PROLOGUE

          Sirens wailed. Hands moved quickly in space. Blood pooled on the deck.
          In the back of an ambulance, paramedics worked furiously to save a young man's life. His pale skin seemed almost ghostly in the harsh, fluorescent light. His lithe body lie limp and still, his long, black hair matted with blood.
          Two paramedics and an EMT did everything they could to keep the boy alive. Dave, the senior paramedic on scene and a twenty-two year veteran of the department, spoke with a sense of urgency and calm authority. “Spike a bag while I get the IV.”
          His friend and co-worker, Mark, with three years on the job, snapped open the cabinet with the saline bags and IV sets and grabbed one of each. Checking the tubing, he saw the familiar “15 drop” and tore open the plastic bag.
          The junior man in the back of the ambulance, an EMT basic named Kyle, with just three months on the job, used trauma shears to carefully cut away the patient’s shirt. As quickly as he could, he applied four lead wires and stickers  attached to a heart monitor and wrapped the blood pressure cuff around the boy’s slender arm. He pressed the button marked NIBP. He stared down at the patient, filled with disgust and pity at the sight of his battered and bloody face. “Jeez, look at this guy...” he said. “He looks like he got hit by a truck.” He turned his attention and watched the two paramedics as they rushed to save the boy’s life.
          Dave pushed the thick IV needle into the boy’s left arm with practiced precision, just at the crook of his elbow. Working steadily, he took the IV tubing from Mark and screwed it into the IV set. Mark moved quickly to tape down the tubing. They were like two parts of the same well-oiled machine, working together to save a life.
          “He’s only breathing about four times a minute, he's got massive facial trauma and we’ve got to secure an airway. We're going to have to intubate him." Dave said with a serious expression.
          Kyle's nerves were on edge. He watched as Dave unrolled the pertrach package. The senior paramedic felt the young patient's throat with his thick, strong fingers. Using a small razor knife, Dave pressed down, slicing through skin like butter. He cut a small incision in the patient’s throat and pushed the plastic tubing through. Pulling the guide needle out, he secured the device in place with a nylon strap and connected the bag-valve.
          “C’mon kid,” Dave said, pushing the bag toward Kyle. “Breathe for him.” Doing as he was told, Kyle held the bag in place and began to rhythmically squeeze and push oxygen into the unconscious boy's lungs. His hands trembled. “Slow down a little,” Dave said. “One every five or six seconds, no faster.”
          Kyle took a deep breath. He forced himself to be calm and slow down. His job was to help save lives but this kid was dying. "He can't be any older than me..." he thought.
          Reaching up to the boy’s face, Dave used his thumbs to open the patient's eyes, looking closely at his pupils. “Got a left three and a right six here,” he said. “Mark, you want to call this in?”
          “I’m on it,” Mark said, reaching for the cell phone. Pushing the preset numbers, he dialed the closest Level One Trauma Center. He heard the emergency room nurse answer and began.
          “Valley North, this is Medic Fifteen, we’ve got a male, approximately twenty-five years old with massive trauma to the head and face.” He looked at the heart monitor and the notes Dave had written. “Blood pressure is one-ten over sixty, pulse is one-thirty-two. We’ve got a sixteen guage in his right AC and a pertrach in. He’s got serious facial trauma. His left pupil is three millimeters and his right is six. We’re bagging him with high flow O2 and checking him for other injuries now.”
          “Ok, Medic Fifteen,” the voice on the phone said. “We’ll have a room for you. Let us know if there’s any changes.”
          “Alright,” Mark said as he hung up. Tossing the phone into a countertop basket, he began to cut and tear away the rest of the boy’s clothing, checking his body for broken bones and lacerations as he did.
          Dave worked to get a second set of vital signs. “Blood pressure and pulse are stable,” he said. "I’m going to slow the drip to TKO.” He turned his attention to Mark as he pulled away the cut up pieces of the patient’s jeans.
          “Any ID?”
          "No, nothing."
          Steadily squeezing and releasing the flexible plastic oxygen bag, Kyle looked down at the boy’s pale, nearly lifeless face and wondered if this might be the first time he watched a person die.
          Before his eyes, the boy’s gaunt, bloody face suddenly distorted with a twist of pain, his eyes opening slowly. He looked around with growing alarm, his dark eyes glassy and distorted.
          The young EMT's expression turned from concern to shock. "Oh, shit!"