Chapter One
Kel's left hand splayed on the counter, propping him up while he signed off the treatment for his patient, hoping to retreat to his office after. Not only was he responsible for patient care paperwork, but all the administrative paperwork for the emergency department. He was the Chief of Emergency Medicine after all. Signing the last page, he flipped the metal clipboard shut with a satisfying clack, dropping it in the right slot. As he slid his pen back in his pocket, the tones from the fire department radio started sounding off. Normally, it was just background noise to them, at times a tool, but he noticed the tones kept going. Finally, the voice behind the tones started speaking, "Battalion 7, Station 127, Engine 8, Squad 8, Station 51, respond to a passenger train derailment at the intersection of La Campo Trail, and Sierras Road. La Campo Trail and Sierras Road, the derailment is approximately a mile west from the intersection. Channel 7 for rescue, time out, 2030."
Frowning, he turned their fire department radio channel to seven, wanting to listen. He knew it was not in their region, as Squad 127, the first listed in the dispatch, transports to Harbor General, but it could still impact them.
The tones resounded on the new channel as Dixie walked up, "That sounds big," she observed, dropping a stack of clipboards on the counter.
"Train derailment," Kel advised. Dixie's eyebrow raised in a hopeful question, "Not a freight train," he answered, successfully deflating Dix's hope.
"How many are we expecting?" she asked with a serious tone.
"No idea, LA's just getting dispatched."
"Hmm," Dix murmured uneasily, walking away to find her more senior staff.
The derailment was bad Kel quickly surmised, considering the first radio transmission after Engine 127 went on scene was to request two additional squads, two more engine companies, the mass casualty bus, and several helicopters, just to start. Kel still was leaning back against the counter, listening intently, his eyebrows scrunched in thought. The phone rang, so Kel answered it, "Rampart Emergency," still half listening to the radio chatter.
"Kel, it's Jack," Doctor Jack Woodley, the Chief of Emergency Medicine at Harbor General said. "Have you heard about the train derailment?"
"Listening to it right now," Kel replied, "What do you need from us?" Kel asked, assuming that's why Jack was calling.
"I don't know, 127 doesn't have numbers yet, but the bus is on the way," Jack said with an audible frown.
"I heard," Kel replied, just as concerned. "You keep us updated, we'll be standing by."
"Once we get numbers, we'll let you know," Jack promised.
Before either doctor hung up, the radio crackled, "Command to LA," someone said. After the smooth voice of LA replied, "We confirm four cars derailed on a six car train, we've started initial triage, but many victims are critical, we may need field support."
"Copy Command, Battalion 7," who would be incident command when he arrived on scene, "Do you copy?" the voice of LA asked.
Kel and Jack focused on their conversation again, letting LA fall to the background. "If they need field support, we'll go, that way you can focus on incoming patients," Kel immediately offered.
"Sounds good, Kel, we'll keep you updated," then the line clicked.
"LA?" Dixie asked as Kel hung up the phone.
"Jack," Kel corrected, "We may end up on the scene, 127 said four cars derailed."
With a brisk nod, Dix walked away again. He sat on Dix's stool and began drumming his fingers on the counter top, thinking of who he would take. Joe, Morton, Donaldson, and himself were on. The question wasn't who would be capable of treating on scene, but more who did he trust running the ER.
"Squad 127 to Command," the radio squawked, bringing Kel out of his thought process. "We have at least thirty occupants per car on the first sweep," there was a pause, "Do we have a triage area set up?"
"Triage to Squad 127, that is affirmative," Captain Stone advised.
Kel smiled, glad to see the Paramedic, now Captain, still able to put his medical training to good use. With a twitch, he realized thirty occupants per car was a lot of people. It totaled to a possible one hundred and eighty patients. Not all could be injured, he theorized, but better to assume the worst.
"Squad 127 to Command, also be advised we have multiple black tags included in that number," which command solemnly copied. Kel frowned, it was worse than he thought.
Dixie came up to the desk, Nurse Carol and Doctor Early on her heels. "They have an estimated total," Kel told her, "At least a hundred and eighty."
Dix swore under her breath, "Patients?" she clarified.
"They said occupants and mentioned multiple deceased too, so I'm not certain," Kel trailed off. The phone rang again and Kel reached for it. He nodded, then looked at Dix, "How many could we take?"
Dix reached for the room chart and nurse assignments, quickly doing math in her head. "Thirty green, twenty yellow, ten red."
Kel copied that into the phone then hung up again. "LA wanted to know," he said, explaining who had called. "In the event we're called in," Kel started briefing his right hand, "I want you and Morton with me, Joe, you're running the ER."
"Carol will be Charge while I'm gone," Dixie followed up with, as she had already prepared her staff. "I also took the liberty of preparing some kits to bring with us," she pointed at a cart Kel hadn't noticed until just then, stacked with supplies. General trauma supplies, fluid, IV start kits, chest tube trays, and field amputation kits, filled the shelves.
"You're too good for me," Kel praised with a smile.
"And don't you forget it," Dix quipped back, smirking.
EEEEEEEEEEEEEEEEE
Kel came to the conclusion he hated helicopters. His lab coat flapped around him, making it difficult for him to crawl out of the open door to waiting hands. Mike had been smarter, choosing only to wear his white scrubs. Dixie followed the two doctors without a care in the world. When they were officially called in, she left her hat in her locker, and threw her hair up into a military bun before leaving. Mike and Dixie used to interact with helicopters multiple times during the day, which was one of the reasons he chose them. Grumbling, he wished for their familiarity. Clutching his bag full of supplies, he followed the direction of the firefighter, who had already started to unload the rest of the supplies.
"Doc, Doctor Morton, Dix," Stoney greeted them, ushering them to a red utility truck on the edge of the landing zone, away from the blasting wind the helicopter was causing. "We'll head to triage once this is loaded," he explained.
"Cap?" someone questioned behind him, which Stone briefly walked away to respond too.
"He was in the second medic class with Johnny and Bellingham," Dix informed Mike, "He was a really good paramedic," she lamented, knowing that his promotion to Captain took him away from the squad.
"I still am," Stone clarified, meeting back up with the group, "I'm not letting my training go to waste, trust me."
"What's the status down there?" Morton asked, straight to business.
"It's not pretty," Stoney put his hands on his hips, "Four outta six cars derailed off the tracks, three of them toppled to the side, the other one could go at any second. Rescue guys are still getting trapped people out." Kel's face twitched at that. The scene hadn't been active for more than an hour, but people still trapped indicated the size of the incident, they were rarely called into the field like this. "Everyone's been triaged, and most critical patients who've been extricated have some first line treatments from Harbor's docs, but we don't have the supplies or personnel to start transporting yet."
Someone closed the back of the tailgate, signaling Stone he was good to go. "Let's go boys," Dixie ordered the trio, wanting to get to the scene as soon as possible.
EEEEEEEEEEEEEE
The triage area was a conveniently located field adjacent to the train tracks, which to the naked eye looked unorganized. However, the Rampart personnel spotted the red, yellow, and green flags separating patients by severity of injury. Kel was appalled by the number of patients in the red area. He looked over to the train partially on its side. It was lit up by work lights. Flashes of light from inside the train, made by firefighters, cast shadows throughout the area. Numerous ladders were propped up against the train and sticking out through shattered windows or through holes in the roof for access inside. Firefighters buzzed around carrying various rescue and medical equipment, stretchers with people, or empty stretchers. White helmets, striped helmets, and black helmets differentiated rank. Turning back to the field, Kel's eye couldn't help but spot the more secluded area with a black flag hanging on it. Quickly diverting his eyes to where he could help, he jogged to catch up with his coworkers he did not notice leaving.
"-Runs red, while 10 is split up and covers the yellow and green." Stone was in the middle of updating Dix and Mike. "8, 127, and 51 are still inside freeing up trapped victims."
Dixie was taking notes on her pocket sized clipboard. "What about transport, what's the plan on that?" she asked.
"We're just waiting for the MCI bus and ambulances to show up, saving the helicopters for special cases." The three Rampart employees nodded. In mass casualties, it would be impossible to transport all the patients in ground or air ambulances.
"Who's Incident Command?" Kel asked, as he was the most familiar with the Fire Department's Chiefs.
"Chief Pince." Kel shook his head, unfamiliar with that name. "He's the 7th battalion chief," Stone explained, "Over in Harbor General's area." Kel nodded in understanding. "Why don't you guys check in with the triage team heads, then let me know what you want, I'm gonna update Chief Pince." With that, he jogged off, buttoning his coat back up as he was back on the scene.
"Right," Brackett said, "Dix, check on green tags, Mike, you got yellow, I'll see to red. And remember, no treatment, just evaluation," he reminded. He watched them jog off. The main reason he chose them in particular was that they had the most experience with triage and working outside of a hospital environment, as they were both medical personnel in the military.
"Doctor Brackett," Craig Brice of Squad 36 greeted. Craig didn't have his turnout coat on, Kel saw, but he did have his helmet with his light on, his work gloves sticking out of his back pocket. Now that Kel noticed, everyone had their helmets on. He couldn't decide if it was for a safety matter, or more for identification purposes, seeing as the field was relatively safe, compared to inside the train. "Bob's checking on the worst patient right now, but-" he droned on giving the newly arrived Doctor the rundown.
After receiving the quickest form of an update from Craig, Kel felt he had a good idea on the number of patients and types of injuries.
"Squad 51 to Red Triage," Craig's radio squawked. Brice answered, "We have another red patient coming to you, bilateral crush injuries to the legs with tourniquets placed. Send 36's engine back with more tourniquets." Kel recognized Roy's voice. Brice copied, then turned to Bob, relaying the information.
"Did you bring more tourniquets?" Kel nodded, pointing to the box of supplies. While initially surprised at the lack of treatment given by Roy and Johnny, he quickly remembered their priority was to get them out.
A horn honked, announcing the arrival of a bus with LACoFD stamped on the side. Stone came back, "Brice, you get four spots," he didn't advise anymore and jogged for the yellow and green tagged areas, shouting ahead of himself, "Bus is here for Harbor, yellow gets ten slots, green gets fifteen!"
Kel shook himself, he got a summation of the patients, but he wanted to see for himself, reminding himself he couldn't get distracted with a singular patient.
Before he made it down the first row, two firefighters brought the patient Roy warned them of. The patient was a pale, sickly color. The firefighters with 36 on their helmets moved the patient from the stretcher to the ground, and asked Bob, who came over to do a more detailed assessment, about tourniquets, "We're gonna need as many as you have," they said.
Craig came running up to the group, extra tourniquets in hand, ready to help his partner stabilize the patient. "This one needs to go," Kel said, not wanting or needing vital signs, able to tell from the patient's skin.
"But so does that one," Bob argued, pointing at another ill looking woman Kel hadn't rounded yet. Bob didn't disagree with the Doctor, but Brackett didn't know what patients had been waiting the longest with similar or worse complaints. He and Craig had a system that only made sense to them.
"Okay," Brackett agreed, trusting one of the more senior medics on scene. "Bob, you select the patients for transport, Craig and I've got this one."
Nodding, Bob left, pulling his work gloves on, getting ready to move stretchers.
Squatting down, Kel assessed the man, not bothering to look at his mangled legs, that would be a surgeon's job later. He started with the basics. The patient's breathing was labored and rapid. Kel could see the man's rapid pulse from his carotid artery, but he was pale and sweaty. All the symptoms of shock. "Okay, let's get access and start some fluid." Craig nodded, opening the drug box he had brought over. Spying a piece of paper, Kel picked it up. With a smile, he realized it was an initial triage tag filled out by 51 inside the train car.
With a frown, he spotted, "Luggage chest fell on chest, presumed pneumo,"
"Would explain the labored breathing," he muttered. Moving the patient's already cut shirt to the side, exposing bruising and abrasions to the right side of the chest. Pulling his stethoscope out of his pocket, he listened to lung sounds, absent on the right side. "He's going to need a thoracotomy," Brackett advised.
"Here's a 14 gauge needle Doctor," Craig said, passing the Doctor the very large IV for a quick and temporary needle decompression. Kel thought of the chest tube tray Dixie had brought, but shrugged them off, this was quicker. They could always reevaluate when they had more time. Counting ribs, he found the correct spot and plunged the needle in the front of the chest, stopping when he felt a pop. The man's breathing visibly eased as air was let out of the space between his lungs and chest cavity. "That's the twelfth one of the night," Craig said informatively. Kel raised his eyebrows, that was a large number.
Shaking himself, "Right, get access and start some lactated ringers, I still want to round the rest."
"On it, Doctor Brackett," Craig said, already getting to work.
While Kel rounded the equally injured and sick patients, a crowd of people walked, or hobbled, past him to the bus. "Good, let's start moving people," he said under his breath. He hoped that the yellow and green triage areas were less chaotic, but he doubted it. In times like this, there was no calm. He always appreciated his paramedic's skills to work in high stress environments like this, but he especially appreciated it now. He was constantly having to remind himself of the limit of medical personnel, equipment, or not to go down a rabbit hole treating one patient. When he did treat patients, he had to remember to either utilize the limited equipment he had access to, or come up with new solutions. Working in the field was not straightforward, accessible, sterile, or even a safe environment. And so far, he had not seen anyone struggling to adapt to it. He credited it to the fire department's training, thankful that this was not an everyday occurrence for him.