Trauma Call/Domestic Violence: Dianna T. Benson, EMT

I am pleased to welcome back award-winning novelist Dianna T. Benson. I love how she writes these scenes fictionally but conveys a host of medical details along with it. 

Welcome back, Dianna!
EMS 6, Stabbing, TAC Channel 12”
     Responding to a domestic disturbance call, my partner and I park our ambulance in front of an upscale home over a million dollars. Not atypical – EMS is too often called out to the rich on domestic violence.
     “Did you know the power company turns off this zip code for lack of pay more than any other in the state?” I ask my new partner.
     “Yep. Idiots living beyond their means. No wonder they’re so stressed out and hurt each other.”
     At the front door, we join a fire crew, as three cops enter the house, all three with weapons drawn.
     “Scene isn’t safe?” I ask.
     “Not sure,” the last cop answers then trails his two buddies.
     The fire crew of four hangs back with me and my partner.  
     “Was the door unlocked?”
     “Yup,” one of the firefighters answers me.
     After five long and boring minutes of standing around on the lawn in the dark of night, I radio in to dispatch. “EMS 6. Standing by outside residence. Any updates from PD on scene?”
     “Yes. Scene is secure. PD is with victim.”
     “Copy that.” I roll the front of our loaded stretcher into the house.
     In the family room, I find one officer bent over a body, the other two talking with an agitated man.
     I kneel at the woman’s other side. She’s supine on the carpet, her lapped hands pressed to her lower abdomen and covered in blood.
     “Ma’am?” I touch her shoulder in comfort.
     My patient blinks at me then flutters her eyes closed.
     “Can you tell me your name?”
     “Judy,” she whispered in a pained voice.
     I brush my hand over hers. “Judy, are you hurt anywhere other than here?”
     “Don’t know,” she mumbles.
     “Judy?” I stare into her eyes, mascara smudged underneath them. “Can you move your arms down at your sides?”
     She does.
     My partner hands me trauma scissors, a stack of 5X9 sterile gauze pads, and an occlusive dressing. As I rip open the gauze packages, my partner hooks up the patient to our cardiac monitor and focuses on assessing and monitoring vital signs.  
     “How can I help?” one of the firefighters asks me.
     “Perform a rapid trauma assessment.”
     “You got it.” He starts at the head.
     With the trauma scissors, I cut Judy’s shirt, exposing the wound. Noting no debris other than blood, I cover the gushing horizontal wound—thin but long—with one sterile gauze pad after another, and apply direct pressure with my palms. “Did a knife do this, Judy?”
     “He did.”
     “With a knife?”
     “Steak knife.”
     “I see nothing else,” the firefighter informs me at the patient’s feet.
     I nod. “Thanks.”
     I glance at the monitor screen for Judy’s vital signs. Her heart rhythm is normal, but her blood pressure is too low, pulse too high, indicating she’s headed to shock due to blood loss. My guess is she’s bleeding internally, the knife blade sliced an organ or two, maybe the abdominal aorta. Regardless of what’s injury, she needs a surgical team.
     I look at my partner. “We gotta go. Now.” 
     “Give me the switchblade,” one of the cops says, alarm in his tone. “Sir, you’re just making things worse for yourself.”  
     “Past time to go,” I whisper to my partner, a rush of panic clogging my throat.
     “No kidding,” he whispers back, wide-eyed.
     “Get out of here,” one of the cops says to us.
     “What’d you say to them?” the agitated man shouts.
     “You don’t want a murder charge, do you? The EMS crew needs to get her to the hospital.”

     The cops deal with the perpetrator, as my partner readies the stretcher. I blanket the dozen or so bloody gauze pads with a towel.
     Inside the moving ambulance, I raise the foot of the stretcher to treat for shock. I cover Judy’s mouth and nose with a non-rebreather oxygen mask and turn on the O2 to 15 lpm. Since none of her organs eviscerated, I do not apply an occlusive dressing. Instead, I add additional 5X9s and a fresh towel and instruct the one firefighter who joined us en route to press his hands over it for direct pressure. I insert an IV saline bolus and consider administering morphine or fentanyl for pain.
     “More cops dispatched to scene,” my partner yells back from the driver’s seat. “Guy stabbed one of the cops and fled the scene on foot.”
     I look down at my patient. She doesn’t indicate she heard those disturbing words.
     “We’re ten minutes out,” my partner yells back at me.
     I pick up the radio. “Wake Med ED, this is EMS 6.”
     “Go ahead EMS 6.”
     “We are enroute with a thirty-eight year old female. Left lower quadrant adnominal stab wound. No evisceration. BP 82 over 56. Heart rate 173. Non-rebreather at 15 liters per minute. Legs elevated for shock treatment. Place OR on stand by. ETA 10 minutes.”
     “See you in 10. Wake Med out.”
     “EMS 6 out.”  
Dianna Torscher Benson is a 2014 Selah Award Winner, a 2011 Genesis Winner, a 2011 Genesis double Semi-Finalist, a 2010 Daphne de Maurier Finalist, and a 2007 Golden Palm Finalist. In 2012, she signed a nine-book contract with Ellechor Publishing House. She’s the author of The Hidden Son, her debut novel. Final Trimester is her second release. After majoring in communications and a ten-year career as a travel agent, Dianna left the travel industry to earn her EMS degree. An EMT and a Haz-Mat and FEMA Operative since 2005, she loves the adrenaline rush of responding to medical emergencies and helping people in need. Dianna lives in North Carolina with her husband and their three children. You can connect with Dianna via her website.

Gun Shot Wound: Dianna Benson, EMT

EMS expert and author Dianna Benson blogs today writing a first person account of caring for a gunshot wound victim. I love how she’s written this post with such detailed information that portrays the medical info so accurately.

EMS 4. Gun Shot Wound. 123 Main Street, Apartment G. 
I flip my book closed—Jordyn Redwood’s newest suspense—and zip it inside my backpack. I rush from my station’s crew quarters to the ambulance bay.
My partner slips behind the steering wheel; I signal us en route to the call via our laptop nailed to the dashboard.
“Twenty-nine year old male, GSW in abdomen, conscious and breathing,” I relate the facts as I read them on the laptop screen. “Raleigh PD already on scene.”
I wait for further information to display; my nerves rev up. GSW calls often place EMS in deadly situations. Even if the scene is safe at first, bystanders, the shooter, even the patient can turn violent. Prepared for anything at any given moment is the hallmark philosophy to staying alive.
“RPD in process of securing scene,” I read the new information out loud. “Stage near the manager’s office.”
“Manager’s office?” my partner turns our ambulance left at an intersection. “That can’t be far enough.”
I hear the fear in his voice. Only six months ago, he suffered a knife wound from a patient’s husband who didn’t want us to resuscitate his wife. 
“I know these apartments,” I say. “Building G is in the back. Furthest away from the office.”
More information came across the screen.
“Patient took off on foot. Stumbled away from the shooter. He’s down. Gas station on corner of Hill Street and Brown Avenue.”
Once we arrive at the gas station and notice RPD has the scene in their control, I duck under the yellow tape blocking the public from our GSW patient lying supine in one of the parking spaces like a car. Five firefighters surround the patient, each one pressing towels to his abdomen, as countless cops hold the perimeter they’ve established.
The firefighters step away, allowing us to take over medical care.
 “Sir, can you tell me your name?” I yell over the chaos surrounding me.
“Ronald,” he uttered with a flutter of his eyes.
I peek under the wad of bloody towels to examine the wound in his upper abdomen. Since bullets often act like a plug, gun shot wounds often don’t produce heavy external bleeding. This one the exception.
“Package and go,” I say to my partner. “Ronald, what medications do you take?”
Gunfire whizzes near my ear, busts the car window next to us. My heart is pounding as cops tackle some guy behind me. The scene is safe again.  
With the help of the firefighters, my partner and I log roll the patient onto a spine board, place the backboarded patient onto our stretcher, and wheel it toward our ambulance.
I lean my face near Ronald’s ear. “What about street drugs, Ronald? I’m not a cop, so it’s best for your health if you tell me the truth. I don’t want to inject any med—”
We load the stretcher inside the ambulance.
“Any health issues? Allergic to anything?” I continue to ask Ronald questions.
“No, no,” he says, squirming. “The pain. It’s bad. Real bad.”
“I’m sure. Hang in there with me, okay?”
One of the firefighters slip behind the steering wheel as two others hop into the back with me and my partner.
I place a bunch of bandages over the bullet wound, crisscrossing and stacking them. I spike an IV bag, as my partner inserts an eighteen gauge needle into our patient’s arm. As I connect Ronald to our cardiac monitor via a 12-lead, one firefighter maintains direct pressure to fresh towels over the bandages, the other wraps a BP cuff on the patient’s right arm then clips a pulse ox to his left index finger for a blood oxygen saturation reading.
I glance at the readings on the monitor. “Hypotensive and tachycardic,” I shout over the sirens wailing and engine roaring. “82 over 54. Pulse 160.” I feel his left radial artery. It’s thready. “Trendelenburg,” I say, instructing the firefighter on my right to lift the foot of the stretcher, a treatment of hypoperfusion (shock), this case hypovolemic shock due to blood loss.  
I’m thinking the bullet pierced the vena cava. If so, this patient is bleeding internally and surgery is vital.
As my partner shoots morphine in the IV catheter, I notice our patient’s eyes are closed and he’s still and silent. Blood oozes from his mouth. His oxygenation reading drops to 91%
He’s unresponsive. I press my fingers to his carotid artery. Pulse still present.    
I suction blood from his mouth. In order to protect his airway, I slide a lubricated oropharyngeal airway down his throat. With a curved laryngoscope, I lift the epiglottis and gain a visual of the glottic opening and white vocal cords. I drop the orotrachael tube between the cords, down the trachea. I connect a bag valve mask over the tube opening. To keep him oxygenated, I squeeze the football-size bulb every five seconds.  
I read the newest vital signs on the monitor, “74 over 46. HR 168.”
My partner grabs the radio, switches it to the closest trauma hospital.
“Wake Med ED? This is EMS 4.”
“Wake Med. Go ahead EMS 4.”
“We’re en route with a twenty-nine year old male. Abdominal GSW. Tachycardic at 168. BP falling, last reading 74 over 46. Trendelenburg position. Administered morphine. Endotrachael in place. ETA five minutes.”
I glance at the cardiac monitor screen. “Astyole,” I shout out. “Take over bagging,” I tell one of the firefighters.
I begin chest compressions, as my partner injects epinephrine and vasopressin into the IV line. Nine compressions later, Ronald’s eyes flash wide.
I smile down at him. “You still hanging in there with me?”
He nods as we pull into the emergency department.   

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Dianna Torscher Benson is a 2011 Genesis Winner, a 2011 Genesis double Semi-Finalist, a 2010 Daphne Finalist, and a 2007 Golden Palm Finalist. In 2012, she signed a nine-book contract with Ellechor Publishing House. Her first book releases March 2013.

After majoring in communications and a ten-year career as a travel agent, Dianna left the travel industry to earn her EMS degree. An EMT and a Haz-Mat and FEMA Operative since 2005, she loves the adrenaline rush of responding to medical emergencies and helping people in need. Her suspense novels about adventurous characters thrown into tremendous circumstances provide readers with a similar kind of rush. You can connect with Dianna via her website at