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   The Fire Within
   Movie One
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               Page Five

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Subject: Gage, The Twit.
From:  patti k (pattik1@hotmail.com)  
Sent: Fri 3/06/09 12:05 AM

Marco heard the bang of a flare gun start to echo around the river valley.
He looked up as he ran, eyeing its ruddy trail. "Cap, the others see or
hear that ranger's chopper coming in."

Hank kept his eyes on the river, looking for pieces of kayak or clothing.
"Okay, start signalling with our mirror, let that pilot know how far up
we've searched already."

Gage lifted his radio. "Tag 70 to 240-Robert Air. Our victim party has
spotted you and is sending up signal flares."

##I see it and have them pinpointed.## Morgan replied back. ##But I'd
like to take a minute to help you find that second victim. I can guide you
in over trouble spots visually if I spot him.## she said.

Johnny paused near a boulder, catching his breath. Cap climbed up
on top of it to keep searching the river. "Two minutes. No more. Then we
need you to transport Victim One as a top priority."

##Understood. Coming over your location now and moving on. I'll 180
after the first minute runs out. Then I'll head back to your party's campsite.##  
Deputy Wainwright shared. ## Until then, I can cover a lot of ground for you. ##

Marco, Cap and Johnny ducked when a nimble black and white helicopter
with bilateral stretcher bubbles shot around a corner in a roar of power.
Its rungs were barely a foot over the water as it sped up the river ahead
of them, following the curves of the rapids, neatly dodging and weaving
over them at high speed.

"Whoa, look at her go." Gage said in amazement as the chopper quickly
disappeared upstream above the water.

Hank and Marco smiled and they picked up the pace again, headed in the
helicopter's direction, too, along a snowdrifted sandbar.

Twenty seconds later, they received a transmission. ##240-Robert Air to 70.
I've got the second victim sighted! A male, about a 1000 feet upstream lying
in a kayak near some rocks on your side of the river. But there's an obstacle.
There's a twenty foot waterfall between you and the height he's trapped on
around the bend.##

Gage toggled the radio switch. "Is he accessible to us?"

Morgan circled once, sliding in closer to the falls. ##The cliffs leading to
him look climbable. They have a solid, clean vertical with plenty of handholds.##

"Is he alive?" Gage asked.


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Morgan shot up the cliff and hovered as low as she could over the
kayak and man she could see floating upright in shallow water. ## His
head's out of the water and his helmet's still on. That's all I can tell.## she
said. ##There's no movement. No, wait! His leg just jerked.##

"Are you sure?" Johnny asked Morgan, biting his lip.

##Yes, very. He's in a calm pool. He wasn't moved by the water.
His color looks good but I'm seeing a lot of blood around his face
and on his hands.##

"Okay, we're headed up there." Gage transmitted, tossing his rope coils
to Cap and Marco to start tying free hitch harnesses around their waists
and pelvises. "We've basic medical gear, enough to stabilize him for
now."

##Roger that. I'll return as soon as I finish getting Victim One to the
hospital.## she said, sliding carefully sideways, fighting strong wind
gusts over the river.  

Soon, Wainwright hovered over the injured kayaker. She toggled her loud
speaker. ## This is Sheriff's Department Rescue. Help's on the way.##
she told him. But there was no noticable physical response.

Morgan, unhappy, gained altitude and looked up to the road tracing along
the top of the new gorge. She soon spotted 240 Robert speeding by the
area on their way to the deer camp. ##240-Robert Air to 240-Ground. Stop
right there and mark a tree to head back to later. You're right above Victim
Two's location near the other firefighters.##

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The sheriff paramedic jeep skidded to a halt in the dust and Thib got out
with a can of bright orange trail blaze paint in a spray can. He marked
a strong arrow riverwards on the road itself and then partially up a pine tree
next to them. He waved to Morgan hovering over the river and gave her
a rapid thumbs up enthusiastically.

Trap hit his mic. ##Thanks, Morgan. We're set. Moving on to Victim One.##
he replied as his partner got back into the truck.

## I'll meet you there. ## And Morgan gained more height with a celebratory
waggle to her partners and to Gage, Lopez and Stanley below before she
nosed down and headed quickly downstream towards the deer camp.

---------------------------------------------------------------------------------------------------

Stoker ran back to the meadow to guide 240-Robert Air in, showing
her the upwind direction to nose into.

Morgan landed neatly in the center of the staked out grass and got out.
"How's he doing?" she shouted over the chopper's rotors, still running hot.

Mike replied. "Still the same. Breathing's poor. How far away are your
paramedics?"

"Less than three minutes out. I just spoke with them." she replied. "I'll go
grab a stokes." she said, pointing tailwards.

"I'll help you." replied Mike. They both ducked low as they headed back to
the chopper's equipment bay. "Do you have any more oxygen? We're almost
out." he shouted.

"Yes, in the tank rack behind the pilot's seat." she told him loudly. "Two D's
and an E. And good news.. We've found the second kayaker. He's still alive."

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Trap and Thib raced up the road and turned sharply onto the dirt road leading
to Tag 70's hunting camp.  They parked a safe distance away from the landed,
but still running chopper.

It was empty.

"Looks like she's already gone down with them. A stokes is missing." said
Dwayne, getting out of the truck and grabbing for his medbag from the back
hatch of the rescue jeep. "I checked the Res-Q-Air. It's fully charged."

"Want the spare battery?" Applegate asked.

"Later. Let's get him started on this one first." Thib said.

Trap, pocketting the keys to the truck, grabbed the heating pack of I.V. solutions
Thib had set up into insulated sleeves along with their drug box and EKG monitor.
He followed his orange coated partner carrying the warm oxygen ventilator device
as they ran to meet Morgan and the California firefighters closely huddled over
their unconscious, chilled patient. Trap thumbed his hand held walkie talkie.
"Appalachia Base, we're on scene. Stand by for an update. I got you on
speaker."

##Standing by.## replied Dr. Almstedt through the base station's telemetry
intercom. ##Ready to receive a strip.##

Roy started talking all at once as the two sheriff paramedics joined them and
began tearing into their gear. "He's still pretty ectopic. Two minutes ago, we
almost lost a carotid. Dehydration's worse." Then he noticed the Res-Q-Air heater.
"Hey, can that thing positive pressure ventilate?"

"Yep." Applegate replied. "Through an ambu bag. We'll start using it now to free up
your friend." he grinned tightly at Chet, who still working through the pocket mask.
Trap turned to his younger partner. "Thib, after he's hooked up on EKG, could you
get a core temp for the doc?"

"Tympanic?" the blond haired Dwayne asked.

"Sure, that's fine." Trap said. Then he turned to DeSoto. "You're one
of the California paramedics?" he asked pointing at Roy. "Sorry, I forgot
all your names."

"Yep, I'm one of them. I'm Roy, and this is Chet and Mike. My partner Johnny's
upriver with two of my firefighter colleagues, Marco and Hank, headed for the
second victim." replied Roy.

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Mike offered a suggestion. "Got any more gear still stowed that you need?"

"Yeah." answered Thib. "In the back of the jeep. Grab the black defib
and the red battery insulation cooler sitting next to it." He grimaced
when he saw Mike take off running. "Ah, wait.. It's locked." Then he
psst'd at Trap Applegate with a couple of gimme fingers.  "Keys." he
prompted.

Trap dug into his pocket and tossed them at Thib without looking up
from reading the notes Roy had written down for vital signs. Thib caught
them and retossed the key set over to Stoker who hurried off to the 240
team's rescue jeep.

Morgan propped up the shattered kayak somebody had retrieved and dug
it lengthwise and upright into the melting snow to use as a windblock.
"There. That'll prevent the chopper's propswash from reaching him
anymore."

Then she eyed up Roy. "The second man looked injured. Very badly.
I hope your people are pretty fast mountaineers."

"They are." Roy reassured her. He unzipped the kayaker's insulation
cocoon a little for the new paramedics. Then he worked on learning
how Thib was setting up the Res-Q-Air unit, handing him the cables
and connectors that Dwayne pointed out to him to thread through
insulation sleeves. "Reach in."

"Thanks, Roy." nodded Applegate, shoving both arms underneath
the thick layers of sleeping bags, to listen to the kayaker's chest with
a stethoscope's drum. "He still sounds clear. No rales. But his apical's
getting pretty hard to find."

Thib negated that worry a second later. "That's just chest wall stiffness.
He's still got a rhythm." he announced as he flipped on the EKG's switch.
Dwayne frowned. "Hmm, the pads aren't staying on."

Dr. Almstedt spoke up from the radio. ##Try a tincture of benzoin under
the electrodes from your wounds kit. If that doesn't work, stab three
24 gauge needles into the skin through the pads. They'll hold then
and the signal will carry through the needles to the conductive gel.
Don't worry about a getting twelve lead. What I'm seeing here in Lead
II's good enough.## They all heard her sigh. ## Now,.. Fellas?
Crank up the QRS amplitude to maximum. I can't see any details.##

Thib did so.

## All right. Got it.## said Joanne. ## Profound bradycardia with
an irregular ventricular rate of twenty. ##

"We see that here, too." Trap told the doctor.

"His carotid's starting to match that rate." Stoker said.

##How are his pupils?## Joanne asked.

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"Responsive." replied Roy to the air.

##Get him assisted on aggressive warmed, humidified oxygen. And begin
transfusing normal saline heated to 110F infused centrally. 300-500 cc's
rapidly, followed by 75-100 cc/hr. Use a jugular. ## Almsted ordered.
##What's his core temp?##

"84F." Thib replied. "Might be higher, there's a lot of mud in his ears."

## Let's assume he's at that level. Try to endotracheally intubate him.
If he slips into V-Fib at any time, shock him three times only, then start
and continue CPR in transit.  Avoid all cardiac medications in that event.
Those drugs will not be metabolized or cleared normally by the
patient's liver and kidneys. If they were to be used, they would accumulate
in his body and only become active as he warms up, possibly overdosing
him. For now, I see pacing's not needed, his brady's probably physiologic
in nature. It should correct itself once he's over 86F or so. Keep
me posted. I'll be on live the whole trip in.##

Stoker returned with the slim defibrillator and second battery bag for the
Res-Q-Air. He set them by the three paramedics' sides.

"Here." said a voice in Kelly's ear, breaking his counting concentration.

Chet blinked at the steaming ambu bag Trap had handed him. "What?"
he mumbled in confusion at the strange jumble of mask, canvas covered
squeeze bag, and orange sleeve covered tubes in his palms. The
battery unit pump and reservoir it was attached to between
Kelly's knees and the oxygen tank began to bleep operational readiness.
"Uh, ..maybe one of you should operate this new contraption instead."

Trap grinned. "It's okay."
"Just use the bag end like normal. The rest of the warmer'll give him continuous
hot oxygen..."  Applegate told him. "..and start thawing him slowly from the core
on out. He'll get stronger very quickly."

"All right." Kelly said, pulling off his cannula and throwing away the CPR mask.
Stoker helped Chet begin to give ventilations to the man with the new delivery
system, holding the warmed, misting mask in place while Chet squeezed the
bag. The rhythm on the EKG monitor began to speed up immediately and
even out. "Wow, this thing's wild." he said in amazement. "Are we doing that?"
he asked Trap.

"Yep." Applegate grinned. "Isn't the Canadian navy wonderful? They just
invented that lovely little warmer last year." he said, swabbing down
a place on the man's neck to try a needle stick for his I.V. around
the bundle of belted in clothes holding his head still. He got flashback
on the second try. "Yes!" he said. "Thib, hand me that heated catheter
on a flow."  
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"There you go." answered Dwayne, dripping some of the steaming
saline he had heating, out the end of the sterile luer to bleed out all the air.

Trap snapped in the life giving fluid line firmly. "Tape it down while I hold
it, Thib. Roy, can you add a Heparin flush to the port?"

"Yeah." DeSoto replied, reaching into the drug box. "You guys use five cc's?"

"Ten." Trap replied.

Stoker put on a soft cervical collar to protect the jugular I.V. when they
were through securing and prepping it.

"Okay, now let's get that airway in.." DeSoto said, grabbing for an ET.

"I'll help with a light." Dwayne offered.

A few minutes later, Roy and Thib gave up attempts to intubate the kayaker
after two tries in between manual hyperventilations from the respiratory
warmer.

"D*mn it, he's still too cold. All his muscles are locking down." Dwayne said
to Roy. He leaned over the radio in frustration. "Doc, the tube keeps freezing
and breaking off at the phalange at tooth level." Thib told his boss. "We
just snapped our second one."

##Skip it then.## said Joanne over the speaker. ##Go with what you had
before with an OPA. It's not the fastest way to warm him, but us beggars can't be
choosers. Boys, once you get him fluid loading solidly, get him the h*ll out of
there!## Almstedt said, getting a little over-eager to fix their patient.

"We're on it." said Trap and Thib, grinning from ear to ear. "Morgan.. drag
that stokes a little closer so we can get him into it. Sleeping bags and all.
We've finally got in a good running line. We'll lift on three. Ready? 1-2-3, go!"
ordered Trap.

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Gage climbed the waterfall cliff carefully, foot by foot, as fast as he could go.
The heavy weight of the rope tied around his waist made him glad he had shed
his winter jacket, for the sun was baking the rocks into a lurid heat underneath his
fingers, making his grip slick and precarious. He dug in his toes even deeper,
guarding against his hands failing. He pressed his cheek into the limestone as
chalk and melting snow drifted down. He coughed.

"Gimme more slack!" he shouted down to Hank and Marco, who were feeding him
a rope line from the ground.  He had one bad slip of a shoe but then, he
rounded the top.

Swiftly, he tied off the end of his tether to a solid tree and he flicked the line
so it rippled down the cliff in a signal. "I'm up! You're tied off. Come on up! Here's
a second line as a backup." he shouted, still out of line of sight at the top
of the waterfall. "I'm going on ahead."

"Got it!" said Cap from the base of the small cliff over the noise of the
thawing waterfall.

Johnny hurried, sweating, towards the small pool the woman pilot had mentioned.
He dropped his medical pack and extra blankets into a pile in the sun and
rounded a copse of yellow leaved trees.

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There he saw the wounded kayaker, just starting to tumble face down into
the water from his still floating, damaged boat.

Gage yelled in surprise and rushed, high stepping into the cold shallow water in
an attempt to catch him before he disappeared from sight.

He failed.

A deep hole opened up under Johnny's feet and he plummeted into frigidness,
neck deep. The numbing icy water made him gasp in shock and he barely
managed to hold his head above the waves as it subsided into a shuddering
breath that was under his control again. Nerves on fire, Gage jerked into
motion anyway.

Reaching out, Johnny lunged forward towards the tipped kayak in the next
second, just catching the back of the man's shirt collar under his heavily
cracked helmet, as it slipped beneath the surface, with a couple of fingers.

Locking his hands on either side of the man's ears, palms down, elbows up, to stabilize
head and neck, Gage drew up the kayaker's face carefully back into the air in front of
his chest.  Johnny began shouting to the others as loudly as he could as he
treaded in the cold water vigorously with just his legs to keep them both afloat.

"Hey! He fell in the water! Get up here as fast as you can and help me out!"

A floating iceberg hit his face, making him see stars. Johnny shook his head
to clear it and spat out frozen silt.  He spun around in the water to push away
other ice chunks floating by, away from the man in his arms, using a free foot.  

"Hurry up!" Gage coughed, struggling for space and air.

Marco and Hank shot up over the cliff's edge along the climbing
rope and ran to Johnny's aid. "We're here!" Hank shouted. "Hang on!"
he said, peeling out of his hunting jacket.

Marco began to throw off his boots.

"No, don't come in! It's real deep by me and there's an undertow. I can feel it.
Just lasso a rope around my upper body and pull us in. I got him firm, but I can't let
go. Something's wrong with his spine." Gage gasped, shivering. "He's really crooked
above the shoulders."

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A sudden cramp bit into Johnny's side and made his head jerk forward. His chin hit
the kayaker's shoulder before he could avoid it.

"AhHHh!" groaned the wounded young man at the light impact.

"Hey, mister? You felt that? Can you hear me?" Johnny asked, panting,
still keeping his arms locked tight around the man's head.

The man began to struggle, delirious, not completely awake.

"No, don't move!" Johnny told him. "We'll--"

One of the man's legs kicked, catching Gage in the stomach, hard. All the air
left Johnny's lungs in a whoosh and he lost buoyancy.

Both of them went underwater just as a circle of rope shot out
and splashed down around where they had been.

"Johnny?!" yelled Lopez.

Hank cursed and ran out to the end of the river sandbar in
his shoes and all. He dove into the center of the circle of rope
that he had just thrown, one hand catching its edge to drag it down
into the depths with him.

Bubbles and chunks of dirty ice tumbled up from the bottom of the pool
and soon, three heads emerged back into the sunlight, two of them
coughing noisily. Gage and Stanley hung on tight as Marco snubbed
the rope they had looped around themselves and the kayaker about
a nearby stump as he hauled them back, hand over hand, to the sandbar.

"Okay, we're safe." Gage hollered up to him. "Get down here and help
us hold him upright, while we climb out." Johnny said, still not letting go
of the man's head and neck from the way he had first clamped onto him.

Stanley spoke from where he was wrapped tight in a bearhug around
the kayaker's bloody shoulders. He was listening close to the man's back.
"He's still breathing a little." he decided.

"How much?" Gage panted, beginning to shiver again.

"It's enough." Stanley coughed as Marco made his way down to them
after tying off their rescue rope.

-------------------------------------------------------------------------------------

Eventually, Cap, Johnny were back inside their winter jackets
with their victim safely secured and out of the river. They had used the
bottom of the shattered kayak as a long board and one of their ropes
as a criss cross braided tie down. For lack of a headblock, they left the
man's helmet in place, padding it off levelly with the rest of his body using
a blanket and cut off only its fastened chin strap for easier airway
monitoring and maintenance.

##What are his injuries, 70?## asked Almstedt, once communications
had been reestablished.

Gage was mummied into a blanket of his own as he sat drying off
against a hot rock against the cliff. He tried to speak without his teeth
chattering. "Probable skull fracture and lower C7 involvement or
dislocation, broken ribs on the left side. I can't find any holes. And
a fractured right ankle. Also moderate--"

##...hypothermia. Got it. Popular theme in our patients today it seems.##
Joanne sighed, watching another ranger team bringing in some campers
suffering from chillblains into the hospital's emergency area. ##So you
say he was conscious for a time and still had sensation below the
cervical/thoracic notch after he fell into the water?##

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"Yes, I accidently bumped his shoulder. He felt it." Gage said, watching
Marco monitor the kayaker's breathing through the oral airway they
had given him.

##That's a good sign. Maybe he didn't sever his spinal cord after all.
How are his vitals holding?##

"Pulse's 130 and thready. Respirations are twenty two and shallow.
BP palp'd is at least 80 at the brachial. I'd guess about a 1000 cc's
blood loss due to cuts and abrasions about the f-face, head and n-neck."
Johnny grimaced angrily as he started shivering again. " And doc, all
hemorrhaging's been a-addressed. There's no more ...uh... leaks. We
found them all."

##Okay, and how are your vital signs?##

"Mine? Why? I'm f-fine."

##Truth now, Mr. River Jumper.##

"Okay. All right. I'm-I'm still shivering but normal." Gage told her.
"Ma'am, believe me when I tell you, I'm not a flight candidate.." he told
her very no-nonsense through tightly clenched teeth.

Cap finally tromped over and dumped another dry blanket on Johnny's head
in irritation. "Would you get out of those wet clothes already?!" he hissed.

##I heard that. Do it now. Listen to your friend. My direct orders. ## Joanne
drawled dryly. ## I'll still be here to give you an ETA on the next chopper when
you get back.##

Johnny just sighed, set down the radio, and started stripping. Soon he
was down to just skin.

##My kind of boy.##

Frowning, Gage startled, and turned the radio around on its rock.

------------------------------------------------------------------------------------------------

Morgan Wainwright's hail came loud and strong through the radio
a few minutes later. ## 240 Robert-Air to Appalachia Central. I'm on
the way in with Victim Number One from Tag 70. I've a civilian
paramedic and Trap on board with one firefighter.##

"Way to go Roy and Chet..." cheered Hank happily. He knew
Stoker would choose to remain behind to either watch camp or to
stow all their stuff back into the rover before insisting on accompanying
the left behind 240-Robert's ground paramedic to his second rescue
assignment with them. "Gage are you warm yet?"

"Getting there.." Johnny said from his naked, spread eagle place on the
hot rock by the cliff base underneath the pile of blankets. "Marco, how's
he doing?" he asked, his eyes watering from the direct sunlight.

"Okay, I think. Pulse's slowing.. and so's his breathing rate."

"Ah, not good." Johnny mumbled, staring at the sky from his refuge.
"Not with a head injury.." he mumbled. "Any JVD?" he asked, a little louder.

"What's that? Bladder and bowel loss?" Marco asked.

"No.. That's incontinence. JVD is when your blood pressure or intracranial
pressure's high or if you have a certain kind of lung collapse going on. Your
veins'll pop out at the neck when you breathe in, and sink back down again
when you exhale,...if there's that kind of trouble." Johnny explained.

"Oh. Uh, let me see.. No there's nothing yet." Lopez reported, running a
few fingers lightly over the arteries in the man's lower neck.

"Good. That's good." Gage said, letting his head clunk back down onto
heated stone again. "Just keep tabs on him real close."

Cap, meanwhile, was clearing away the brush from the only column of clear
sky that he had found through the heavy trees.  Surrounding them, were
more steep cliffs like the kind ringing the lower waterfall's valley where their
deer camp was located. "Hey guys, I think I found the place." he said
studying his perspective view straight up through tree limbs.
"Yeah, I think a chopper cable can lower down through here, just fine."

Image of capthinkingclose.jpg Image of birchtrees.jpg

"Yeah, but how's the wind up at the top?" Gage asked, getting sleepy and
fighting it.

Cap squinted and analyzed the tree tops. His face fell. "Pretty bad.
There's a lot of twisting going on up there."

"G*d d*mn it.." Johnny cursed. "Had to be hard, didn't it? After all the
trouble we had....... getting up here to rescue him?" he groused. "Aw, man."
Then he started coughing.

Hank frowned and wandered over to where Gage was lying on the boulder.
"How are you really doing?" he asked seriously, taking Johnny's pulse at his
wrist.

"Uh,.. "

"You're getting cold again." he said sternly. "Slow pulse. Come here, pal. No, don't
get up." And he dragged Gage by the ankles, blankets and all, down the big, flat
boulder to a new hot spot.

"Ow! That's hot!" Gage said, arching up and cushioning his hands underneath his
butt.

"Good, glad something's burning your *ss again. Now shut up, lie still,
and conserve your body heat."

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***************************************************
From: patti k <pattik1@hotmail.com>
Subject: Shake, Rattle and Roll..
Date: Thu Mar 12, 2009 9:58 pm
 
Ken Baxter was just edging over into the lake valley when a new call
came out.

##Appalachia Central, Bluebird Five.##

"Go Appalachia.." said, Ken, hefting up his radio mic.

##Marker 70 reports a second victim upstream four hundred yards
above Kaaterskill Falls. An off duty paramedic is in attendance. 240
Robert Air is transporting Victim One, and will be 10-6 for twenty.
Reroute to assess extrication by aerial cable from the head of the
falls. 240 Robert Ground will rendevous.##

"I copy transmission. Heading to those coordinates now. Do you read
transponder code activation?"

##10-4. Positional is 37 23.516 -122 02.625 easterly. Alert: Winds are
building in your area. Gusts possible to 3-5.## replied the dispatcher.
##Radar indicates no squall.##

"Bluebird Five concurs and acknowledges. Will report when on hover,
over contact." Ken replied over the channel.

##Copy, Bluebird Five.##

Joey Collins shifted in his seat, staying quiet as he listened to the
interchange between his pilot and the ranger base. When Ken finally
nosed the chopper away from the broad lake, he spoke.
"It's bad, isn't it?" the boy asked.

Baxter kept the calm smile on his face. "Not necessarily. We've only
been called in to scout things ahead of time for a climbing team.
Nobody's dying or the dispatcher would have pushed up our response
time with a real sharp hint or two."

Joey eyed up Ken thoughtfully. "There's not much you can do anyway.
There's no place to land."

Baxter nodded ruefully, and mumbled under his breath. "Ain't that the truth?"

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----------------------------------------------------------------------------------------
In 240 Robert Air, Roy DeSoto worked quickly with Thibideaux to
keep the first kayaker stabilized. "What are his core temp and vital signs
now?" he asked Dwayne, the sheriff/paramedic.

Thib looked up from his detailed exam that he had just completed.
"93.2F. His carotid pulse is 40, strong and regular, pupils are constricted
but still equal and reactive to light. Monitor's nonspecific bradycardia."

Chet Kelly looked up from his work with the heated, humidified bag valve mask.
"Respirations on his own are 8 and shallow. I'm keeping him at twelve manually."

"Keep it easy.." Roy cautioned him. "We don't want him to warm up too fast."

Dwayne eyed up DeSoto where he was listening to the quality of breaths going
into their patient with an amplified stethoscope. "Worried about afterdrop?"

"The thought did come to mind.." Roy admitted, pushing the warmed
I.V. fluid into the drip chamber a little faster.

Thib bit his lip. "Chet, uncover his legs... slow the heat building up there."

Just as Kelly was doing so, the kayaker arched up into a back breaking
but rigid convulsion, sighing deeply in new, ugly gasps. Luckily, the
backboard straps held him down. "Is he waking up?" Chet yelled, fighting to
keep the steam at least on blow by over the man's mouth and nose.

"Yes." both Dwayne and DeSoto said together.

Roy ordered. "Chet, keep him oxygenating."

Dwayne leaned down low and pulled out the man's oral airway and suctioned
out the limp, drooling mouth around Chet's mask. "Sir.." he asked near an ear.
"Can you hear me at all? Easy. You're in good hands. We've found
your buddy and he's alive. Try and open your eyes. Can you do that for
me?"

Image of thibchetroytreatbag.jpg Image of victimtendednight.jpg

The man's loud, noisy breathing gained strength and vigor and his whole body
spasms suddenly relaxed as his eyes rolled. He gurgled vocally. Kelly
held the bag of warm steam over the man's nose and mouth without
squeezing it anymore and some fluid drained out. The kayaker moaned
and grabbed his chest.

Roy and Dwayne propped up their patient's backboard and headblock onto a
stack of blankets to ease his breathing. "Spit it out. We got you." DeSoto said,
helping Thib get the suction wand around the man's shivering teeth. "Mister, do
you know what happened to you today?" he asked as the man began to grope
the air purposefully with shivering fingers as he fought back to consciousness.

The man coughed, proving his throat was finally clear. He tried to swipe the
hissing, heated Res-Q-Air mask away from his face clumsily with both hands.

Thib dissuaded him.
"Nope. Leave that alone. It's just some warm oxygen. You need it." said
Dwayne, gently restraining the man with crossed wrists over the man's chest.
"You're doing fine. Do you know who we are?"

The man finally opened his damp, bleary eyes.. "Rangers?" he guessed.

All three rescuers in the chopper smiled. "Yes. We're paramedics and we
pulled you from the river." said Roy. "Do you hurt anywhere?"

"I'm really...c-cold.." shivered the man. Then his body arched up into another
involuntary convulsion. The kayaker was aware enough to be frightened by it.
He shouted inarticulately.

Thib grabbed his shoulders.
"Relax,.. just try to relax! Those are cramps from being chilled too much. They'll
go away in a few minutes. Keep taking deep breaths on that steam mask, okay?"
Dwayne shouted. "Hey... Can you hear me?"

But the man was lost in his seizure and soon fell unconscious at the height of it.

"Help him on the in's, Chet." Roy told Kelly. "Until it's over. I'll put in a toothguard
to keep him open."

Chet worked carefully, getting in a few deep ventilations.

The kayaker fell still and quiet, his heart beating quickly from stress.

"What's going on back there?" Morgan Wainwright shouted from the
open glass cockpit, just in front of their horizontal stokes.

"His temp's dropping again." Thib told her.

"I'll let Appalachia know." she said, toggling her radio mic relaying to
the ranger base hospital. "240 Robert-Air to Appalachia. We're
encountering a patient setback. I'm increasing speed."

##What's the nature of the problem?## Dr. Almstedt asked.

"Falling core temp." Morgan told her.

##10-4, we have peritoneal dialysis and an extra-corporeal blood warming
bypass team standing by.## Joanne replied calmly.

Roy and Thib worked hard to heat up the blankets and I.V. fluids with packs.
But there was no change in the kayaker's mental status even after a few minutes
of aggressively pumped in breaths on the steamed O2 ventilator.

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"Is the battery going dead?" Dwayne asked Roy, eyeing up the Res-Q-Air unit.

"How can you tell?" Roy shot back, worried.

"The amp needle on the indicator at the back.." Thib told him. "It should
be in the green."

"It's red." Roy replied.

"Then the power's losing output. Hang on. I'll switch it out."

Morgan shouted over the noise of her chopper's rotary props.
"We're clearing the final ridge of mountains. I'll have us landed in four
minutes!" she updated everyone. The chopper buffeted, jolting in a
sudden side wind. Wainwright compensated nimbly, keeping them steady.
"Now where did that come from?" she mumbled to herself, moving
her other gloved hand onto the flight stick. ::Huh. Completely clear
skies all the way around us. Now why isn't it smooth sailing up here?:: she
wondered.

As if in reply, the helicopter gave a shudder as another series of wind
gusts shook them, like a dog with a rag in its teeth. They filled
the chopper with the distinct tang of salt.

::Clever ocean breeze? Not today.:: Wainwright smirked mentally.

Protectively, Morgan gained altitude.

-------------------------------------------------------------------------------------------------

Bluebird Five pitched and yawed skillfully over mountain ridges and
over tree tops like a falcon.

"Almost there, young man." Ken told Joey Collins. "Make sure your
seatbelt's fastened tightly. When we get near the ground the wind'll
get rough, you hear? I don't want you rattling out of your helmet to
the point where I have to grab your shirt to hold you still."

"Yes, Mr. Baxter."

**************************************************
Subject: Nature..
From:  patti k (pattik1@hotmail.com)  
Sent: Mon 3/23/09 12:59 AM

Their rescue helicopter banked over a tall ridge and headed
east toward the distant river and its small waterfall. Beech and pine trees
bending in a breeze over a mountain top alerted Ken to a change.

"Holy mackerel. It's a microburst." the Baxter chuckled as he
stabilized Bluebird Five's altitude.

"But where are the storm clouds?" Joey radioed back through his
foot toggle and headset.

"Doesn't have to be any this close to the ocean. Daytime heating
and cooling are enough to make 'em happen this time of year.
Hang on, we'll try entering their valley from the north." Ken told him.

----------------------------------------------------------------------------------------------

In 240-Robert Air, Thib straightened up from reconnecting a new
battery to the Res-Q-Air ventilator. "Okay.. it should get back up
to operating temperature in a few seconds." he told Roy.

"Chet, how's his seal?" DeSoto asked.

"Fine." answered Kelly, holding the ventilator mask firmly over
the kayaker's mouth and nose. "Still good chest rise when I
help him out."

"He should be improving." Dwayne frowned, checking and
rechecking the respiratory tube and insulation coat leading from
the small heated oxygen ventilator machine to Kelly's mask.
"We fixed the problem." he said, frustrated. Then he asked.
"What's he at?"

Roy reached down and got another tympanic temperature
reading with the helicopter's scanner. "90.3F. Let's bump up
his I.V. Maybe he's out because he's getting seriously
hypovolemic with that polyuria."  DeSoto turned the drip chamber
to wide open after marking down its starting volume and the time
on a chart. "Line's still patent into that vein at.... 110 degrees."

"That's just where the doc wants it." Dwayne grunted, thinking. He
finally pursed his lips. "Huh...I'll check for a peripheral B.P. so we
know what it is for sure." Thibideax nodded. "He should have one
showing up in his legs by now. They're almost warm to the touch."

"Here." said Roy, handing him a thigh cuff.

Thib worked swiftly, listening with his stethoscope. Then he looked
up. "Yep, he's low volume. 80/62." he reported.

"From afterdrop?"

"No, his arms and legs are still pale. Nothing's dilated circulatory
wise here yet." Dwayne replied.

"Second I.V.?" DeSoto suggested.

Image of royplaidshirtcloseright.jpg Image of sizeoralairway.jpg Image of thibcloseexam.jpg

"Yeah. I'll get one ready." Thib agreed quickly, running his hands
over the kayaker's stomach in a check. "Belly's still soft."

"So, no large internal hemorrhaging inside."

"Nope." Dwayne said. "There's still no bruising anywhere." he exasperated.

Roy toggled his chopper helmet's talk button. "Morgan, notify the
doc that we've begun forcing fluid. He's getting real volume shocky."

##I'll get on it.## Wainwright replied. ##We're two minutes out from the
park hospital. And I just heard Bluebird Five. She's been confirmed
by Base, as heading directly for the second victim to scout out
good air access there.##

Thib nodded, signalling Morgan over the noise of flight with a
hand gesture. Then he turned to Roy. "I'm going I.O." he said,
grabbing for a bone gun package. He bit it open.

"What?" DeSoto blinked, not comprehending.

"Intraosseus. It's a new thing. A needle cath into bone marrow."
Thib replied, tearing off the sterile paper from the tool.

"Where?" Roy asked dubiously.

"Top of the shin, below the knee cap. It'll be very stable." Dwayne
grinned. "And we can push. A lot." he said of fluid loading.

DeSoto raised his eyebrows, impressed. "Whoa. Walk me through."

"Watch. It's easy." He uncovered the kayaker's leg and turned
it sideways. "Swab that down." he said. "Right along the front
of the bone."

Roy did so.

Now Dwayne reached for the blue drill gun sitting on its wrap and fitted
it with a round snub, bearing a thick, one inch needle bore. "You feel one
finger width medial to the tibial tuberosity, right below the knee cap,
on the big toe side. See that groove?" he said, landmarking the spot
with sterile gloved fingertips.

"Yep." Roy replied, holding up a flushing syringe of saline, prepped and
ready.

"Set the driver ninety to the bone." he said, carefully angling the lancet
into position. Then he triggered the gun.

*Bang!* it went.

"Now it's in." Thib shared, holding the embedded cap's cover with a thumb
while he unscrewed the gun nozzle from the cath circlet. "You just remove
the stylet, and test the flow with the flush catheter syringe extension set. Like
this." he demonstrated. "See how the blood's welling up through the hub?"

"It's slow."

"Ah, don't let that fool you. The space under there, inside, is a bottomless pit.
Just aspirate a little bit of it, as the marrow's thick, to create some room."

"What about pain when he wakes up?"

"There's only some when I'm injecting or drawing up. A ten mil bolus of
lidocaine into the marrow will handle it for hours. And punching through the
skin's nothing. It's so thin. There's no muscle in the way." He delivered the
medication. Then he wiped up with a sterile 4x4 and connected their second
flowing, hot saline I.V. line.

Then pointing, Thibideaux gestured. "Now try to rock that."

Roy looked down at the disc of plastic embedded into the shinbone with
its small vertical shaft tube, and grabbed hold of it. He tried to move it.

Image of eziobox.jpg Image of ezio.jpg

It didn't budge.

DeSoto made a small sound of amazement. "No tape's needed there."

"That's the beauty of it. And we can dump in as much as we want. There's
no venous resistance getting in the way. It's all porous. Like a sponge.
And no risk of embolus at all." he said, recovering up the leg to keep it
warm.

"Wow." said Roy, dialing up the new line to wide open.

"You want these for your fire department?" Dwayne asked.

"Is fire hot?" Roy gaped, still tickled.

"I'll send some out for your docs to play with. The manufacturer's
free licensing."

"What's it called?" DeSoto said, picking up the used gun to study
it in detail.

"EZ-IO." Thib coined.

"Perfect name." Roy chuckled. "This'll catch on like wildfire back
at home."

Chet made a noise and shifted uncomfortably from where he was
sitting at the man's head.

"What?" Roy asked him.

"Eoowww." Kelly shivered. "You just darted a man's shin bone."

"That bothers you?" DeSoto asked with a smile, surprised.

"Duhhh. When was the last time you hit yourself with a hammer
in the leg?" Chet scoffed right back.

Soon, the kayaker awoke as his temperature responded to
the newly recharged humidified oxygen and the additional fluid he
was being given.

Then Dwayne, Chet and Roy had their hands full managing him
as best they could through another series of involuntary muscle
spasms that were an improvement over the earlier convulsions.

------------------------------------------------------------------

Ken Baxter circled in the air high over the juxtaposition of
three adjoining mountain ridges fringed with tall, twisted weather
warped pine trees.  "Okay, we're toeing the line. Ready to get
down to business?" he asked Joey.

Collins grinned, and rechecked his seatbelt and helmet strap
buckles. "Yeah. Will there be bad turbulence coming up?"

"More than a bit I suspect, but I'll bring us over those firefighters
by the waterfall nice and easy." Baxter told him.

"Then I'm ready when you are." the boy said firmly, still gripping
his navy hat.

"So,..." Ken said, popping his lips. "You aren't nervous?"

"Why? Should I be?"

"Well, yeah." Baxter countered. "You aren't flying this beast."

Joey just rolled his eyes. "Mr. Baxter, you're older than
me by a whole elephant's lifetime. So if you haven't learned
something about helicopters in all your years yet, I'm a girl." he
said.

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   The Fire Within
   Movie One
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