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Emergencies happen anywhere, anytime, and sometimes medical professionals find themselves in situations where they are the only ones who can help. Is There a Doctor in the House? is a Medscape Medical News series telling these stories.

I had just come back from a business trip to LA and was taking the subway home from the airport. I had two big suitcases with me, so when I got to the Manhattan 86th Street station on the #6 train, I took the elevator to the street level. Just as the doors were closing, I heard a commotion. It wasn’t your typical commotion in the subway. I thought, that doesn’t seem right.

After getting off the elevator, I went over to the stairs and asked someone what was going on. They said, “Someone fell onto the tracks.”

I had no clue what the situation really was. But I do have skills. I figured if it had just happened, I should go see if there was anything I could do. I carried my bags down the stairs and through the gate. A security person said he would watch my stuff, which was amazing.

I carry a bunch of first aid supplies with me everywhere — Narcan, Benadryl, EpiPen, dressings, a pulse oximeter, things like that. I want to be prepared. But even when a situation isn’t serious, I’ve found that it helps to pull out some gloves, a stethoscope, and maybe a blood pressure cuff. It gives someone who isn’t feeling well a level of comfort. I grabbed some things to take with me, including a tourniquet.

The platform was chaos, it was rush hour, and there were a lot of people standing around. No one quite knew what was going on or what to do. I could see the train hadn’t pulled in fully. There was a cop at the front of the train with a flashlight trying to figure out what happened. The motorman was still in his cab, probably in shock.

We didn’t know where the person had fallen or their status. Fortunately, some people on the opposite platform could see him. They were pointing, saying, “He’s right there. It looks like he’s moving.” So, that was a good sign.

I jumped down off the platform to the tracks. Everyone was saying, “Don’t touch the third rail!” I’d never been on subway tracks before. But I knew enough to be worried about the third rail. The motorman had gotten out of the cab at that point, so I assumed the electricity had been turned off. I later learned that might not have been the case.

I walked along the side of the train, straddling the third rail, and saw my patient. He was clearly not in a good situation. His lower leg had been completely severed. It was lying on one side of a track close to the third rail. The rest of him was underneath the train in the open space behind the wheels. There was a fair amount of blood pooling around him.

My training just kicked in. I started with the typical ABCs — actually CAB now. I couldn’t obtain a radial pulse, which meant that his systolic was likely below 90 mm Hg. Hypovolemic for sure. He was in and out of consciousness and murmuring, but nothing I could understand. I looked to make sure no other body parts were unattached.

I applied the tourniquet, which I had never used before, above the knee because there wasn’t really enough meat below. I know having a tourniquet applied can be very painful, and the patient seemed to respond to that. He started to moan, and I tried to talk to him. But I couldn’t get his name or much of anything.

After that, we waited for the cavalry. We were in a precarious spot, to say the least. I was kind of wedged in right next to that third rail. But at least the train wasn’t going to move.

The fire department would have to wait for their own command to advise them that the power was off before they could come down. Same with the police. I knew that would take 10 or 15 minutes. If I’d been on duty, if I’d needed to follow that procedure, the patient would have bled out by then.

Ultimately, the fire department showed up. Two firefighters with a backboard navigated the space between the train and the track bed. I tried to protect the patient’s wound from the dirt and debris as best I could with triangle bandages while they sort of slid and yanked him onto the backboard.

I picked up the lower leg and put it on the backboard too. I didn’t know what they could do with it, but I wasn’t going to leave it for the rats.

They pulled the patient out, and EMS applied a second tourniquet. Then they lifted him up and took him away.

I, a disheveled mess by this point, picked up my bags and went home. My 23-year-old daughter was there, and the first thing she said to me was, “Oh, I’ve had such a bad day.”

I said, “You’ve had a bad day?”

My wife came home, and I told them what had happened. And then I just moved on with my week. As I’ll explain, that didn’t go well.

I’ve been an EMT for more than 30 years. I got certified because I loved firefighting, and I still do it. As a firefighter in college, I was going to all these motor vehicle accidents, and I noticed that the EMTs were having a lot more fun pulling the patients out than we were tearing the car apart. I know that sounds weird. But ask any first responder, and they’ll understand.

When you’re in a situation like this, there’s no emotion. It’s all GO, and you pick up the pieces later. (Literally, in this case.) When I’m on the job, it’s a lot easier. There’s some mental preparation that you do as you go into a call. But this was different.

A week later, PTSD started to hit me, and mentally, I fell apart. Couldn’t shake what had happened. I started drinking heavily. I stopped communicating. When you put those two things together, you have a recipe for disaster. I was living in a bad world, and I became very destructive.

It wasn’t until a month later that I piped up and told a therapist how I was feeling.

It’s so clear that medical professionals need therapy. And not enough of them will get it. We all need to work through the serious things we see. It took time, but I can say that therapy was very helpful. I’m much better now. And each day, what I experienced gets less and less present, which is good. I don’t need to carry around that baggage.

I’m open about it because I want everyone to know that mental health struggles are okay. It’s okay to have PTSD and PTSA. It’s okay to feel terrible. Not only is it okay but it is also expected. But you better do something about it.

The guy I saved never attempted to contact me, which is perfectly fine. I’m used to that in my world. We drop people off at hospitals and usually have no idea what happens to them. That comes with the job. But I knew this patient was quite well stabilized before they took him away, so I felt confident that he would be okay.

I still love the subway. I go in and out of the 86th Street station all the time. Once in a while, I’ll find myself staring at the wheels of the train that has just come in. Not in a terribly negative way, more matter-of-fact. I still carry my medical supplies everywhere I go. My ambulance agency, Gotham Volunteer EMS in Queens, graciously replaced my tourniquet, which, on that occasion, was pretty handy.

Matthew Tirschwell is a volunteer EMT with Gotham Volunteer EMS and the owner of Tirschwell & Co. Inc., an architectural lighting design firm in New York City. He also is the founder of EMS Access Inc., a nonprofit creating best leadership practices for volunteer ambulance agencies.

Are you a medical professional with a dramatic story outside the clinic? Medscape Medical News would love to consider your story for Is There a Doctor in the House? Please email your contact information and a short summary to access@webmd.net.

Read more in the series:

Doctor Aids In-Air Emergency Birth – With a Wild Plot Twist

14 Victims: Doctor Controls Chaos After Fatal Backroads Crash

A Doctor Gets the Save When a Little League Umpire Collapses

Read the entire series here.