Cardiac Arrest. Your first time..

[Piper76]

My first code was on a rotation a few weeks ago. 2 yr old girl hit by car. I ended up bagging her and started suction.

We got to hospital and they did 5 or 6 rounds of epi/atropine/bicarb. She was worked her for about 1.5 hours total. She didn't make it. It turned out she had broken her neck and severed her spinal cord.

It was a tough call...that was my first code and death in the field. There were a lot of teary eyes that day....

I didn't shy away, and I did what I have been taught. I got credit from the fire-medics and my preceptors for how I handled myself during a tough and hectic situation. Running that call taught me a lot about myself, and served to show to me that I am making the right decision to pursue a career in EMS/Fire Service....

 

[jgmedic]

1st as an EMT-B- in a strip club, pt was getting a lap dance, according to dancer, had a seiz and then collapsed. Worked him in the rig as the club refused to turn the lights on or the music down, dancer then asked us to get her 40 dollars from the pt. Classy.

1st as a medic- in a con home, pt was on the floor, with 2 CNA's there, one stroking the pt's hair, other placing a pillow under his head. He didn't make it.

Last shift bid I ran 13 FA's, 11 no go, last two walked out of the hospital. couple of weeks ago, there were 2 codes on 10 min. at the same con home, one of our medic called the 1st one, worked on the 2nd one and called that pt just before the 2nd unit arrived.

 

[MrBrown]

...pt was on the floor, with 2 CNA's there, one stroking the pt's hair, other placing a pillow under his head....

Those updates are in the 2010 AHA Guidelines right?

 

[EMTinNEPA]

Um...why?

Patient had a prescription for morphine for chronic pain, per the wife had been depressed recently, and when the bottle was checked there was a buttload of pills missing.

Hs and Ts...

 

[EMSLaw]

Those updates are in the 2010 AHA Guidelines right?

Yeah, I'm sure that's right up there with chest compressions.

 

[MonkeySquasher]

Okay, I'll bite. This is mostly aimed at the newer guys out there.

Some things never leave you, especially for certain types of calls. Dates and smells seem to trigger memories the most for me, but that's different for everyone.

My first Code was, in fact, an easy one, because we didn't do anything. It was a 3-vehicle high speed MVA, where one of the vehicles burst into flames just after impact. NYS Troopers were able to drag two of the people out, but an 18y/o female in the back of the Geo Tracker was wedged and they couldn't get her out. She was unconscious from the accident and, we're hoping, already dead.

This was also my very first call. I then drove a half hour away and barged into a friend's house at 7am to share a couch with my girlfriend and cry like a baby for over an hour.

I love this job because it requires 110% from you- mentally, physically, emotionally- All day, every day. I also hate it for the same reason.

You will be called to see things you never imaged. Things you never asked to see. Things that will make you think, things that will make you laugh, and things that will make you just shake your head, either out of stupidity of others or disappointment at mankind. At any given time, you can be thrust into a chaotic situation, way over your head, and be asked to do the impossible, with 100% accuracy, and have it done 5 minutes ago.

You'll experience things that, in "normal" society, people don't even think about. You'll feel ribs break as you do compressions. Ever done chest compressions while watching Oprah on the tv next to you? Or confirmed a GSW to the head while the guy's cigarette was still lit in his hand? Things that your mind will have a hard time comprehending. At any given time, you will doubt your skills, your faith, your profession, your coworkers, and even society as a whole. Questions like "Why?" or "How?" will eventually come up, either in conversation or in your mind. Sometimes those two words will haunt you.

Sometimes, these feelings may overwhelm you. Maybe you can't sleep. Maybe you don't feel like "going out". Maybe you drag yourself into work, "burnt out", and half-*** your job. Maybe you get angry, upset, nervous, or sad at seemingly minor occurances.

We (EMS/Fire/Police/Military) are taught to be brave, and many- both male and female- are taught to be tough. Nothing bothers us, we're rocks. We help people, we don't need the help. Despite what some people expect, you are not a robot.

These after-effects are called "Critical Incident Stress" and, while perhaps mentioned off-hand in class, are rarely fully covered or discussed in normal curriculum. A CISD meeting is usually a one- or two-time ordeal, as a group. This can help deal with the acute after-effects of a "bad run", but does nothing long-term. Some CIS may not develop for a few days, a week, or even a month. How does one deal with stress past the end of the call or the AAR?

First, be honest with yourself and others. Be receptive to anyone who notices changes in you, and take an honest look at yourself and the way something has affected you. This is, above all, the first step.

Second, find an outlet. And no, booze and Burger King aren't the answer. Talk to people.. Talk to your partner, your coworkers, your friends, your significant other. Talk to a Supervisor. Try exercising and turn that emotional stress into physical energy.

Third, know your limits. Know when to step back and slow down, or take a break. Sometimes you need a couple weeks or a month to just clear your head. And know when to ask someone for help, or talk to a professional about the stress you're experiencing. It's not weakness - Everyone experiences it at some point in their career ('On a long enough timeline, etc'), and it's a completely natural human response to exposure to completely unnatural circumstances.

 

[firetender]

Okay, I'll bite. This is mostly aimed at the newer guys out there...

First, be honest with yourself and others. Be receptive to anyone who notices changes in you, and take an honest look at yourself and the way something has affected you. This is, above all, the first step.

Second, find an outlet. And no, booze and Burger King aren't the answer. Talk to people.. Talk to your partner, your coworkers, your friends, your significant other. Talk to a Supervisor. Try exercising and turn that emotional stress into physical energy.

Third, know your limits. Know when to step back and slow down, or take a break. Sometimes you need a couple weeks or a month to just clear your head. And know when to ask someone for help, or talk to a professional about the stress you're experiencing. It's not weakness - Everyone experiences it at some point in their career ('On a long enough timeline, etc'), and it's a completely natural human response to exposure to completely unnatural circumstances.

MonkeySquasher, your post is exceptional! Thank you.

Your prescription to forestall burnout is right on and needs to be drummed into the head of every medic NEW OR GRIZZLED: Take personal responsibility and ASK FOR HELP!

There's only one glitch. The "culture" of the paramedic, not to mention allopathic medicine as a whole, has still not evolved into something transparent where there is reinforcement for medics to experience the work as human beings as well as Flesh Mechanics.

I've been on this site for five years and you know what? I'm actually encouraged 'cause there's a lot more guys like you out there -- who deal with the trauma of the profession directly -- than there has ever been.

Yes, I'm pushing for medics to broaden their perspective of themselves and the work they do. Personally, I've been out of the field for 25 years but my EMS experience has been the cornerstone of all the work in the healing arts I've done since. This site has actually been major momentum for me to find a way to influence that evolution. The book should be available in June. I wrote it for all of us.

What I've come to understand better, through this site, is that most of the medics are quite competent technicians, truly committed to the work and the welfare of their patients, and not terribly interested in exploring the more human, personal, aspects of the work.

BUT, and it's a big one, there are maybe 25% out there who get satisfaction out of such explorations (or at the least, acknowledgment of their human experience) and the dominant culture discouragestalk beyond, "Yeah, that sucks, that happened to me, too, now get on with it."

...and that's what I like about this site. For some reason there's enough safety here for many medics to bring out such issues; issues that have been closeted in the past. More heartwarming is I see many stepping up to the plate, sharing their own paths, and offering support.

But all this is on-line. We need to build safety nets for each other right in our own stations, up close and personal, human to human.

I believe medics can take more personal responsibility for the emotional, psychic, spiritual support of their peers, as you are doing right now. I encourage everyone to take more risks in that arena so we can make room for MANY points of view and support each according to his or her own leanings.

Let's expand the conversation and develop a "Culture of Mutual Support".

 

[MonkeySquasher]

...and that's what I like about this site. For some reason there's enough safety here for many medics to bring out such issues; issues that have been closeted in the past. More heartwarming is I see many stepping up to the plate, sharing their own paths, and offering support.

But all this is on-line. We need to build safety nets for each other right in our own stations, up close and personal, human to human.

I believe medics can take more personal responsibility for the emotional, psychic, spiritual support of their peers, as you are doing right now. I encourage everyone to take more risks in that arena so we can make room for MANY points of view and support each according to his or her own leanings.

As you say, this is online. The anonymity of a computer screen does wonders for loosening the tongue... er... fingers?

Just over a year ago, I wouldn't have said that. Or, I would have said it, and not practiced it. But, we all have our tipping points, and I hit mine this time last year.

Personally, I don't like the term "burned out". I think it's frequently misused as a selfish, cop-out answer, and a reason to be lazy and complacent. At my job, I have Basics who have 6 months on their card and in the company, who will stand around outside an ER smoking and talking and dodging calls because "Oh I'm so burned out". Or call in because "I just can't work today, I'm so burned out". If you ask them "Okay, why are you burned out?", they'll answer with "Because everyone else is", or "Because I work too much", or "I must be, because that's what others say".

"Burn out" is, I believe, merely a state of mind. If you can rationalize what you do, maintain a positive attitude, talk to/relate with your coworkers and have an active hobby or social life, you won't be "burned out".

(firetender, just I'm not jumping on you using it, only commenting on the phrase in general. )


There's this girl at my volly company... It's no secret that we don't get along. And yeah, there's a story involved, but that's for another time. haha We took a Code once at the University within our district. Male, mid-twentys, was playing basketball, fell backward, struck head, seized, apnea. Worked into the ER, ER tried for an hour, no luck. At the hospital, it was just a bit too much, and she left the ER hurridly. I went out to find her bawling her eyes out behind the ER. And, if it wasn't coming from my own mouth I wouldn't believe it - I walked up and hugged her. And the (term for female dog) got eyeliner all over my shoulder. But that's not the point.. She hugged back. I asked if she was okay, and she just said that it was hard because he was our age, and "it's not supposed to happen like that".

A few months ago, one of our newest guys took his first Code. He's a tall tough-looking kid, in ROTC, ready to take on the world. They get back, and we're talking about it, and he remarks how he broke her ribs, and how weird he felt, and just sort of stared... You all know that look, where you're just lost in your head. And I asked how it made him felt, and if he was okay with it, and reassured him that he was doing the right thing, and it'll feel weird afterward, but know that his feelings are natural and if he ever wanted to talk, my number is on our personnel board.

At my paid company (name withheld to protect the guilty! lol), there's this rule.. To any pediatric cardiac arrest, whether it's a BLS or ALS rig responding, they always dispatch another ALS flycar, and our Supervisor. After the call, the Supervisor takes aside all members involved, talks to them, and assesses how they are. Then, they've given the open to clock out and go home if they feel they want some personel time. ....The Supervisor, however, is then expected to go back and finish his shift like nothing happened. I know a Medic who, as Supervisor, took THREE different Ped Codes in one day. He was expected to do all three, and continue his shift. He quit the next day.

Because in my experience, you almost never get help from your paid company, and your volunteer companies rarely have the facilities or money available for counseling. Not to mention, like we've said, the "culture" behind our profession isn't always the most condusive to open conversation on our "feelings".

Why can we effect changes in emergency healthcare, theories, and treatments, yet we can't just talk to each other about how we feel?

The change has to start with us, guys.

 

[reaper]

Just wondering why the medic would not be expected to finish his shift? That is part of the job. If he didn't have a problem after all three then he can continue working.

 

[MonkeySquasher]

Just wondering why the medic would not be expected to finish his shift? That is part of the job. If he didn't have a problem after all three then he can continue working.

That's the thing though, he doesn't have an option like the other crews do.

Just trying to highlight how, especially in some paid atmospheres, no emotional assistance is provided. You're expected to be infallable.

 

[reaper]

Funny, My service will provide real therapy. Not talking the CISD crap that most push.

 

[Seaglass]

Just wondering why the medic would not be expected to finish his shift? That is part of the job. If he didn't have a problem after all three then he can continue working.

My volly squad has a tradition of letting someone have the rest of the night off after their first code, or something that hits them really hard. Usually you'll get a bunch of offers within the hour after things go bad. Most people don't take them up on it, but some do. Sure, traumatic stuff is part of the job, but I'd rather see that than someone who's too upset to function staying in the field.

 

[iamjeff171]

also something i find interesting is that there is little/no CISD for those of us who are students. so, those of us who are new and have the least coping skills have little access to assistance. i could see this leading people down the path of developing poor coping skills.

also, on my first code, i found that i wasnt bothered at all by anything related to the direct care of the patient. instead it was the hysterical grandaughter distraught that grandma was dead that got to me.

 

[MonkeySquasher]

i found that i wasnt bothered at all by anything related to the direct care of the patient. instead it was the hysterical grandaughter distraught that grandma was dead that got to me.

Same. When I'm on a Code at home with family present (someone has to find the person, right? haha), I make sure all pets are locked into a room far away from us, and then have someone from my crew approach the family. And it'll go one of two ways. If they're distraught or getting in the way, someone escorts them to another area out of view, sits them down, and talks to them. If they're coping well (relative term..), I have no problem with them standing to the side and watching with someone explaining what we're doing. I've found that can actually be rather therapeutic, because they can see we're trying everything we can, and they can understand what we're doing, and the gravity of the situation.

Ped Codes are a little different. First, you will never, ever get the sound of a mother's scream out of your head. And it's a sound that you cannot describe, but also can't mistake for anything else. And it is the worst sound in the world. Conversely, after a Ped Code, a crying baby will be the greatest sound in the world to you.

For Ped Codes, excepting cases of possible homicide/abuse, we always transport, and either a Supervisor or PD bring the parents to the hospital. This is not because of the usual "oh, they're a baby, they can still be brought back!" No, chances are they'd be brought back with some sort of horrible retardation or palsy. But, no one in my crew is trained to handle the emotional needs of the parents... The hospital is. In a Ped Code, you don't have 1 patient, you have 2, or 3, or more, depending on people present. They'll all need emotional support and treatment, and the hospital has those resources either on staff, or on call.

 

[LanCo EMT]

I am a pretty fresh EMT-B in PA. I just finished my orientation training, and will be crew chief on my next shift. I am pretty confident about it... But I am nervous about getting a code; especially since we have a nursing home in our district that we get calls to almost daily.

 

[LucidResq]

Held a patient's hand on Friday as she peacefully took her last breaths in hospice.

 

[MonkeySquasher]

I am a pretty fresh EMT-B in PA. I just finished my orientation training, and will be crew chief on my next shift. I am pretty confident about it... But I am nervous about getting a code; especially since we have a nursing home in our district that we get calls to almost daily.

It wouldn't necessarily be a bad thing. At a NH, they could have a DNR*. They could have been down for hours.

As "Crew Chief", does that make you in charge of the crew, or the patient? If you're in charge of the crew (all Basics, or AEMTs too?), your job is management... "Nurse, continue compressions. John, attach our AED. Sally, start BVMing. Charles, grab the backboard." etc. You help, of course, but mostly just assign jobs and make things run smooth (see ICS).

I believe that's half of a Medic's job at a Code, where you have Fire present too. Delegation of duty. Someone compress, someone monitor, someone bag/tube/airway, etc. Then you do line and drugs, and everyone starts working together to check off the Hs&Ts.





* Note - Yes, I've been called to a NH for a Code and been presented with a DNR, and asked to transport the patient. I could have slapped her.

 

[FLEMTP]

First code ever was at 15 years old.. barely through my medical first responder course for the volly service I gave time to...one of my neighbors dropped into cardiac arrest..

my first code as a solo medic was also my first call as a solo medic.. came in as trouble breathing.. and lemme tell you.. she was having trouble breathing alright.. she wasn't!

it went as smooth as a first code can be expected.. and the outcome was very predictable... she was dead upon arrival to the ER.

Now I get a code on average of about one every 2-3 weeks..just part of the job now I suppose...except I usually don't end up transporting. We don't transport dead bodies here.

 

[DarkStarr]

Was doing my 3rd ride along with the local ambulance service. Pulled into the driveway and caught the ambulance on the way out the driveway. 2 minutes later we arrive on scene to an 78yo unresponsive female. Long story short, she didnt have a shockable rhythm and I got to do some CPR. Medics did their stuff and I did compressions. She didnt make it.

 

[MGary]

I'd been running for about 5 months at 60hrs/week (Volunteer) before I got my first code. Luckily, we had myself (a still very fresh EMT-B at the time) my Medic partner, and an EMT-B with approx 5 years experience that jumped on as a third. We also had a deputy who is an Intermediate and who volunteers with our service when he has time, that responded in his capacity as a deputy, but luckily was not above managing the airway for us (Basic management; OPA, suction and BVM).

I've since lost track of how many codes I've seen (1 w/ ROSC, I responded POV on that day and beat all of the other medics and just managed w/ CPR and BVM until they got there, something's to be said for basic skills, even in a code)

I can still remember that guy's face, his wife's cries, and his wife repeatedly asking "Is he ok?" obviously in shock/disbelief. She didn't want to stay in the other room and said she was a nurse, so we let her watch from a distance. In retrospect, it might have been better to ask her to stay in the other room, I don't know. To this day I remember exactly where his house is, exactly where his body lied in the doorway, I even remember what color the jackets were in the coat rack that I threw our IV bag on so that nobody would have to hold it. I was first to start CPR on that guy and though we had radial "pulses" from my CPR so I'm sure the ribs were pretty well broken (Large guy), I don't remember feeling ribs break. However, I don't remember ever feeling ribs break. I guess I concentrate more on what I'm doing and rate and everything and watching the monitor while I'm working so that I don't feel them break.

But know what the weirdest thing is? Even though I remember everything and can replay the whole scene like watching a Youtube video in my head, I never felt that depressed or saddened by it. I knew we'd exhausted every option we had. We'd followed ACLS protocols, pushed 3 rounds of drugs, and worked him for a total of 45 minutes. We got online med-direction to call it. We went back to the station, cleaned up and restocked the rig, and opened up a bag of hotwings and that was that. I've still yet to feel too saddened or depressed by a code. I make sure we exhaust every option we have (Epi, Atropine, Bi-Carb, etc.) do the best CPR possible, and work it with all we've got. Then if we lose him, his creator called him back and I move on.