The Drunk Driver Walks Away
It was 1983. I was just finishing dinner when I got a call from the hospital that the ambulance was coming in with three patients: a man, a woman and what they estimated as a 4 month-old baby.
I ran down the street to the hospital, two blocks away. The nurse at the door of the ER told me that there was a collision between two pickup trucks. The EMT’s had radioed that one pickup truck had t-boned another at a “T” intersection along the two lane highway for which Bob Dylan had named one of his albums. A drunk driver in one pickup failed to stop at the “T” and T-boned a pickup with a woman and her child in it.
The ambulance arrived and it was controlled chaos.
The man was hypotensive and tachycardic. He was unconscious. His abdomen was tender. We got in two IVs running normal saline wide open and it wasn’t helping. I was sure he had internal bleeding, most likely a ruptured spleen but other organ injuries, like fractured liver or a large artery injury, weren’t out of the question. I had the nurse and an EMT (there was only one nurse at night there) place MAST trousers (these are “pants” that you place on a hypotensive patient suspected of internal bleeding and you inflate them to compress the legs and send the leg blood to the rest of the body and brain) on the patient and get him ready for ambulance transfer to Duluth. We didn’t bother with any testing like lab or x-ray because we had a “30 minute rule”.
The “30 minute rule” was: you had to get a really sick patient out of the ER within 30 minutes of arrival. Analysis of past ER admissions showed patients spending more than 30 minutes in the ER were highly likely to die. They all required transfer and the nearest tertiary hospitals were at least an hour away. The sooner the patient got to the higher level of care, the higher the survival rate. You had to line them (put in IV’s) and stabilize them (like immobilize a broken bone) and get them out ASAP.
An EMT was holding the baby. She was alert, without bruises, breathing normally. We only had one ER bed at the time so I had to assess the baby on the counter top. She had no tenderness anywhere. She was moving all extremities.
The woman was unconscious and had a large bruise on the left side of her head. She started seizing. She had bruises mostly on her left side, likely where the truck door got pushed into her. Her left arm appeared to be broken. We got two IV’s in, gave her valium and a loading dose of Dilantin, wrapped her arm and prepared her for transfer.
We loaded all three patients into the ambulance. The man was on the right on a stretcher. The woman was on the left on a stretcher. An EMT was holding the baby in the passenger seat of the ambulance.
We roared out of the hospital parking lot.
That ride to Duluth was total chaos. I had to alternate back and forth between the intermittently seizing woman and the hypotensive man, pushing valium on the woman and changing IV bottles as they ran out to keep the man’s blood pressure as high as possible. I sure was glad to get to Duluth.
As usual, the Duluth hospital ER staff met us at their ambulance door and whisked the man right up to the OR. They took the baby and woman into the ER bays.
We didn’t stick around very long there because it was very late and we all had to get up early for work. I got an call from the Duluth hospital several days later with an update on the three patients.
The woman had a severe closed head injury, now called a TBI. Her prognosis was poor for functional outcomes, but she would survive. It turned out, her best residual functional status was equivalent to a six-year-old’s mentality. There was no way she would ever care for her child.
The baby was quadriplegic. This really shocked me as the baby looked fine in the ER. The theory was, swelling increased on the ride up and during her ER stay that cut off blood supply somehow to a section of her spine. She would be total cares and confined to wheelchair for the rest of her life.
The occupants of the “not-at-fault” pickup were neurological disasters!
As for the man, his only injury was a ruptured spleen. He successfully recovered from his abdominal exploration and splenectomy surgery and walked out of the hospital. His blood alcohol level on admission to the Duluth ER was twice the legal limit.
Another example of the drunk perpetrator ending up with the best, minimal harm outcome.