The Golden Hour
The water was cold in the early morning, washing the rescue-ship in the shadow of trees in the hours after sunrise, such is the beginning of any shift in the high mountains with the remote station.
A three-day shift began on Rescue-Medic-10. For two-hundred Terran years it had been the base for rescues in the wilderness of the planet’s northern hemisphere. It was a planet just coming out of an ice-age, giant glaciers still were visible in the distance, miles thick, they still retreated up to one-hundred meters per planetary year. A few faster, many slower, still the settlers from the home world would forge a living in the spreading alpine-forested world.
Once rocky and barren, not so much as a microbe had been found with probes, introducing cyanobacterium and land-plants four-centuries before had caused a spike in oxygen that surpassed that of the normal twenty-one percent Terran air quickly, becoming an energetic twenty-eight percent in the four centuries since humans planted in the carbon rich atmosphere.
The planet, chosen for atmospheric manipulation as the stellar system that surrounded the orange-dwarf star was emerging from a dense cloud of space-debris that had blocked the radiation and heat from the planets sun.
‟Incident assigned.” Came the sound from the station-wide speakers.
‟Long fall, male fell from roof of structure, approximately five meters.”
The crew of three moved to their vehicle, a ducted-fan vertical-lift airship warmed up and lifted off.
‟Rescue-Medic-Ten responding.” Justin Timeagain spoke into the mic-boom of his helmet. Long a medic in the wilderness, once he had gone to earth and had spent a few years in the black-paved forests that were the cities before returning to the planet of Sunkissed-two with stories of horrors on man versus man over the price of stale beer.
‟ETA five minutes.” Rajish Coriolis said.
‟Copy Rescue-Medic-Ten.” The disembodied voice came over the earphones. ‟Incident update, victim is on the ground but sitting up, reporting party states that victim has an altered level of consciousness and is not speaking clearly.”
Justin and Rajish looked at each other. Rajish, the best pilot in the out-lands had worked with Justin for nearly three decades, attending each other’s weddings and birth of children.
Good friends that had been together often over the years.
Honoria ‟Honey” Stathatos, a field nurse-in-training assigned to Justin for her orientation to flight rescue. Engineer and communications officer, a polyglot from earth Jose ‟Yak” Herrera, the only one of the crew that spoke as many languages as could be known. His talent for learning a langauge fluently in a week was legendary in the company, but he was dangerous with anything heavy or sharp.
Lifting off, they rose above the rapidly growing forest, trees already taller than the tallest living things on earth sprouted and grew in the high carbon atmosphere and iron rich soils that oxidized, releasing ever more nutrients for the planets new life to live on.
Evolutionary effects changed life forms rapidly. Bees became larger in the dense atmosphere and low gravity of the super-earth.
‟Rescue-Medic-Ten, be advised, reporting parties on scene say the victim is impaled in the thorax.”
‟Well, that makes things a whole lot harder.” Justin observed quietly.
Raj just smiled, not wanting to make any inappropriate humor comments that might be picked up by the flight-deck recorders. Where they headed was under a storm-cloud. The small VTOL craft was over-engineered, over-engined and powerful with contra-rotating impellers of the ducted fans, just the machine needed for dependable operations in the overgrown forests that orbited as an emerald jewel around the gem of the orange-dwarf star.
‟Rescue-Medic-Ten, this is Bald Mountain Fire Protection Engine-4, Captain Yehn. We have a landing zone for you cleared. Lat and long transmitting to you from my location.
‟Copy Captain Yehn. Our ETA is short, we are vectoring with you in sight.” Raj reported without emotion.
Yak came on the intercom, his voice more baritone since he arrived from earth.
‟Justin, we have a super-cell developing to our south and east, just the direction we will want to go. Weather forecast shows it might go over the top of the incident.”
‟Thank you, Yak. I wonder if the winds there have something to do with that.”
‟Could be.” Raj agreed. ‟I’m showing gusts of greater than thirty-knots around the LZ.”
‟Copy that,” Justin said. ‟Yak, monitor any rotation that develops on doppler and keep us updated, we are going to hot-load, if we take time for tea, we may not get out for a while if there is a rotation.”
‟Justin, what are you worried about.” The female voice of Honey sounded in his ear.
‟Rotating storms in these mountains get a boost from the shapes made by the glaciers, downslope winds compress, pick up moisture and then sucked up. If it rotates, we could have the makings of a tornado. In this area, they are more-or-less stationary and last for long minutes and some as long as hours. We find bare areas in the forest, trees are not native here and have not adapted to these kinds of storms.”
‟What— how do you adapt to that kind of wind?” She asked. A native Terran, she had arrived on the S-2 planet six months ago.
Justin and the others chuckled.
‟There is no defense other than to go to ground as far as we know. We can build to withstand the wind, but that takes time and money the company does not like spending, and going into a hole is faster.” Yak said over the sounds of the engines.
‟We are on final approach, lady and germs, strap in for a bumpy landing.” Raj said matter-of-factly. ‟We have cross winds that are just at the redline, but we have a wide area to put down in.
‟That… That is a wide area?” Honey said, looking at the thumb-nail sized patch of rock they were approaching.
‟It looks bigger when you are on it.”
‟It better, it is nearly microscopic from here.”
‟Don’t look out the window, focus on the descent speed and altitude readouts. You’ll feel less panic then.” Raj sounded as if he had done this a hundred times.
And he had, more than a dozen times over.
‟Quiet please, emergency traffic only while I put the bird down.”
The group fell into silence, as the contra-rotating blades changed speed and pitch, the HummingBird class rescue airship, agile and fast when need called, set down on the landing wheels.
‟Yak, keep an eye on the doppler and the boilers stoked, old friend, we will be back asap.” Raj said, second in command on the ground, he followed Justin out the back ramp with his backpack and calculators. ‟This is all kinds of farked up to operate in these conditions!” Raj yelled at Justin as they made their way to the linked-treaded construction tank. Brutally spartan in the interior, it was only good for short-range transports of people, in this case, it was a make-shift ambulance.
Technically against any written protocol in civilized areas, here in the wilderness, they did what worked and wrote their own rules without a leader that had any important title. They were Medical Emergency and Trauma Helilift.
‟Justin! Raj! There are some teams we are plain glad to see land.” Lieutenant Robin Wise smiled as the trio of Honey, Justin and Raj walked up with their hardware.
‟Where is our patient?” Justin asked as they entered the tank. ‟And the appreciation feels nice, thank you.”
‟On his way. Justin, he is hurt bad, he fell on a fence post and it has impaled him, they are having to cut the post off for transport.” She said sadly. ‟Justin, it’s the new sheriff. Do every trick you know.”
‟Oh, damn.” The Paramedic in Justin kicked in, the new Sheriff had moved from the southern hemisphere and gotten control of the corruption that had crept in, the area had become a seed of crime that the leaders had decided that the current sheriff that had a drug problem and needed replacing. A decision that backfired, multiple arrests of community leaders, police officers, a minister later, the miniature crime wave came to an end.
The heavy link-treaded tank clanked along the path that served as a road to the sub-rural area, it stopped and lowered the ramp, allowing the flight-crew to enter.
Tomatsu Kia was well liked, an encyclopedic knowledge of the law made him respected by politicians and criminals, and his good looks made him popular with the women when he was on patrol, his manner would have made a doctor jealous.
Today, after falling off the roof of his own house, the pointed post of the gate entered just below his left ribcage and out just on the opposite of his sternum, piercing his left lung in two places and as Justin assessed the Sheriff, he found that Tom’s right lung also sounded diminished.
‟We have an eighty-kilo male, blood pressure has been steadily de-compensating.” The EMT told Justin. ‟We have him splinted as well as possible with vacuum braces, one-hundred percent oxygen by non-rebreather mask, his nail beds blanch and take a long time to come back to color. More than five seconds.”
Justin nodded, more than just lungs were an issue, then remembered the nurse, Honey.
‟Raj, put a cuff on him so we can get an auto-bp on him asap when we get to the bird. Honey, start an IV, I’ll spike the bags. Please reassess the lungs, give me a report”
Honey nodded and as Justin held out to packages of IV tubing he asked which one.
Laughing inwardly, he was making her give orders and she chose the tubing most used in surgery that this patient would need.
‟Let’s get him to our gurney, we do everything on the way after I get the first IV in, Justin, you do the second one at the same time.
Smiling and nodding. Justin knew she had it handled. Her orange-red hair was nearly white in the starlight of the orange-dwarf star, jokingly refered to as Sunkist in stellar traveler circles.
‟Oxygen saturation is down below ninety percent.” Raj said.
Tom was grunting with every breath.
‟Honey, we need to do something. What would you like me or Raj to do?”
‟We need a chest tube placed.”
‟Sorry, fresh out. How about something in protocol that won’t get us put in jail and our license shredded.” Justin pulled out a package and broke open the seal.
‟Thoractic decompression! Yes. Let’s do that.” Honey jolted from her stuck moment.
‟Copy that.” Justin said as he applied a silicon flap-valve to the end of the large catheter he punctured into the side of the Sheriff.
‟I have mine leaking blood.” Honey’s voice was tight and high.
‟Afirmative, Yak, toss us some towels, would you please? Honey, what do you think to begin transport to a definitive care center for Top-Gun Tom here? He is one of my fave souls in this part of the planet, hate to have him bleed out with this fence stuck in him.”
‟Yes, Raj, get us off the ground and to Challenge Medical Center. What is our ETA?”
‟Forty-minutes at conservative speed.”
‟We were en route here for ten-minutes from time of call,” Justin gave a time report of their current call. ‟It was another five to seven minutes for someone to call and another two minutes to get the call to us. We have been on the ground six minutes, twenty seconds. Of our golden hour before irreversible shock sets in, we have now have used twenty-five plus a half-minute of the sixty we need to get him to a surgeon.” Justin nodded to Honey.
Taking his math into account, Honey looked at Raj.
‟What is our ETA on emergency speed?”
‟Twenty-five minutes, but we will be on vapors when we get there and the engines will be too hot to shut down straight away.”
‟Let’s do it.”
‟Yes, ma’am, code-3 it is.”
The jet engines turned up the contra-rotating blades, Raj adjusted the pitch and they lifted off the ground as if the airship was anxious to leave, the machine knowing that a life was in the balance and time was short.
‟Lady and gents, sit down, shut up, strap in and hold on.” As he buried the throttle to the edge of the top if its scale, after a minute of acceleration, Raj pulled the throttle sideways until it clicked and pushed it forward slowly, the sounds of the airship changed from one of ducted fan to one of jets as the fans disconnected and feathered into ring-shaped wings.
Justin directed Honey to call through the recorded communications system to the emergency department at the medical center. Several stuttering starts, Honey hit her stride on painting a picture of the patient’s condition and communicating with the surgical team at the trauma center.
The gentle increase in felt gravity, kept at a perceived vertical by the gimballed treatment area that the team and patient was in. A new feature to the Hummingbird class vessel, during acceleration or deceleration, the treatment area’s perceived vertical did not change. The emergency team would sit, strapped, in moving seats that prevented falling during treatment procedures.
A tone sounded after the automatic blood pressure cuff cycled, Tom’s vital signs were diminishing. His blood pressure had fallen below the normal values and he was hypotensive— low blood pressure— and his heart was beating faster at over one-hundred twenty beats per minute. His body was losing the fight to stay alive, even with the fluids that where initially used.
‟Honey, he is leaking faster than we can put in, progressive shock, if we do not increase his body’s ability to transport oxygen to the tissues, he will go into refractory shock.” Justin said calmly. ‟What is your plan of treatment now?”
‟He needs to have vasopressers.”
‟Hm.” Justin pulled at his ear. ‟Something more immediate that we don’t have to measure. Perhaps Syntheglobin? It has balanced electrolytes and a variety of other needed components that he is losing.”
‟We have that partially covered with the application of Quickclot bandages, we do not administer that intravenously, don’t even carry it. That is a hospital med only.”
‟Okay.” Honey nodded. ‟Hang two bags of Syntheglobin and infuse it wide open.”
‟Bags already spiked, wide open for infusion.”
‟Justin.” It was Yak on the intercom.
‟Yakkity-Yak, please talk back.” Justing gave a wink to Honey.
‟Information only, a wedge tornado touched down right after we left. There are casualties, they are declaring a multi-casualty incident.” Yak’s voice was grim, but professional.
‟Pilot copies.” Raj said. ‟We are unable to go any faster, as it is we have a required cool-down time on the engines of twenty minutes after landing, then we have to refuel.”
‟Ugh, copy that, Raj.” Justin said. ‟Yak, please keep us posted on the incident and weather.”
‟ETA to the Trauma center, ten minutes.” Raj informed the crew. ‟Clear air between us and them.”
‟Copy, Raj.” Justin said. ‟Honey, what is his oxygen saturation reading?”
‟It’s showing only eighty percent!”
‟Correct. Using the artificial blood it has difficulty in picking up the new blood’s oxygen capacity. It is clear and the translumination of the red light on the probe will not pick it up, we have to change probes that are compatible. On the shelf marked ‟Synthe” pick out a probe and let’s place it on his ear, there is a special clamp for that.” Justin nodded.”That will give us a true reading now that he has had…” He looked at the bags. ‟Two and a half liters of Syntheglobin, and this flavor of Synthe is four-times the oxygen capacity, there is another kind of Synthe out now that has double that, so we can use less of the blood replacement for each victim and use the normal saline for the balance. Hospitals are liking it as they can then use different electrolytes without overloading the patient or having some other challenges.”
Honey nodded, getting a little glassy-eyed.
‟How, I mean, where. That is, how do you keep all that in your head?”
‟I wear earplugs to keep it from leaking out.” Justin laughed.
‟He knows all that useless crap.” It was Raj’s voice. ‟We just need to plug holes and run. Only the doctors need to know it by memory, the rest of us have our data pads. But Justin, he is annoying.”
‟Well, keeps us where we are.”
‟ETA 5 minutes.” Raj’s voice changed instantly to all business.”
‟Assess his lungs again.” Honey told Justin. ‟Monitor shows his heart-rate dropping, below one-twenty.”
‟Good, three liters of Syntheglobin in. Sensors on the I.V. catheters show a blood ph of seven-point-four-two, we have slight alkalosis, but in good shape.” Justin said. ‟Tom, are you still with us?
‟Yeah, I keep going to sleep, though. I don’t feel so good.”
‟Well, according to my rule-book, you are not supposed to. You have a hunk of bronze stuck through you, best I can tell, you have missed your heart, spleen and other organs.”
‟But you said it punctured my lungs?”
‟Ah, you weren’t supposed to pay attention to that. Yeah, but you’re in good shape, we are putting down on the tarmac now. You’ll be in and out in no time.”
Justin looked at Honey. ‟Time?”
‟What do you mean?”
‟Of our golden hour, how much is left?”
‟We have, if our time is correct, eighteen minutes.”
‟Awesome, let’s get him out, swap things over to the portable and let us get this show on the road to the Emergency Department.”
Rolling the stretcher to the edge of the Hummingbird, it fit the waiting emergency room gurney tightly with clips that fit into the frame of the wheeled table and they walked quickly through the doors where the surgical team waited them.
Tom lived long enough to make the golden hour and would live to come home.
Reports made, the crew of the hummingbird headed for home, lifting above the clouds of the storm, Yak said it was overcast with showers, but no major storms in the area when the computers on board illuminated with information and a computer generated voice chimed in on the pleasant converstions…