"This was supposed to be a fun Space Bros trip!" Alan couldn't help the thought as he hit the ground, arms wrapped protectively over his head as glass and expensive crockery shattered, people screamed and gunshots cracked overhead. Beside him John was also flat on the floor, glancing up every now and again as he tried to identify the source of the gunfire.
They were in Washington for a conference on space flight and space station design. Originally it was supposed to be a day trip but the Smithsonian had a special exhibtion on the Mercury 13, a group of women who passed the same physical tests and had practically the same, if not higher, qualifications as the Mercury 7 astronauts but weren't allowed into space because of gender discrimination. Alan had successfully lobbied John into making a weekend of it so they could see the exhibit the next day.
The conference had been interesting and overall a success. Alan had shocked the socks off several people who couldn't believe he was an astronaut approaching 500 hours of flight time in space while John had humbled an arrogant jerk of a space 'entrepreneur' by exposing his designs as nothing more than moonbeams and technobabble (John had a vested interest in preventing the next Langstrom from cropping up in his turf) . Between the two of them they'd also scouted several promising engineers and designers for Tracy Industries with four lined up for interviews before the end of the day.
They'd been enjoying a late dinner in the half full hotel dining room when someone decided to shoot the place up.
Alan looked up just in time to see John spot the gunman, his back to them as he ranted something unintelligible. Turquoise eyes narrowed as John calculated the range and angles, gathered his long limbs under himself and sprang like a cat, catching the man in a chokehold and dropping him in a matter of seconds. That danger neutralised, Alan stood on a chair and shouted to be heard over the generalised chaos. "EVERYONE, IF YOU CAN WALK, GET OUT NOW!" He ordered, pointing to the main doors. "YOU!" Alan pointed to the hostess with his whole hand "CALL THE POLICE!"
Jumping down from his chair, Alan quickly swept through the dining room to herd people in the right direction. As he rounded a pillar his ears pricked up at a shriek of pain over the general cries of fear and panic. He homed in on the sound, spotting a small knot of people huddled by the bar. Most of them were standing around and wringing their hands, but one was crouched down and pressing both hands to a wound in the thigh of a waiter who was sprawled on the tiled floor.
"Hi, I'm Alan, what's happened?" He asked, dropping to his knees beside the wounded man as he pulled out the medical gloves from his pocket. Scott's apparently innate ability to find a situation almost everywhere he went had put them all in the habit of carrying at least a pair of gloves on them every time they left the Island.
"He's been shot!" The man holding pressure to the wound snapped out, his voice brittle with panic. "Can't you see that?!" He demanded.
"I'm here to help, okay sir?" Alan soothed, automatically dropping into rescue mode. "I'm a medic, I'm here to help him."
While he would have much rather been packing that wound and helping the patient, he had to deal with this guy first. Panicking people were a danger category all of their own, they did weird things sometimes and he and his siblings had all been or nearly been clocked by panicking patients or bystanders at some point or another. Gordon in particular bore the brunt of that with water rescues- people absolutely freaked out and out of all of them he had the highest 'helmet on at a rescue' from the number of times a swimmer in trouble tried to use Gordon as a ladder to climb out of the water but only succeeded in pushing him under. Only last week Gordon had had to resort to bringing someone out of the water with a black eye that they didn't have going in. While punching people to knock the panic out of them wasn't exactly condoned in the big book of rescues, they all counted it as 'in extremis danger management'.
Working quickly, Alan convinced the man to lift his hands for a second and let him get a look at the wound- small and neat it was the entry wound- then lifted the patient's thigh to see if there was an exit wound- and yep there was, a big, grapefruit sized crater blasted out of the back of the thigh exposing muscle and fat. The only good news was that the bleeding, while heavy, was dark and sluggish and the patient's writhing showed his femur was intact.
Alan sat back on his haunches for a second to think. No haemo kit, no clotting gel, no fluids, no pain relief. Off duty rescues sucked. "But I do have other stuff." He reminded himself as he cast around the room. "I need a tampon, regular size," he directed the question towards the group at large, "You in the red shirt, give me those napkins next to you!" Was his next instruction, pointing with his first two fingers at the man he'd identified, "You in the blue dress, that table runner and a chair please." He said, doing the two finger point again, then looked to the patient. "I know you're scared, but I'm here to help you, okay? What's your name?"
"Matthew!" The patient managed to get out. "Please! It hurts! I'm scared!"
"I know you're scared," Alan squeezed his hand reassuringly, "that's okay, but we're going to get this sorted for you. My brother's got the guy and I've got you, okay?"
"Okay."
By this point someone had produced the tampon and Alan stuffed it into the entry wound, making sure the string was hanging out. The linen napkins he folded up and packed into the exit wound and used the table runner as a makeshift bandage. Finally the injured leg was raised by resting it on the dining chair and someone's jacket was draped over the poor man to keep him warm while Alan snagged an unused napkin and used it as a note pad to jot down the vital signs, patient details and medical history.
Sirens finally approached, a cop looked over at their huddle and waved over two paramedics toting bags of equipment.
"Hi," Alan greeted the medics, shuffling back to give them access to Matthew and handing over the napkin with the details, "this is Matthew, 26 year old male, shot in the right thigh with a small calibre weapon. Moderate bleeding and a through and through injury. Wounds are packed, penicillin allergy, on salbutamol for minor asthma, cap refill of 2 seconds, pulse of 98, resp rate 24, no other injuries."
To their credit the medics took the professional report from a teenager in their stride. "Thanks, we've got it from here." The older medic nodded to him. "Great job on the leg."
The main focus of this chapter turned out to be scene assessment and dangers. Rule one, dangers always come first. You can't save anyone if you're too busy trying to save yourself. In this case the obvious danger was the gunman- BTW, please don't pull a move like John did unless you are trained and experienced in doing such a thing. As Optimus Prime put it 'there's a thin line between being a hero and being a memory.'
Other dangers could be things like debris, animals, slip hazard, traffic and bodily fluids, but the biggest danger are the bystanders- everyone not you and not the patient. A key thing is using a voice of command- people respond to authority so a loud, strong voice and small words/short sentences is key. When giving commands and you don't know names try identifying people by an item of clothing or hair colour, point and make eye contact so it is crystal clear you are talking to them and you want them to do it.
If a person is becoming a hazard, you've got to stay calm and deal with it first by either explaining what you're doing, diverting them with another task, getting someone else to manage them or calling for backup. If you've found a situation, you can see someone getting wound up and you can step in, please do, the crews will be very thankful.
The 'black eye' story is actually one I got from my Dad from when he was a volunteer lifeguard and they didn't have the floats for patients to grab that they have nowadays.
Speaking of gloves- I have a pair of gloves on me every time I leave the house. I've come across things often enough that I never leave home without something on me. While you can go in bare handed and be relatively safe as long as the skin of your hands is intact and you wash your hands properly afterwards, I don't want to chance it.
If you can pull together enough information for a patient handover, it's really useful. It's basically the same information from 'Tourniquets' plus 'this is what happened, these are the treatments I've done/meds I've given and roughly when'. We'll double check medical details with the patient at some point, for the same reasons as in 'Dislocations', but whatever you can give us, nice and succinctly, is helpful.
I hate doing it personally (it feels SO wrong and I can all but hear my mother's horror), but I've seen medics writing notes on the bottom sheets we have on the stretchers as they get all the information organised before writing up the patient's story. Sheets and similar make a surprisingly good writing surface in a pinch. I usually make notes on the back of my glove, but it can get a bit tricky when your patient has a pharmacy worth of meds and a book's worth of medical history.
Gunshot wounds are basically treated like bleeds. They tend to have a (comparatively) small entry wound and a big exit. Shotguns with scatter shot make a big mess- lots of entry and exit wounds. Pack both with whatever you have that's absorbent and clean.
As a side note on pointing, there are quite a few cultures where pointing at a person with your first finger is really rude. When I first started teaching I had to learn to point at someone with my whole hand or first two fingers instead. There's a surprising number of little things you can do that can really change an encounter with someone by being culturally sensitive. One thing here in NZ that surprises friends of mine from overseas is that you absolutely do not sit on tables and bench tops. Tables are used for food, in Maori culture food and food preparation surfaces are tapu- sacred or special. You absolutely do not put your bum on surfaces where food goes. The same goes for the head. The head is tapu, so you don't sit on a pillow used for someone's head and ask for permission before you touch the head of a Maori person.