State Fair Shooting

"911 Emergency"
"Help! Someone was just shot at the state fair. I'm by the gate, the shooter is in a red fight! shirt. Help please! I think he's still alive. Help!"
"Police are on their way, stay out of the way please, don't panic"
"I see a man shouting he's a sheriff, I think he's got him."
"Okay, I'm still sending police. Just don't interfere. Don't be a hero, is first aid underway?"
"My wife is a nursing student, so yes"
"Alright thank you"

*COPA*
"ERT EMS please send medics to State fair for possible shooting, send two ambulances and have support on standby pending arrival. Triage has not begun, one guaranteed victim'

"EDRC on scene."
* I arrive on scene, and see a man on the ground with a woman giving CPR. I get out, walk to the back of the car and get the Thomas Pack and surgical bag. With those in hand I jog over to the victim.
'I'm Doctor Kaizer from ERT, what happened?' I ask the woman while I open the Thomas pack.
'I was keeping pressure on the wound, but he stopped breathing a little while ago. So I started CPR.'
I nod and glance over at the victim. Male, mid 20s with a central chest GSW.
'You're doing fine, keep going with the CPR.' I say, and grab the BVM from the pack. I then check that the airway is clear, and start ventilating. Looking around, I wave a bystander over. 'Keep pressing on this bag at the rate I'm doing it.' The bystander nods, and takes over the bag while I get out the intubation kit.

"EDRC, what's the state?"

"Alright, focus on your victim, we'll leave the radios clear until an ambulance arrives. ETA is five minutes, we've got a medic unit coming off of a call, and RA-1 should be able to make it as well"

"EMS-1's out. EMS-1 to EDRC, what do you need over there?"

*I pull into the scene parking near Kaizer's truck. I put the ambulance in park, press anti-theft to idle the truck, then take the keys out and open the door.*

'The sheriff should have everything covered here, scene is secure, but still, just watch your back.'

*I step out and shut the door, I walk around and grab the jumpbag, EKG, and Defibrillator, as I retrieve those items, I listen to what Kaizer needs.*

"EMS-1, if you can spare someone to check for other minor injuries, that'd be great, bullet may have strayed or something"

"EMS-1, I need portable suction, oxygen, ECG and IVs. Break break. COPA I'm going to need all hands from EMS-1 on this patient."
* I finish intubating the patient. From the surgical bag I pull out the prepacked thoracotomy kit and start preping.

*I hear the talking on the radio and turn to Doug

'I'll take the jumpbag and suction. You can get your paramedic stuff.

*I take the bag from him, then take the suction from the acbinet and walk over to the doctor and his patient.

'Hi. Doug's getting his paramedic stuff. What do you need me to do?"

* I look up from the gear.
'Grab a pair of scissors and get his shirt of please.'

*I hand Kelly the jumpbag*

*I grab the EKG and drug box, slam the door shut with my elbow, and walk over*

*I nod to Mike* 'Mike Kaizer, it's been a while.'

*I kneel down I open up the drug box, then start getting out the EKG leads and getting it ready*

"Units on scene, do we have any other injuries there, has anyone even checked?"

(shouldn't that be up to other first responders, not ones responsible for a coding patient?)

'Sure has Doug, though we have to stop meeting like this.' I say with a grin, and not to the patient. 'Once you've got the leads on I'd like bilateral large bore IV access please. Run one open, the other TKO, I don't think he's lost that much blood. If you're hit in the heart, it's not the blood loss that'll get you most of the time, it's blood filling the pericardium, the sack around the heart. It will keep filling until the pressure is too large for the heart to keep beating.' I say while I put on a second pair of gloves outside the ones I have, to make it as sterile as possible. I hear the call from COPA, but don't want to touch the radio with the new gloves. 'Someone answer that please, tell him no we haven't looked, and no we can't look. I can't do open chest surgery by myself.'
* Once Kelly has removed the shirt, I start swabbing the incision site. Once done I grab a 20 blade scalpel and wait for IV access and monitor.

*I open the jumpbag, flip open the top half of the bag, take the oxygen tank out, and get scissors out and cut off the victims shirt

*I pick up the oxygen tank

'I will, and want me to start oxygen?'

*I get on the radio

"No COPA, and we cant right now. I think somebody would've stepped forward by now if there were other injuries, but if there's another ems unit available you can send them to check."

*I finish getting the leads on, and turn on the EKG*

'Bilateral large bore? No problem.'

*I say as I get out a large bore IV, Hook it up to the patient, taping over the needs in the man. I keep one line open, and the other TKO, as I listen to Kazier's info about being hit in the heart.*

'Yeah Kelly, start him on oxygen through a non-rebreather mask.'

*I turn to Kaizer and nod to be sure he agrees?*

((You're the doctor, just making sure lol))

(( I'm going to move on a bit here, since Doug is leaving tomorrow. ))

'Yeah, plug it into the BVM, then stand by with suction. Doug, when you're ready I need you to stand by with the rib spreaders please.'
* I make the incision into the plural cavity with the 20 blade, in the left fifth intercostal space from the sternal border to the midaxillary line. Making a small hole in the intercostal muscle, I use my fingers to push away the lung before completing the transection. I then make another incision right to reveal the pericardium. I lift the rib cage up a little.
'Rib spreader in. Suction please, try to get most of the free blood in there'
With scissor I open the pericardium gently. I scoop out a handful of partially clotted blood and dump it in a medical waste bag. The heart, now free from the pressure, starts shivering in fibrillation. There is a visible hole in the heart, with blood coming from it. I plug the hole with my finger.
'Suction please, get as much of the blood as you can. I think he's in V-fib. I don't have internal paddles, so I'll close the wound temporarily with a Foley catheter, then we close him up and shock him. Open both IVs wide please.'
With my free hand I grab a Foley catheter from the kit, insert the balloon into the heart and inflate it until the bleeding stops, clamp and remove the catheter. I then remove the rib spreader and close the skin as much as possible.
'Alright Doug, hit him.'

(You should check the scene regardless, just incase, never know. Plus it could make use for another unit)
"OIC, what's the status?"

* I look down at my now blood drenched gloves, then over at my radio microphone and sigh. I look over at the student nurse.
'Could you help me with this radio please?' She comes over and holds the microphone in front of my mouth, and depresses the transmit button.
"EDRC to COPA, patient in V-fib, we'll be transporting pretty soon. You might want to roll another unit to check for other victims, we have to move quickly. Nobody has approached us though, and we can't see anyone from here. Out."

"EDRC, I believe the ALS team should be capable of transport, so if you are able, can you check out the scene to be safe, it's protocol with shootings"

*After hooking up the oxygen to the BVM, I begin to set up the suction

*After the doctor says to, I start the suction and try to get the blood out*

(( Sorry this took so long, been crazy busy. I'm just going to wrap this up. ))

* I look up at the nurse student again.
'Can you take a quick look around to make sure there aren't any others who got hit?' She nods and jogs off.
* Doug shocks the patient and he returns to sinus brady.
"EDRC for COPA, we have someone checking for other victims, I will be transporting with Medic 1."
* We take the patient to the ambulance, and load him up. The nurse returns just as we're about to close the doors, and confirms there are no other victims.
"EDRC for COPA confirming there are no other victims, repeat there are no other victims. Transporting one code 3 to ERT Medical, alert trauma team."

*I get in the front of the ambulance

"EMS-1 to central. One adult male to ERT hospital"

*I turn on the lights and siren and drive to the ert hospital

"Understood, advise when active again"

((Kelly, I don't know if you have to still do this since Kaizer already made the topic about this patient in the ER, but remember to fill out the chart and everything in the ER topic))