I find that whenever I am starting to feel overconfident about something, that is the time that something will come along and knock me back down to make sure know my place. I had been working as a Paramedic for about 6 months and was starting to feel like I could handle pretty much anything that Oakland could throw at me. So when we got a call to respond to a recycling facility for the hand injury, I didn’t think much of it.
Along the way there we got a radio update that said that the patient was a man with his hand caught in a machine. I tried to think of what kind of a machine someone could get their hand stuck in at a recycling plant, and all I could come up with was that maybe someone but their hand in one of those banding machines that they use to band piles of cardboard together and had banded themselves to a bunch of cardboard. No big deal right?
We arrived on scene and a few people were kind of standing around the big open bay door that trucks would back into to drop off and pick up bug pallet sized cubes of recycling. They led us inside the warehouse where newspaper is recycled, and it was a big building. There were mountains of shredded newspaper up to like 20 ft high, and everywhere except a few feet of floor were covered in shredded newspaper. It was like going to the dunes, except instead of sand, it was all newspaper. In the middle of the room was this huge blue machine, the size of a big tour bus, with a dump truck sized hopper attached at the top. Apparently they use a system of conveyors to move the mountains of shredded newspaper so that it falls into the hopper and then the big blue tour bus spits out a solid cube of newspaper about 6 feet cubed weighing several tons.
But instead of cranking out ridiculously big cubes of paper, the machine was silent. Lying at the foot of one of the mountains of paper was a man in blue coveralls. By the way everyone was looking in his direction, I could tell that he was the patient, but everyone seemed to be keeping their distance, which I found kind of odd. As I approached the man, I could see that he was conscious and was moving his arms and legs in kind of a slow, feeble, purposeless sort of way, kind of like he was swimming in the sea of newspaper, which meant that he was alive, which was a good thing, but from the angle that I was approaching, I couldn’t immediately see what was wrong. As I got closer I could see the man’s face and that it wasn’t a particularly painful face, more of like a far off stare. He looked at me, but I’m not sure he really saw me; it was more like he looked in my direction and responded to my voice. Then I saw what the problem was. The guy was still doing his feeble, purposeless arm and leg, slow motion flailing routine, but one of his arms wasn’t moving, and his upper arm, right as it attaches to the shoulder was a bloody, shredded mess.
Apparently what had happened was that the tour bus cube machine had gotten jammed, and the coverall guy had opened an access panel to clear the jam, but had neglected to turn off the machine first. Using a broom handle to clear the jam, the machine started back up again, but sucked the man’s right arm into the machine. The machine pulled him as far as it could, and since his body was bigger than the access panel, it relentlessly beat his head and torso against the side of the machine, twisting his arm so that his body flipped over and over, rotating him as it tried in vain to pull his entire body into the machine. Eventually the machine gave up on the whole tamale, and ripped his arm off just below the shoulder. Although it remained attached by a few threads of tissue, his mostly torn coveralls were what provided the real strength to keep his arm relatively attached when his screams attracted other employees who shut down the machine and drug him clear of the machine.
Upon realizing the severity of the man’s injuries we leapt into action, and it wasn’t long before we were strapping him onto a backboard. I used a pair of shears to cut off the man’s coveralls so that I could look for other injuries. When it came time to strap the man’s chest we came to the decision point of whether to include or exclude his arm in the strap. With it strapped it might be slightly more stable, but we might loose access to the arm. Since his arm wasn’t really going to be useful to us, and since he didn’t seem to need it at the moment, we decided to include his arm in the strap. Trying to keep something long and relatively thin strapped in with only one strap proved to be a little more difficult than I first imagined. His arm kept falling out of the strap. It was one fall too many and the tiny threads of tissue keeping his arm attached broke and his arm fell the ground when we picked up the backboard.. You never really think about how heavy an arm is until you reach down to pick up a severed arm. You see, normally when you pick up an arm it is attached at the shoulder, so you really aren’t picking it, up, you are rotating it around the shoulder joint, and the joint is still bearing most of the weight. When you pick up a severed arm, there isn’t a shoulder to take the 15 or 20 lbs that is a person’s arm. With no place else to put it, I put it between the man’s legs.
The man was still awake, and was even answering questions although he spoke mainly Spanish. When we went to load him into the ambulance we made kind of a mess. See, when you load someone into the back of an ambulance on a gurney, it’s kind of a disorienting feeling. You aren’t in control of your body position so when the attendant tips you back in order to raise the gurney’s wheels, people often get the sensation that they are falling, and will instinctively reach out with their arms to steady themselves. When the patient did this, his left arm reached out and grabbed the bench seat and the other… Well, the other was just a bloody stump of about 6 inches of his upper arm, which would have reached out to grab the equipment cabinets if it was still attached to the rest of his arm. So the bloody stump just smeared a bloody streak along the plexi-glass cabinets leaving a 6 foot long stain until he was loaded into the ambulance and on our way.
On the way to the hospital I did the normal Paramedic things I was supposed to do, although my memory of doing them is sort of foggy and faded. I know I examined the rest of his body and found multiple crepitous spots on his head and chest, which I can remember being more worried about than his severed arm. His arm wasn’t bleeding very much, and I didn’t feel like he was likely to die from a severed arm, it was his dented and broken head and chest I was worried about. I know I also placed a couple of 16ga IVs, and I know that at some point I re-strapped his severed arm more securely against his side so that it lay in a roughly anatomical position. I know that we arrived at Highland and that I gave report to the trauma team and moved him over, but other than that, I can’t really remember much all that clearly. The clearest part is the far off stare he gave me while his arm and legs writhed in slow motion as he tried to stay afloat in the ocean of newspaper.
About a week later I stopped by to see my one armed bandit in the hospital. I was happy to hear that he had not died like I had feared he might. In fact, his other injuries turned out to be relatively minor. Unfortunately the doctors were unable to re-attach his arm because it was too badly mangled to be salvageable. I found him sitting in his room, smiling with his family. He had no memory of who I was, or how I had played a role in his care, which re-affirmed that he had not really seen me that day. He was grateful for my help never the less. I wished him well and left him to his family and his smiling.