Saturday, August 01, 2009

On Being New

It was years ago that I was a new EMT. My first license was issued to me in 1995, and after the requisite orientation I was assigned to a probationary shift on my town’s rescue squad. Call volume is generally pretty low in the town so there usually wasn’t much going on. That said, when I finally was able to respond to a call it gave me a serious look at reality that has stayed with me up to now.

Dispatched for an unresponsive person at a residence out in the woods. When we arrived at the house, I was surprised to find the first two rooms we went into had dirt floors. The patient was found in the bathroom – female, I’m not sure how old she was. I’m guessing she was in her mid-50’s based on what I remember her appearance to be. One of our first responders was there attempting to secure her airway and do compressions at the same time. The EMT in charge on the ambulance sent me over to help with words to the effect of “come on new guy – this is how you learn. Now get in there.”

I was intimidated. I mean, what was I supposed to do? I had all of the training and thought I would know what to do when the time came, but I froze for a second. However, he gave me a gentle shove towards the patient and, once I started moving, things came. Slowly, of course, but they came. Compressions, breaths. Switching off. More compressions. More breaths. No defibrillation due to asystole. In a bathroom the size of a walk-in closet.

The ambulance was BLS, and we didn’t have access to a Paramedic. Bear in mind that it was nearly 15 years ago; things were different then, at least in the area I live in. We did what we could at the level we were working at, and I remember everyone working hard. But we transported what was, in effect, a dead person.

Fast forward to 9 years later. I was a brand new Paramedic. Checked out and on my own with an EMT-Intermediate on a Manchester 911 truck. I’d been working on my own for 3 shifts doing mostly routine calls when early on the fourth shift we were dispatched for a cardiac arrest. No further information available.

When we arrived at the location an engine company was already there working on our patient, a 47 year-old male with a history of esophageal cancer. The tumor in his esophagus ruptured, causing him to bleed out. His wife found him lying in a large pool of blood in his living room. There was a piece of the tumor on the floor next to him. He was pulseless and apeneic, and it was before we had IO drills in our trucks. As I had no extremity access we ended up getting access in both of his EJ’s. Intubation was a problem in itself because we had to suction out more of the tumor, but we were able to secure his airway after that. He got lots of drugs; he was in PEA with no changes after multiple rounds of Epinephrine and Atropine. When we arrived at the ED there was blood ready for him but it didn’t matter; the attending called it not long after we arrived with him.

It’s interesting: I have two different perspectives on being new within my job. While the situations and the details were different, essentially it was like doing the same call twice. And I don’t expect I’ll forget either one anytime soon.

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