I was taking Kit to a medical appointment in town (in the next county), and there was an ambulance call. Not for us, so we continued on. Then there was a second call. Also not for us, but that meant both ambulances are now out.
We arrived at the appointment, and I go in with Kit — and my pager goes off. A third call, and it sounds really serious. I lock eyes with Kit. “If they don’t have a third crew available, I’m the closest.” And that’s not good, because we are 20 minutes from the call, and that’s with lights and siren.
When I didn’t hear anyone responding, I told her I’d come back for her and dashed out to my car. I got on the radio to ask Dispatch if anyone has responded to the call. “Negative.” I made the decision to order up an ambulance from Montrose, in the next county, to take the call, and ask Dispatch to get them going. And I head toward the call, which is at one of our County buildings.
Definitely Serious
The update comes when the town marshal arrived, and it’s bad: “CPR in progress.” I let him know what’s up: I’m on the way, I have a defibrillator, and I’m the closest, yet still 20 minutes away. That County building doesn’t have an AED — a defibrillator that anyone trained in CPR can use — but the next County building, five minutes away, does. They ask “someone” to bring that one. The Montrose ambulance is rolling, but they’re 10-15 minutes behind me. Ugh.
I know the head of the department in the building I’m going to. Chris is part of the vehicle extrication squad, which rolls on all crash calls. He’s got good training, and a level head. He also expects his guys to take CPR classes, so I know that whoever is doing CPR is probably doing a good job.
Helpful Workmates
When I finally arrive, I find everyone outside the building: the patient dropped in the driveway, and they’re working on him right there. Good: at least there’s plenty of room!
And indeed the guys are doing good CPR — on a co-worker. They had gotten the AED there before I arrived, but it was saying “No Shock Advised” — it doesn’t work “just if” the heart is stopped, it has to be a “shockable” rhythm. Sometimes you need to get drugs in to get the heart active enough to shock it. I start to work on setting up an I.V. so that when the Advanced Life Support medics arrive, they can hit the ground running, getting those drugs in.
Chris is there, and I recognize several other of the guys. “You OK to continue CPR?” I ask. They are, and are switching off the way they were taught — a tired rescuer can’t do good CPR, so the training is to switch off every two minutes, when the AED checks to see if a shock will help. I know that the ambulance is still at least 10 minutes away, so I get going on the I.V.
Sometimes That’s Hard
There’s only one problem: when you go to the doctor and they want some blood, they put a band around your arm so your veins stand up, right? There’s only one way that happens: your blood circulation pumps down the artery in your arm, and the band keeps it from leaving your arm via the veins. The veins get engorged and pop up, so there’s a target for the needle.
But you have a blood pressure! This patient didn’t: his heart was stopped, and CPR only barely keeps blood circulating. No veins popped up. It’s hard to start an I.V. in that situation. Not impossible— I’ve done it several times before— but a definite challenge. Sometimes people’s veins are a challenge even when their heartis beating.
But I could feel a vein, and maybe I could get it. I tried, but nothing. I tried again, and nothing. Just then the ambulance pulled up. Cool! I switch the band to the patient’s other arm so they can try. In some ways, I’m relieved when they can’t get a vein either.
There’s another emergency route to get drugs in, though: we can pop a needle into a bone! It’s called intraosseous infusion, or I.O. — osseous means relating to the bone, and it’s a way to get drugs in effectively that works pretty much as well as an I.V., but it’s almost a “sure thing” to get it established whether the patient has “good” veins or not.
As you might imagine, it hurts, but it’s not deathly pain: I once saw a paramedic volunteer to get one in his humerus (upper arm bone). He winced, but he took it. Our patient, though, was beyond feeling pain, and they popped it into the preferred location: his shin. We had a drug route.
We Can’t Always Win
But, to make a long story short, the drugs didn’t get his heart to react. We never got a “shockable” heart rhythm, and the patient was pronounced dead.
Normally, that’s the end of things for me. Kit was done with her medical appointment now, and I “could” go pick her up. But she has a new job in the county: the first of the year, she was appointed Deputy Coroner. I called her and told her what was up. She called her boss, who happened to have to drive by where Kit was to get to the scene. So she picked Kit up and brought her to start a “Death Scene Investigation” and, the part I sure wouldn’t want to do, go notify the patient’s wife. I waited with the body so the wife, if she desired, could come see him. And she desired it.
We’re too small of a county to have a “Coroner Van”, so we have an arrangement with a local mortuary to pick up bodies. I told their driver he’d have to wait, and asked him to park off to the side, as the Coroner and Kit brought the wife to the scene to say her goodbyes.
So that was my afternoon, rather than finishing up True on time! I love it when we get a good “save,” plucking a patient away from the Grim Reaper (not this time, buddy! Ha hah!) But sometimes, no matter how hard we try, we can’t save them, and the Angel of Death wins. It’s part of the job: we have to be ready for it.
And if you think medics are somehow “special” for what we do, I have to say the Coroners and their deputies are very special too: they take the really tough job of notifying the family, and being there for them. They watch out for the interests of the deceased: securing their property, and advocating for them, for instance ordering an autopsy if someone dies at work and it’s unclear why. It’s not a job I would want, but my wife has taken it on, because she wants to be sure that the dead have someone watching out for them.
So next time you meet a Coroner or a deputy, shake their hand and say thanks. I think they have a tougher job than I do.
Update
The county administratorsreally didn’t like that I posted this. It’s not a HIPAA violation (dead people don’t have privacy rights under that law), but they figured anyone who knew the patient would know it was about him. To me, that’s OK, even if his wife read it: she’d know that everything possible was done to save her husband, and alot of people jumped into action.
In truth, the autopsy showed he was basically dead by the time he hit the ground. He wouldn’t have survived if he this has happened in front of doctors and nurses in a fully equipped emergency suite. The reason I write these stories is because few people know what really happens in a medical emergency like this, and what goes through the rescuers’ heads. And that’s true even if you’ve seen every episode of theEmergency! TV show. Seriously: did theyever have a CPR case where the patient didn’t wake up and go on their merry way?
So I made no apologies for writing and publishing this. People learned from it, and maybe the patient’s wife got some questions answered. We tried, but “Sometimes you lose one.”
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