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The car had collided with a pickup truck. "We got right to work," recalled Bowen, who said he had quickly noted that nearby residents were arriving on the scene. "The guy in the truck had abrasions and his leg was stuck in the truck. I told the Marines to watch him, and not let some passerby move him," Bowen said.

The other two victims-a mother and her 16-year-old son-had been thrown onto the road's rocky shoulder, their clothing shredded from the impact.

Bowen put the medical pack he had been issued that weekend to good use, intubating the son, putting a C-collar on him, starting IV fluids, dressing an open arm fracture and keeping him still. He stabilized the mother, and kept both warm using Marine-issue sleeping bags, while waiting for paramedics to arrive about 90 minutes later.

While the mother escaped with only a bruised spleen, her son underwent emergency surgery to repair shattered thoracic vertebrae, and has some residual paralysis in his legs, said Bowen, who received a Navy and Marine Corps Achievement Medal for his efforts. "He could have been worse, if he had been moved."

Personal tragedy

Difficult, even tragic outcomes, are not uncommon when dealing with medical emergencies. But some nurses have also faced personal loss.

About nine years ago, Ginger Bergeson, RN, was driving with her three daughters in River Falls, Wis., when a truck smashed into their minivan. Her youngest, 6-year-old Abby, had been in the back of the van. Although her seat belt remained buckled, she had flown through the back window, hitting the pavement.

"She wasn't breathing, she didn't have a heartbeat. I did CPR on her and did get a heartbeat back, but no breathing," said Bergeson, who was an ER nurse at the time.

Abby was flown to the hospital in St. Paul, Minn., where a dazed Bergeson, and her husband, Dale, a physician assistant, learned that their young daughter was brain-dead.

The parents-honoring Abby's wish to "recycle" her organs when she "didn't need them anymore"-donated her kidneys, heart and liver.

Of her ability to treat her injured daughter in such a traumatic crisis, Bergeson said, "It's just so automatic. You think, 'This is what has to be done.' My husband kept saying later, 'I couldn't have done that.' But you're put in that position and you just do it."

After the accident, Bergeson took three weeks away from nursing, then headed back to the ER. "It was good to go back because it gave me something to do," she said. "Work is so busy, it gives you a brief moment to forget."

Clever improvisations

Making do alone, often with little more than quick thinking and improvised resources, is a common thread for many nurses who respond to emergencies.

Karen Taylor, RN, was on vacation in Maui last summer, on her way down from a strenuous day hike to the Iao Needle, when she came upon a traveler in distress.

"She was slumped over her on her knees, in front of her husband, who was desperately trying to hold her up," said Taylor, who lives in Red Oak, Okla.

Taylor, 48, who specializes in psychiatric and mental health nursing, helped the woman to a sitting position on a nearby rock, and immediately did an assessment: "Tall, obese, middle-aged woman, short of breath, pale, cool and clammy. She complained of feeling light-headed and nauseous. Pulse was weak, even and within normal limits," Taylor said.

The woman also, according to her husband, had non-insulin dependent diabetes and hypertension.

Taylor suspected low blood sugar, and obtained snacks and juice from other hikers, along with wet wipes and bottled water to make cool compresses.

With two men assisting her down the mountain, the woman made it back to her car, where she vomited the food and liquids, said Taylor, who advised the woman's husband to take her immediately to the hospital.

"Treating in the field can be challenging when without the tools," Taylor said. "It allows one to use improvisational skills that you don't learn about in nursing school."

When Teresa Shuff's son Marc fell and broke his arm playing basketball at home years ago, she grabbed the handiest item she could find for a splint: a wooden spoon she was using to cook dinner. Then she made a sling out of one of her infant daughter's receiving blankets.

At the ER, Shuff, a 41-year-old RN from North Liberty, Iowa, heard somebody compare her triage efforts to those of a Boy Scout or Girl Scout. "I thought it was a pretty good compliment," Shuff said. "Scouts are prepared and know how to make do."

With nothing else available, Debra Faulk, RN, used her own clothing to help a shooting victim in San Francisco. One evening, years ago, Faulk was in Bible study at New Bethel Community Church in Hunter's Point, one of the city's most crime-ridden neighborhoods.

"We heard a blast, it sounded like a tire had blown out. Then we heard another, then someone screaming, 'Help me, my sister's been shot.' I ran outside," said 46-year-old Faulk, who lives in Richmond, Calif. "I was verbally restrained, told not to go out, but I guess that's the nursing instinct. Someone's screaming for help, how could I just sit there?"

Faulk found a young woman slumped in the front seat of a car, amid shards of broken glass.