Doctor at Risk

He wouldn’t be listening to the alien sound of people trying to communicate through dust masks against an almost constant background of crackling radio transmissions, the staccato intrusion of pneumatic tools or the dull roar of heavy machinery shifting rubble. He wouldn’t see the kind of bewildered fear and pain on the faces of the victims they found either. These people hadn’t chosen to enter an environment with inherent risks. They had had no protective clothing and absolutely no warning of imminent disaster.

Yes, he would have picked a mountain rescue in preference but there was no way he would choose to be anywhere else at this point in time. These people needed him and Ross knew he was precisely where he was supposed to be.

Not that any of them had anticipated being in a situation like this so soon. Or of ever being in a situation of this magnitude. At 15.38 hours yesterday, on a sunny Friday afternoon, a massive explosion had occurred in Westgate, a popular suburban shopping mall in Christchurch. Its unprecedented level of destruction made it the largest multi-casualty incident ever seen in the small country of New Zealand, and had resulted in the first full-scale deployment of personnel trained in urban search and rescue.

Including the most recent graduates of the USAR training course held in Christchurch, Dr Turnball among them. Given his medical qualifications, his presence on the course had been welcomed. His years of experience as part of a mountain search and rescue team had put him right at the top of the class but Ross had been eager to add to his knowledge base. He’d wanted to add skills that would enable him to respond to any kind of emergency situation. To reinforce the quiet confidence he already possessed that he could assist or, if need be, lead the kind of people who were willing to risk their own safety to save the lives of others.

That risk was starting to feel familiar enough to make the fear of personal danger seem almost irrelevant. Ross turned to speak to a man standing to one side and well below his own position.

‘If you hold a rope I can tie it round my waist and lean over far enough to reach her.’

‘I could climb down there.’

‘No way.’ Ross swung his gaze back to the small figure in blue overalls perched close to him on the mound of debris. It might be easy to dismiss the fear for his own safety, but Wendy Watson’s was a completely different matter. ‘We have no idea how stable this side of the void really is. You could end up being buried as well.’

‘I’m smaller,’ Wendy protested. Her bright orange safety helmet tilted as she lifted her face to look directly at her senior colleague. ‘And lighter. I’d be less likely to make anything collapse.’

‘We don’t even know if she’s alive yet.’ Ross peered over the concrete slab obscuring the lower half of the woman lying just out of reach below them. The discovery of the woman had been made in Sector 3, when the pile of debris had shifted following the removal of a large beam obstructing the path of rescue workers nearby in Sector 2. USAR Squad 4 had been on their way to a new deployment on the second level of the shopping centre but they had been quickly diverted by news of the discovery. A rapid survey by members of a civil defence team, in consultation with an engineer, had allowed permission to be given for USAR 4’s medics to move close enough to try and assess the victim’s condition.

‘She doesn’t look dead.’ Wendy sounded hopeful as Ross turned his attention to securing the rope around his waist. Her optimism was contagious, despite his exhaustion, but it was probably no more than wishful thinking. The few victims they had found on their last tour of duty had been well beyond their assistance.

‘Ross!’ Wendy’s voice was excited. ‘She moved. Look!’

Sure enough, the woman’s hand was moving, her fingers curling slowly into a fist. A rush of adrenaline surged through the whole squad.

‘I could climb around to the back. Maybe there’s access to the void from that direction.’

‘Stay right where you are, Kyle.’ The squad leader, Tony Calder, had been one of the instructors on the USAR course. He was well used to containing the youngest class member’s enthusiasm when necessary. ‘We’re not going to risk making this situation any more unstable than it already is. You and Matt can hang on to this rope. And be ready to pull Ross clear fast if I give you the signal.’

Making a primary survey of a multi-trauma victim whilst hanging head down was not a skill Ross had previously discovered he possessed. His hands felt heavy and his head was pounding gently as gravity affected his own circulation.

‘She’s breathing,’ he reported a short time later, ‘but the chest movement looks unilateral.’

Wendy was leaning as far as she could without a rope. ‘Possible pneumothorax, then,’ she suggested. ‘Do you want a stethoscope?’

‘Not just yet.’ Ross was rubbing a knuckle on the woman’s sternum. ‘Hello, can you hear me? Hello?’ His voice rose as the woman made an inarticulate sound. ‘It’s all right,’ he reassured her. ‘I’m a doctor. We’re here to help you.’

His hands continued moving. ‘Good carotid pulse,’ he called back to Wendy. An air hammer had started up in the vicinity and it was difficult to know whether she could hear him. ‘Trachea’s midline. There’s no obvious cervical deformity and no sign of a major head injury.’

Wendy had heard. She had a cervical collar and was reaching forward to dangle the Velcro strap within his reach.

‘I’ve just guessed the neck size,’ she said. ‘She looks like a medium from here.’

‘I’m sure you’re right,’ Ross responded. ‘You’ve dealt with a lot more spinal injuries than I’ve ever seen.’ He had to wriggle forward a few extra inches to give him room to manoeuvre the collar into position. A shower of plaster dust seemed to come from nowhere and too much of it settled over the victim’s face. The demonstration that she was not unconscious enough to have lost her cough reflex should have been a relief, but Ross was not alone in the alarm he felt at the tiny movement of the concrete slab he was lying on.

Tony raised his hand and dropped it in a sharp cutting motion. Matt and Kyle hauled on the rope to help pull Ross clear quickly. He slid down from the pile of debris and staggered slightly as he tried to catch his balance.

‘You can stop pulling now, Kyle,’ he said drily. ‘I’m out now.’

Wendy was still perched above them to one side of the slab that Ross had been leaning over. ‘We need to get an oxygen mask on her,’ she called. ‘And to listen to her breathing. If she’s got a tension pneumothorax she’ll need decompression.’ Wendy was clearly frustrated by the delay.

‘It’s too dangerous for me to keep leaning over that ledge. My weight and movement could send it right down on top of her head.’

‘There’s room for me to stand down here, I’m sure of it. And I’m only forty-five kilos. If it hasn’t moved too much with Ross’s weight, I could easily get past that slab.’

Ross had to admire her courage. She had weighed the risks—almost literally—and she was determined to carry on. He would probably have chosen to assess the situation a lot more thoroughly before taking action but Wendy’s enthusiasm was contagious. So was her confidence. It was a package Ross couldn’t help responding to and it had been that way from the first moment he’d seen this woman. He recognised all her qualities as being the ones he nurtured in himself but she had a glow that illuminated shadows he’d never known he harboured. Like conservatism and prudence and maybe too much of a professional distance. It was no wonder he’d fallen head over heels in love with this pint-sized powerhouse of a personality, and he wasn’t the only one affected. Poor old Kyle was staring at her with an expression of hero-worship as Wendy put her case. And the squad leader, Tony, was actually grinning—albeit ruefully.

‘If you’re sure you want to try, it’s OK by me.’

‘I’m sure.’ Wendy looked serious now. The hint of mischief that usually lurked in that elfin face was nowhere to be seen. She was far too intelligent not to understand what she was letting herself in for and while Ross felt an almost overwhelming urge to protect her by protesting the decision, he knew his only real option was to offer his support.

And Wendy needed him. Ross took her previous and more secure position, well away from being able to touch the victim but close enough to pass supplies and advice to his medical partner.

‘Breath sounds are absent on the left and it’s difficult to hear the heart.’ Wendy pulled the earpieces of the stethoscope free as she looked up at Ross. ‘I can’t see the trachea or neck veins now with the collar on but her colour’s getting worse and she’s on a hundred per cent oxygen.’

‘I’d say a tension pneumothorax is highly likely. You’ll have to do a needle decompression.’

A look of alarm crossed Wendy’s features. ‘I’m not qualified to do that! The only thing I do with cannulae is put IVs in. We’ll have to get her out so that you can do it.’

‘There’s no time.’

‘But I don’t think she’s actually trapped under that slab. There’s other stuff holding it up and I’m pretty sure I could shift some of it. We could get a harness on her and lift her out.’

‘There’s still not enough time. If it is a tension pneumothorax and she’s deteriorating this quickly you’ll have a respiratory arrest on your hands within the next couple of minutes if you don’t release the air in the chest cavity. You can do it, Wendy.’ Ross was already sorting the gear she would need into a pouch. ‘I’ll talk you through it.’

‘OK.’ Wendy’s tone advertised her trust in his judgement. She still looked scared, however. ‘But I’m depending on you here, Ross.’

Ross had every confidence in his dependability. And in Wendy’s ability.

‘Find the second intercostal space in the mid-clavicular line,’ he instructed calmly. ‘That’s the point for the needle insertion.’

Wendy put clean gloves on, swabbed the skin with an alcohol wipe and ripped open the sterile package containing the cannula. The tiny shake Ross could see in her hands was gone the moment the needle penetrated the skin.

‘Keep the pressure on. It’s tougher than getting into a vein.’

‘I’ve got it, Ross. I can hear the hissing.’

‘Good girl. Well done.’ It was a small miracle that the noise in the surrounding area had dropped with such good timing. The reason for the sudden quiet became apparent as Ross finished his directions for Wendy to secure the cannula. He could hear the faint shout from another USAR squad working nearby.

‘Rescue team here. Can you hear me?’

Wendy had also heard the call. ‘That sounded like Fletch.’ She was reassessing her patient as she spoke. ‘Colour’s improving,’ she reported happily. ‘What next, Ross?’

‘IV access,’ Ross said promptly. ‘We’ll get some fluids running. Then we’ll see what we can do about getting her out. We might try getting her into a body splint, too. There’s no way we’re going to get a backboard down there.’

It took careful management and the skills of more than one rescue team to extricate the survivor but their success made the extraordinary effort worthwhile. By the time the woman was securely strapped into a Stokes basket for transport, her blood pressure had risen thanks to the fluid load, her respiratory distress was only mild and she had regained consciousness enough to tell them her name and thank her rescuers. A life had been saved. Wendy and Ross were congratulated as being the tight single unit everyone knew them to be.

And Ross was walking on air.