Tilted Forum Project Discussion Community - View Single Post

MSD · 03-02-2007, 09:32 AM

This reminded me of a horrible story I read on another forum in an EMT's thread about his job. Sometimes you just can't do the right thing.

Link to the original post. If you want more stories about real EMT work, ranging from funny to tragic, check out the whole thread. If the thread stops displaying and you get the message telling you to register, you can clear your browser's cookies and continue on. Note that the forum name "Comedy Goldmine" is a bit deceiving, and it's for all great threads, not just the funny ones.

Quote:

Guilt

“3-12, 3-12”
“3-12, on the air – where to, CMED?”
“3-12, Humphrey Avenue, pediatric anaphylaxis – bystanders report the patient is down and unresponsive.”
“3-12, en route.”

We were dispatched to deal with a boy who had gotten stung by several bees. At least that’s what we figured because when we arrived on scene the boy was unconscious and had visible chest rise. He was red, blotchy, and his lips and nail beds were certainly more purplish than I was comfortable dealing with. A by stander told us the boy was seven, and his parents were at work.

“3-12, on scene – do we have a medic?”
“Hold 3-12… Negative, medics from the city are on zero-point.”
“Roger, get me med control when you can.”

I look at the patient, he’s cyanotic. I see the boy’s chest rising rapidly, but he’s not breathing. His airway has closed up, he’s trying to breathe but he couldn’t – this wasn’t going to be pretty. My partner pops in an oropharyngeal adjunct and starts bagging, it doesn’t do any good, and the boy’s lungs were locked behind walls of swollen airway. I turn to my radio; the CMED dispatcher dropped a different tone to alert that they had a doctor on the horn.

“This is Doctor Jones.”
“Hey Doc, 3-12 – have a seven year old boy, multiple bee stings, bad reaction, fully compromised airway. Can we hit him with an Epi Jr.?”
“3-12, is he breathing?”
“Trying, airway’s shut.”
“Ok, 3-12, administer .15 mg epinephrine via an Epi Jr. Report back after 5 minutes.”
“.15 mg epi via Epi Jr., talk in 5. Roger.”
“Doctor Jones out.”

I grab the EpiPen Jr. from our jump bag and push it firmly against the patient’s thigh. I wait until the window in the auto-injector is red and toss it aside. I grab the boy in my arms and run to the bus, my partner hops in the front. A police officer had shown up on scene several seconds after we had – he told me he would grab all the information he could on the patient and meet us at the hospital.

The kid’s airway wasn’t opening, I continue to try and bag. He’s purple and splotchy from the nipples up. He’s crying, he’s trying to sob but the air just won’t come. I get the doctor on the radio again.

“3-12, how’s he doing?”
“Airways still bad, nothing’s passing through.”
“How much does he weigh?”
“Approximately twenty, twenty-five kilograms.”
“3-12, hit him with another Jr if you have it – contact me again in five”
“Roger, administer another Epi Jr., talk to you in five.”
“What’s your ETA?”
“About ten, too long.”

I administer the second EpiPen Jr, bringing the total epinephrine count the boy had been dealt to .3 mg, the same as an adult EpiPen. He’s still not responding, he’s not crying anymore – staring into oblivion. I check his carotid pulse – tachycardic, his heart is working hard trying to compensate, yet failing miserably. I keep trying to bag him, hoping that after the second dose his airway would start to open up. After several minutes, I gave up trying, it wasn’t opening. I grab the radio – I grab a scalpel and an IV catheter. We had been trained to do cricoidotomies and tracheotomies in our EMT class, even though it was well outside of our scope of practice.

“3-12, talk”
“Doc, no response to the second dose. Let me do a cricoidotomy.”
“3-12, you’re not a medic, I don’t know if you can do it right.”
“Doc, we’re trained to do it in EMT class – I need to do something or I’ll be bringing a body in to your ER.”
“Just keep trying to ventilate; it’s all you can do.”
“Doc.”
“Listen to me 3-12, I know I’m tying your hands – but it’s the way it has to be.”

I put a pulse-oximeter on the boy’s finger; I continue trying to bag him. He has a blood-oxygen saturation of thirty, I watched as his pulse dwindled. I kept looking to the scalpel, did I want to try and save this boy? Why the hell wasn’t I doing everything I could? I was letting this boy die – letting him suffer – no, forcing him to suffer. With one twitch of my wrist, I could ventilate him properly; I could bring sweet oxygen-rich air to the darkest depths of his lungs. Who was I to deny this child life? If I helped him, I’d lose my license and my job – if I let him die, what good am I?

The error tone of the pulse-ox attracts my attention, the number next the section labeled “pulse” consisted of six lines arranged in a circle. The heart, oxygen starved and dying finally gave out. I call for my partner to inform the hospital that our patient is in cardiac arrest. We’re about two minutes out, I slide the pediatric short-board under him and I start compressions. I had to do something.

I can rationalize that the boy had been oxygen deprived for too long, his brain and vital organs were no doubt severely damaged – the big question would become whether it was worthwhile to save him. Would his quality of life be worth saving? In the back of my head, I knew the boy was better off dead, but last time I checked things in the back often get the least attention.

The doctor meets us at triage with two techs and a nurse, they grab the gurney from us and pull him towards room one. I’m trembling, I’m angry at myself for not performing the cricoidotomy. I have a cigarette.

The police officer who met us on scene comes to the ER as I’m working on my third, I can’t fill out the paperwork until I get the information from him.

“How’s he doing boss?”
“Doctor pronounced him about ten minutes ago.”
“poo poo, seven years old. I’m sorry bro.”
“Bad stuff happens all the time.”
“Got that right, family is coming… Here’s all the info.”

As I perused the information and filled out my forms, I morbidly thought about how little Andrew learned a valuable lesson today. I imagined a grotesque caricature of Big Bird explaining the importance of breathing, and how not breathing is bad.

When my partner nudged my shoulder, I snapped back to reality. My vision was blurry and my cheeks had a few wet streaks.

“Matt, big accident. We need to roll dude.”
“Alright, let me just drop this info off with triage.”
“I’ll be in the bus.”

I can’t even cry if I wanted to – because when I need to, there’s no time.

Over the past few years I've made a conscious decision to make sure that nobody in my presence falls victim to the bystander effect. I don't care how many people are around, I will personally call 911 anytime it's appropriate unless I'm explicitly told that someone else already has. On several occasions when I've witnessed accidents and near-accidents I've had my phone out, 911 punched in, and my finger on the send button before all the cars involved had stopped moving. Once I know the police and paramedics are on their way I'm the first out of my car running to see if I can do anything. Maybe if people see me running to try to help they'll be inspired to do what they can, maybe I'll be the only one. All I know is if people need help it isn't safe to assume that someone else will do it.

Based on the story I came to the conclusion that if I ever came across a situation like that and knew what was happening, I would tell the EMT that since he couldn't do it I was going to take his scalpel, and that he could either tell me exactly where to cut or let me figure it out myself. I'm trained in First Aid (and I've read up on how to do a tracheotomy,) and CPR, so I'm confident that I could do it if I needed to, and I don't think anyone would tell him he did the wrong thing if a gigantic man ran up and demanded instructions. Maybe I'd get in trouble for interfering, but the kid would still be alive.