What is it about emergency medicine that's so addictive?
Last weekend we were at my daughter's school for a school spirit day - the kids' olympics. In the cafeteria, we sat, a crowd of kids and parents, at rows of tables eating lunch. I was standing at our table, talking with my kids, and I heard someone calling out from the middle of the cafeteria - "Does anybody here have any medical training!" I looked over, it was a like a zoom lens. I just pushed my way out to the center of the room, found two women trying to revive an apparently unconscious 3 year old girl. The mother said she had just fallen off the back of her bench, smacked her head on the floor - She has food in her mouth, the mother said, as I picked the girl up.
She was completely unresponsive - Her face was flush, eyes listing open but pupils rolled back, lips pursed and cyanotic, arms hanging back. The mother kept saying she had food in her mouth - I could see she wasn't breathing, and I had a hard time trying to open her mouth to establish an airway. The tight jaw and pursed lips looked more like seizure than choking, but she had been eating, I couldn't get an airway and she wasn't breathing, so I turned her face-down and gave a few back blows. Nothing came out.
"Come on girl, come on ... breathe for me girl, come on"
I'm not really sure what else had been happening around me - where the mother was, or who else was standing there looking. I was just trying to get respirations. At some point I turned her up, her mouth was open a little. Someone else there said wait - she's breathing just a little - one very faint whimper.
FD paramedics arrived outside, and the principle led us out to meet them. I carried the girl, still limp and unresponsive, through the door and out to the front driveway. Where was the mother, and who else was walking with us - I didn't even think about it / there was a fire truck, paramedics, and a crash kit being laid out on the grass. I walked right into my element.
I carried her to the truck, ready to hand her off to the medics but strangely, nobody took her from my arms. They looked at her, began oscultations, checked her pupils, faint respirations, while I held her. I said something about the incident - that she had seemed post-ictal though the mother stated no allergies and no PMH. We were talking about her complexion, that it was coming back and her jaw was now able to open. Initially she had no respirations though pulse was a strong 120. Something like that.
When we laid her out on the grass, face up, we started her on O2. One of the medics started a line and I did something to help hyperextend the arm. I was holding light traction and watching the O2 mask - told the mother to lean forward and talk to the girl, still not completely awake but beginning to come back - "She's OK, she can hear you - go ahead and talk to her" I said - partly to give the mother something to do, re-assurance that the child was doing better. At one point I noticed the medics had a pedi board out - I said "Oh you wanna board her? - OK" I started to get her shoulders ready - I said to the mother "Ma'am we're gonna need you to back up a little so we can get this board under her" - and it was like - which way was I about to go?
Previously, this would have been about 4 minutes before we boarded the ambulance and drove off, heading for the hospital where we'd give the report, transfer the patient, and move on to another call. But that was another city, 20 years ago. What is it about ambulances and EMS that's so addictive and lasting?
But the funniest part was just after that - talking with the FD medics. An ambulance had come to take the girl, leaving the fire truck there with the guys who had first arrived. We just chit-chatted, did the fall cause the seizure or the seizure cause the fall. I smiled. I looked down and noticed, for the first time, the Lifepack defibrillator they had out - "Oh man, check this thing out!" I pointed to it - "Man, when I was working the streets it was a Lifepack Five!"
"Hah - Lifepack Five?" The older guy chuckled - "Yeah those were the days". Hah. "Yeah remember sending telemetry? - Apcore radios? - Waiting for protocol to use D5W?" He looked at one of the younger cops who was laughing. "Hey that was before your time!" Yeah, hah hah hah - I was trying to laugh but shit - how fast did 20 years fly by? After a while I walked back up to the school cafeteria. The EMS vehicles drove away.
|A night on Boston Community Ambulance with Ed Trzcinski|