Sunday, June 6, 2010

Can I really do this?

CAUTION: Long Post Ahead...
Last month the Handover Blog Carnival was hosted by Steve over at “The EMT Spot” and the subject de jour was “What was your ‘Moment when it all clicked’?” I’ve been enjoying the blog carnival since Mark started it last year, and this last issue was no exception. I even thought of posting an entry, but I still had not gotten back into the writing mode. Now that I am ( back in writing mode) and have a few minutes, I thought I would take a shot.
I tell this story a LOT to new EMT’s as a way to explain how we all go through similar adjustments, fears, and self doubt as we enter this field. I am thought of as a pretty solid EMT by most folks I work with, especially the new ones who don’t know any better, and many have a hard time believing I ever doubted myself and my abilities. So, let’s go back a few years (ok, many years)…..
At this stage in my ‘career’ I am a newly ordained Certified First Responder (CFR, one step below EMT-B in our State) and have been a functioning and active driver for a couple of years. I had taken the class and got my ticket because I was frustrated when we could get a rig out for an ‘off-hours’ call but had no medical folks to initiate care until our backup ALS arrived. Most of these calls I could have handled just based on my life experience and knowledge, but without the proper credentials, I couldn’t offer anything more than conversational therapy. So I jumped in and soon realized that now I would have to handle more than just the simple bumps, bruises, lacerations, belly aches, and all the other things we see every day. I began to wonder how I would perform when the big one hit and I had arrived first or second to the patient’s side. That would put me in the position of making decisions and ‘doing stuff’ that could make all the difference to that patient. I thought about this a lot and worried that I might not function as well as I needed to. I had two main concerns: 1) What about the major call, where what we did would undoubtedly make a difference in whether that patient lived or died?, and 2) What about the ‘big blood’ call? I had never had a call with a LOT of blood and wondered how I would handle it, and if indeed I could do the right thing. I thought about these questions for about a month before the first one was answered.
The scene: It is Sunday on a major religious holiday weekend in the spring at about 6pm. A family has just enjoyed their big dinner and had a nice afternoon enjoying each other’s company. All the kids and grand kids came to spend the day with Grandma who is finally going to a doctor the following day to get her long standing issues looked at. Grandma is tired from all the activities and goes in to take a shower while her kids are washing the dishes and cleaning up the house after all the activity of the day. A loud ‘thump’ is heard from Grandma’s room and when they check, they find her on the floor. 911 is called and I am ½ mile away when the page goes out. I throw the family in the car and head for the rig, but it passes me already headed to the scene 2 blocks from the firehouse. I turn around, tell my family to ‘wait in the car’ and head across the lawn. The rig driver calls out to me and throws me a BVM (Bag-Valve-Mask) and says they need it inside. I head in and look around: We already have a competent Officer in charge trying to usher family members into another room but stops when he realizes that the new EMT at the patient’s head has forgotten all of his training and is losing it. He has not begun any treatment and is confused. The Officer kindly and gently says to the EMT “um, Chuck, you know the family, do you think you could come out here and help me collect some information? UU is here and he can take over from you. I could really use your help out here.” I am disarmed by how calmly the Officer got things re-arranged and I quickly find myself working next to a very experienced and competent EMT who is presently overloaded. When I land on my knee, he barely lifts his head and just says “ Can you take the airway?” “Yup” I replied and tilted the head while I fumbled for an OPA. I got the OPA in (much easier than on a plastic mannequin!) and started bagging. CPR was rolling along and we were in a groove pretty quick as the equipment was coming in or being setup. The AED says “NO SHOCK ADVISED” and I think ‘Damn!’ but I keep plugging and am now starting to think beyond what my hands are doing. I call for a backboard and begin to converse with the 2 others who are now working the patient. We are planning how to get the patient on the board and out of here without losing the rhythm any more than we have to. 1-2-3 and she is on the board and secured, then onto the stretcher as ALS arrives. The ALS rig is a ‘double medic’ which is rare in our parts, and soon two more off duty medics arrive who are volleys on our Squad during their off hours. Grandma doesn’t know it, but she has 4 of the best Medic’s in the county working on her.
ALS sees how tight the bedroom is and they decide we need to get her out to an area we can work, so we roll her out and I see that our fire police and firefighters have cleared the dining room out so we can get through easily. “This will do, right here” says the lead Medic. We stop there, switch out the AED for the Monitor/AED, get some lines started, I turn the airway over to an EMT and run out to the rig to get the portable suction unit I have requested twice and nobody can find. I run it into the house, set it up and get suction going on the patient, showing the ;’Airway guy’ how the switches work on this unit, just in case he missed the in-service on it. I ask around the gurney if anybody needs anything and get “it’s all good” as my only answer. Drugs aren’t working, defib isn’t helping, the patient is in PEA (Pulseless Electrical Activity: The signals are there, but the muscles are not responding). The medics decide it’s time to move out. I grab two armfuls of gear and do a run-around on the gurney, jump in the rig, stash the gear, and start setting the rig up, get the O2 turned on, get the suction pump running, and all the inside lights on just as they bring the patient into the rig.
At this point I am thinking ‘whew, I’m glad I’m done here’ and I start to climb out of the jump seat to make room for a Medic or EMT better trained to do this. (By this time we have amassed about 10 extra people on the front lawn and I see 4 EMT’s among them. I am assuming one of them will take my place because I am just a CFR. Nobody steps forward.) As I start leaving the rig, the first Medic enters at the head of the stretcher. I wished him luck and said I would get him a fresh EMT if he wanted it. He grabbed my shirtsleeve and flipped me back into the jump seat. “You just stay right there and keep doing what you were doing.” I said to him “You know I’m just a CFR, right?” His hands never stopped working as he positioned all the equipment and worked with the other Medics to get set in the rig all the while compressions continue, I am unconsciously hooking up the O2 to the BVM and getting some more suction in the airway so they can get another shot at dropping the tube. He never looked at me and spoke like an old geezer sitting in a dark bar dispensing wisdom to some kid who needs it. In a calm, relaxed, and conversational tone he said “Look, you are doing a great job and right now I don’t care if you’re a flipping Cardiologist or a Janitor, what I need is someone I can trust to handle the airway while we try to get the damn tube in and you have just been elected.” ‘OK’, I thought, ‘You’re the boss’. So off we went on the 15 minute run to the hospital as I watched and learned and did what I was asked. Mostly I watched and learned. Grandma didn’t ‘make it’ but it wasn’t for lack of trying. Four good Medics, a super quick response (the first responder was on scene in under 2 minutes of dispatch), and all the tea in China could not reverse what had happened to this woman over the years of avoiding the Doctors and proper medical care. We arrived at the Hospital, the Doctor did his assessment and ordered the cessation of resuscitation. I collected gear to return to the rig and when I looked into the back of the Ambulance I realized it was a mess we had. Lots of stuff on the floor: papers, wrappers, some ‘wet stuff’, and tubes hanging here and there. Then I took a look at myself: Soaking wet and beginning to smell a bit from all the sweat. I took a walk out to the heli-pad a dozen yards away and had a cigarette. My hands were shaking just a bit and I had some strong emotions boiling up. Strangely, I had no remorse or sadness and this surprised me. Someone had died here and I wasn’t sad. Instead, I felt elated in a queer sort of way. I was pleased that this patient had received every lucky break to save her life and everyone worked well together, but it was just going to happen. This wasn’t ‘our fault’ and I fully knew that. I felt good because I didn’t ‘mess up’ and I found that I could, in fact, ‘do this job’. Of course I felt pretty bad about the fact that I felt pleased with the way the team worked.
The medic came out and asked how I was ‘doing’. “OK”, I said “I’ll start cleaning up the rig in a bit, I just need a minute to calm down.” He looked at me, and looked over at the rig and said “Yeah, that rig is a sh—house now, sorry about that.” “You know” he went on, “something you said back there gave me the impression this might have been ‘YOUR FIRST’, but working with you I had the impression you have done this a few times before. That’s why I kept you in the rig. You did good and should be happy with that. It’s all we can ever expect.” “Yeah, I know”, I said, “I have done this before, but this is my first time ‘on the job’ before today, it was as an untrained civilian and it wasn’t pretty. Today I was hoping somebody else could step in and help get a better result. I guess it wasn’t meant to be.” “No”, he said, “This isn’t a movie and you know that. You did good today, we all did, and that’s all I can give you.” “That works for me” and I looked at him and gave him a smile and got to cleaning up the rig.
Question #1 had been answered and at that moment I had no idea that question #2 would get answered in the next 2 weeks.

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