Worthwhile

Yesterday I felt that my role as a RRU was justified, and this, coupled with the better weather, means that I am in a much better mood.
The unfortunate thing is that it was a tragedy that made me feel better.

The first job of the day came two hours into my shift, the call was “Woman fell out of bed, not breathing”. I got to the house in two minutes and climbed the narrow stairs to find a 55 year old woman laying in the lap of her daughter – also on the bed was two small children (perhaps one and two years old). The younger woman was crying – my patient wasn't breathing.

I had to pull her out from the side of the bed so I could get my resuscitation attempt started, not very dignified, and probably not that nice to watch either, as a stranger in green pulls your mother across the floor.

I connected her to my heart monitor/defibrillator, and saw that she was in PEA, so I started chest compressions, and ventilating her with my ambu bag.

While doing this I was trying to get some form of medical history, but none of her relatives could speak English that well, but I managed to gather that she had just rolled out of bed, and besides tablet controlled diabetes she was otherwise healthy.

I was just about to finish the first round of CPR when I heard the ambulance crew turn up – I shouted down the stairs that the call was indeed a 'suspended', and when they entered the room they started to intubate and try to gain venous access. Venous access means that we can give potentially life-saving drugs, but in this case the woman's veins were so small that after two attempts we realised that it wouldn't be possible in this case. Instead we were able to give her the drugs via the ET tube, which is the breathing tube we use to protect the patient's airway.

We then saw a change in her cardiac rhythm, from PEA she entered VF so we 'shocked' her with my defibrillator. She then went from PEA to VF and back again every time we shocked her.

At one point during transport to the hospital we got a pulse back, but this soon degenerated into VF.

The hospital worked on her for an hour, and at one point she had both a pulse and a blood pressure, but unfortunately she later died.

And the memory of the job that I have is of cleaning her hair from where it had gotten stuck to the ambu bag, just after she had died in the hospital, hoping that the son-in-law wouldn't then choose that moment to look in the back of the ambulance.

At least I felt justified in my role – all too often you get used to being called to jobs that are, frankly, crap. This was a 'proper' job, and although we didn't save her, we gave her the best chance we could – if we hadn't been there, then she wouldn't have had even that chance.

This is a strange job – people who aren't sick annoy you, and yet the really sick people are 'good jobs'. We are only happy when someone is suffering.

8 thoughts on “Worthwhile”

  1. You're right Tom, it is a strange world; the world of healthcare.'Proper' patients are almost by definition those who are 'properly' ill. I've found myself sitting around hoping that something bad is going to happen to someone, in order for us to go and save their life.

    I've found myself wishing misfortune on others. It's a sorry state. I should be pleased that no one in my area is properly ill, but then I feel sad that I'm not using my skills and instead sitting drinking coffee.

  2. Love your blog. I am an EMT and first semester medic student (in the US) with alot to learn. As i sit in my firehouse ( hoping for a call! ) studying, this post got me thinking as to causes and treatments.thanks. keep up the good work.

    brett

  3. This is a little off topic specifically but generally it's applicable… What does it actually take (as in, what do you need to have achieved) to be a paramedic?I'm just asking because it's something that's struck me as rewarding and kinda… definable, as in, you know when you've actually done some good, as opposed to 'you're just helping the sales figures/contributing to the bottom line/fixing the code' jobs, if you see what I mean. 'Offers personal fulfillment' perhaps 🙂

    Anyway what's needed? I know in the USA you basically have to have a driving licence and do a course and that's it, because no-one wants to work for the low pay, but what about over here? Is there a start-from-scratch no-previous-healthcare insurance track or is previous experience in the healthcare field required?

    I'd appreciate it if you answered, although I'm gonna go and look it up too!

  4. Strange -no not really. For most of us , helping out others is a form of reward in itself. Sometime you can help , sometimes you can only give that person another chance as in the case above but it's no surprise that it gives you more of a boost than another worthless call to someone with the runs. Having spent a fair few years selling kit into the ITU and theatres I always wanted a “really good case” to demo the kit (monitors) but I never actually wished it on anyone. I just knew someone would come along anyway.

  5. Wow, I'd say that's pretty inaccurate about becoming a paramedic in the US…here's the deal.Becoming an *EMT* in the US is not particularly hard. Many states require you to be affiliated with an ambulance service or, say, a volunteer firehouse, which takes generally a background check, physical test, and simple recruit school. Then the actual Basic EMT class is about 120 hours of classroom and practice time. (Driving the ambulance is a seperate endeavor, usually requiring something like EVOC (emergency vehicle ops class) which is on top of a normal (or commercial) driver's license.

    However, being an actual paramedic (EMT-P) – the terms are far from synonymous. You can either work up through various flavors of EMT or start from scratch, but at the end of the day, It'll take the equivalent of a solid 2 year's full-time coursework. Medics carry and administer drugs, can start IVs, have some marginal differences in trauma care, can do real intubations and real cardiac rhythm analysis. Some places will give you paramedic as basically a bachelor's degree, with additional normal college requirements.

    Here's the other part – they don't necessarily get paid that badly. EMT-onlys sure do, but EMT / firefighters or paramedics or paramedic/firefighters, where they are paid, can be paid quite well. In rapidly growing counties (think the Southwest,) it is not impossible to be pulling $70k+, or $85k+ for a medic / ff….

  6. I really sympathise with you, my job entails I do this in a hospital setting, but somtimes you cannot ussur away relitives and they stand their watching a horifying undignifyed chance (death). the fact you have to block this out and carry on is astonishing, even with minors in the room.,keep up the good work

    me

  7. You sound very tired and cynical. It is a little concerning that the first thing you do when you get home from a long shift is write all about it. I hope it is cathartic, and once you have finished you are able to stop thinking about work and have a life. If not, you may want to consider getting another job for while before you go insane!

  8. Fooey to that last comment. Reynolds, your post was great and you sound far from cynical. Having been there & done that for many years I know what you mean both about getting the hair off the ambu bag (those things have such a weirdly sticky texture), and about the case being a good and proper job.I don't think it's that we are glad when people suffer but that we are glad to have the chance to do the work we are trained to do. It's a worldwide problem that EMTs and paramedic and ambulance officers are trained for X and instead spend their shifts doing Y, and meanwhile management gets twitchy about response times but those on the road resent being expected to speed to yet another cold in the head.

    Morale, anyone?

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