A Nurse's Search and Rescue

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?’