It’s like a roller coaster.

The last two and a half weeks have been both the best weeks and the worst weeks of my life professionally and personally.

It all started on what was supposed to be a 36 hour shift over New Years Eve and New Years day. Great time to work EMS right? Good calls, fun times.

Well it didn’t quite work like that. First few calls of the shift were all routine. A drunk or two, a minor MVC or two, a drunk doing CPR on a fully alive drunk person (“Sir, if the patient is saying ‘OW!’ every time you compress his chest, he DOESNT need CPR!”), and then it started to get interesting.

We worked a nasty tractor trailer rollover about 15 miles from town. We get on scene and see a pretty much demolished tanker truck laying on it’s side. The roof of the cab had been peeled back by the wreck and the patient was laying about 10 yards from the truck. He was laying on the ground moaning but not really responsive to us at all.

We quickly get him collared, boarded, stipped, and strapped and then haul into the bus. Just a quick look at him showed what looked like a grossly deformed femur, shattered left arm, distended neck veins, and no breath sounds on the right. Left pupil was sitting pretty at about 4mm and slow to respond while the right was about 2mm and non-responsive.

Our second bus pulled up on scene as me and my medic were getting him situated in the back. We pull the medic from the second truck to come with us while her basic drove. A PD officer drove our second truck back into town. It was decided by my medic that we would call the local fixed wing transfer service to get them ready and just meet them at the airport to get the guy to the Lvl 1 200 miles away from us, since the rotor would take at least a half hour to get to us, and the airport was in town.

We took off towards town and started our thing. Pads and electrodes on, 1 14g in the good AC, an EZ IO in the good leg. Started giving him a fluid bolus cause his pressure was in the dumps. My medic darted his chest and got a little air out, but not much, which led us to believe maybe a hemo. I cleared his airway with suction and tossed in an NPA, then tried positioning and tossed in an OPA.

I noticed his breathing was getting more and more ragged and irregular, so I double checked with the medics and grabbed a scope and ET tubes. Snap on a Mac 3 and grab a 7.5 w/ stylet. Go in and take a look and I can’t see crap. I suction him out some more and still can’t see anything. Ask for cricoid pressure and finally see that white winking of the cords. I sink the tube, pull the stylet.

Grab the slipstream, hook it up and start bagging. Listen to lung sounds? Yep they’re there. ETCo2 looks good too. I look over the patient, who is looking more like a train wreck every minute. His femur that’s deformed looks like it’s quickly collecting tons of fluid, which between that and the chest would very easily explain his low BP. We get about to the airport when I notice that I can’t feel a pulse in his neck anymore. I look quickly to the monitor and notice flatline (like the monitor making all sorts of noise doesn’t clue us in). My medic starts CPR just as the back doors to our bus open up and the flight team hops in.

Since we’re not sending him by flight we beat feat to the ED and get him in there as soon as we can. They work him for another twenty minutes but never get any organized rhythym, let alone pulses, back.

We take our time cleaning up from that call and get paged out to an 911 hangup call that PD went to and then called us out on. The PD officer sounded frantic which made us wonder what was really going on. We get on scene and find something that goes down as the worst call in my career so far.

“PD, Medic 4, we’re pulling up now, does the officer have an update for us?” I casually ask into the mic, wanting to make sure the scene is still safe for us to enter and see what we might need.

“Medic 4, PD 214, get in here quick, young child unresponsive, trauma related!” This PD officer used to be one of our EMTs back when we were a volunteer agency, or so I’m told, so we know we can usually trust his judgement. Hearing him that upset rattles us a little bit though.

We bail from the unit, grabbing our pedi-board, collar, first in bag and toss it all on the cot. As we get inside we get the story from the officer.

“The husband and wife were apparently having an argument, and the kiddo dropped and broke something. So because the father was upset and the kid broke something he beat the kid until the kid was quiet. Wife called 911 then hung up after she thought better of it,” The officer tells us. We take a look at the kid and my vision goes red.

He is completely unresponsive to us as we get in there. He has bruises already forming on his face and neck, along with old bruises that we reveal when we start cutting into his clothes. He has several lacerations to his face, along with several to his forearms that look like they are defensive injuries. His face appears to have several fractures, but we can’t tell just how bad.

My medic and I work quickly and silently as we get the little boy packaged up onto our board and call our local fixed-wing service to get the boy transferred up to the childrens Lvl 1 250 miles+ away from us. I drive the bus so the medic can be in the back with the kiddo but we wind up staying in the ED to help prep the kid for the flight out. During transport my medic had intubated the kiddo because he had stopped spontaneous respirations, and reported that the kids’ pupil was blown.

The kid was transferred to the flight crew without any more problems and flown to Big City Hospital Lvl 1. I’m still waiting to hear more, I would love to hear that the kiddo would be ok, but I don’t know if he is. He is still on my mind and I can’t get him out of there. It’s just… I don’t know…

Seeing that just shook me to the core. I don’t like kids, but I want them eventually. My ex-fiance and me were supposed to have one, but working in the field made her miscarry, at least that’s what the docs said. There’s another little girl that I would help take care of in a heartbeat if the mother decided she wants to come out here with me. I love them both more than anything and I haven’t even met the little one yet.

What makes this even more like a roller coaster is the fact that the call that I term as the best call of my career. I had my first delivery in the field as a lead EMS provider. It was the most amazing experience I’ve ever had. I helped deliver a healthy little girl into this world without any problems for her or mom. I.. I can’t even begin to put into words how this felt. It felt like it made up for all the bad calls I’ve had since I moved here, all the bad stuff I’ve seen since I became an EMT 3 years ago (BTW, I realized that earlier this month marked my third year anniversary as a certified EMT). It has given me the energy and drive I need to push me forward, to continue on and keep going. To keep on riding hte bus day after day.

Then again, life is like a roller coaster to begin with, and EMS just exemplifies this.

Yay… new year… new challenges

Well, another year is over. I’ve noticed a lot of bloggers looking back on the last year, and figured I might join in. But, take note, that I hated 2010 for hte most part, so there will be very few good things I can say about it.

Last year:

My ex-fiance got married to my ex-partner,

I quit my job and moved to CO on the promise of a job (which never materialized),

found a job at a private IFT ambulance, then promptly got fired for doing something stupid.

Fell BACK in love with a girl who had been out of my life for years, had my heart stomped on in front of me, set on fire, and then the ashes scattered by said girl.

Moved back in with my parents,

Spent a lot of the rest of my money that I had saved applying for state certs in bordering states and going to places for interviews.

Got a job in BFE TX on a 911 truck (probably the highlight of my year)

Applied for, and get accepted to, paramedic school in the City.

Strengthened a lot of ties with #CoEMS friends and other great friends I’ve made on Twitter. I’ve found out who really will be around when I need a friendly avatar to talk to.

———————————–

Yea, that’s my list of 2010. This next year will hopefully be easier to make better. I’ll have new challenges. Like working FT, PRN, and being a full-time paramedic student. But I know I can make it through everything that gets thrown at me. I’m used to being on my own, and I’ll prove that I can make it all on my own.

Although the year is off to a rough start with us here in BFE. I pulled what was supposed to be a 36 hour shift over NYE and NYD. It wound up being a 24 since we had a busy day and 1 really bad call. We worked 3 major MVCs and one of those turned into a trauma arrest while we were transporting to the airport to meet a fixed wing to get him to a Lvl1 Trauma in Big City 250 miles up the road.

Curiously I didn’t really feel anything with any of those patients. Sure it was sad they got into accidents over a holiday weekend, but I just did my job and walked away with no questions in my mind or doubts about why stuff like that happened.

For the most part, calls that day had been routine calls. Headache, dizziness, drunk, the usual for a holiday weekend. No suicide attempts or people doing grossly stupid things… Until we got the call that got me sent home early.

We got dispatched out secondary to PD for a 911 hangup call. They got on scene and sounded pretty damned flustered when they were calling us, so we got there relatively quickly.

Now, keep in mind, I hate kids. With one very large exception I don’t want them. And the person that I would have helped them raise their daughter… well, long story. Longer than I wanna go into. That and kids on calls scare me, since I don’t deal with them well.

Anyways, we get on scene and find a kiddo that has been beat to within an inch of her life. Why? Because her low life dad was a fuckign drunk and apparently she had dropped something that broke. His solution? To wail on the kid until she was quiet. The mom called, then apparently ‘thought better’ about it and hung up.

I don’t wanna talk too much abotu that call, since I know it’s already going to give me nightmares. But yea, this year is not off to a good start.

So anyways… new year, new challenges. Let’s hope things go well. School, work, work, school. That will be my life this next year, and I can’t say I mind. Keeping busy is good. Keeps me from thinking too much. As I’ve found out this past year, thinking hurts in more ways than one.

Oh and I decided to not give up caffeine like I was planning this year. That would be suicidal I think. So I decided to just give up carbonated beverages (like my Monster  O_O), with maybe the exception of a beer a week if I ever am off duty long enough to have one. So, the drinks and losing weight are my only new years resolutions other than rocking the paramedic course and earning my disco patch by the end of the year.

I am one very tired TransportMonkey. It’s been… well, it’s been a week.

 

Some very good calls, and one that left me with a horrible feeling afterwards. And several transfers that really had no business being sent up to the City Medical Center. All in all, not a bad week, really. Even with that one call hitting home in a bad way.

 

One thing I’m finding out about working in this rural area… For the most part, the 911 calls are usually legitimate calls. I’ve seen more people actually drive themselves to the ED for minor things than have called us to take them to the ED. I have run one call that would usually be considered BS. Compared to when I pulled medic internship in NM I could run a twelve hour shift with 8 or 9 calls and they’d all be BS.

 

Our transfers on the other hand… If Rural County Hospital even think it might be a patient they can’t handle, they will transfer them out. Some high acuity, legitimate transfers get flown out on either fixed or rotors. But they will usually turf some calls to us that leave us scratching out heads. For example, these are some of the type of calls I’ve seen, personally, come out of that hospital:

Finger that needs sutures

Chest pain, non-cardiac in origin

Pt needing a lapcholy

Any cardiac chest pain.

Abcessed tooth.

 

In fact one of the medics I ran with joked that the criteria for transferring chest pain patients to Big City Medical Center is… Chest pain. They have yet to keep a single CP patient in the last 9 months.

 

One of our transfers runs an average of 3 hours of time from start to finish. That is if we run into no delays picking up or dropping off the patient, run into bad weather, or stop to eat while we’re there. When you wind up doing three of them back to back with patients that a Lvl4 trauma center should be able to handle, it gets old quick. Especially when the patient gets back to Small Town before my bus does cause the ED in Big City discharges them right away.

 

Add onto this that my department now thinks I’m a gigantic black cloud. In the last two weeks I’ve seen… 5 dead bodies, plus the two I’m gonna tell you about later. Only one of them was a viable code. That’s more DOAs than the agency has seen in the last two months put together. Between that and the fact that we ran a 5 pt rollover along with 7 other calls last night on the 1800 to 0600 shift (that I wasn’t even on duty, just on call for… although I was on duty for 10 of those 12 hours), it just seems like the call volume has gone up steadily as I’m there.

 

Now… onto the call that made me just question even if I want to do this job forever. Don’t get me wrong, I love my job and couldn’t imagine doing anything else, but when I see things like this I question things.

“Son of a…!” I curse quietly to myself as I shocked myself on the battery terminal on my car. One of the advantages of this job is I can try to get my car fixed once station chores are done and no calls are dispatched for us. And since I have gotten stuck at the station during my oncall shift cause it wouldn’t start, I wanna get it fixed so I can got to my apartment and sleep.

 

“DEEEEEEEEEEEEEEEEEE-BOOOOOOOOOOOOP!” I hear the radio on my belt signal the EMS tones. “All EMS Personnel, please respond to neighboring county, rural route highway, marker 20, for reports of several patients with GSW.”

I quickly sprint from the driveway back into the station to slip on my uniform shirt and grab my stethoscope from where it was hanging by our little closet. My partner passes me as I head out to the rescue we’re taking out there. He hops in the driver seat while I pull out our map book.

 

“Rescue 1, leaving quarters, en route code three to call location,” I say quickly into the radio, letting dispatch know that the station was empty. We flip on our beacons and siren to clear the road so we can get out.

 

“How far out are we?” I ask my partner, since I’m not familiar with the area we’re headed to.

 

“Not too far, about 8 miles out.” He replies as he scans the intersections to his side.

 

I return the favor and scan mine. There are only a few intersections before we’re out onto the rural route and don’t have to worry about cross traffic. “You’re clear on this side. Glad to hear it’s not too far out.”

 

“Rescue 1, Dispatch. New update from deputy on scene. Looks like two codes. LEOs are investigating looking for shooter.” Our radio squawks at us, I pick up the mic and answer in return. “Copy dispatch. Advise of any further updates.”

 

We spend the rest of the time running out to the scene in almost silence, punctuated only by conversation when we need to clear intersections or my partner is telling me what he wants me to haul into the scene. As we get closer we can clearly see the area of the shooting, since there are many emergency lights strobing the air. We turn into the street and just see a deputy shake his head at us.

 

I keep my head on a swivel as we pull onto the scene, trying to take everything in at once. I see what looks like two bodies in a heap beside a vehicle. There appears to be family all around the bodies, and PD is doing next to nothing to control the scene. I think to myself that this is not a good looking scene.

 

I hop out as soon as we stop and reach into the cabinet on the outside of the box behind the cab to get the first in bag. I’ve already gloved up just prior to us getting on scene, so that’s one less thing I need to worry about. I walk over to the patients and just from looking from 10 feet away I can tell this is not going to be a workable situation.

 

I look over the patients as I get close. The male patient is lying on top of our other patient, blood spilling out of his mouth with gray matter in a pattern behind his head. Yep, that’s an injury that definitely is not compatible with life.

 

I turn my attentions to our other patient. She is lying in a pool of blood. I get in quick to check a pulse and feel nothing. When I look for where the injury is, it looks like a grouping of 4 rounds right in the area of the heart. I turn the patient slightly looking for exit wounds and see three. My medic makes the call not to work the patient, and I have to agree, since it looks like the rounds most likely took out the heart and pretty much her entire blood volume is in a puddle under her.

 

We get up without opening our bags, being careful not to contaminate what is now a crime scene more than we have already. When the family sees this they let out that sound. That god-awful sound that I have only heard a time or two in the past. A sound that I could go the rest of my life without hearing again it it would still be the worst sound I’ve ever heard. It’s the sound of realizing that someone they love isn’t going to be getting up off the ground. I’ve heard it most commonly called by other EMS providers as ‘The Wail’. It’s probably the most disturbing sound that you can hear while doing this job.

As we get up the family that is surrounding the scene starts to surge in towards us. They are upset that we aren’t doing anything. They feel like we’re not doing our job. Then I see something that just breaks my heart. The victims two small children (both elementary age) kneel down in front of their parent and just cry. It’s not a sight I don’t think I’ll ever get out of my mind.

 

There are some days that this job really sucks

 

 

So… yea. It’s been one hell of a week. The last two weeks I’ve racked up over 100 hours of time on duty, plus 80 or so of on call hours. And tomorrow I have to head up to the city to turn in my application for medic school that starts in January. I need to find something to do to distract myself from work. That’s the only downside to working in a small town.

 

Ya’ll stay safe out there.

 

 

 

 

http://transportjockey.com/2010/11/16/165/

Rural EMS can really suck sometimes

“Dispatch will be changing frequency to dispatch ambulance.”

As I hear those words I grab my boots and quickly slip into them and start running, carefully, down the stairs. I know from experience, quite painfully actually, that if I don’t pay attention while going down these stairs, I’ll wind up head first heading towards the floor. I quickly grab my steth and hat off the table where they lay after we got back from our last call.

“EMS, EMS, Ambulance requested in tiny south-county town. Called in as a difficulty breathing. Deputy is responding to scene,” The radio on my belt squawks. I stop and think about where exactly they’re sending us. I can’t recall that little town being on any of our response maps.

“EMS to PD Dispatch, copy call, clear page,” I say into my radio as I pull it from my belt. I head into the bay and hop into our rig. The senior medic I’m riding with is right behind me. We start the rig up and he flips the lights and siren on as well pull out of the parking bay.

“Hey, OldMan, where the hell are they sending us?” I yell over at my partner, while flipping through the map book trying to see where we’re headed to.

“It’s just north of SmallerTown. Usually their vollies will cover that area, guess they can’t raise anyone again, so we’re covering the county,” He tells me as he scans the road ahead and to his left as we blow through town. He gets on the radio to ask dispatch if the volunteers are responding at all.

“Negative on that, EMS. Volunteers are out of service today due to insufficient crew available. SO is sending a deputy out to assess the scene for you. He should be there in ten minutes.”

“Copy that. We have an ETA of 45 minutes to the scene,” my partner tells them, shaking his head in frustration.

The South Town Volunteers might only be BLS capable, but they could still make a difference in this call if it’s anywhere near serious. But since they are unstaffed, a common occurrence lately from what I’ve been told, the patient has to wait for our EMS service to show up. Since we are a paid department, and the only other EMS agency in the county, we are always staffed. Luckily.

We hit the highway once we’re out of town and OldMan gets on the gas for all he’s worth, trying to get there in time. It’s a long trip there, even running flat out with lights and sirens. Luckily it’s pretty much all flat and straight till we get into Tiny South-County Town.

“Dispatch to EMS, SO reports that the patient is not breathing and has no pulse. He is starting CPR.”

“Shit!” My partner curses in the radio’s general direction before picking up the mic. “Copy that dispatch, get EMS2 rolling once they get into station.”

“EMS2 to EMS1, copy direct,” The voice of the OldMans son comes back, since he is the on call lead today. “We’re rolling now.”

Thirty minutes still till we get to scene. No telling of how long the patient has been down. This could wind up not being fun at all. I just hang on and watch the terrain fly by to either side of us, keeping alert for cross streets so I can tell my partner if something looks like it’s gonna come out in front of us. I know what to do if we have to work a code, so I try to relax and just be ready.

As we pull up on scene I notice it’s a single family dwelling, with a slew of vehicles parked in front of it. This gives me a little hope that maybe we got called the minute something started to go wrong. There’s also a deputies truck parked in the driveway with it’s lights still twirling. I quickly glove up and grab the first-in bag from the side compartment behind me. I see my partner grab the cot first thing.

“There’s that working a moving code mentality again.” I think to myself.

We rush inside the residence and take a look. The deputy is in the middle of the floor of the living room with an AED attached to the victim, while performing CPR. I see a face mask there too, so it looks like he’s been doing everything right. Judging his compressions I see that they are good, solid, and deep. Perfect.

The OldMan has him stop and he does his quick assessment. By the way the body moves when we roll it, this person has been down a hell of a lot longer than 45 minutes. As we look at their back we notice lividity present as well. We both look at each other and shake our heads. As he talks to the family to get the story, he motions me to talk to the deputy to get his viewpoint since he got there.

The family is of course not happy with us when we do not continue CPR. They are mad at everyone, especially us, for how long it took their call to go through. It sounds like they tried calling the Small Town Volunteers station to try and get response from them for about a half hour before calling 911. They told the dispatcher that she wasn’t breathing. So why did we get paged out for difficulty breathing? Ya’ll know dispatchers as well as I do. Guess.

Apparently the family thought that calling the vollie station was just as good as calling 911. And they couldn’t figure how the station could be unstaffed in the middle of a weekday. They apparently weren’t happy finding out that the vollies have real jobs and don’t have the staff to maintain a crew 24/7. They were blaming us for taking so long to get there from town, even though it’s impossible to get there faster than we did.

The deputy said he got there and started CPR as soon as he checked for a pulse and got none. He never thought to look for rigor or lividity, but then again that’s not his job. I get some more information from the deputy for our report and watch as he goes to call the JP and make arrangements.

I meet up with my partner again after I finish loading the cot into our rig and put the bag back in the side compartment. As he sees I’m done putting things away he asks, “Still so happy to work in a system like this?”

———————————————————————————————————

This is the first time working here in Rural Town, TX that I wanted to pull my hair out. I wonder if this will be the call that gets the county and my town to decide that our service needs to spread to cover the entire county and needs a station down south in Small Town. In a situation like this it might have made all the difference.

Code? Code!

 

So I’ve now worked two codes for my new service. I’ve discovered a major difference in the way my training for codes was and how this service runs codes. In fact it’s a difference that to me seems backwards to how I would have expected it, coming from an urbanish area.

First code I worked was a nasty one where an ILS provider was the highest level of care on the scene, with no backup coming. I worked it like I was taught and did ok, even though we didn’t get ROSC. I got a tube, drilled the pt for an IO, ran through my asystole algorithm, and worked it for 30 minutes on scene.

The problem arose when my basic partner made multiple comments that we needed to get this guy to the hospital.

Wait? Transport a dead guy to the hospital? What the hell. Granted I’m not a medic, so I wouldn’t be able to pronounce on scene, but our chief was finishing up with his call by this point and could have come by to do that for us. I was thus informed of the procedure that all working  codes, regardless of who’s working it, get transported to the ED.

This was a large shock coming from a system where you were expected to work codes on scene, even though the hospital was maybe 10 minutes away at max. This seems to be backwards in my thinking, if transporting a working code was actually a good idea.

Out here, I could be upwards of an hour from a hospital with a working code out in the county, yet procedures say that I drive the patient to the hospital code 3 while me or my partner are in the back doing CPR the whole time? I’m not a big fan of that, and I’ve already let my new boss know this. In my opinion it’s too dangerous for too little gain.

You’d figure that being so far away, they’d want to work the code on scene, since in most cases there is very little an ED can do that an ALS ambulance can do for a working code. Hell, even as an EMT-I I’m allowed to shock, drug, and tube during a code.

The second code I worked a couple days ago when I was the on call crew was the first code I’ve ever worked that the whole purpose was the get the patient to the hospital within 20 minutes of getting on scene. We did it, and it was an odd experience. We had 2 crews plus the chief helping out with it. I did compressions (where I managed to give the pt a BP of 160/80-ish according to the monitor NIBP cuff :) ) the entire time, except for where the basic took over so I could push my Epi and Atropine.

Seems to me that doing compressions in a moving vehicle is counterproductive. You just can’t give good compressions when you’re being flung around in the back on the way to the ED. I tried. I failed. I can give great compressions to a pt while I’m standing still, but there’s just no way to steady yourself in that big old monster of a rig that we have to give adequate compressions.

So yea, there’s another thing that is different to me since coming here. And, like I said, it’s something that I figured would be the other way around versus what I’m used to in the city with 7 hospitals within a couple miles and a half dozen medics showing up to most calls.

I do think, however I might research trying to get a grant to get something like the Autopulse to make our crews a little safer if they intend on sticking with this asinine procedure of moving codes.

 

Why am I doing this?

“3027, we’ve got a code 3 two blocks from you,” a radio crackles from the cab.

I look up from my paperwork and sit bolt straight. Time to stop being the box troll and actually get to do something.

“27, responding to address,” my preceptor calls in as the MDT shows the location. “Any info on type of call?”

With this I perk up, picking up the handset in the back to listen better to what is going on.

“Working code. PD states scene is secure, officer performing CPR. Fire is five out, Engine and Rescue 12 responding with you,” the usually demonic box blurts out.

Hearing this I start piling the gurney with our bags and monitor. I look up and see us pulling up to the address stated on the monitor. Jumping out of the module, I notice a chaotic scene already. Multiple police units on scene blocking off traffic. We get to the wreck of a vehicle, or what had once been a vehicle and take in the area.

A blue Land Rover, brand new from the paper plates on the back end, somehow wrapped itself around a light pole in a residential community. Usually a quiet section of town, everyone seems to be out rubbernecking. The front end of this SUV seems to be pushed all the way into the passenger compartment, with the engine no where in sight. No glass anywhere in the vehicle, the rear end shatter with wheels pointing in opposite directions.

We rush over to where the cops are all gathered in a huddle and ask what is going on.

“Kid was racing some friends down this road, lost control and then over-corrected, looks like he rolled it once or twice and then smacked right hard into that pole. We found the kid laying right here,” the shift Sgt tells us as I look at the distance between the wreck and the body on the road. A good 20 yards or so.

I look at the mangled form lying before us. He doesn’t look a day older than 16, wearing the colors of a local high school. Blood coming from his nose and one ear, a leg that is bending in a way it shouldn’t, bone coming out of his left wrist… This kid is not doing good. The cops have him hooked to their AED and are doing CPR, for once good quality, and bagging the kid. I quickly remember that being the box troll means I’m in charge of the scene.

“Get our monitor on him, grab the airway kit and O2 tank. Lets get him exposed,” I start barking out orders as I get set into motion. “We need someone to hold him C-Spine and then get IV access. Two large bores if we can get them.”

As I’m saying this the engine and the rescue pull up onto scene. I yell at the oncoming crews to being a board, block, and straps. Quickly looking at the monitor I see a flat line where we should be seeing beats. It turns into a mess of jumbles when the cops finish their bagged breaths into the kids and start compressions again. I look at the fire medic and tell him to get me some lines.

With that I grab the intubation gear and move to the head. 7.0 tube, stylet, 10cc syringe, laryngoscope, and tube tamer all in my hands as I get set up. I look up as I get ready and see two lines in place from the fire crews.

“Push a mg of Epi now!” I shout out towards the other medic. Then I turn my attention back towards the head. They have just finished bagging him again. I lay on my stomach with the scope and tube in my hands. Feeling the gravel cut into my chest, I go in and take a look. I ask for suction and start to clear away some of the bloody secretions I’m seeing. I think I’m seeing the white lined hole of the vocal cords. I push the tube through and pull the scope out. Pulling the stylet out and inflating the syringe I hold the tube steady. I quickly attach the inline capno and the bag to it and tell the firefighter to give it a few good squeezes.

Grabbing the stethoscope from it’s place in my right left pocket, I take a listen. It’s hard to make out, but I hear air movement in the left and very little in the right. A quick glance at the capnography shows that we’re in. Thinking quickly I reach over to the airway kit and bring out some iodine and a very large fourteen gauge catheter. Swab the betadine and stab the cath into the right side of the chest. We get a large rush of air and the firefighter tells me that the bag is easier to squeeze now.

“Squeeze that bag about 15 times a minute and tell me if it gets harder to squeeze again. Don’t stop while he’s doing compressions!”

I go to the med box and start handing my fire medic drugs as I want him to push them. A mg of Atropine, then another mg of Epi. We alternate until we have all three of Atropine on board. Then it’s just straight Epi. Amp after amp of the drug is pushed into this kids body. We don’t seem to be making a difference. I decide on a Hail-Mary and toss the other medic an amp of bicarb. We push it in along with another 500cc’s of fluid. Still nothing. I tell everyone to stop what they’re doing. Looking at the monitor reveals no change. They resume.

I ask for the hand-held from my preceptor, about to call the hospital for orders to terminate efforts when we stop and I see a lot of random squiggles on the monitor. V-Fib!

I reach over and crank the monitor to 200J, and yell out to everyone to clear.

“Everyone clear! Shocking!” The monitor hums as it builds energy. When it stops and the button flashes I hit the button, kindly marked with a lightning bolt for those firefighters who can’t read (I kid I kid, but we do call it firefighter proof). And then the sound. The sound that only a defibrillator can make. The patient gets a good jolt as 200 Joules of electricity get pumped into his body. The person doing compressions, now my units driver who happens to be an EMT-Intermediate, starts up as soon as the shock is delivered. I take the bag and start squeezing, trying not to go so fast, and knowing I’m failing at it.

When we end our set of compression I look again. This time it’s a more regular set of squiggly up and down waves. Ventricular Tachycardia. I reach towards the neck and am rewarded with a weak and thready pulse. But it’s a pulse!

I give the bag to another firefighter and reach back to the med box. I draw up 1.5mg/kg of Lidocaine to try and get his heart under control. No more compressions and he seems to pink up a little. The Lido is in. We quickly get him boarded and in my truck. The rhythm is still V-Tach, still has a weak pulse. I flip the monitor to sync cardiovert as I feel us get moving.

“Code return!” I shout up to the front. Grabbing the radio I give a quick report, “Male, late teens, was pulseless and apneic on scene. Tubed on scene. Worked him for twenty. 3 of Atro, 3 of Epi on board. 1 of bicarb. Went into V-fib, shocked once at 200 then into V-Tach with a pulse. 1.5 of Lido on board as well. Running hot to ya’ll, be there in five, see ya in the trauma room. BP is 70 palp. Getting ready to sync him.” I try my best to keep it short and give them all the info they need.

I charge the monitor to 150 and ensure it’s still on sync. It is, marking the peak of each QRS. “Everyone clear!” I yell out.

I let it charge and listen to the whining sound it makes. Then I press the shock button. The patient jolts again. I quickly look at the monitor and feel for a pulse. Monitor is showing a sinus rhythm with multiple PVCs. Pulse is now
stronger.

We get to the hospital and have a team of techs and nurses waiting for us in the bay. We get the gurney out and rush him into the trauma room. “Late teens male, was pulseless and apneic on scene. 7.0 22 at the teeth, good waveforms on the monitor. Apparently ejected from vehicle. 3 Atro, 3 Epi, 1 of bicarb, and 1.5 Lido on board. Converted to VF, one shock at 200, converted to VT with a pulse. Low BP. Sync’d at 150 converted to Sinus with multiple PVCs. A liter and a half in so far.” I watch with fascination as the trauma team takes over from here. An art line, blood hung on one of our lines, ABG drawn, fractures assessed.

We get the kids wallet out of his tattered pants and give the unit coordinator the info. I look at the date of birth… The kid is seventeen a couple of days ago. Seeing that I walk out to the bus, and look inside. It’s a mess. Almost like a tornado hit it. I suddenly feel dizzy and sit heavily on the back bumper. I feel my breakfast coming up and the next thing I know I’m staring at it in a puddle on the sidewalk.

I feel arms help me up and someone putting a mask to my face. I see my preceptor smiling and telling me that I did great for my first code. I’m not really hearing it. I just keep seeing that kids birthdate floating in my head.

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I have been asked, since this is my extension, why I want to do this. Why I want to be a paramedic. To run the streets and help people. I’ve never been able to come up with a good reason. It really boils down to the fact that nursing school was full and had a long wait list. Now it’s become something else.

I can’t imagine doing anything else. The street has an allure that is not easily turned down. And when you have that good call it energizes you. Calls like the one above. My first code this internship. My first field tube. My first shock. My first save. I can’t get the memories of that call out of my head even now, a week later.

I’ve been told that I have all the knowledge I need, but now I just need to show I can use it in the field. Calls like this help with that. It shows I can think on my feet. I know what needs to be done so I do it.

And for anyone wondering what happened to us after this call… We were out of service for almost an hour, and I was sucking down O2 for a good half hour trying to calm down. It feels good to get it on paper though.