"Debbie, I'm going to send you for X rays," he said. "We need to make sure you haven't fractured anything." He looked at the nurse. "Stat CT, skull, and C-spine. And ... " He paused, listening.

Another ambulance siren was approaching.

"Get those films done," he ordered, and trotted back outside to the loading dock, where his staff had reassembled.

A second siren, fainter, had joined the first wail. Jack glanced at each other in alarm. Two ambulances on the way?

"It's going to be one of those days," he muttered.

"Trauma room cleared out?" asked Anna.

"Patient's on her way to X-ray." He stepped forward as the first ambulance backed up. The instant it rolled to a stop, he yanked open the door.

It was a man this time, middle-aged and overweight, his skin pale and clammy. Going into shock was Jack's first assessment, he saw no blood, no signs of injury.

"He was one of the fender benders," said the EMT as they wheeled the man into the treatment room. "Got chest pain when we pulled him out of his car. Rhythm's been stable, a little tachycardic, but no PVCS. Systolic's ninety. We gave morphine and nitro at the scene, and oxygen's going at six liters." Every one was right on the ball. While Anna took the history and physical, the nurses hooked up the cardiac leads. An EKG blipped out of the machine. Jack tore off the sheet and focused on the ST elevations in leads V1 and V2.

"Anterior MI," he said to Anna.

She nodded. "I figured he was a tpa special."

A nurse called through the doorway, "The other ambulance is here!" Jack and two nurses ran outside.