“Oh man! Hey Emily, come look at this!”

I was at the foot of the stretcher, pulling our trauma patient towards the roof top doors leading to the elevator.

We had been sent to transfer a trauma patient who had the unfortunate luck to be in her convertible enjoying the day when a truck hit her.

She was at the sending hospital for just enough time to be assessed, have trauma (Advanced Trauma Life Support) films taken and blood hung. For those of you unfamiliar with ATLS, it is standard to have a lateral c-spine, chest and pelvis x-ray done as quickly as possible in search of the injuries that can kill you quickly. According to the ATLS course manual (p. 7) “X-rays should be used judiciously and should not delay patient resuscitation.”

In this case, we were able to roll into the room, glance at the films and immediately understand that this patient needed a trauma surgeon, and quickly.

Some how, in some way, she was maintaining her oxygen levels even with a hemothorax, multiple rib fractures, and a possible flail chest. Her blood pressure, initially, was in the scary low category and even the novice, looking at her, would see that she had a closed head injury. Her disconjugate gaze was disconcerting, even to me.

As I thanked the EMS gods that we got her to the trauma center quickly, and made the right decision to “load and go” instead of “staying to play,” I ran over her vitals and coupled them with what we had done for her. High flow O2, pain medication after her blood pressure stabilized, packed red blood cells, IV fluid, c-spine immobilization, reassurance.

I couldn’t think of anything else.

I heard Steve’s voice, and hesitated, realizing what an amazing night it was and how much I loved to be on the roof of the hospital. Strange the things that float through my mind during a transport.

My head turned and I saw my flight physician’s hand holding a dressing over the top of the patient’s head.

I know my face reacted, but I stifled my voice. The last thing I wanted to do was let the patient hear.

Her skull was almost pearlescent. I caught a glimpse of its milky white before he replaced the dressing which had come loose. The area was bigger than my hand.