"Copy. Going in."
Silence. I stare at the radio. I can hear him breathing. I can hear the girl screaming in pain.
"I have it!"Jax yells."I have the vessel! Clamping!"
There is a grunt of effort.
"Bleeding is controlled,"Jax reports."Miller, get a line in her! Drag her out!"
"Good work," I say, exhaling. "Now get out of there, Jax."
"Negative,"Jax says."I have another patient. Driver. He’s pinned at the front. I’m moving forward."
"Jax, wait," I say. "What is the stability of the vehicle?"
"It’s... precarious,"Jax admits.
"Do not move forward," I order. "Wait for Fire. If you shift the weight distribution, the bus could slide."
"The driver is crashing, Max,"Jax interrupts."I can hear the agonal breathing from here. I’m going."
Jax
I leave the girl with Miller’s team and crawl toward the front of the bus.
Every time I move, the bus groans. Metal screeches against rock. Gravity is trying to pull us down the ravine, and the wind is helping.
I climb over rows of crushed seats. It’s like a jungle gym made of razor blades.
I find the driver.
He’s a heavy-set guy, suspended upside down in his seatbelt. The front of the bus is smashed in like an accordion. The steering column is crushed against his chest.
He’s turning blue.
"Base, I’m with the driver," I yell into the radio, wedging myself between the dashboard and the roof. "Male, fifties. Cyanotic. He’s gasping."
"Check the airway,"Max’s voice comes back, crystal clear in my earpiece.
I rip the driver's shirt open. His chest isn't moving on the right side. His neck veins are bulging like ropes.
"Trachea is deviated to the left," I report. "Absent breathsounds on the right. Subcutaneous emphysema. It’s a tension pneumothorax. His lung has popped, Max. The pressure is crushing his heart."
"He needs immediate decompression,"Max says."Can you reach the second intercostal space?"
"Barely." I reach into my Go Bag. My fingers are numb, but muscle memory takes over. I grab a 14-gauge angiocath needle. "I’m going to needle him."
I locate the spot on the man’s chest. I jam the needle in.
Hiss.
A rush of trapped air escapes. The driver sucks in a desperate, ragged breath.
"Decompression successful," I pant. "But his sats aren't coming up. His airway is crushed. I need to intubate."
"Jax,"Max warns."Intubating upside down in a darker environment with no suction? The risk of aspiration is?—"
"I know the risk!" I shout. "But he’s obstructing! I have to secure the tube!"
