I left my home responding to the call which was approximately 1 1/2 miles from my house, upon arrival there were two vehicles involved in a head on collision, the first vehicle was an older model midsize oldsmobile and the second vehicle was a newer model Honda Passport. I approached the first where there was a woman standing outside of the vehicle I triaged her very quick and put her a priority three patient. As I approached the second vehicle I tried to make access from the drivers side but the door was locked and the windows were up, there was a single male sitting in the drivers seat slumped over being held up by his seat belt. Ispoke very laoud to see if the male was conscious and he spoke back to me that was great. I went to the drivers side and broke out a back window so I could gain access to the locking mechanism of the vehicle once I had the doors unlocked I entered the vehicle on the passengers side and evaluated the gentleman. At this time a second responder, Engine Company and Medic 11 was arriving on scene. The gentleman was alert and oriented howevere he stated to me that he could not feel or move his ars or legs, I did not attempt to take c-spine at this time because he had a patent airway and was speaking I wanted to wait until I had additional help. We got the stretcher, KED, backboard and cid devices ready for extrication. Medflight was landing on our scene at this time. I took c-spine and started to bring his head and neck to the correct anatomical position and as I move his head I could feel and hear crepitus in his cervical spine, we applied the c-collar and it was less than one minute before the gentleman went unresponsive and quit breathing, this is not good so we went into a rapid extrication mode, once we had the gentleman out of the car and on a backboard we starting bagging him. we secured him to the backboard and headed towards Medflight. The genleman was intubated before Medflight left the ground enrout to Huntsville Hospital. As for the woman in the other car she had no injuries and did not want to go to the hospital however after the State Trooper got there we found out that she was legally intoxicated at 9 am in the morning. I usually put milk on my rice krispies I guess she doesn't. As for a stressful call this is the one that stands out in my mind, I have been on alot of calls in my 15 years but this one stands out because I had his head in my hands and felt him die right there. I deal with stress different than most people do I handle it as a job and if I do my job right people live and if I do my job wrong people die and I dont bring it home with me when I clock out it stays on my timecard. I know this sound like I don't care but I do this is just the way I dealwith it. This call had a good outcome though not only for the gentleman but also for our Fire Department and the community. The gentleman survived as a quadrapalegic and travels the state and country now giving lectures to high school students and institutions. The name of his lecture is "I was killed by a drunk driver". The genleman visited our fire department about a year later and told us thank you for keeping him alive so he could make a difference in somebody elses life. STEP 2 1. As for the stress levels I couldnt really tell you if they were high as everyone did their job as they were supposed to do and I did not recognize any on scene stress. 2. Stress management during this call was managed by everyone having good training and doing their job. As for after the call I believe there needs to be a debriefing to help people manage their stress, does this always happen NO but i wish it happened more often. 3. As for the patient dying he did not and had a greta outcome, as for the Kubler-Ross stages of death I have seen this before in terminal patients but I really do not understand how this affect the paramedic, I guess it could affect someone different than it affects me I have come to realization that every mornig I wake up I am dying another day so lets make the most of it.