By Meredith Koch
Think hard — what is the most unbelievable, most unique call you have had? The longer you have been on the ambulance, the crazier your stories become.
Calls like delivering a baby in the backseat of a car on the side of a freeway in the middle of a snowstorm, getting kicked out of a patient's house on Christmas Eve or a guy coding in a Walgreens while shoplifting make-up, get added to your story deck that gets shared amongst colleagues and used for training sessions.
However, I would place a strong guess that no one, except for the crew at Colchester Rescue Squad (Vermont), can say they have responded to a call for a female paralyzed from a piano falling on top of her.
The leading causes of spinal cord injuries are motor vehicle crashes, falls, gunshots and sports-related accidents. According to the National Spinal Cord Injury Association, approximately 11,000 SCIs occur in the U.S. annually, with over half of the injuries affecting persons age 16-30. Many more men (81.2 percent) sustain SCIs.
On May 29, 2015, I became one of those 11,000 SCI incidents, one of the estimated 350,000 people living with an SCI in the U.S and part of the 20 percent of Americans overcoming a disability. I learned what it is like to be completely helpless, to be in so much pain that no pain scale applies and to put my life in the hands of the paramedics.
As an upright piano, weighing approximately 850 pounds, was getting moved out of the back of a pick-up truck, it came crashing into my back, causing me to crumple down to the ground. The piano fractured my sternum, shattered my L1 vertebrae causing significant compression to my spinal cord and instantly paralyzed me from the waist down.
Despite the excruciating pain, I was alert and oriented, knew exactly what was happening and did not hesitate in barking orders at my friends. The first three things out of my mouth, other than screaming in agony, were "Call 9-1-1. Get me a medic. I need pain meds."
Self-assessment and trauma exam
The blessing in disguise amidst my accident was that I was a volunteer EMT with Colchester Rescue Squad, and thus, I knew the paramedics who responded.
By the time the ambulance arrived, I had put my EMT experience to work and completed an initial rapid trauma assessment of myself. I determined that I had sharp pain in my upper right chest that prevented me from taking a deep breath, had unfathomable pain coming from my back, could move my arms and hands, could not move anything below my waist and had zero idea where my legs were in relation to my body or the ground.
I remember being thankful I was not a quadriplegic, that I had not hit my head on the way down to the ground, and that I did not feel like I was going to vomit. My friends at the scene were also EMTs and they had grabbed a first-in bag from the truck to take my vitals.
As I was lying on the ground, I alternated between screaming in pain and talking about what hurt or cursing out the ambulance for taking so long to get to me.
The paramedics arrive
In reality it only took six minutes for the Colchester Police and Colchester Rescue Squad to arrive. I let out a huge sigh of relief because not one, but two kickass paramedics stepped off the truck.
At that moment I knew I could give up control, trust that they would treat me intelligently and feel a bit calmer in their presence. Little did I know that every decision they would make over the course of the next hour would lead to my ability to walk again.
One of the paramedics immediately took control of holding manual c-spine stabilization, even though I knew not to move my head or neck. The other paramedic knelt next to me and asked in the most composed voice possible what was wrong.
He got in reply a detailed report from my self-assessment. I remember him joking how nice it would be if all his patients would tell him so succinctly and accurately what they were feeling.
The third crew member was immediately told by the crew chief to get equipment to backboard me as there was no doubt in anyone's mind that I had a spinal cord injury. I was trying my best to hold it together, to let adrenaline fuel my body and let humor tackle the immense fear I was feeling.
After a quick set of vitals, the excruciating process of moving me began. Having volunteered in EMS for 11 years at that point, I knew how a logroll worked and that amongst experienced crew members, it generally is not extensively discussed.
This logroll however, could go down as the most planned out, most precisely performed and scariest logroll of all time. Amidst screams of agony, I was log rolled onto my left side since the my upper right chest was in so much pain.
The crew chief performed a physical exam of my back and discovered noticeable deformity to my lower thoracic spine. Below that point, I stopped shrieking in pain and could no longer feel him palpating.
Despite no words being spoken by the EMS crew, I could tell there was a shift in the air due to an "oh crap this is not good" moment. Very carefully I was rolled onto the backboard, strapped down and my head immobilized.
Important transport decision and destination
As the crew lifted me into the ambulance, I remember joking with the medics that I had great veins for them to stick me and that I was a lightweight for pain meds. Within minutes IV access was obtained via a 16 gauge in my left AC and an 18 gauge in my right AC without me even realizing it. A 4 mg IV Zofran dose was chased by a starting dose of 25 mcg IV fentanyl. With that, off we went, lights and sirens, to the University of Vermont Medical Center Emergency Department in Burlington.
The paramedic who was driving the ambulance made a decision that may seem trivial to some, but in hindsight, could be the reason I have any function in my lower extremities. He chose to take a longer, yet smoother route to the hospital in order to minimize my pain and the risk of the fractured vertebrae severing my spinal cord.
As you know, backboards are inherently uncomfortable. Now lie on one in a moving ambulance with part of your vertebrae sticking out your back.
A second dose of 25 mcg IV fentanyl was administered very soon after transport began. The fentanyl had barely touched how much pain I was experiencing.
The paramedic and EMT in the back of the ambulance did their very best to keep me talking and laughing, as well as to comfort me when the pain was too much to hold back tears. A final dose of 25 mcg fentanyl was pushed as we pulled into the emergency department parking lot to help me make it through the transfer and exams.
In a time of absolute fear, panic and helplessness, having a crew of compassionate providers made a world of difference. I trusted them implicitly, knew everything was done that should be done, and that I was in the best hands possible.
Trauma team activation
I knew I met the criteria for a trauma code; thus, it was no surprise to me when we were greeted by the entire trauma team. A whirlwind of activity ensued, from X-rays to head-to-toe physical exams to blood draws to additional pain medications to rectal exams.
I alternated between cracking jokes at my own expense, such as not being able to feel the rectal exam or how the male doctors could not get my earrings out for CT scan, to having minor freakouts about not being able to feel or move anything from the waist down. The last thing I remember is returning from the CT scan and being given a concoction of drugs to ease my pain and keep me from remembering how scared I was prior to surgery.
Birthday in the ICU
I woke up the next day, my 25th birthday, in the ICU surrounded by my family and discovered that I had undergone an eight-hour surgery to repair my L1 burst fracture and to alleviate the compression on my spinal cord. The pain was still overwhelming and I could barely move in bed.
The doctors told me the pain was due to the extent of my surgery, which resulted in 84 staples to close three incisions.
The spinal surgeon fused my T12-L2 vertebrae with two vertical titanium rods, four horizontal screws, a steel cage where my L1 vertebrae had been and human cadaver bone graft.
Three days in the ICU, four days as an surgical inpatient, and a four-hour ride with UVM HealthNet Transport later, I began the official spinal cord injury rehabilitation process.
Walking miracle
Spaulding Rehabilitation Hospital in Boston pushed me every single day of my month-long inpatient stay to find the strength to learn how to do basic activities such as sit up in bed, get dressed, stand, shower, walk and do stairs.
In conjunction with adaptive sports, an exercise rehab program called Journey Forward in Canton, Mass. and outpatient physical therapy, I have regained function down to L4 in my spinal cord.
I now frequently participate in adaptive rock climbing, cycling, skiing, a paralympic swim club, and most recently surfing.
I ambulate using bilateral ankle-foot-orthoses and forearm crutches.
Being a paraplegic has hindered my ability to continue to volunteer in EMS. However, I am hopeful that in another three to six months I will be strong enough to resume volunteering as an Advanced EMT with Darien EMS Post 53 in Darien, Conn., where I have been a member since the age of 14.
In Boston, where I live now, there are no volunteer EMS agencies, but every time I see an ambulance go past, I miss it. Ultimately I would love to get involved in EMS education, especially related to spinal cord injuries.
Victims with SCI depend on EMS
There are days I forget I am a paraplegic and that I have all that titanium holding me together, but I never forget that I am a walking miracle due to the decisions the paramedics, the doctors, the nurses and my rehabilitation team made. In the heat of the moment, not one person lost their focus or rushed in how they moved or treated me.
With careful assessment and communication, EMS providers are the first line of defense for a SCI victim. We depend on you to give us the best shot at recovery by not damaging the spinal cord any further and getting us to a trauma center safely and efficiently to relieve the compression and to prevent further ischemic injury to the cord.
SCI patients will have a long rehab road ahead of them, but with today's biotechnology and specialized rehab programs, many of us, quadriplegics, hemiplegics, and paraplegics alike, are making significant recoveries. I can guarantee you we are not disabled, rather, we learn to be adaptively abled with our physical disability. If you don't believe me, go volunteer with adaptive sports or watch the Paralympics this September.
About the author
Meredith Koch began volunteering in EMS at the age of 14, quickly finding a passion for patient care and medical devices. After completing her Masters Degree in Biomechanical Engineering at the University of Vermont, she began working for Medtronic as a Cardiac Rhythm & Heart Failure Clinical Specialist. Since that fateful day in late May 2015, when she became a paraplegic, she has fought hard to make great strides in her recovery, attributing much of her success to her healthcare providers and adaptive sports.
Meredith can be followed on Instagram @bionicmere and the hashtag
