For nearly five years, I have been a white cloud in EMS. When I'm around, there are no emergencies. I can walk into a fire house, and have the alarms be silent for hours. Days, sometimes. And, the moment I leave town, the pages start coming in.
No more. I have lost my white cloud status.
Part of being a white cloud is that I do not have a lot of experience with the most extreme type of EMS call, the code. The code, code blue, cardiac arrest. When the patient has no pulse, no heartbeat. And in nearly five years, I did not have a single code.
Then came July.
A few weeks ago, I had my first code, and it was as smooth as codes can be. We were dispatched for something vague and non-emergent, something like "female not feeling well". We originally thought that the county ambulance (primary response, with a paramedic) would be responding, but learned that they were at least 10-15 minutes out, so we jumped in the bus and rared out.
We arrived on scene at a restaurant (a pretty fancy steakhouse). The driver, the other tech, and I were quickly ushered into the restaurant. I turned to the other tech, who was a new EMT and going through the process of getting his department credentialing, so he could tech on his own, and said, "Alright, this one's all yours." He responded, "Let's see what it is first." The assistant chief, who was first on scene, was hurrying us along. "She doesn't look good," he called out.
I was wearing a brightly colored t-shirt and my Roslyn EMS scrubs (we are required to wear something with a FD logo), but the officer on scene asked me to go back and put on a jacket, so I'd look more professional at a public place like a restaurant. Whatever. I did that, while the rest of my crew grabbed the stretcher and took it inside. I put on a giant FD jacket, made for a man three times my size, and sweated across the 90-degree parking lot into the restaurant. I opened the door, and saw that they had already pulled the stretcher out. I held the door open for them, and then jumped in the back of the bus while they lifted the stretcher inside (I'm rubbish at lifting; I'm better off leaving it to two big guys and a couple of cops). At this point, I don't know the condition of the patient...that is, until the chief shouts to me, "Start compressions!"
Oh, ok. I've never done CPR. I've never seen a patient without a heartbeat. As I found out later, she coded the minute before, which gave her a better chance at survival, although she was about ninety years old. And frail. I took half a second to silently freak out, and then began compressions.
It was easier than it is on a CPR dummy. There's less resistance on a little old lady than on a flexible lump of molded plastic. And ribs didn't break, they just kind of--separated. Everything in her chest separated as I pounded on it. And her face was expressionless. Just...there.
After everyone got on the truck, I passed off the compressions to my partner, so I could take off the jacket. I then took over ventilations with the bag-valve-mask. At this point, the paramedic from the county bus showed up, so he hopped in with us. He intubated the patient, and after one failed IV attempt, sent us rolling. The heart monitor indicated PEA, or pulseless electrical activity. In other words, the electrical signals were working, but the heart muscle wasn't doing what it should have been doing. That was a good sign, or at least, not a bad sign. It meant that the heart knew what it was supposed to do, even if it wasn't.
We arrived at the hospital about 3 minutes later, and took the patient right to the trauma room. The medic had called the hospital ahead of time, so they were prepared for us. The patient was treated, and our chief met us in the ER. Fortunately, the medic would be doing all of the paperwork, but we had to go help clean the truck. We didn't all need to do the cleaning, but none of the three of us wanted to admit that we'd rather watch the code in the ER than help clean, so we all got to work.
After the inside of the truck shone like the top of the Chrysler Building (really, the only standard of cleanliness), we walked back inside the ER to get an update. We didn't hang around to get details, but I was satisfied to hear "BP 110/70." The patient had a normal blood pressure. The patient had a blood pressure. The patient's heart was beating on its own and we did that.
A few days later, at the FD's monthly meeting, the chief congratulated us on our good work. The woman was doing well.
No comments:
Post a Comment