Thursday, January 28, 2010


I worked in Newton yesterday. As 24 hour shifts go, it wasn’t especially horrible. For that matter, I haven’t worked an especially horrible shift since I’ve been there. On average, over a 24 hour period we’ve been doing between 5-8 calls per ALS truck and maybe slightly less than that per BLS truck. Moderately busy, but not killer. Not like I expected it would be. But then it is winter, after all. And there have been some interesting calls that I’ve been on. Some of them even worth talking about.

First, I have to talk a little about my partner, Keith. He’s been a Paramedic for a really long time – probably 14-15 years of experience. He’s also a part-time supervisor, which is unique. Two senior-level medics on a truck is a a bit of a novelty in itself, but it works really well. We don’t waste time on calls, we back each other up, and we provide, at least in my estimation, good care. Plus we have a good time.

One cannot ask for much more than that.

Every one of Cataldo’s ALS-level 911 trucks has a Zoll Auto-Pulse on board. For those not familiar with it, the Auto-Pulse is described by Zoll on their web site as a “non-invasive cardiac life-support pump.” It is minimally apt description of the device, and the reason I say that is because of the manner in which it works. Basically, it is a short board with a band that is attached underneath and around it. The band itself attaches to a wheel of sorts that spins in alternate directions in high speed, providing the ability for the band to constrict around the patient’s chest. And the way it does, at first glance, looks absolutely barbaric.

But it works.

A couple of weeks ago we got dispatched to a residence for a cardiac arrest. Arrived on scene, found a 75 year-old male lying on the floor of his bedroom, not conscious, not breathing, no pulse. His sister, whom he lived with, reported that there was maybe 10 minutes of down time. There was a houseful of responders, from the two police officers initially on scene to the engine company who responded with us as well as Keith and me. There were probably 10 people there and the potential for it becoming a mess was actually pretty high. Keith had brought the Auto-Pulse in with him and I had the monitor as well as the first in bag. The first thing we did was got him placed on it. Prior to our arrival the officers had put him on their AED and were able to get a shock in. When we got there, though, he was asystolic.

When we got him placed and set up on the Auto-Pulse, we turned it on and let it do its job. And, as I said, initially it is a rather barbaric thing to witness if you’ve never seen it in operation. But the good things it does include squeezing the whole thoracic cavity and not getting tired. Except when the battery runs out, of course, but the life of the battery can be anywhere from 30-45 minutes.

So we got him out of the house with the Auto-Pulse working, Keith intubated him, and I placed two IO lines. I did this because in getting medical history I found that he was in End Stage Renal Disease – he had a tesio catheter implanted into his chest, and there wasn’t any way I could access it. First, they’re out of bounds for other than dialysis use because they are a twin-catheter system; one lumen goes into the venous circulation, the other into arterial circulation. Second, even if accessing something like that were in my scope practice and allowed by protocol, I wouldn’t have a clue what to do with it. He had nothing to speak of for peripheral vascular access, which is pretty typical for renal patients, so I really didn’t have much choice.

The IO’s worked flawlessly, though. We got everything done within 10-12 minutes and were on the road. He got 2 rounds of medication on the way, and by the time we got to the hospital he had pulses return.

He lived for short time – maybe 1 or 2 days – but ultimately he did pass away. We found out a couple of things that nobody made us aware of after the fact, also. First, he had a DNR. It would have been nice to know that, obviously, but we didn’t have that information. Second, he was a retired chaplain for the Boston Fire Department. A Catholic priest. Which makes sense in hindsight; between the San Damiano crucifix and the byzantine-style icons hanging in his bedroom and the fire helmet on the shelf I should have figured that this or something like it was the case.

Regardless, it was amazing to see a device like this work so efficiently. And there are many cases where recovery was full and complete.

Not all of our calls have been so intense, though. It seems we’ve transported a large number of older people, but there is a good share of the not so old as well. Like the 19 year-old male we transported this morning with nausea and vomiting as well as some increased respiratory effort over the past 4 days. A history of asthma plus what I suspect is a virus of some sort that won’t shake itself loose. He needed anti-emetics, so he got Zofran from me during transport. Clear lung sounds but some discomfort on inspiration and no abnormal respiratory effort. This made me suspect something viral even more.

It’s a really interesting place to work. An affluent community that at the same time is somewhat needy, for lack of a better word. Starting a week from this Saturday I’ll be in Newton full-time as I’ll be working on the other medic truck on that day. While I’m looking forward to it, I’m going to miss Jenn, my partner on the Boston truck. But she doesn’t need me anymore. For that matter she’s never really needed me. I was in the right place at the right time to help her with confidence.

But I’ll still miss her.

No comments: