Everything you read here should be considered fiction. Patient rights will always be respected. Any resemblance to persons living or not is purely coincidental.

Friday, August 5, 2011

My first live chest compressions...on a dead woman

If there's one thing we spent tons of time working on in EMR (First Responder) class, it was CPR.  Not only did we take our requisite AHA CPR&AED for Healthcare Providers course (for which I have a spiffy little card in my wallet) but we also touched on it every week, no matter what the subject matter.

So I should have been better prepared.

I was driving the agency ambulance toward our community hospital - couldn't tell you what was wrong with our patient - I can't remember, but it was a BLS transport so no medics aboard. Just one EMT-B and an EMT-I in the back.  I was driving along the river, swollen to near-flood height by the melting snow and off-and-on drizzle we'd had throughout the day.  The water was mocha brown from the runoff and fully-grown pine trees, roots intact, were a common sight floating down the river.  Just a couple miles outside town sat a gray van on the side of the road.  People were climbing over the guardrail on the river side and waiting until we passed to cross to the van.  They were all wearing wetsuits, pfd's, and some had on helmets.  A typical rafting party.  I slowed down to pass between them and the normally-clad older man next to the van managed a weak wave.

The scene puzzled me, and I forgot about avoiding the bumps in the road for the next few miles.  What was going on there?  It was near a put-in/take-out point on the river, but why didn't the van drive down to pick up the passengers?  "Ah, the raft must have flipped or something, and they were all getting out and ending the trip early - it is so cold and rainy out..."

The radio crackled to life.  Tones I had never heard.

"Volunteer fire, volunteer ambulance, volunteer search and rescue, respond to report of rafter ejected from raft near the 20 mile point.  Female, 40-50, last seen being swept away from raft guides."  Then not a minute later, "Agency fire, agency ambulance, agency search and rescue, inter-agency request from volunteer service to join in search."

We were miles down the road and down stream.  I turned to the EMT-I and asked what we should do.  "Keep driving."

So I drove.  My mind wasn't on the road.  With another 45 minutes to the community hospital, I had only a few minutes of time to listen to the radio traffic before the mountains got in the way.  Ms. Medic was on her way.  ICS was up and running.  Cars were racing downriver to viewpoints for spotting.  Volunteers were rushing in to help.   Then nothing but static as we exceeded radio range.  I wondered, pondered.

We arrived at the small ED and unloaded our patient.  I cleared the cot back to the ambulance and pulled it out of the way.  ED nurses let us in on the news - they found her.  The volunteer ambulance was right behind us - hypothermic, unresponsive patient with active CPR going on in the back.  My heart pounded and mind raced - hypothermic - you're not dead until you're warm and dead.  Could be they would get this one back!  Cool!  Get to see my first real save!

I was at the back doors when the ambulance arrived.  The volunteer ambulance is a Type II, just a glorified Chevy van, and 5 people jumped down out of the back.  It was like clowns exiting a VW bug at the circus.  The urge to laugh bubbled up in my throat, but sunk back down as they jumped out, sweat dripping and hair hanging limp.  They had been doing chest compressions for over an hour in the back of that cramped van.  I got the hell out of their way.

We all followed the cot as my EMT-B buddy, Van, continued chest compressions into the emergency room.  The screen was pulled around her limp body as the ED staff took over.  I turned and busied myself with getting fresh linen for our ambulance.  I worked on the ambulance, cleaning, tidying up, changing linen, when Van came out to find me.  "You should go do chest compressions for a while."  Dang, not a bad idea.

I ran into the ED and into the small emergency room area which is closed in by 3 walls and the fourth is a sliding glass door/curtain arrangement.  There were at least 10 people in this small space, with all manner of EMT's and medics switching out for compressions.  I stepped in on the opposite side of the patient from the person that was doing compressions.  I took over.

And my mind went blank.

I couldn't get high enough to do them correctly (there was a step stool on the patient's left, I was on the right).  I forgot to count out loud.  Everyone on staff in our EMS area was there - including the supervisors.  I started to sweat.  The nurse on the BVM told me to count out loud.  I was trying to stay up on my toes so I could get in proper position and give good compressions.  I was failing.  Van stepped in across from me and took over.  That's when the world started to spin.  I couldn't hear, then there was a ringing in my ears.  I was now crunched back in the corner of the room, seemingly miles from the door.  I've felt this way before, but where?

Holy crap.  I'm going to faint right here.

I must have been ashen, because Lonnie (one of the EMS supervisors) took one look at me and said, "Are you alright?"
I thought about lying and playing tough for a millisecond, but instead responded, "Nope.  I'm going to pass out."
Lonnie grabbed me by the arm and pushed through the crowd. "Get some air."

But the air didn't help.  It wasn't the blood, the gore, or the whole situation.  It was the exertion.  I'd been going all day and hadn't eaten.  After the adrenaline rush and exertion of compressions, I was probably ready to go down.  I staggered out to the truck and grabbed a bottle of gatorade.  Five minutes later I was fine, sweaty, and chagrined, sitting on the back step of our ambulance.  Van came out and tried to say something nice about my compressions, but I knew they were crappy and everyone thought I was going to pass out from the blood.  Great impression I made.

Then I saw them.  Two of them sitting on the ground outside the loading bay.  Both still wearing wetsuits, one even had a spray skirt on.  They were in shock - just sitting on the asphalt on this cold day and trying to come to terms with what had happened.  Turns out they pronounced her during my little hypoglycemic episode.

I stopped caring about the bad impression I made.  I admit, I stared at their grief.  The guy on the left looked up and saw me watching.  He managed a brief smile.  A smile of thanks, I guess.  Every one of us had worked on her, but it made no difference.

"You own the treatment, not the outcome."  Mr. Medic's words ring in my ears.  I know he's right.

But it was still a long drive home.

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