Rules Keep Me in Line

I was starting to really get a routine down. My shift was a 12-hour, weekend-night rotation. I was generally home by 0500 hours (military time again…I am official), and in bed by 0600. If everything went well, I would normally be conscious (not awake until caffeine has been consumed) by 1400…2 p.m. for you lay people. If I had any errands to run before work, there was plenty of time to get them done. Otherwise, I had time to iron my uniform (I was still all about a clean, crisp-looking uniform.) and catch up on the news…who am I kidding? I watched some chick flicks and got ready for work. Oh, and I had to feed the cats. Oh, did I forget to mention that I somehow acquired two stray kittens? They were appropriately named I.V. and Fiddle.

I had a routine on the ambulance as well. I would arrive at work and check out my ambulance. I made sure that I had all of the appropriate drugs/medications. I counted the number of I.V. needles and I.V. fluid. I made sure that my cardiac monitor was working properly and the batteries were fully charged. Oxygen cylinders full…check. Intubation equipment present and working…check. Blank paperwork in my clipboard (this was the dinosaur age before laptops were used on rigs)…check. It was the same regimen every shift.

The mic would be keyed by my partner or me. “Unit 101 in service.” Routine. I silently said 3 Hail Mary’s at the start of every shift. Routine. And I also silently freaked out about the first time that I would run an adult cardiac arrest by myself. I also dreaded the first time that I would have to take care of a pediatric cardiac arrest and the delivery of a baby…just to name a few. Routine again.

I was learning that there were certain rules to “the streets” (as we referred to life outside of the ambulance). These are the unspoken and unwritten rules that will make your life much easier if you follow them. Break them, and you feel the wrath of God…so to speak.

Stretch…Yawn. Ten more minutes and my shift would be over! BEEP. BEEP. “Unit 101. Respond to a cardiac arrest.” Oh. S#%T! Clear the cobwebs. My mind started racing through all the steps of the ACLS algorithms. I pulled the pocket guide out of the right side next to my pink trauma shears. I flipped through it furiously. I just have to remember my schooling. My partner was groaning as I was freaking out. We were so close to going home!

We pulled up behind the fire truck. “Unit 101 on scene.” I bounded out of the rig, and tripped over my feet. Ugh. I grabbed the medical bag, the airway bag, and the cardiac monitor. I walked into the house like a packhorse.

My hands were shaking and sweat was rolling off of me in rivulets. The fire captain informed me that this patient was going to be a “DOA. No one has spoken with him since last night”. Umm. I knew that my protocols required ME to confirm that the patient was in fact “dead on arrival”. I scooted around the captain, and his eyes bugged out of his head.

Rule #3: Don’t Piss Off the Fire Crews

Apparently I had stepped in a giant pile of proverbial dung by wanting to make sure that my patient was actually dead. As I walked in to the bedroom where the man was lying on the bed, I glanced at the surroundings to make sure that there wasn’t anything that could have caused the cardiac arrest (i.e. pills, gunshot wound, etc.). I looked at the patient, and he had no signs of rigor mortis (stiffening of limbs or jaw) or lividity (pooling of blood under skin). Uh oh…those were two of the requirements that I needed per my protocol. I attached the heart monitor to the man’s chest and my partner checked for a pulse. I knew it…PEA. Pulseless Electrical Activity. I jump to action… Move patient to the floor; start CPR; get I.V. bag ready; get meds ready for me to push; etc.

I turn my head. The fire crew is standing there. Statues. Great first code experience…insert sarcasm here. Oh…”Please,”I said to get them help. Nope. That wasn’t it. They were having none of it. Cajoling wasn’t the key, so I ended up having to be firm. OK…maybe a bit on the bitchy side of things (very uncomfortable for me!). We packed up the patient, performed CPR, and pushed cardiac medications all the way to the hospital. Despite my best efforts, the patient died at the hospital.

And so did my rapport with that fire crew…for nearly the extent of my paramedic career.