Matthew R Brewer submitted 2017-08-18 00:00:00 +0000

It was an odd mix of sadness and accomplishment—the feelings I had sitting with my wife on the train in Trinidad, Colorado. The somber thoughts, because our honeymoon was just interrupted by a fatal minivan versus train accident. But why a sense of accomplishment?

An hour before, the Amtrak train suddenly stopped and a page went out for anyone with medical training to respond for assistance. The conductor hurriedly escorted two others and I to the front of the train. My mind rolled through memories of other railroad accidents I had worked as an EMS responder in the past.  We jogged to the front of the train and a crumpled green minivan was visible, pinned under the front of the locomotive.  A high-pitched scream was coming from the back of the crushed van which smelled of radiator fluid and gasoline.  I counted “1-2-3-4-5…Oh God a baby…6.”  “Conductor, let the dispatcher know there are six people in this vehicle.”

I looked around at the surrounding Amtrak crew who stood with blank, paralyzed stares.  A globus sensation rose in my throat, but I put it aside. Then I calmly asked, “What tools do we have?” A crowbar, leather gloves and a pocket knife were handed my direction. “Do we have a medical kit available…And who here knows CPR—I will use you right over here.” I began to organize those who stepped up to help. We popped off the back windows and pried on the doors to attempt access into the van.   I reached in and cut the seatbelt on the screaming 4-year-old. Her femur was visibly fractured, and I slid her out of the rear window onto my straightened arm like a makeshift backboard, laying her on a nearby blanket.  I tell a crew member, ”She’s pale, femur’s fractured, keep her flat, and tell me if her breathing or pulse changes”. I crawled in the back of the mangled van.  The broken glass cut my legs, but I could tell two of the remaining children were still somewhat pink and I wanted to give them a chance.   “Let’s just focus on these two”, I said as we pulled free a cracked carseat holding an infant and then handed a limp 2-year-old out the back window.

Three now remained. One was a gnarly decapitation and two others were gray, apneic and pinned under the locomotive. We had no means to free them so I moved on. “Chest compressions with two fingers”, I instructed as we began CPR on the infant and toddler and cleared their tiny airways as best we could. The sun beat down on our backs and a siren wailed in the distance. Minutes later an EMS crew arrived. I gave them a brief report and they welcomed the assistance as we continued the resuscitation. Thankfully I still had good IV skills from my years before medical school as a nurse, and was able to help them with IV access, an intubation, medications and fluids.

The 4-year-old, still conscious but pale, was flown to Denver with multiple fractures and recovered completely.  We got a pulse back on the infant and moved her to a waiting ambulance. I later learned she was taken to a local hospital where she died.  We resuscitated the toddler for an additional 30 minutes, but had no success. It was a somber, but quiet moment. I said a silent prayer over the family. The investigators arrived, took our information, and I went back to my seat. As I sat through the remainder of the Amtrak trip, the sadness was heavy and real. But why this feeling of accomplishment?

The sense of satisfaction came as I thought back over the previous decade of my life.  My interest in emergency medicine started in 2008. I was a new EMT. I joined a volunteer fire department and started work at a local ambulance service. The irony hit me, as seven years prior my first EMS call with the ambulance company was a teen hit by a train. I noted how different my reaction had been. Tunnel vision, instead of triage. Feeling panicked, not prepared. Reaction, instead of leadership. When had I changed? Maybe it was during nursing school, or when I worked as a level 1 trauma nurse. Maybe it was the years with the ambulance service. I thought back to similar pediatric resuscitations I had seen, some in the field, some in the trauma bay. Each had challenged my skills. And today, as unprepared as I was for this tragedy, I could see how I had grown. It was a moment where I stood in a tragic yet familiar scene—a test—one that showed me exactly who I had become.

It has been a year since the accident last June. I remain as committed to the goal I set back in 2008—to serve with excellence in emergency medicine. Every training opportunity whether in EMS, nursing school or medical school has changed me for the better. Yet the training is not over. I am in the midst of my fourth year of medical school and applying to emergency medicine residency programs. But even afterward, the training will continue. It is a calling. It is my calling. We must train—so others may live.