A/N: So this one's dealing with a slightly different topic. Consciously or unconsciously, we all have different facets of our selves- the work self, the home self, the hobby/interest group self, the parent self, the spouse or partner self, the child/niece/nephew/cousin etc self and so forth. A lot of emergency professionals have a very clearly defined work self that they keep separate from their not-work self as a coping mechanism because of the things we deal with. My hubby calls it 'Medical Mode' when I drop into that mindset and apparently my voice and body language noticeably changes when it happens.
As a part of the safety features of Medical Mode is professional detachment: while we do let the patient know we care, we can't care too much. We have to mentally keep them restricted to the role of The Patient, broken down further into individual problems or conditions that need to be addressed. If you've seen the Scrubs episode that touches on professional detachment it sums it up quite well.
I once read an interview with a small town paramedic here in NZ that touched on this- she was called to a car vs pedestrian. She was busy cutting clothing off the unconscious patient to get at his injuries, wondering if all teenage boys wore this brand of underwear and thinking some mother was going to be wild with her because she knew exactly how much those jeans cost. She asked the patient's girlfriend what his age was and any medical conditions he had that she knew of. She replied 'You'd know that better than I do, he's your son!' She'd been called to her own child and hadn't recognised him because of the necessity of the compartmentalisation we all learn to do.
This is my thoughts on what it might look like for International Rescue, set in SOS pt 2 after they've pulled Gordon from the ocean but before they get him into the hospital.
Compartmentalisation was something they all did to different extents.
It let The Commander send Scott's brothers into danger and TB1 step aside and defer to a specialist. It was how John, TB5, The Astronomer and The Voice Who Answers shared the same space station. It was what kept The Aquanaut focused when there was something that would have captured Oceanographer's and Marine Biologist's attention. It let Alan play video games and whine about school work in one moment and become either TB3 or The Astronaut the next and it was how Kayo protected her heart in the harsh world that Thunderbird Shadow operated in.
As Pilot called up the flightpath back to the Island, Grandma ordered them to a hospital instead. Medic stepped in, accessed the data The Commander had compiled and made a quick clinical judgement about which hospital TB4 needed with the injuries he had.
The look at the readouts also told him what to anticipate in the next few moments from the module.
Pilot stayed in place long enough to save precious seconds by punching the destination into the autopilot and setting the engines into full throttle before he spun out of his seat as The Commander radioed up to the cockpit. "Virgil! We need you down here for RSI, I'll fly Two!"
"On my way." Medic replied, already halfway there. He passed TB1 in the narrow stairwell along the way. Virgil noted Scott's pinched expression and bloodless lips pressed into a line as they slipped past each other, then Medic was clattering into the module and making a bee line for the stretcher. TB3 was there, having trouble shifting into his own Medic mode by the looks of things, looking up at him gratefully when Medic took over with his greater training and experience.
"Traumatic brain injury." TB3 reported, worrying his bottom lip between his teeth. "He's starting to show abnormal flexion response, we got an LMA in, saturating at 96% on oxygen. All drugs and doses were already prepped and checked by me and Scott."
"Good start, let's do that rapid sequence intubation and upgrade to an ET tube." Virgil surfaced for a moment to pat Alan's shoulder in reassurance before Medic stepped in again. "You know what to do. Get IV access, two sites if you can."
"Got it." TB3 nodded sharply, shoulders squared as he laid open the right arm of TB4's uniform from shoulder to wrist with the specialised cutting tool. "Right femur, tib and fib and left arm are in several pieces, I want to leave the uniform in place there to hold it all together." He explained as he swiped an alcohol wipe over the inner elbow and the back of the hand and tied on the tourniquet. TB3 knew exactly where to find the good veins on TB4's right arm, they'd all practiced on each other and done it in real life often enough.
"Good idea. Any internal bleeding?" Medic asked as he looped a stethoscope around his neck, loosened the tube holder that held the laryngeal mask airway in place and prepared the endotracheal tube he would replace it with. He didn't detach the auto ventilator just yet, it would need to stay in place until the last possible second.
"Suspected, going to recheck once the airway is secured." TB3 replied shortly. He had the IVs set up and a saline drip attached to the back of the hand, now he reached over to slit TB4's uniform from neck to navel then hip to hip, exposing a chest and belly already starting to mottle with bruising. It was a minor miracle his suit hadn't been compromised in the crash, exposing him to the lethal cold and pressure of the unforgiving ocean.
"Okay, 7mm ETT, laryngoscope, boogie, holder, 5ml syringe, 20 ml syringe, ventilation, suction, oxygen, cricothyroidotomy kit, capnography ready." Medic reeled off his portion of the checklist as he stood at the head of the stretcher and ever so gently adjusted the folded towel under TB4'S shoulders to make sure his head was tipped back into a neutral alignment.
"All drugs drawn up and ready." TB3 reported, his hands hovering over the collection of half a dozen syringes of opiates, sedatives, paralytics and muscle relaxants lined up and ready to go into the elbow IV.
"F.A.B." Medic triggered his radio. "Scott, keep Two very straight and level for the next ten minutes." He ordered, waited for the acknowledgement and looked to TB3. "On my mark, start the drugs. Mark!"
TB3 started rattling off the drugs as they went in one after the other. Medic deflated and removed the LMA, forcing himself to stay focused as TB4's breathing instantly turned into an unhealthy rattling snoring sound as soon as the LMA was removed, his airway collapsing as the muscles relaxed.
Medic brought the sickle-like laryngoscope to bear with his left hand; the metal 'blade' clicking against teeth as he slipped the laryngoscope into the mouth, delicately tipped his wrist back and pulled up to move the tongue, lower jaw and airway tissue out of his way. "Landmarks sighted, vocal cords visualised." He announced, using his right hand to thread the ET tube, stiffened with the boogie wire, down the guiding blade of the laryngoscope and into the throat.
Medic paused and let go of the ET tube for a moment to feel TB4's throat at the larynx for the presence of the tube, then continued to feed it down and inflated the cuff that held it into place. Without needing to be told, TB3 reached over and connected the capnography to monitor the carbon dioxide output through the tube and attached the tube to the automatic ventilator while Medic removed the laryngoscope and boogie and leaned in with the stethoscope to listen for the sound of moving air. "...good air sounds, it's in." He breathed a sigh of relief and secured the tube into place.
The biggest immediate problem dealt with, Virgil turned and pulled his littlest brother into a fierce embrace for a moment. "He's going to be okay." He murmured softly, seeing the trembling in the hands that Alan clutched him with. "Gordo's going to be okay."
A/N: The way I see the various facets breaking down is there's the specialist roles- Commander, Voice (plus Astronomer subset), Medic/Engineer (though that didn't come up in this one), Aquanaut (plus Oceanographer/Marine Biologist subsets), Astronaut, Shadow, and alongside that are the generalised roles of Pilot and/or TB1-5 and S. How it plays out is for example when Alan is flying Three he's Astronaut, but when he's on Two with Virgil to assist and drive one of the pods, he's TB3 instead. Or when Scott is there to back up someone else, he's TB1, when he's there in charge, he's Commander.
I don't know who first used 'The Voice Who Answers' as a title for John, but I love it as one of his compartmentalisation facets. Whoever you are who coined it, thank you.
Disclaimer: Rapid Sequence Intubation is something WAY out of bounds for EMT/Paramedic as NZ measures things, hence why Virgil the medic with his higher skill set than the others got called in. It's literally sedating and paralysing the patient to take direct control of their breathing, an in the field version of what happens when someone is put under for an operation. Your airway is largely made up of hollow muscular tubes, especially the upper airway, and those muscles go floppy and the airway collapses when the paralytics go in, so the crews have to work very fast to get the tube in to secure the airway. I've been trained to play with some of the gear and we regularly get training on 'this is what you need to do to be useful in this situation' for when the Intensive Care Paramedic comes to do the RSI. (An ICP is effectively three steps down and three steps sideways from an ED doctor, going by how NZ measures and credits these things)
When it comes to airway adjuncts for an unconscious patient there are three levels- the bronze standard is oropharyngeal airway- basically a hollow hook of plastic to hold the tongue and keep the mouth from completely closing- and the nasopharyngeal airway- a soft plastic tube that goes down the nose to the back of the throat to bypass the mouth. Some occasions require 'the hedgehog' - a naso in each nostril and an OP in the mouth. Silver level is the LMA/laryngeal mask airway- it looks a bit like a she-wee and it goes down the throat to sit on top of the larynx/voice box and has an inflatable cuff to seal the air pipe (trachea) off from the food pipe (oesophagus) because unconscious people tend to bring up their lunch and you really don't want that in the lungs. The gold standard is the endotracheal tube which goes right down and isolates the lungs completely.
I have no idea why the boogie (pronounced boo-gee) is called the boogie. It's a long, thick plastic coated wire that's used to keep the ET tube going the way we want it to.
A Traumatic Brain Injury is Bad News for many reasons. As a first responder one of the big concerns is what happens to the airway in a TBI- because of what's happened to it your brain starts to lose control of the finer details, such as muscular control, and when that happens, they can stop breathing because their airway has collapsed. Abnormal flexion is a sign that the brain is starting to really lose its marbles.
When you inflict pain on an unconscious patient to see what response you get (pinch the trapezius muscle or a pen across the cuticle and squeeze) the ideal response is they wake up and tell you off. The next level down is they grab at the source of the pain- that tells you they can pinpoint it and control themselves enough to stop it. Next down is a pull away from the source of pain to try to escape it. The flexion response is the next one- you pinch them and their arms pull in towards their chest- the pain has become a generalised sensation not a localised one. The next step down is abnormal extension where their arms and sometimes legs flinch outwards in response, it's just a reaction to stimulus. The worst is when you pinch them and nothing happens.
Cricothyroidotomy is for when everything has gone terribly bad and awfully wrong with the RSI. It's quite literally cutting a hole in the throat as an alternative airway, something movies show time and again as being doable with a pocket knife and a ballpoint pen by the plucky protagonist who flicks it in between snappy one-liners. Sadly no, Hollywood medicine strikes once again on that one. All the ICPs I've asked about it have all said their hands were shaking every time they've had to consider doing that.
When it comes to drugs, the ideal situation is you hand the ampoule or vial off to someone else first and they read out loud the drug, concentration, amount and expiry date and hand it back for you to double check. We have a lot of colourless liquids in clear or brown bottles, it's easy to think you've grabbed one or the other if you're in a hurry.
Last but not least- don't be fooled. Medical professionals and emergency professionals and volunteers see some nasty stuff. We get used to it and make extensive use of black humour to weaken the horrors but we still have cases that leave us with shaking hands and nightmares. Regular people don't get the level of desensitisation we do, so don't be surprised or feel ashamed if something hits you hard but we're walking around apparently unaffected. If you've come across an emergency with no medical mode to slip into, it can be quite scary. Never, ever be afraid to go talk things out with a professional or someone you trust who has wisdom and experience after attending an emergency. Wounds of the mind are just as valid as wounds of the body, they need care too.