Ed's previous lightheartedness quickly became overshadowed by worry.
So much worry that even Roy saw it in the ME's eyes as he checked his patients, grabbed items from his two suit cases, went back to check for something else and in between all that, hesitated briefly, as if to calm his own fraying senses.
Roy had just returned from radio'ing the group, letting them know that Mike and Steve had been found alive, a burdensome weight he knew had been on everyone's minds since the beginning of this rescue mission. Advising Tanner and his group to continue to go after their suspect even if it meant rolling out of their signal distance as they got out of the mountains; he'd advised the comm-van about their situation, and explained that they'd give more precise information on their patients' condition as soon as it became available.
And from the look on Ed's crumbling professional facade, things weren't on the up and over quite yet.
"Let me know if I can help in any way…", he mumbled, powerless to interfere as the ME pulled the blood pressure cuff off Mike's arm, before covering it again with the sleeve of the black overcoat for a small measure of comfort.
"You will get your chance, Roy, I can guarantee you that…"
Questioning the cryptic words but unwilling to distract the man working so hard to save his detectives, Roy bit his lip and glanced down, watching his lavender tie fly in the breeze and trying to keep his mind focused. Out of the corner of his eye, he could see both Andy and young Roy Delaney approaching from their cars, leery of the situation they were walking into.
"They're both hypovolemic…", Ed muttered tensely and pulled out a small penlight, before raising Mike's chin and shining it into his eyes, "Pretty hypovolemic unfortunately."
Grinding his teeth, Roy looked back and forth between the inside of the Galaxy's cab and the two young men who'd joined him, before clearing his throat.
"I…I don't understand what that means, Ed. Remember, I am a cop."
The bearded man looked up, acknowledging the remark, before sighing faintly.
"They're both in varying stages of severe shock mostly due to blood loss, but it's compounded by stress on their systems, I suspect exposure being one of the issues. Dehydration, hypothermia, pain, stress…it's a bad combination. I am hoping we can slow the bleeding on Mike's arm and shoulder down somewhat, because it would be beneficial as we push a bunch of fluids into him quickly and not further delay counteracting the effects of the shock. I am glad he's in as good a physical condition as he's in, because between his injuries, the blood loss and the weather, it's wearing on his system quite a bit. He's already showing signs of tachycardia and hypotension. I want him to reach a systolic reading of at least 80 on his blood pressure before we even think about moving him. And when we do, I am going to want to ride in the car with him to closely monitor his fluid intake, heart-rate, blood pressure and oxygen saturation. He's doing okay now all things considered, but he may not last at that level until we get back to the hospital. If he starts to go downhill, we're going to be in for a wild ride because I am limited on what I can do as far as in-field resuscitation is concerned, especially if he becomes arrhythmic."
Roy bit his lip, before motioning over at the young Inspector in his ex- partner's arms.
"I guess I will be riding with Steve then?"
"Oh, yes you will.", Ed answered and leaned back a bit, before running a nervous hand through his beard again.
"It looks like Mike tried to stop the bleeding on these…these cuts here but he ran out of material. I'm actually going to be a bit more aggressive on treating him in the field, in hopes of getting him stabilized before we get to the hospital. Because his blood volume is a concern, we need to control his fluid losses pretty quickly. My guess is he lost consciousness long before Mike did, that's why the Lieutenant tried to keep him warm. And I won't lie to you, when I've seen guys in the field end up this hypovolemic, it turns into a numbers game with their vitals. And when we start messing with them at a higher than 20% blood loss, which I think happened here, they either snap out of it ok with the right intense intervention…or they drop real fast, faster than we could ever get him to a hospital. Now he's young and strong, so I feel that an aggressive approach might be beneficial now, knowing that we're not exactly right next door to an ER."
"I am going to pretend that I understand what you are saying, Ed…", Roy muttered and swallowed hard, "Just let me know what your game plan is and I will do what I can to help."
"Well, first I am going to clean and stitch these cuts up a bit. They're smooth cuts, my guess is they came from a scalpel. Hopefully that won't stress his system too much and it'll allow for us to slow the bleeding significantly. While I do that, we're going to be pushing some fluids into Mike, and you'll be taking care of holding that bottle and ensuring that we have proper open flow. Judging by the needle marks on both of their necks, somebody tried to operate on them, so I am not sure what kind of chemical cocktail is floating around in their veins. We need to be careful on what meds we administer. At least, if we run into trouble, we can use the same route to fill Mike up with fluids and get an even better flow rate. We won't know his exact requirements until we get started. He might stabilize after 2 liters, or require far more."
Unable to take his eyes off the eerie scene inside the Galaxy, Roy nodded faintly.
"If the regular IV gets Mike stable enough, we're going to move him to the chase car and I will set up my machinery to monitor his heart rate and make sure he stays stable. In the meantime, we're going to try and get some serious fluids into Steve. Hopefully with the decrease in bleeding, his system will take to it ok. His systolic is bottoming out as we speak though, and his oxygen levels are concerningly low. Which means I need you to continue running his triage on the way back. You're going to do both, hold the IV bottle and maintain ventilation."
"Ventilation? What do you mean?"
Ed looked up in guarded neutrality when he said those words, his mind having gone into full doctor mode.
"Meaning we need a ventilation of at least 5L/min on this boy or he's never going to regain consciousness, even if we replace all the fluids. We need to create enough negative pressure to improve the venous return of blood to his heart as soon as possible; it's the best and fastest way to stop his decline. Best case, it will help him work through this with little further intervention needed besides a bunch of plasma bags and additional stitches. Worst case, if we increase his intra-thoracic pressure too much, you can cut off blood flow and oxygenation to his brain and cause a far worse outcome. I have a bag-mask on me and you are going to squeeze that bag once every 8 to 10 seconds, helping him breathe slower and deeper, and get some oxygen into his system. When we get back to the intersection, I'll check him again and if he's not snapping back, I will put an endotracheal tube into him and you're going to keep ventilating him that way until we get to the hospital."
"I…we're going to do all this in the field? Intubating people? You sure about all this, Ed?"
Roy's voice was beginning to break, his hand clenching the doorframe of the Galaxy anxiously.
"That's why you brought me along, didn't you, Roy? To try and save your men? Because I can assure you right now, if you just pop them in the back of your car and head down that mountain for an hour or so, there's a fair chance you've got two dead cops on your hands before you ever even reach the hospital. Remember, just because they have a pulse doesn't mean that they're not actively going downhill."
