Inside, it’s a mess of twisted metal and luggage. I see her. Blonde hair, pale face, trapped under a crushed row of seats.
"Help me!" she screams when she sees my flashlight. "Please, I can't feel my legs!"
"I’m going in," I yell down to Miller.
"Doc, the bus is shifting!" Miller warns. "If it slides, it goes over the edge!"
"Then hold it steady!"
I don't wait. I drop into the wreckage.
It’s claustrophobic. The world tilts on a forty-five-degree angle. Luggage is falling on me. I crawl over the ceiling—which is now a wall—shoving debris aside. I reach the girl. The metal has sheared through her thigh.
"Miller!" I scream up at the window. "I need the comms! Patch me through to the hospital! I need a consult on the extrication!"
Miller drops a radio handset down to me.
I grab it. I key the mic.
"Trauma One to Base. Do you copy? This is O'Connell."
Maxwell
The ER is bathed in red light.
The backup generators are humming, a low, ominous vibration. I am standing at the triage desk, gripping the console with hands that are shaking.
We have been waiting for ten minutes. Ten minutes of static.
Then, the voice cuts through the white noise.
"Trauma One to Base. Do you copy? This is O'Connell."
The relief that hits me is so violent my knees almost buckle.
"Jax," I breathe into the mic. Then I snap into protocol. "Base copies, Trauma One. Go ahead."
"Max,"Jax’s voice is crackly."I’m inside the bus. I have a female patient, roughly twenty-five. Complex entrapment. The seat frame has pinned her right thigh. High femoral bleed."
"Can you apply a tourniquet?" I ask, staring at the wall map.
"Negative,"Jax says."No clearance. The debris is too tight. I have to clamp it manually, but I can't see the source. I’m going in blind."
"Jax," I say, my voice steady. "If you cannot visualize the artery, you risk clamping the femoral nerve. You could paralyze her leg."
"If I don't clamp it, she dies in two minutes,"Jax snaps back."I need you to talk me through the anatomy. I’m upside down. My orientation is shot."
I close my eyes. I visualize the anatomy of the thigh.
"Okay," I say. "Locate the inguinal ligament."
"Found it."
"Move two centimeters distal. Palpate for the pulse."
"Pulse is weak. Thread-y."
"That is your landmark," I instruct. "The artery runs deep to the sartorius muscle. You need to go in manually. You will feel the tear."
