“Being a Paramedic means spending 99% of your time doing mundane, routine work, involving transporting patients who aren’t actually sick to and from hospitals and appointments, and the other 1% seeing things that most humans never see, and pretending that you’ve seen these things a hundred times before and know exactly what to do about them” – Australian Paramedic
So this is what I expected for my first day on the job.
I had just finished my theory training, and it was my first day “on the job.” I started at the 0700 shift, and met my Training Paramedic Officer. I was young, naive, eager to learn, and all too concerned with checking the Ambulance before we got the first “Big Job.” My Training Paramedic Officer was concerned with making a good cup of coffee and sitting down to read his newspaper, before we were rudely interrupted with the “Big Job.” At 0705 the phone rang. John, my Training Paramedic Officer looked over at my excited expression, and said: “That’ll be the sign on call.” It wasn’t…
We were called to a 16 year old boy, found unconscious in the backyard after apparently being involved in the consumption of a lot of alcohol the night before, not breathing, and without any pulses, while his brother was attempting CPR.
John looked at me, “Okay, here’s your orientation to driving lights and sirens… as the passenger, your job is to watch for cars coming from the intersections on the left (Australians drive on the left side of the Rd). Acknowledge “Clear” or “Stop” if you think a car’s not going to stop. I’m not going to be looking on the left side… so if you want to avoid being hit by a car on your side, you’d better pay attention…”
I paid a lot of attention.
As we rapidly progressed through the busy city streets, lights and sirens blaring, I felt as though I was on a roller-coaster ride for the first time in my life, and unable to interpret all the information that appeared to be buzzing in from all directions…
Overtaking cars, trucks, cyclists…
Driving through red lights, and listening to the multitude of cars, driven by people not yet fully awake, who are honking their horns, in complaint of the vehicle in front, which has stopped – for no apparent reason, oblivious of the Ambulance desperately making its way through.
Trying to weave our way through a large procession of early morning, city dwelling pedestrians on their way to work, with I-pods in their ears, blissfully ignorant of the Ambulance desperately trying to get through, John looks over at me “Do you want acknowledge all that?”
I feel like I’ve fallen asleep and just woken up in the middle of giving a speech at the point in which I’m about to identify the brilliant solution – completely unaware of what I was meant to say.
“Acknowledge what?” I ask, sheepishly.
John calmly looks over (as though he doesn’t have enough to think about/look out for while driving fast through the busy city streets)… “Weren’t you paying attention to the radio?”
While trying to interpret all the other excessive information… my ears didn’t mention to me that despatch was giving me specific information about my patient…
After all – I was still trying to remember how to set up the resuscitation equipment…
John grabbed the radio and acknowledged the information.
Suddenly, the ride stopped.
We were at the scene. There was a neighbour urgently waving both hands, as though his urging could somehow speed up our presence.
We grabbed our gear… and followed the man around to the back yard.
In the middle of the yard, we found a young man, stiff as a rock, cold, and very clearly deceased from the night before. My Training Paramedic started to explain to me that this patient had obviously died during the night and then proceeded to place the cardiac monitor dots on the patient. This was part of policy, with any deceased patient, to ensure that he/or she was in assystole (the flat line on the monitor that means there’s no electrical activity in the heart). We did this, even in patients who had clearly been dead for some time and no amount of resusciation efforts would ever help bring them back.
To our surprise… the monitor started to beep.
The rhythm was almost completely normal. My Training Paramedic looked at me, as though somehow I had made a mistake putting the ECG dots on, as though it must be my fault – because obviously this patient was dead, and there could be no electrical activity anymore.
No…. the monitor doesn’t lie… this person’s heart was still firing its normal electrical currents – but the heart just wasn’t doing what its supposed to and actually beating (this is called EMD – Electrical Mechanical Disassociation-, or PEA – Pulseless Electrical Activity).
We immediately start CPR – with me doing chest compression, and my Training Paramedic ventilating the patient.
The Intensive Care Paramedics then arrived, and while one of them inserted an ETd tube into the patient’s trachea to breath for him, the other Paramedic inserted an intravenous cannula into the patient’s jugular vein (neck vein) and started to administer adrenaline.
Within five minutes the patient’s heart spontaneously started to beat on its own… and the patient had a good, strong, pulse…
We quickly loaded this patient into the Ambulance… he starts to moan… and with both arms reach for the ET tube…
Everyone talks about Ambulance Miracles… and this appeared to be one of them, because this guy was dead… I mean… his arms were that rigid when we got there that we couldn’t move them at all…. and now, we were fighting with him and trying to tell him not to pull the tube out because it was helping him.
About five minutes from hospital… the Ambulance miracle ceased… and the monitor shows that the patient is now in assystole (flat line, like the movies)…
CPR is immediately commenced – and the Intensive Care Paramedic says to me… “this is your baptism of fire mate… every Paramedic’s gotta learn to do CPR in the back of a moving Ambulance at some stage…”
The patient’s condition remained unchanged.
At hospital, the medical teams continued to work on the patient for another half hour and then pronounced him dead…
I talked to my training paramedic while I was given the rookie job of cleaning the Ambulance and re-setting all the equipment, and asked what he thought had happened to the young man…
“Mate… there’s another learning lesson for you… sometimes the srangest things happen in this job… and that’s all there is to it… no explanation no rhyme or reason why one patient dies and another lives…”