Sunday, March 14, 2010

Why Do We Do This Job?

I was going to leave a comment on a post put up by Ambulance Driver, but it is long enough to be its own post.

It was a beautiful spring day, probably right about this time of year. The sun was shining, not a cloud in the sky, perfect for some parasailing on a Sunday morning. The view must have really been impressive, and I'm sure he could see for miles and miles.

While he was in the air he started to feel ill, so he brought the parasail down in a field where his adult son was waiting for him. They began to package the gear when it happened. He clutched his chest and his heart likely stopped beating before he even hit the ground. His son called 911 from his cell phone and immediately started performing CPR. An ambulance was dispatched along with the local first responders. There happened to be a sheriffs deputy near by who just also happened to have an AED in his cruiser. How that Crown Vic with its low ground clearance made it down that muddy, rutted road to the field we'll never know, but the deputy made it there and applied the AED and delivered two shocks. After just a couple of minutes the local first responders arrived on scene and took over CPR, they suctioned his airway and placed an oropharyngeal airway and provided oxygen via BVM, minutes after the first responders arrived two ambulances made their way down that rutted muddy road.

The first responders in this town can be hit or miss, it all depends on who is in town and available, on this day there were plenty of them, but not knowing that, both ambulances responded. As we made our way down that muddy road I took the radio "Gini, you're on airway. Brett, get history from the bystanders, Abbie will get a line. The EMT student can do compressions. I'll take the monitor & drugs."

The first responder who was bagging the patient was one of our full timers, he quickly made room for Gini, the ink not yet dry on her EMT-Intermediate license, to get in position for her first field tube. As the eager EMT-B student got into position to start compressions I told him "push hard, push fast, only stop when I tell you to." The deputy's AED wasn't compatible with our monitor and so I peeled his pads off and placed ours on the patients chest- asystole. Fuck.

The student continued the picture perfect compressions that the son had started. Gini placed an 8.0 ET tube into the patient's trachea and we confirmed its placement via condensation, colorimetric CO2 detector, good, clear bilateral lung sounds and waveform capnography. Abbie had an 18 at the left A/C and so I tossed her the epi & atropine. Brett gave us a report on the history and I had the EMT pause compressions. V-tach. "He's already had two AED shocks, I'm charging to 360. Stop compressions, everyone clear!" Sinus tach at 120. "Son of a bitch, he's got a pulse! lets get into the truck and check a BP." One of the first responders came over to use with a longboard & straps & C-collar & blocks. We got him onto the board and secured to the stretcher and into the truck.

The patient's son followed me to the curb door of the rig and I told him that he was welcome to ride up front. "I'm not leaving my father! I've been with him through everything this morning, I'm not leaving him!" I learned long ago to pick your battles carefully. He had a point, he was the one who started CPR, he was already committed, who was I to deny him that.

I sat on the bench, the son to my left, the student across from me, ready to start CPR again if necessary, Abbie at the head to maintain airway. On the way in to the hospital I got on the radio "Podunk General, this is Medic 8, we're about five minutes out with a male patient, 50's, status post asystole arrest. After one round of ACLS drugs he's in a sinus rhythm now at 80, I've got a lido drip running, 12 lead shows an anterolateral infarct, he's got a pressure of 130/70, I'll see you in five, might want to start LifeFlight now."

Every link in the chain of survival was there that day. His son provided early CPR. The deputy provided early defibrillation. The first responders were able to provide good BLS airway control. My crew and I provided early ACLS and rapid transport. The ED staff was on top of their game that day as well. Just over an hour passed from the time he went into arrest until he was back up in the air, this time in an Agusta helicopter on his way to a cath lab. Several days later he walked out of the hospital under his own power. His only deficit- he doesn't remember landing the parasail.

And that is why I do my job. Because I was a part of the team that saved his life.