ambulance crew, via phone: Vehicle did not roll. Upon our arrival Maria was up walking around. Her only complaint is the pain above her left breast. She does state, however, that she is pregnant. She just said that she found out a couple of days ago through a home pregnancy test. Right now she is in full C-spine immobilization, IV has been established, monitor is showing a sinus tachycardia without any ectopy, and she is on O2. Last set of vitals, she’s got a BP of 136 over 89, heart rate is 100 strong and regular, respirs are at 18, lung fields are clear and equal bilaterally. There is nothing noted on palpation at the area where the pain is. She is requesting transport to your facility mainly because her daughter, who was also involved in the accident, is coming to your facility, and she wants to be where her daughter is.
Matthews [walking]: We have a mom and a child coming in. The child meets red criteria, which is the highest level of activation because the child’s heart rate is so high. So we will get her into the trauma bay. I am going out to the ambulance bay to meet them right now. The child is 3 years old, with a heart rate of 138; greater than 138 is pediatric red-trauma criteria. The patch phone is ringing again.
ambulance crew, via phone: Yeah, do you copy?
ER staff: Go ahead.
ambulance crew: We are on scene at I-10 and milepost 76 and Hark in Gila. On scene with a 59-year-old male who was traveling westbound on I-10 at approximately 75 miles per hour. I believe he swerved into the ruts of the road, lost control, tried to over-correct and rolled his vehicle. He is in a large pickup truck. There was some pretty heavy damage to the vehicle, air bags were deployed, and he was restrained. Patient states he remembers the entire event, no loss of consciousness. Patient is A and O times four. The only injuries that we can find is that he’s got an abrasion to his right arm and he’s got some small lacerations to his right knuckles from the glass from the windshield, and he’s got a small bump on the right side of his head.
Matthews: So three traumas, three burns, three OR cases today. We are currently waiting for all of these victims to arrive. It must be a Friday night and – I’m sorry, this is a blunt trauma that is coming in. We are waiting for the “knife and gun club,” which should start sometime soon here. [Pause] Sounds like we have a mis-triage. Uh, we are here with the little one – the little one is coming in with a C-collar [a device that immobilizes the neck]. What’s the heart rate?
EMS: It went down to 108.
Matthews: 108. OK, that sounds fine. Just bring the little one in here. OK, we got a little bit of time to take care of ’em. Thank you.  The mom should be here in just a second. What is her name?
EMS: Marianna. She has calmed down.
Matthews: Marianna. OK everybody, this is Marianna. Her heart rate is down to 108. So she was billed as a red trauma because she was up to 138. Let’s be gentle. You can take your masks off so that she can see your face. Unless you are me, then it’s a whole different issue. My wife will tell you that.
ER staff: Yeah, you can take off your masks. We don’t want to scare her.


     It’s time to multi-task. Matthews calms a 12-year-old boy with some tender words and pain medication to keep him from lashing out at nurses. The French fries helped, too.
     A Cantonese man, meanwhile, has just arrived via helicopter with flash burns on his face and upper extremities. Matthews examines him while waiting for the arrival of a boy who ruptured his spleen during an accident with his BMX bicycle.

Matthews: The patient has facial burns to his face, singed facial hairs.… There doesn’t seem to be any evidence of respiratory distress, he’s got a good heart rate and good blood pressure, but his burns around his arms are second-degree burns and I’m worried about a development of a compartment syndrome [impaired blood flow caused by inflammation]. In looking at the left arm, it is now not circumferential. There is a broad strip that is non-burned. I’m looking at his right upper extremity that is nearly circumferential. That is going to be a problem spot for him....
     He just told us through the interpreter that he was unable to breathe normally and that his throat felt like it was closing off and he was having difficulty breathing. So the interpreter said one thing and the family member came in and started saying something different. We eventually had to negotiate placing a breathing tube. This is a life-saving procedure because, if this man’s airway closes off, this man could die.
     Sadly, this was not understood by the family member, and now the family member understands and is telling the patient that he needs to have the breathing tube. This is [one of] the tender mercies that we have in dealing with folks that cannot speak the English language. We are more than willing and happy to discuss with folks in their own language, which is why we have the 24-hour interpreter, but it does make the propositions of safe medical care very, very delicate in such an instance.