Every scene is different. This one was awful, said Dr. Michael Dailey in a near whisper.
An SUV flipped over on the Northway, slamming into a tree in the median. Two teenagers were ejected from the vehicle. Two more were trapped inside.
Paramedics at the scene recognized quickly that this situation was going to require a physician’s help on the scene. Dailey, director of pre-hospital emergency care, and a fellow Albany Medical Center doctor got the call.
“They knew that they had two kids really horribly entrapped in the car and at that point they couldn’t even get close enough to those kids to find out how sick they were,” recalled Dailey.
Sitting in his office nearly two weeks later, he carefully and quietly recounts the scene. He won’t describe everything he saw the night of Dec. 1 out of respect for the teenagers’ families.
Many physicians like Dailey provide emergency care outside the realm of an emergency department. Their specialization is in pre-hospital emergency care, and the only thing they know for certain is that no scene is like another.
They show up at homes engulfed in flames, ride along with police on dangerous raids, assert calm at the scene of a gas leak and disentangle severely injured patients from crumpled cars, buildings and machines.
The environment is one of chaos. But they’re the ones you want by your side when no one else knows what to do.
“They weren’t sure A, how severe their injuries were and B, how severely trapped they were,” said Dailey of the tragic Northway crash that took the lives of Shenendehowa seniors Christopher Stewart and Deanna Rivers on Dec. 1. “They didn’t know how much disentanglement was needed because they couldn’t get close enough to the patient.”
Bailey Wind and Matt Hardy, both 17, are alive and on their way to a full recovery because of the care Dailey and first responders provided on the scene. Wind suffered five broken vertebrae in her neck, one of them completely shattered. She also needed two titanium plates put into her jaw and lost five teeth. Hardy suffered numerous broken bones.
About 30 physicians are employed within Albany Med’s Department of Emergency Medicine. They work regularly with Colonie EMS, and Albany and Schenectady fire departments. But they will respond to any emergency that occurs within the boundaries of the map hanging on Dailey’s office wall.
“If you can see it on the map, we’ll go,” he said.
The Greater Capital Region for him stretches as far south as Poughkeepsie and as far east as Vermont. When an emergency occurs in Greene or Montgomery counties, he travels by helicopter. When it occurs in the greater Albany area, he dashes to his trusty silver van and hits the lights. Inside are always the same items — helmets, reflective coats, first-aid kits, and minor surgical gear like sutures, scalpels, bone saws and tourniquets.
When he expects he might need to do a transfusion in the field, the hospital allows for the emergency release of an operational medication box and blood supply.
He brought both to the scene Dec. 1.
“We ended up not needing any of it,” he said.
When Dailey arrives at a scene, he heads straight to the incident commander. His job is not to take over a scene, but to assist paramedics — whether that means providing additional medical orders, expertise, patient evaluation or determining how best to extricate someone.
“Basically, I’m using the training that I have as a physician and the background that I have as an EMT to help them doing the job that they’re already frankly experts in,” said Dailey. “I’m merely serving as another layer of care.”
Paramedics are highly qualified for on-site care. The scenarios wherein they decide a physician should be on the scene are three-fold: there are a lot of patients, there is concern about who needs care first, or there is a patient who is profoundly injured and can’t be disentangled from wherever he or she is trapped.
“It could be someone who is trapped in a piece of machinery or something else where having a physician there may change the course of care,” said Dailey.
He first gained experience in first response scenarios in 1983 as an EMT — first with a suburban volunteer squad, then in Clinton County and then in New York City.
He eventually realized he was a physician at heart, so he earned his medical degree from Albert Einstein College of Medicine and completed his residency at the University of Pittsburgh. But every physician has a specialty.
“I wanted an undifferentiated patient population without these well-established diagnoses, with intermittently life-threatening or limb-threatening events and from a broad range of socioeconomic climates,” he said.
What better, then, than a career in pre-hospital care? He doesn’t have cabinets full of lengthy files on patients he sees over and over again. They’re all Average Joe or Jane — the person who is crossing an intersection one moment and being toppled by a car the next, or the kids who are driving home with their boyfriends and girlfriends one moment and rear-ended by a speeding driver.
The things Dailey sees often stay with him. On a bulletin board behind his desk, Dailey hangs photos and newspaper clippings from tragic accidents where he’s helped. He even has a photo of firefighters and paramedics assisting a man who had been in a fire. He wasn’t even there, but he respects the work.
The things Dailey couldn’t describe from the Northway crash will stay with him. He’s a person before he’s a physician, he remarked.
“Something like that can’t not affect you as a human being,” he said. “It was awful.”