The street-side scene in Woodlawn was utter chaos.
Five lifeless bodies were strewn on the grass, the human wreckage left by a car that had plowed through a group of women and children standing at a bus stop. Grieving relatives were collapsing on the road. And rush hour rubber-neckers crept past, trying to get a look at the aftermath of Thursday morning's accident.
But through it all, four men worked quickly, quietly and efficiently to save a small boy's life. Trying a delicate medical procedure that called for a needle to be inserted into the boy's chest cavity, they waited for the crucial sounds: a pop and fizz, like a soda bottle being opened.
That was the moment Charles J. Stevens, an emergency medical technician paramedic at the Westview Fire Station, knew the procedure had worked. The 2-inch needle had hit the mark, releasing air trapped in the 8-year-old boy's chest -- air that threatened blood vessels flowing to the heart.
That quick thinking and skill by Baltimore County paramedics might have saved the life of Charles "Chas" Edgar Dorsey V, who was critically injured in the accident, which left his stepmother, two stepsisters and two cousins dead. Yesterday, the boy was in good and stable condition at the Johns Hopkins Children's Center.
It was a coup for Mr. Stevens, 27, who had never performed the technique on a live person. In fact, this was only the third time this procedure had been performed by Baltimore County paramedics in the field; Maryland added the procedure to its paramedic training three years ago.
Mr. Stevens and Lt. Vernon E. Noratel, who were among the first to arrive at the accident, vividly recall the traffic accident, the worst they had ever worked on.
The call came at 6:58 a.m. Mr. Stevens was talking to a vTC co-worker in the station's medic room when he heard over a loudspeaker that a pedestrian had been struck on Woodlawn Drive near Security Boulevard. Lieutenant Noratel, a shift commander at the fire station, had just walked in the door.
Within two minutes, a fire engine carrying four firefighters and an ambulance carrying two paramedics pulled up to a horrific scene -- "the likes of which nobody had ever seen before," Lieutenant Noratel recalled.
"There was so little time to think," said the lieutenant, who worked with Mr. Stevens to assess the situation for triage operations. "Who's dead? Who's alive? Who needs immediate attention? How much more equipment do we need? We had to work fast."
Mr. Stevens began focusing his attention on the one injured, but still surviving, member of the family: little Chas, who was lying on his left side between the bodies of his stepsister Keisha Dorsey, 7, and his cousin Darrian Hough, 8.
At the same moment, Lieutenant Noratel repositioned Keisha's mangled body to check for vital signs, and Firefighter Alvin Euler did the same for Darrian, whose head was twisted to the side.
More than 100 feet away, Firefighter Steve Hobbs was dealing with three other victims: Chas' stepmother, Kim Linair Dorsey, 27, his 3-year-old stepsister Chanell and his 4-year-old cousin, Jasmine Little.
It was quickly determined the five were "unviable," said Lieutenant Noratel, using medical terminology for a conclusion that "no matter what you do, there's nothing you can do or no way you can bring them back."
White sheets were used to cover their bodies.
"Hey, are you OK? Can you hear me?" Mr. Stevens asked, while checking Chas' carotid artery on his neck for signs of life.
"He didn't respond so I leaned over his head and heard him grunting and trying to breathe," he recalled. With the help of two paramedics and a firefighter, Mr. Stevens rolled the boy over, placed a cervical collar to immobilize him and put him on a backboard.
He saw that the boy was breathing irregularly. A stethoscope showed no sound coming from Chas' right lung, but normal respiratory sounds from the left lung. And using his hands, Mr. Stevens felt an unstable heartbeat. All signs indicated that Chas might have had a collapsed or punctured lung, a condition in which air leaks into the chest.
When a lung is punctured, air pressure outside the lung rises, forcing the organ to close in upon itself like a deflated balloon, says Dr. Robert Bass, executive director of the Maryland Institute for Emergency Medical Services Systems.
The lung can no longer open -- and the accident victim can breathe only through the injured side of his chest. A person can survive with one lung, but the air-pressure shift can cause blood vessels flowing into the heart to kink and to compress with deadly results, the doctor added.
Emergency workers reinflate the lung by inserting a needle into the chest cavity. This allows air to leave the space, and the lung to open. A one-way catheter on the outside end of the needle keeps air flowing out of the body, but not in.
But the procedure is not performed frequently -- perhaps about once a month somewhere in the state, Dr. Bass said.
"I had to decompress the lung," recalled Mr. Stevens, who had to obtain a doctor's permission by phone before performing the needle decompression. "I really felt deep down inside that if I did not do this procedure, Chas would have died."
Pressing down hard on the boy's ribs, Mr. Stevens found the exact position where the needle would be inserted. Just above the third rib, away from any veins and arteries, he carefully inserted the needle one inch into the chest cavity.
As he pulled the needle out, leaving the white catheter partially inside, someone told Mr. Stevens: "I heard the [popping] sound."
By 7:31 a.m., a Maryland State Police helicopter had landed on the grounds of the Social Security Administration, beside the accident scene, to whisk the boy away. Within four minutes, Chas arrived at Johns Hopkins, where he was immediately treated for critical injuries.
"What's important is that [paramedics] recognized some very crucial signs and symptoms and acted appropriately," says Dr. Charles Paidas, a Hopkins pediatric surgeon who worked on Chas.
Because of patient privacy restrictions, he cannot confirm that the boy's lung had collapsed. But he praised the emergency workers.
"They made the observation that there were no breathing sounds," he says. "They also recognized the mechanism. The kid was hit by a car, he was then thrown and he had the second impact of that fall . . . they did their job very well at a time when a potentially life-threatening condition existed."
Funeral arrangements for those killed Thursday were completed yesterday. The public can pay respects from 8 a.m. to 11 a.m. Tuesday at Rising Sun First Baptist Church, 2211 St. Lukes Lane in Woodlawn. A private service will follow.
Friends also may call tomorrow at the March Funeral Home West, 4300 Wabash Ave. Hours were still to be determined.