A few Saturdays back I was scheduled to (assist) teaching EMS students with
practical skills at the local University. This is the same class I took when I
trained, so I know the hours and how long the Saturdays can be.
I was put in the Standing Take-Down*/Helmet Removal station with two new
instructors, who I had taught in the prior class. I love doing that
practical as it's a lot of fun, but I also make sure all of the students get to
experience how it feels to be the "patient" so when they need to do
it out in the field, they have a good grasp of how the patient is going to
feel.
Toward the end of the day, the students had grown weary of all of the
stations and were somewhat trying to distract us instructors. I know the game I
had been there before. Many of the new instructors aren't currently practicing
EMT's, at least on a regular basis, so a lot of what happens out in the field
gets asked of us returning instructors.
Our final group had just entered our class room. All day, I and the other
instructors had been doing a quick demo of the Standing Take-Down and Helmet
removal and then had broken off into groups for practice. After the short demo
I asked if anyone had questions. One student raised his hand and asked,
"You ride on an ambulance right?" I responded I do, and then he asked
the question that every single student asks every single instructor, "What's
the worst thing you've seen out in the field?"
I know what the student wanted to hear, he wanted to hear about the blood,
the guts, the gore, the broken limbs, the intestines spilled out all over the
ground, etc. But what I told him was much more sobering.
A few years ago, our state had a massive storm just before Halloween. It
crippled the state, power was out for days, trees and power lines were down at
least every half a block. I had been scheduled to work the day of the storm,
and then literally was not able to make it home from my station. I explained to
the student that several calls that night made what we did very
"real" to me.
I explained that scene safety extends beyond just getting on scene.
Early in the night before all the power was out, we gotten a call to assist
another town as all of their ambulances were out. We had made it safely to the
location of the patient, (even though we could hear the cracking and the subsequent
BOOMS of the tress falling around us), gotten them packaged up and were
transporting to the hospital. My partner was driving our ambulance, the local
tri-town paramedic was in the back of the ambulance, and I was behind them
driving the fly car to the hospital. About 3 blocks into transport there was a
series of tell-tale large blue sparks that exploded right on the side of the
ambulance, right where the main oxygen tank is housed... and I saw the wires
fall right in front of the medic truck I was driving. I stopped and watched as the
ambulance drove away trying to figure out what route I was going to take to get
to the hospital. When I arrived, my partner and the paramedic were glad to see
me and know I was safe. On the way back to the station, my partner and I talked
about how lucky we were and how the results of the night could’ve gone much
differently.
The second call that came in was for an infant who had fallen off the bed
and had an actively bleeding head laceration. My partner and I got into the
ambulance, our service car joined us and the paramedic was en route. We tried
several routes and were not able to find an unblocked one to get to the house.
Every road leading to the house had either large trees or wires or both
blocking our path. Our service vehicle had broken off and tried to find other
ways to get to the location of the call without any luck. We called dispatch
and even though they offered to send out crews to remove the trees, it would’ve
taken several hours to clear even the most accessible path.
We were advised the Paramedic (who was coming from a different location than
we were) was able to make it out to the family and was taking care of the
child. Our crew had no choice but to go back to the station without being able
to assist the obviously frightened family.
I told the student, the next
morning, when the roads were clear enough for me to make it home, and the world
looked like a twisted, snow covered Dr. Seussian world, it became very real
that we were not going to help every patient we are asked to. I let the
students know that I went home and cried. I explained that as EMS we are
trained to be able to help people, but not really trained on what happens when
there is nothing we can do. It was a very humbling experience for me in many
ways.
I told him the second experience I had was "real" was during my
paramedic student clinical rotation at the Level 1 Hospital. The patient
had gotten in shortly before my shift started and had been complaining of
numbness in their legs and some trouble breathing. I walked over to the patient
and told them that we were in the process of getting some medication for them.
They reached their hand over to me and said they were scared and asked me to
hold their hand. I obliged. The medication that was prescribed had a side
effect of making the patient drowsy, so after the medication was administered,
I let go of the patients hand and tucked it into the covers. I got the story
and the patient’s extensive history from the nurse and wrote up a short
little note in my pad for class.
Shortly thereafter, a trauma came in, so I left the patient in care of the
nurse and moved over to the incoming patient. About 30 minutes into my new
patient, I hear the doctor in the other room say, "Get the EPI!" I
moved back to the first room and see several people in line to perform
compressions on the patient. I hear the nurse yell, "CLEAR!"
and watch everyone on the room step back and put their hands up in the air
(showing they are clear of the patient). The patients’ torso raised up about an
inch and then fell back, the doctor ordered to continue with compressions, and
I grabbed the bag valve mask (BVM) and started to squeeze air into the patient.
For a few minutes, everything around me was kind of a blur. I just remember
listening to the commotion in the room as I watched the monitor to make sure I
was adequately breathing for the patient. Respiratory was setting up their
ventilation machine and the patient was placed on it and at the same time, CPR
stopped, the patient had pulses again. I don't exactly recall all of the
events, but the patient was back, at least for a while.
Sometime later, the patients’ family had come in to say their goodbyes. The patients’
child was holding their hand and said, "I'm so sorry I said I hated
you." I had to choke back my tears. Just a few hours ago, this patient was
holding my hand, and now their child is holding the same one begging them to
hold on. Watching someone come in and say goodbye to their loved one was almost
too much for me to bear. To top it off, knowing this child's last words to
their parent were words of hatred and anger, made my heart ache for the guilt
they will carry for the rest of their life. I don't know if the patient ever
pulled through, as they went to the ICU.
The last story I told the student was about how we were called to an unknown
medical, possible untimely (DOA). The DOA's adult child had called 911 after
finding their parent unresponsive at home. We arrive on scene and we are assessing
the patient. The paramedic turns to me, hands me his gear and asks me to bring
it out to the fly car. After doing so, I go back into the apartment and the
adult child stops and asks, through tears, what was going on. I advised them
I'd let the paramedic come out and talk. A few moments later, the paramedic
walks over to the adult child and says, "I'm sorry, but your parent is
dead."
The adult child fell into the paramedic's arms and began to sob; the medic
held the adult child for a moment before their neighbor grabbed the child and
consoled them.
I explained to the student that watching the paramedic be so firm and
compassionate at the same time was a huge eye opener for me, and something I
didn't realize I wanted and could be to be until I saw it.
I explained to the student that as EMT's while on duty we kind of get a
semi-superhuman feeling. Not that we don't know that we aren't invincible, but
there are many moment's I've had where I've been knocked from that
"savior" peg and felt human... And that was the hardest thing, was
knowing that at times there is nothing we can do. And that for each patient we
touch, we will impact someone's life, for the good or for the bad.
After my stories, both the students and the other instructors were listening
with full attention. They understood there needs to be an expectation of
those "human" moments. Sometimes as medical providers, we lose sight
of the fact we are dealing with people, not just patients, and the refocus into
the human element will either make or break them. It's the kindness, compassion,
passion, understanding and empathy that make a good EMS provider.
The student thanked me and admitted he was looking for the guts and the gore
stories, but said he understood why I gave him the stories that I did and why
they were the "worst" calls I had done.
The students in that group that day all look at me with different, more
clear and focused eyes when they come into my stations now and it makes me feel
good that I was able to get through to some students and make an impact.
*A Standing Take-Down is a procedure used in the
field to immobilize an ambulatory (walking/upright) patient after
self-extracting from a car accident or a fall, etc. It is used when there
is the potential for a spine injury. The patient is asked to stand in the
location where they are, c-spine precautions are taken, a backboard is placed
behind the patient, and at least 2 responders hold the patient and the
backboard and guide the backboard and the patient to the ground safely.
