Today I determined to pack up and take a trip back down memory lane to my days as a Denver medic nearly 20 years ago..
A Day at the Races
Standby at the horse races was a unique duty. If you liked horses and racing, you might enjoy it. However, if you didn’t care for either, you didn’t stand a chance.
The horse racing industry had developed a standard for emergency response that placed the ambulance as close to the potential victims as possible. The infield of a horse racing track tended to be very well kept, decorated with fountains and brand new cars, (obviously placed there for a fee, by a dealer hoping the days winners would want to buy one of their cars). This area was off limits to an ambulance, their heavy load being much too destructive to the manicured lawn. A steel pipe fence surrounded the inside and outside of the track in an effort to keep the high-strung race animals contained. This left only the race track itself as a possible staging area for a crew and their vehicle. Someone in the ‘planning-for-the-worst’ department determined the best possible place to stage, would be directly behind the horses… always.
“There’s the bell!! And they’re off! ”
The gates flew open and the jockeys raised up slightly, legs tense, leaning hard over the necks of the straining horses beneath. The animals began to work together, horse and rider. The horses had been raised to run. Programmed to bolt at the opening of the gate, the bell adding a sense of urgency to their launch. A shock of a riding crop and the small weight on there backs being an annoyance that would only encourage their all out thrust to an even greater limit.
Faster, always faster!
The horses exited the gate simultaneously, while slightly behind and to the right, as if the gate and bell and sting of the crop weren’t enough they could hear a rumble building to a growl and right behind them. (did they even notice us?) As the hyped animals entered the first turn of the track the growl from behind could be heard to drop a bit farther back, but still it was close. Close enough to hear despite the thunder of the animals all around, despite the sting and the coarse words of encouragement.
“Careful around this turn.” my partner said.
The four wheel drive van, higher than most and carefully altered in the most inexpensive way, entered the banked curve. The track was made of soft dirt, turned between every race to provide a fair racing surface to all participants, at the same time creating a very low traction environment for anything with wheels, including our ambulance. Each race was similar, the fastest horse would win, and the ambulance would come in dead last. The idea being that if a rider were to fall the ambulance would be right there, not even requiring the time to drive the quarter mile around the track, a time period questionably worth the fuel and effort involved. I never saw a rider fall, but I ran many a horse race, round after round, as many as 14 races in a day. All four wheels grabbing for traction, the ambulance sliding slightly sideways through the curves, the engine roaring, always and dutifully finishing last. Easily the best part of a horse race in my opinion.
This was not a race day however. My partner Mary and I were driving through southwestern Aurora wishing something bad would happen so we would have something to do.
“204, Iliff and Quebec”
“Copy 204. Code three, Arapahoe race track, on a man down”
“Copy, code three, Arapahoe race track”
“That’s correct, security will be on scene to guide you in, appears to be a head injury in the horse stall.”
I turned to Mary, “Cool! A long hot run.”
It was fun driving lights and sirens, and the only thing that would have made this better would have been more traffic. Traffic provided obstacles which was a more interactive and adrenaline inducing exercise. I reached over and flipped on the lights. Light bar- click, flashers- click, strobes and headlights- click, click. Then turned the knob on the siren to wail.
This ambulance had a nice siren, by placing the knob in between settings a high pitched squeal could be created which may or may not have been more effective at notifying other drivers we were coming, but this sound was different from the usual and therefore, fun to do. Pushing down on the accelerator I pulled into the oncoming lane of traffic and through the intersection we had been waiting to cross, enjoying the privilege of getting to go while others had to wait. We found a Straight route out of town and headed onto the country roads that would take us the 20 miles to the track, pushing the ambulance towards its limit of 70- mph downhill, 55 up. We arrived at the track to find security waiting to guide us in through the main gate and through the maze of a parking lots to the rows of horse barns nearby. We pulled off the paved lot and onto the graveled road that led in between the long steel buildings that provided services for the jockeys and stable workers, some restrooms, a cafeteria and a business office for the horse and track owners and officials.
Pulling up to a stall midway down the third row, a frenzied group of bystanders let us know we were in the right place. One man came running up to my partner’s door as she stepped out.
“He’s waking up!” The bystander hollered, providing us with a clue that at one time he was possibly unconscious.
“Good.” We both replied, smiling.
On many scenes I’ve found that a bystander or responder will have had a contact with the patient and by doing so will have laid a sort of ‘claim’ on them. Along the lines of counting coup, a practice by the Plains Indians in which an unarmed warrior or juvenile would ride or run through the battlefield rapping victims with a coup stick in order to gather strength and power from the fallen enemy and to show their own bravery. These ‘claimants’ of the victim can sometimes be a valuable source of information, maybe having seen the incident, thus immediately bestowing a manner of status on themselves, eg. “I saw it happen” said proudly, head up and back straight. Other times this person can be a hindrance, failing to ‘bow out’ at the proper cue or demanding recognition for their actions, “I helped them! I pulled them out! I helped!!” “Yes, yes you did. Thank you…”
In this case the bystander was of the more helpful and informed kind.
“I think he got kicked in the head. He drinks a lot. The boss told him to stop but he still drinks. ”
“Do you know if he has any medical problems?” As I approached I saw a man in his early 50’s seated in the dirt of a horse stall, the horse had been removed. The man was awake and his color was good. His breathing was short and shallow, but he did not look ‘sick’.
“Not that I know of.” Replied the helpful bystander.
Although I was close enough to the patient for him to have answered my question himself, he seemed content with the answer provided and did not offer more. I leaned down in front of the man who told me his name was Jerry. I felt his pulse, strong, not too fast. As he said the word I caught the sweet smell of alcohol on his breath. ‘Yes, he‘s had a few’, I thought. I turned to Mary and told her of the current plan. Backboard, 02, IV. EKG. On further exam it was discovered Jerry had chest pain and no memory of what had happened to him.
“Jerry, what happened to you?”
A slightly slurred response, “I don’t know.”
A further investigation of his discomforts combined with the visual clues helped develop a theory. Jerry had been cleaning a stall standing behind a typically high strung steed when the horse, lamenting its poor choice of career, had lashed out a hoof, catching Jerry either in his head or his chest and throwing him into the post at the rear of the stall where Jerry struck his chest or his head, and then had crumpled to the ground, possibly unconscious.
Jerry’s chest pain appeared centered around a reddish area on the right side of his chest over the 7“’ and 8“’ ribs. I made the determination to transport non-emergent to Swedish Medical Center, the closest hospital and still 30 minutes away. We loaded up quickly and headed out of the race park.
About ten minutes out Jerry began complaining he was having trouble catching his breath. His breath sounds were difficult to hear as he was only taking short, shallow breaths. He had begun to sweat slightly and I thought his breath sounds were a little less audible on the right side than they should have been. This could indicate that when the hoof had struck Jerry, or Jerry the post, he possibly fractured a rib and punctured a lung. Bad for Jerry but providing me with a golden opportunity.
I leaned forward into the cab. “Better step it up to code three. ”