Having participated in hundreds of flights, many of them unremarkable, there remains one that I will never forget. It’s memorable not only because of its outcome, but because it probably logs in as the world’s longest scene call.
Harry and I were working that night, with Vicky as our pilot. Vicky is a small, slender blonde who shrieks tomboy. By the time she was hired at CALSTAR, everyone seemed to know her and the guys had all tried to get some time with her. Whenever she flew, the towers would want to chat and nearby aircraft would ask us to come up on an unofficial frequency to flirt with her. She rarely went out with them.
When we got the call, it was Elise on the phone from dispatch. “Hi, Janice. There’s been a big rig accident in southern Santa Clara County and they’ve requested a helicopter. Highway 152 south of Gilroy. I’ll contact you en route with the coordinates. About twenty-minute ETA from liftoff?”
“That would be about right. Catch you in a few minutes on the air.”
Harry and I sprinted off to the helicopter, where Vicky was already cranking up. We climbed aboard, belted in, and were off into the night sky. I immediately asked dispatch for the details.
“CALSTAR One,” said Elise, “these are two trucks that hit head-on. Your patient is still being extricated. You will be talking to CDF Engine 5102 on fire white, 154.280. San Jose Medical Center is open and accepting.”
“Good copy for CALSTAR One.”
As we proceeded down the valley, we peered over the darkened landscape, looking for emergency beacons. “Boy,” Harry said. “152 is only two lanes there, and if they really went head to head, this could be a mess. I wonder which truck won?”
“Obviously not the guy we’re going for,” Vicky concluded.
The scene was not hard to find. The Santa Clara Valley is mostly flat, and the gathering of emergency vehicles in a relatively rural area is pretty easy to spot, especially at night. I tried again. “Engine 5102, this is CALSTAR. We have you in sight. We should be overhead in two to three minutes. We will be approaching from the north, and we have just activated our Night Sun. Do you have a visual on us?”
It’s hard to imagine being unable to spot a helicopter with a Night Sun—it can light up the ground brighter than day. Harry stood in front of it one time when they were testing it, and in less than thirty seconds it melted his pants and burned him.
“That’s affirm,” the firefighter replied. “You will be landing in a field just to the east of the accident. There are wires on the east side of the road, but otherwise no obstructions. The field is plowed dirt, and we have watered it down for you.”
“Copy that. Be overhead in a few,” I replied.
There was little moonlight and as we orbited the scene, checking out the landing zone, we were impressed with the spectacle on the ground. There were indeed two double tanker trucks, but both were now unrecognizable, and the wreckage was spread over a hundred yards. One of the trailers was obviously leaking some sort of white fluid, which covered the roadway. I prayed this wasn’t some exotic chemical, making this a hazardous materials spill—a total nightmare. “Uh, Engine 5102. We see fluid leaking from one of the trailers. Have you identified the cargo of this vehicle?”
“CALSTAR One, we have identified the cargo as milk.” All three of us breathed a small sigh of relief, and we circled the scene one more time to identify all the potential hazards, then turned short final. As soon as we were on the ground, Harry snatched the scene bag and headed off to the crowd of firefighters surrounding one of the trucks. As the ambulance arrived, I recognized the paramedics, Jamie and Tom.
“Jamie,” I yelled over the noise of the helicopter. “What’s going on with this guy? Do you know how much longer it will be before they can extricate him?”
Jamie shook his head. “From the looks of it, we’re going to be here a while. All we have access to is his head and part of one arm. The whole truck is more or less on top of him. And I mean the whole truck. The engine is perched on top of what used to be the passenger compartment, which is crushed in around him.”
“Should I tell Vicky to shut down the helicopter?”
“Yeah. It’s going to be at least an hour, probably more.” I nodded and headed back to the running helicopter.
“We can shut down,” I yelled, motioning with my hand. “It’s gonna be at least another hour.” Vicky nodded and pulled back the controls. As the screaming of the jet engines died out, the noise of the Jaws of Life and the fire department’s diesel compressor took over. Ducking under the still-moving rotors, I trotted over to the scene to help Harry.
When I got closer, I saw Jamie had not been exaggerating. The firefighters were huddled around a twisted heap of wreckage that was over twenty feet tall. Jagged chunks of metal were strewn all over everywhere. Harry was now hanging upside down through the rear window of the cab while the firefighters were attempting to cut through the metal. Every time they cut something apart, the wreck would collapse in another spot.
I approached the incident commander. “Can I go talk to my partner?” I asked. “He may need some help.”
“Yeah, just go around to the other side so you’re not in the way.”
I scurried around the corner, and crawled over the wreck behind Harry. “Yo, Harry, what can I do to help?” I asked, looking over his shoulder into the cab. Our patient was lying on his left side, with only his head, neck, left shoulder and left arm visible. Everything else was buried in the twisted metal. He appeared to be awake, but only marginally so. The paramedics had placed a cervical collar on him, but were unable to access any more of his body. Harry craned his neck toward me.
“Get the airway kit out for me,” he said. “He’s nodding yes and no, but can’t talk because he’s so short of breath. I think his chest wall is pretty tightly wedged in there, so he’s got to have a thoracic injury. I want to nasally intubate him now before his respiratory status gets any worse.”
I nodded and crawled out feet first. I returned with the intubation equipment and a fresh tank of oxygen. As I crawled back into the wreckage, dragging the equipment behind me, I felt a sharp pain in my thigh. I looked down and realized I had caught my pants on a jagged piece of exposed metal, which had ripped into my flight suit and cut my thigh. “Damn,” I muttered, “now I’ve got to get a tetanus shot.” I pushed the bag toward Harry, then handed in the fresh bottle of oxygen. He carefully handed out the exhausted tank. “Hey, can you guys out there hear me?” he yelled to the firefighters over the noise.
“Hold up,” I heard a firefighter yell. The din of the compressor stopped temporarily.
Harry yelled out. “Listen. I’m going to intubate this guy, so can you give me about three minutes? I need to be able to listen for breath sounds and confirm placement. We got oxygen tanks in here, so let me know if you’re generating any sparks. I don’t want to give this truck any reason to catch fire. I’m pretty well wedged in here.”
The incident commander peered into the compartment. “No problem. Let us know when we can crank up again. The oxygen tank is OK for now, but the fuel tank is partially ruptured. We’re pumping out the rest of the diesel in the tank now.”
Harry nodded, then turned back to the patient. “Sir, can you hear me? Just nod yes if you can.” The patient nodded imperceptibly. “Great. Listen. We’re gonna get you out, but it’s going to take a while. You were in an accident, and that’s what got you pinned in here. Try not to move your head. Are you having trouble breathing?” Our patient mouthed yes. “OK, great, you can understand me. Listen, I have to put a tube down in your windpipe. It may be uncomfortable going in, but it will make it easier to breathe, OK?” Harry introduced the tube into the patient’s nose and advanced it with each breath. Suddenly, the patient began to cough, and Harry began to help his respirations with the bag. After a few minutes his breathing slowed and our patient relaxed. Harry reached over and listened to his chest, what was visible anyway, and smiled. “All right, we have him tubed,” he yelled. “Hand me up a blanket before you start again so we don’t get showered with glass.” Someone handed a blanket up to me, and I passed it to Harry and started to back out.
“Harry, I’ll be right outside. Let me know if you need anything, or if you need to rest, and I’ll spell you for a while.” The sound of ripping metal obscured his answer. I stood outside with the medics, feeling totally helpless. The priority was simply to free this man, and there was nothing I could do to help. I could only get out of the way and let them do their job.
Twenty minutes of trying to pry through the metal made it obvious the extrication team wasn’t getting anywhere. They had only been able to release the left arm, but the rest of his body continued to be hopelessly buried under the metal. One of the paramedics had crawled in to help Harry start an IV in the arm they had recently released, but there was still nothing the medical team could do.
The fire department started a new approach. Each time they pried open a section, they started using expanding hydraulic power bars to prevent it from re-collapsing. This meant they needed to call for aid from neighboring fire departments. One by one, new fire trucks began to arrive, carrying equipment. Soon fifteen fire engines were parked around the vicinity, with everyone’s attention focused on freeing one man.
After standing around feeling useless for half an hour, I realized my leg was oozing a little blood, and I still had some paperwork to do from a previous patient. I leaned into the cab again. “Harry, would it be OK if I went into the ambulance and did my chart from our last call? I can’t get in there to help you, and I cut my leg on some metal, so I need to get it cleaned up. Jamie and Tom can come get me if you need anything.”
“Sure. But could you tell them to get me another O2 tank? I’m down to less than 250 here.” I yelled to Jamie, who scurried off to get a new tank.
As I walked down the dark road toward the helicopter, I tripped over something and almost fell. I looked down and saw a circular piece of metal about a foot in diameter, deeply imbedded in the asphalt. “What the hell?” I wondered aloud. A firefighter heard me as he was walking by, and shined his flashlight on the object wedged in the road.
“My God,” he said. “Do you have any idea what that is?”
I shook my head. “A big chunk of metal is the best I can come up with.”
“It’s a clutch plate from the truck. That sucker must weigh seventy pounds.” We looked back toward the accident, which was a good hundred feet from us. It must have flown off the truck during the impact and wedged itself into the pavement. Pretty impressive.
“Do you know what happened?” I asked.
“Yeah, I talked to the other driver before they took him to the hospital. He wasn’t hurt too badly. A mule from the field over there wandered out into the road, and he swerved to try and avoid him. Unfortunately, there was another tanker truck right there, and they hit head on. Thank God neither one of them was hauling any hazardous materials. Then we’d really be up the creek.”
“So how did the mule do in all of this?”
The firefighter swung his flashlight over to the ditch beside the road. The mule was lying on its back with all four legs straight up in the air.
When I got to the aircraft I found Vicky standing in the field, talking with the man who owned this ranch. I briefed her on the situation, grabbed the chart, and headed back toward the wreck. As I was jumping over the ditch by the road, I felt my foot sink into something squishy. I looked down, thinking I had stomped on a cow patty. To my horror, it was a very neat pile of entrails—the entrails of that unfortunate mule. He had been hit hard enough to jar the organs out of his body, and they had landed in a neat pile some twenty feet away. The visceral membrane was still intact, making it a tidy little sack of guts. I felt my stomach turn.
As I got back to the accident scene, Harry was standing outside and Tom’s feet were sticking out of the back of the cab. I could see no real improvement in the extrication. Harry’s hands had gotten tired from bagging, so the medical crew had started rotating inside for relief. There was still nothing I could do, so I headed off to the ambulance to start my chart. I glanced at my watch. It was now 2:45 a.m., and we were no closer to freeing our patient than three hours before. I turned my attention to the laceration on my thigh and gingerly dabbed the wound with Betadine, wincing in pain. After carefully cleaning it, I taped a four-by-four dressing over the top.
An hour later, I had all the paperwork complete and I climbed out of the ambulance, stiff and sore. No, they still weren’t any closer to getting our patient out. The problem remained the same: Every time they cut something apart, the weight of the huge diesel engine would collapse the metal somewhere else. They were now using pneumatic pillows in addition to the power bars to support the structure, but that still wasn’t enough. And to make matters worse, all of their efforts had destabilized the huge weight of the engine, and the whole thing threatened to topple and crush anyone inside or near the cab.
Harry, Jamie and Tom were all starting to tire from the hours of bagging this man. I crawled into the cab for my turn. I gently helped the patient breathe with the bag and pulled the blanket over us. I could see “Jim” embroidered on his shirt. His face was covered with dried blood.
“Is your name Jim?” I asked, and he nodded. “Hi Jim. I’m Janice. I’m one of the helicopter nurses, and I’m going to stay with you for a little while. You’re probably pretty scared about now, huh?” Again, a little nod. “I can understand that. The firefighters are trying to get you out, but you’re pretty well wedged in here. But they’ll get you out. Are you having a lot of pain?” I asked, stroking his cheek. Jim nodded slightly. He followed my every move with his eyes. I reached down to feel his radial pulse, which was strong but rapid, and turned up his IV, which was getting low. “Hey you guys, can you get me another IV? This one is almost out.” I glanced over to the portable oxygen tank, which was also nearly empty. “And an O2 tank, too,” I yelled over my shoulder. “Hey Harry, what do you think about giving him some morphine? He’s got a blood pressure, and we’re going to be here for a while.”
“The trauma surgeon may not like it, but let’s try to titrate a little in at a time,” he said, and fetched an IV, an oxygen tank and a syringe with morphine.
“One more thing,” I yelled. “Can somebody hand me a couple of damp four-by-fours? His face is covered in blood.” I stuck my hand out, and was handed a stack of four-by-four dressings and a bottle of sterile saline.
I spiked the new IV, switched the tanks, and then gave Jim small amounts of morphine until his face relaxed a bit. Pulling the blanket over both of us, I gently washed the blood off his face, and then cradled his head in the crook of my arm, quietly talking to him about nothing in particular. I simply wanted him to know another human being was there with him. The whole scene was almost surreal; flashing red lights and the bright white truck lights were filtered through the blanket, muting them. Occasionally we were showered with glass, but under the blanket we were warm and protected.
It was now 4:30 a.m. They had been able to get down to his chest, but no farther. His right arm had been freed, but was badly fractured in several places, and his chest was badly bruised with some unstable rib fractures. We still couldn’t get to his back. Unfortunately, when they released his chest, his level of consciousness had deteriorated but in a way that was merciful. He was still obviously terrified and, despite the morphine, in a great deal of pain. His blood pressure was also starting to drop.
Jim’s time was running out. The incident commander and the firefighters realized it was useless to continue, and we had to make a move. The new plan was risky, but no one could come up with a better one. The idea was to lasso the engine with chains, and a tow truck with a large crane would pull it up, allowing us to slip Jim out from underneath. The problem was that there was a very real chance the engine could come loose from the cradle of chains and fall onto Jim. But, in a way, it really didn’t matter. We already knew he had head, chest, and abdominal trauma. We assumed his pelvis was broken and that he had major lower extremity trauma. If we didn’t get him out soon, he would die trapped inside the wreckage.
The incident commander ordered us out of the cab. They hooked up the winch and started slowly pulling, lifting the engine. There was a loud popping and scraping from the twisted metal, but it was moving. When it had been lifted two feet, the firefighters were able to open the side door, which had been pinned against the pavement. We slid in a backboard and started to pull on his torso, but after getting his hips and thighs disentangled we hit a snag. Harry and I crouched in the dirt, holding Jim’s spine in alignment. One of the firefighters reached in and found the problem: Jim’s right foot was twisted around the brake pedal, and it was wedged in tight. They threaded in the Jaws of Life—a hydraulic tool that looks like a pair of scissors on steroids—and tried to pry it off, but it was firmly planted under the demolished dashboard. Harry turned to the medics, who were holding Jim’s torso.
“Does he have any pulses?”
Jamie reached over to get a femoral pulse. “Just barely,” he said. “We don’t have much time.”
I could see Harry’s mind racing. “I hate to even think of this,” he said. “But we’re going to have to amputate his foot unless anybody else has any ideas. He’s going to die soon.” We aren’t trained or qualified to perform such a task. Sure, it’s a relatively easy thing to do, and Jim had no perfusion to that foot, so the bleeding would be minimal. And he probably was going to lose the foot anyway. In a last-ditch effort, Harry reached in and pulled as hard as he could, while the fireman pushed with the jaws of the tool.
Suddenly he came free. Relieved, we pulled him out onto the backboard, face down, then put another backboard on top and turned him over. The injuries we hadn’t been able to see were worse than we thought. He had several large abrasions and bruising over his chest and back with unstable rib fractures. His pelvis was mushy, indicating a bad fracture. His abdomen was tense and distended. Both femurs were fractured, and his right ankle had an open angulated fracture. We all feverishly started applying the backboard straps to secure him, then headed for the helicopter as fast as we could. As we were headed across the field, I saw a huge pile of oxygen tanks. “What are all of those?” I asked a nearby firefighter.
“That’s all the oxygen we burned while we were sitting here. Your patient used up every O2 tank in the South Valley, and we’ve been shuttling O2 from San Jose for the past two hours. Last count we used twenty-one tanks.”
We lifted off from the scene, heading for San Jose Hospital. En route we started a third IV and feverishly poured in fluids. When we arrived, we hit the ER at a dead run. Jim had not regained consciousness and his blood pressure was barely palpable. The trauma team descended on him as we backed out the door.
I glanced at my watch. It was now 6:00 a.m. We had been on scene almost six and a half hours. Harry and I were covered with dirt and oil. We both sank into a chair and stared at one another. “Son of a bitch,” was all Harry had to say.
Nobody really expected Jim to survive. But he made it through the initial surgery, which lasted over ten hours. His ICU course was rocky and fraught with complications, and he nearly died many times, yet he had the tenacity to hang in there and was discharged five months later. Everyone was ecstatic.
A year later, Morgan Hill CDF called us. “We’re going to have a party for Jim Henderson next week, and we’d really like you guys to come, especially the crew that was on that night.”
As Harry and I walked in the door, there was a man supporting his right side with a cane. I didn’t recognize him, but he walked directly up to Harry and shook his hand enthusiastically. Other than the limp, he looked perfectly healthy.
“I remember you,” Jim said to Harry. “You were the guy that stuck that tube in my nose.” They both laughed. “I want to thank you. You helped save my life. I owe you one.” He turned to me. “And I remember you, too,” he said simply. “I remember you holding me when I was trapped. I was afraid the truck was going to catch fire, but I figured as long as you were there with me, I was going to be OK. I can’t tell you how alone I was, being stuck in there. I knew you would help me. Thank you.” He hugged me tightly. Somebody snapped a picture at that moment.
I will always treasure it.