Chapter Two

An ominous groan of metal interrupted all work on the scene. People looked up from patients, clipboards, stretchers, extrication tools, and cameras alike. The press on scene became silent, for once. All eyes turned to the train car. The one still partially upright was losing its battle with gravity, despite the department's attempt to secure it. Kel watched in horror as it fell to its side with a loud rumble. Landing with an echoing boom, the dry dirt and gravel dust from under the tracks became unsettled, casting a dusty and gloomy fog over the scene. There was a seconds pause before the radio lit up with voices talking over each other. Straining to hear through the cacophony, Kel jogged closer to an engine, the radio going through the loudspeaker system. A loud tone came across the channel, effectively silencing the chatter.

"Command to all units, radio silence until a roll call is completed," a commanding voice said. Silence blanketed the scene, movements stopped, everyone was listening and waiting. There were fourteen units and two chiefs on scene, totalling to forty-eight personnel. Nobody wanted a Code-I. "Squad 127," he started his role call. After a response he continued, "Engine 127." Command started methodically listing units, starting with those inside, waiting to hear responses before moving on. "Squad 8," then, "Engine 8," When "Squad 51," was called, Kel held his breath. Johnny, who had the radio now, answered on their second call. His eventual response got sighs of relief from everyone. Engine 51's strained sounding answer came quicker.

When roll call was completed, with no missing units, Squad 51 piped up, catching Kel's attention. "If there are hospital personnel on scene, can we have a Doctor to our location?"

"Command to Triage," Chief Pince called.

"Standby," Stone came running over to him while Command specified exactly where 51 was, which naturally was the recently flipped train car. "You willing to go up in that mess?" Stone asked, getting right to the point. It was dangerous, the recent shifting of the train demonstrated that. It was not a hospital. Kel swallowed and nodded, gripping his bag.

"Triage to Command, we're on our way," after a pause, "Stone to Yellow Triage, send Doctor Morton to Red please." Releasing the talk button on his radio, "You'll want to leave your lab coat here, it'll only catch on the debris." As they began walking to the train, sans lab coat, Stone began unbuckling his turnout coat and loosening his helmet, "Here, take these, you'll need them."

"You're not going in?" Kel asked, now slightly apprehensive about going in solo. Kel watched as new ladders were set up against and inside the newly sideways car, windows already conveniently shattered either from the initial collision, or recent from getting tipped.

"I'm not, but 36 or 10'll help you in," he assured. "I can't get caught up in the weeds, I'm Paramedic Command," he reminded the Doctor who was not used to the hierarchy and order of operations on a massive scene.

"Right," he awkwardly buttoned up the heavy coat while Stone watched, smirking slightly. Usually, Brackett was the expert, having the roles reversed was amusing. If it were a different situation, Stoney might even think about teasing his medical boss.

While Kel tightened his helmet strap, after receiving instruction on how, Stone handed him his gloves, "Don't take these off unless a man in blue okays it," Stone advised. "I don't need you cutting your hand and ending up in green, okay?" Kel nodded, thankful for the direction. Still realizing how much he took the sterile hospital environment for granted.

"This way Doc," a firefighter he didn't know with a white stripe and 10 on his helmet directed. "Up this ladder here."

Kel shakily climbed the ladder, knowing Mike would probably be more comfortable with the task, but as a resident, less experienced with treatment. Another firefighter helped him on the roof, gripping the turnout coat's shoulder for stabilization while he got on a different ladder to descend into the train. Reaching the bottom, he squinted as his eyes adjusted to the dimly lit car. As the train was on its side, some of the seats were still bolted into place, eerily hanging sideways on the wall, while others were on the ground, making for a dangerous obstacle course. A tall helmet light came up to him, obstructing his view of the person wearing it.

"We're in the back of the car, guy's caught in between the luggage racks and a seat. "It's a pretty tight spot," Hank Stanley's voice announced.

Kel was expecting the worst, and that was the worst, "Take me to it," he said simply, wondering if he was going to perform a field amputation today. As Hank wormed them around another team, he heard hydraulic lifts whirring from another rescue, the generator outside creating a white noise on top of the radio chatter and conversation in the car.

"You look good in turnout gear, Doc," Hank added with a smirk, pulling Kel's attention back, almost missing Hank's comment. "Specially the white stripe you got there." Kel suddenly noticed that Hank was cradling his wrist. Kel scrunched his eyebrows in concern.

The crew of 51 were all in the back corner, their rescue equipment littered around them, some of the cases open and broken. Kel blinked, all of them looked beat up. Gage had a rip down his shirt that his unbuttoned coat revealed, blood just visible through the blue. Roy's face had a scrape littered with abrasions down the front cheek, Mike's turnout coat sleeve sported a jagged scratch that he suspected went through to the skin, Chet was sitting, his pant leg torn from the knee to the ankle with bandages showing, while Marco's helmet had a substantial and fresh looking new ding. None of them seemed to notice though and kept working. Johnny skipped pleasantries, despite being pleased that it was a Rampart doctor and not Harbor General, and got right to the point, "41 year old male, left arm is caught up in the luggage rack and pinned at the elbow by the seat that fell in between the wall and the rack. He's just lost consciousness, which is probably for the better," John commented, "We can't apply a tourniquet because of how high his shoulder is caught in the rack." Kel looked away from Johnny to the patient, and Johnny stopped talking, letting him take in the sight himself. As the side of the car was now the floor, the man was laying sideways alongside the rack, his arm indeed caught up to the shoulder, with a parts of a dislodged seat on his elbow, jammed up against the wall. Kel didn't want to think about where this man was before the roll of the car, or the entirety of station 51 come to think of it. He knew their job was dangerous, but it became real at that moment. Hearing about it after somehow, seemed to take away from the real risk. This time, he was right there with them. Kel shook himself, feeling a pair of eyes studying him, realizing Gage was talking again, "We've tried lifting the seat," Johnny continued, "But the mechanism bolting it to the floor is caught up in the rack. We've tried cutting at the rack, but it just shakes the metal, worsening the bleeding. Roy's got a hold of the brachial artery right now, which is the only thing preventing this man's entire blood supply from bleeding out on the floor."

Looking down, Kel noticed the rather large pile of blood he had missed in the eye noise of the scene.

"We're really outta options Doc," Johnny finished, spelling it out for him, "We either leave him to bleed out and black tag 'im, now he's unconscious, or amputate his arm."

Kel didn't answer right away, reassessing the situation. There really wasn't a lot of shoulder exposed to work with if he was going to amputate, but he could make it work. He knew there were more people to rescue. He could hear the other squad and engine crews working to free other victims. Naturally, 51 was the only crew at the time in the car that rolled, and was landed with the most complicated extrication. Indecision plagued him for a moment, pondering what was the best option. They were all waiting for him, he knew. He also knew they had worked their hardest for this patient, and the mental strain it would leave on them if he decided to leave the patient for dead. But, there were only three teams working inside, and 51 was one of them.

"Doc?" Johnny questioned.

Blinking, Kel realized Roy hadn't said a word, "Roy?" he questioned. "You okay?"

"What do you wanna do Doc?" Roy asked, sticking to the more important question at hand.

"What do you have for access?" Kel asked, indirectly answering he was going to try his hardest to save this patient they had worked so hard to free.

"Nothing yet, we were tryna' get him out first," Johnny replied, automatically reaching for their drug box. Grabbing the equipment for an IV, Johnny looked up to Captain Stanley, "Let Stoney know we're doing a field amputation in here, get a helicopter ready for this one." Stanley nodded, pulling the antenna out on their radio. "Doc, what do you want for fluid?" Johnny asked, cleaning a spot on the patient's arm, a wince on his face as he moved his chest.

"I want ringers," Kel responded, tucking Johnny's wince into his mind. Johnny looked at Chet expectantly, who was sitting next to the drug box and pulled out the correct fluid and drop set.

"Roy, how's your fingers?" Kel asked, knowing that cramping was a real risk, but he also wanted to check to see if his most senior medic was alright.

"Decent," Roy tightly replied, concentrating on his task.

While Kel started prepping for the major surgery in the most unconventional and unsanitary of places, he continued asking questions, "What happened to your face?"

"The train moved," Roy grit out, shifting uncomfortably in the tight space. Roy was laying on his side, head to head with the patient. His arm stretched under the shelf, the only access large enough, to pinch the artery.

"I see," Kel said sympathetically. "Any dizziness, nausea, loss of consciousness?" he questioned while he pulled off the bulky firefighting gloves, already forgetting Stoney's request.

"Not yet," Roy said, smiling slightly at the concern coming from the Doctor.

"Marco?" he questioned next, "Don't think I didn't notice that dent in your helmet." Kel stated, observing all the injuries 51 had, triaging the head injuries first.

"Bien," Marco said, also smiling with a partially surprised look on his face. Kel looked at him, not encouraged by the Spanish answer, but Johnny or Roy didn't look concerned, so he let it go, for now.

"You got access, LR is flowing, Marco and Roy aren't concussed, I already checked," Johnny updated the Doctor.

Kel half smirked, then turned his attention to the trapped arm and the patient attached to it. With a frown, he realized the patient didn't have an airway placed, sedation, or paralytics given. Frowning even deeper, he realized this intubation wouldn't be easy. The patient was not conveniently laying on a bed in an open room. He was trapped, partially underneath a seat and tangled in a luggage rack, whose metal bars were too narrow to get hands in between. Only the left side of the patient was accessible, as he was laying alongside the rack and wall, which is why Roy was on the floor at the patient's head, not wanting to take the only accessible side.

Settling himself for a hard airway, "Do you have your intubation medications and equipment in here?" Brackett asked, knowing their priority was getting out, not treating. Quick realization dawned on him, Roy was dedicated to holding an artery, so he only had Johnny to assist. He thought about pulling Dixie, or another paramedic, but decided against it. He couldn't afford to pull them away from their current tasks.

"-brought in all our stuff Doc," Kel realized Johnny was in the middle of replying with a defensive look.

Assuming Johnny was answering in the affirmative, he began running off medications he knew they carried to assure the patient was going to remain unconscious through the whole procedure. Then he began asking for intubation equipment, used to a team assisting, and being the only one in the room able to intubate. "I want a 7.5 tube, and a Mac 4 blade please," Kel said, automatically rolling his go-to equipment off his tongue.

"Hold on a sec doc, just me in here," Johnny said, still drawing up the first medication Brackett asked for. Kel blinked, realizing he was task saturating his only trained help. With an apology, he hunted down the second medication from the drug box and helped. Chet set up the intubation equipment Brackett wanted with a nod from Gage.

Medications drawn and given, Kel went to maneuver his way to the patient's head in the tight space, only to trip on the train's window frame, as its side was now the floor, getting caught by Marco's free hands.

"Heya Doc?" Johnny said, while Brackett was untangling himself from Marco's arms, "Why don't you let me do it?" he respectfully suggested. Johnny was closer to the head, plus, Brackett would have to move back to get to the arm anyway.

"Right," Kel relented, enviously watching as Gage stepped around the patient and in the tight enclosed space with relative ease. Kel watched silently as the well oiled crew worked. John grabbed the laryngoscope blade handed by Chet, and positioned himself to get the best access. Not finding a good spot, he grumbled then laid chest down on the floor, wincing as he forgot to button up his coat, exposing his scratched chest.

"Junior," Roy chastised, the two were shoulder to shoulder.

"I know," Johnny admitted, then in the same breath, "Marco, cricoid pressure please?" which Marco complied with without a second pause, knowing what that was.

Kel blinked, unsure as to why he was surprised at the efficiency coming from Roy and John's coworkers. He couldn't imagine how many hours of training his two medics put the engine crew through to get to this point. "Got it," Johnny said, taping the tube and securing it. Marco automatically had a mask ready and began breathing for the patient while Chet passed Johnny a stethoscope. He noticed that no words were spoken, everything just happened. Everyone acted as if it was business casual. He nodded in approval, it probably was.

"Captain Stanley!" A voice called from the back of the car.

Hank turned, "We're back here," he projected back.

A firefighter was carrying a stack of sealed and sterile trays. "The nurse said you'd need these?"

"Talk to the Doc," Hank said, pointing out Kel.

"We do," Kel replied.

"Take 'em over there for me then," Hank directed, still avoiding using his arm.

"Thanks," Doctor Brackett replied, looking approvingly at the medical equipment. Watching the men of station 51 work in the past several minutes made him feel better at the outcome of this surgery. Taking stock of the manpower he had, he opened up one of the trays and passed a pair of gloves to Johnny, Mike and Marco, with the instructions of, "Time to scrub in fellas, I need all the help I can get."