shape of the child’s left arm, obviously fractured midway between her wrist and elbow.
‘Does it hurt to breathe?’
‘No.’
‘Is your neck sore?’
‘No.’
‘Does anything else hurt, darling?’
‘I don’t know.’ Chloe started sobbing. ‘I want to get out. Mummy’s hurt, too. Her face is bleeding.’
‘We’re going to help you all get out,’ Tori promised. ‘Who else is in there with you and Mummy?’
‘There’s Jack. He’s hurt his leg. And Toby’s asleep and Holly was crying but she’s stopped now.’
‘Are you the oldest, Chloe?’
‘Ye—es.’
The response was a frightened whimper and Tori’s heart sank. There were three more children in the back of this van and ‘asleep’ or ‘quiet’ could well mean unconscious—or worse.
‘I need you to help me if you can, sweetheart.’ Tori kept her tone as encouraging as she could. ‘I want you to use your arm that isn’t sore and see if you can turn the handle to wind this window down.’ She turned to Roger, who was staring in horrified fascination at the injured driver. ‘Can you try and push the window down to help Chloe open it?’
He seemed relieved to have the distraction of something to do. ‘Sure.’
Sirens could still be heard in the distance but they had been switched off in the two emergency vehicles now arriving on scene. The first was a police car and the second a fire engine. Tori saw some of the gathering crowd of onlookers pointing in her direction and then a police officer moved swiftly towards her.
‘I’m told you’re a nurse and you’ve got a handle on how many injured here.’
Tori nodded. ‘There’s a total of eight victims as far as I can make out. At least two are seriously injured— status two. The driver in the van here and the passenger in that car there.’ She glanced towards the cab of the logging truck again. ‘Possibly a status zero in the truck and there are several children in the back of this van that I haven’t been able to assess yet. How far away is an ambulance?’
‘ETA of about three minutes.’
A fire officer was approaching now. Roger had pushed the window of the van right down and Chloe was calling.
‘I want to get out! Please, get me out now.’
‘Shall I lift her out?’ Roger directed the question at Tori but she looked towards the fire officer. Control of any scene had to be handed on to the most qualified person available.
‘Is she injured?’ the fire officer asked.
‘As far as I can tell, her only injury is a broken arm. We need to get her out to have any chance of reaching Chloe’s mother quickly—and the other children in the back.’
‘I’ll get her, then.’ The fire officer was both taller and broader than Roger. He was remarkably gentle as he eased Chloe through the gap.
‘Roger, can you look after Chloe?’ Tori asked. ‘Take her over to the side of the road and take care of her until an ambulance gets here.’ She turned to the fire officer. ‘Can you help me get to the driver? She needs help urgently.’
More fire officers were approaching. A tarpaulin was being laid on the ground and cutting equipment being set up. The police officer was using his radio, relaying the information Tori had given him and requesting further back-up, like heavy machinery to deal with the logging truck and traffic control for the approaches to both sides of the bridge.
The first ambulance pulled up and an officer got out, took a look around at the scene and then approached Tori’s group.
‘This woman’s a nurse,’ the fire officer informed the paramedic. ‘She’ll fill you in.’
The paramedic turned towards Tori and his eyebrows rose sharply.
‘Tori!’
‘Hi, Matt.’ Tori’s smile was a mixture of relief and surprise. ‘I haven’t seen you for ages.’
‘I’ve been on the south side of town.’ This was no time to renew an acquaintance, however. ‘Have you triaged the scene?’
‘As far as I can. We’re just trying to get access to the back of this van. There’s three children I haven’t seen yet.’ Tori took a deep breath. ‘The driver of the logging truck hasn’t moved since I arrived. Possibly status zero. The car over there…’ Tori pointed across the road ‘…has a passenger who’s status two, unconscious. His airway was occluded and I’ve got someone holding his head and keeping the airway patent now. Driver is possibly status three. She was conscious and breathing well but her GCS is down. She wasn’t responsive enough to question.’
Tori could see Matt’s partner spreading a blanket on the ground nearby and setting up equipment. ‘The driver of this van is a priority. She was moving when I first saw her but she’s not now. She’s still breathing but she’s losing blood pretty fast from a head wound.’
Matt had been watching Tori intently as he’d listened. Now he turned to his partner.
‘Joe, get a collar and some oxygen over to the other car and check the status of those patients. I’ll stay here and get Tori to help me.’ He turned to the fire officer. ‘How soon can we get access to the back of the van?’
‘We’re just checking the stability of that log. We don’t want it shifting when we start cutting.’
‘Is it stable right now?’ Receiving an affirmative nod, Matt turned to Tori. ‘Could you grab a dressing and bandage, a C-collar and an oxygen cylinder and mask from that blanket? I’m going to see if I can get far enough through the window to reach the driver.’
Following instructions from someone who knew what he was doing on the front line was a relief. Matthew Buchanan was more than just a paramedic. His training and involvement with the Urban Search and Rescue task force meant that he was an expert in handling a major incident.
Feeling like she was part of a team that was going to deal with whatever trauma this disaster had left in its wake was suddenly exciting. The adrenaline buzz was still increasing as Tori lugged the requested equipment closer, stepping over the hoses from the hydraulic cutting gear. Another child, a boy this time, was being lifted by Matt from the window of the van.
A glance towards the side of the road showed Roger, holding Chloe in his arms. It also showed the arrival of a second ambulance, whose crew went straight to the second vehicle on Joe’s signal. Flashing lights from police cars were on both sides of the bridge now and another fire engine was crawling past the traffic buildup. Spectators were being herded further away from the scene, but even with the burgeoning number of emergency service personnel Tori was not asked to step aside.
Instead, she found herself drawn even deeper into the rescue effort.
‘I’m too big to get far enough through this window to be in a position to do anything useful,’ Matt told her. ‘And the fire boys want to try cutting the back of the van first to get in to the other children. There’s a baby in a car seat and a toddler who appears to be unconscious. Are you OK to stay and help?’
‘I’m not going anywhere in a hurry.’ Tori’s smile was rueful as she waved at her VW Beetle, now completely hemmed in by a fire engine and two police cars. ‘What can I do to help?’
‘How would you feel about hanging upside down for a while?’
Tori’s level of circulating adrenaline went up another notch. ‘What do you want me to do?’
‘Get a collar on if possible. Assess her breathing and put some oxygen on. Get a dressing and some pressure on that head wound before she loses any more blood. Maybe start an IV.’
‘Sure.’
Tori used one end of the log to gain enough height to get through the open window. Matt passed her the pieces of gear she needed. She was perfectly capable of doing any of the requested procedures more than competently in the emergency department. She had done them hundreds of times.
She had never tried to do any of them whilst hanging virtually upside down over a crumpled door, with her head pounding from the build-up of blood and at an angle that was only secure thanks to the fireman hanging on to her legs.
The woman’s airway was patent, the movement of her chest appeared normal and Tori could feel a radial pulse that indicated her blood pressure was not dangerously low, but she was unresponsive. Tori eased the moulded collar into place and secured the Velcro straps. She inserted a plastic OP airway into their patient’s mouth and then she took the oxygen mask dangling by its tubing in mid-air beside her and positioned it over the woman’s nose and mouth, pulling the elastic strap over the back of her head. She covered the laceration with a thick dressing and wound the bandage to hold it tightly in place.
The van rocked slightly as she was securing the bandage and Tori felt the grip on her legs tighten.
‘It’s OK,’ the fire officer called. ‘They’re just cutting into the back.’
Matt’s voice was also close. ‘I’ve got the IV gear ready, Tori. Sam here is going to pass it in to you. I’m going to check on the other children.’
‘OK.’ Tori reached a hand up behind her. ‘Can I have a tourniquet, please, Sam?’
Her head was more than pounding by the time she had tied the tourniquet around the woman’s arm and used an alcohol swab to clean the area above the vein showing in the crook of her elbow. Black spots were appearing in her vision, which didn’t help as she slid a cannula into the vein and screwed a luer plug onto the end.
‘I need the tubing for the IV fluids now, Sam,’ she called. ‘You’ll need to poke the blue spike into the bag and then hold it up.’
Even her fingers were feeling clumsy by the time Tori got the IV fluids running. If she didn’t change her position soon, she would probably faint.
‘Pull me out, Sam,’ she called. ‘I need to stand up for a bit.’
She caught a glimpse of Matt bent over a baby’s car seat—his stethoscope in his ears—through the gap between the front seats, but standing up was a mistake. The sudden change in posture after being upside down for so long made her feel extremely unwell. Her vision went completely black and she could feel her legs crumpling. An ungainly collapse to the ground was prevented only by the strong grip on her arms.
‘Are you all right?’
‘Bit…dizzy…’ Tori managed.
‘Sit down. Put your head between your knees and take a few deep breaths.’
The buzzing sound receded and Tori blinked to find it was Matt’s hand circling her wrist as he took her pulse.
‘I’m OK,’ she told him. ‘I’m just not used to working upside down.’
‘You’ve done brilliantly,’ Matt told her. He smiled. ‘Thanks.’
‘How are the other children?’
‘The toddler seems to be OK. He was conscious— just too frightened to move. The baby’s had a bump on her head, which may be more serious. They’re both being transported, priority one. We’re going to break the windscreen and do a dash roll to get the mother out now.’
‘And the others?’
‘They’re being loaded now. The driver’s OK—badly shaken but no more than a few bumps and bruises, thanks to the airbag. Her husband regained consciousness but had to be sedated. He was very combative due to his head injury.’
Matt glanced up as a fire officer stepped over Tori’s legs. ‘I need you to move a bit so we can get on with this extrication. You feel OK to stand up?’
‘Sure.’ But Tori was grateful for the assistance Matt gave her and she staggered slightly before stopping to lean against the side of the closest fire engine from where she could watch as they cut open the front of the van and used a backboard to secure and move the unconscious woman.
A new ambulance crew was ready to transport the patient and Tori wondered just how many vehicles had been deployed to this scene. The closest emergency department would be that of the Royal, where Tori worked, and that thought made her glance at her watch and groan. They would be hard-pressed to deal with the influx of casualties and she should have been at work over an hour ago.
‘Excuse me,’ she called to the ambulance officer on the end of the woman’s stretcher. ‘Are you going to the Royal?’
‘It’s the closest hospital.’ The female paramedic nodded. ‘They’re working under a disaster management code for this.’
‘I’m Victoria Preston,’ Tori told her. ‘I’m supposed to be on duty in the ED. If you get a chance, can you let someone know why I’m held up?’
‘Sure.’
‘Do you want to go with them?’ Matt had overheard the interchange. ‘The police can arrange for your car to be sorted later.’
‘Are you leaving now?’
Matt shook his head. ‘We’re on standby for the moment in case anyone gets injured, trying to clear this scene. The crane’s arriving now, too, so we’ll wait until we can check the truck driver. Not that I hold out much hope for him.’
‘No.’ Tori looked at the slumped figure in the truck’s cab, still dangling over the side of the bridge. The carnage of the other vehicles, now even more deformed by the extrication efforts of the fire service, were a reminder of how many people had been seriously injured here, and the enormity of it all really hit home. Tori suddenly felt exhausted. ‘I’ll stay for a while, too,’ she said. ‘I’m not sure I’m up to starting a shift in ED just yet.’ Taking a deep breath, she exhaled slowly. ‘I don’t know how you cope with this sort of thing on a daily basis.’
‘Big incidents like this are few and far between,’ Matt responded. He grinned. ‘And you know what we’re like in the ambulance service. Being able to do what we’re trained for on a scale like this is a highlight of the job.’
That adrenaline buzz might only be a memory now but it was strong enough to make Tori nod slowly.
‘It’s a very different ball game compared to hospital work, isn’t it? You have to be far more self-reliant. Yelling for help isn’t necessarily going to get someone who’s going to be any more able to deal with the situation.’
‘And every challenge is that little bit different. It never gets boring, that’s for sure.’
Matt’s partner, Joe, was packing away their gear but Matt seemed content to take a break. He leaned against the side of the fire engine beside Tori. ‘So, how are you?’ he queried. ‘It must be nearly six months since I’ve seen you.’
‘That’d be right. You talked me into coming to that USAR introduction course you ran last year, remember?’
‘Of course I do. You were hopping around on crutches. How’s the leg now?’
‘Good as new.’
‘Did you find the course at all useful?’
‘Absolutely.’ Tori smiled at Matt. ‘That session on triage started flashing like a neon sign in my head as soon as I found I was the first on the scene here.’
‘Really?’ Matt looked so delighted that Tori found her smile widening.
‘Really,’ she confirmed. ‘It was a great course.’
‘You should come and do some more advanced USAR training, then. We could do with some more medically qualified people on the teams.’
‘Hmm.’ Tori was enjoying the look of genuine interest on Matt’s face. His encouraging smile seemed to reach all the way to a pair of equally warm hazel eyes. ‘I might just do that.’
For a fraction of a second Matt held her gaze and Tori was reminded of a connection that had been completely buried over the last six months. A base for a friendship that had just been strengthened by what had happened this morning. A friendship she would be more than happy to build on.
Not that she’d want Matt to think she’d changed her mind about anything else, though. Tori broke the eye contact hurriedly.
‘How are all the kids?’ The reminder of just what had put Matthew Buchanan firmly off any agenda other than friendship was definitely timely.
‘Settling in finally, I think. That’s why I kind of disappeared for a while. I took a desk job, thinking that the more regular hours would help.’
‘And did it?’
Matt shrugged. ‘Maybe. Trouble was I missed being on the road too much. In the end I decided that making myself miserable wasn’t going to help any of us in the long run. It was rubbing off on the family, no matter how much I tried to hide it.’
Tori found her gaze caught again. He would have tried to hide it, wouldn’t he? Anyone who’d been prepared to turn his life upside down and even sacrifice a long-term relationship for the sake of four orphaned nieces and nephews had to be some kind of saint. Or, at the very least, an awfully nice guy.
‘So you haven’t found anyone to help run the orphanage yet?’
Matt laughed. ‘As if! Any sensible woman is going to run screaming into the middle distance at the mention of four kids.’
‘True,’ Tori grinned. ‘You’ll just have to find someone who isn’t sensible, then.’
‘Totally mad, you mean?’
‘It might help.’ The humour was a thinner veneer than Tori felt comfortable with, however, because she knew better than most the implications of the undercurrents here.
Changing the subject was fortunately effortless enough to be perfectly acceptable. ‘Oh, look! They’ve got the cab of the logging truck onto that crane. It’s moving!’
‘That’s my cue, then.’ Matt straightened and watched for a short time as the cab containing the unfortunate driver of the truck swung slowly towards solid ground where it hovered before starting a gentle descent. Matt moved towards the ambulance. ‘I’ll grab my kit.’
‘Can I help?’ Tori’s exhaustion had mysteriously evaporated. There was, after all, the smallest chance that the truck driver was still alive.
‘Joe?’ Matt got the attention of his partner. ‘Tori’s offered to third crew for us for a bit longer. Give her the heavy stuff, eh?’
Joe was grinning as he held out the lifepack. ‘If you carry the oxygen cylinder in your other hand, it kind of balances you.’
‘Cheers.’
‘Just kidding!’ Joe put the lifepack on top of the stretcher and then added the oxygen cylinder and suction kit. ‘We’ll just take the whole bed. Pull out those handles at the end and help me lift it out.’
They had to wait as the cab was very slowly lowered to the ground. Then Matt swung himself up on the step and opened the door. Tori saw him reach to feel for a carotid pulse on the driver’s neck.
The shout, seconds later, was astonished.
‘Hey…I’ve got a pulse here. He’s alive!’
