Tuesday, June 01, 2010

Flashes Of Light

I worry, I weigh three times my body
I worry, I throw my fear around
But this morning, there's a calm I can't explain
The rock candy's melted, only diamonds now remain

--John Mayer, “Clarity”

Ever have a lucid moment where you realize later that everything around you is moving slowly even though you’re moving at warp speed? And at the same time have you ever realized what you are doing is both the right thing and your actions are flawless? I actually had an episode like that once. I haven’t been able to re-capture the rhythm or the sense of right that went along with it since. But I try every time I go out on the road. What was especially bizarre about this particular incident was that I was running the show; I had a Paramedic student with me as well as my partner and an engine  company, and things just worked the way they were supposed to.

January 2008. Dispatched to a local car dealership for a party who fell through a skylight. Updated while we were on the way that the party had an episode of unconsciousness and was now combative but still down. We arrived on scene all at the same time: the engine company, the police, and us. And we found our patient, a 45 year-old male who had been installing new lighting on the roof of the dealership (I don’t know what the lighting was for, nor do I care) when he lost his balance and fell onto a skylight that he was next to. According to witnesses who saw the fall, he landed flat on his back and appeared to stop breathing for a short period of time. One of the employees “knew CPR” and attempted to rescue breathe for our patient. That was when he regained consciousness and became combative, from what we were told.

We looked up and judged the distance that he’d fallen to be approximately 20 feet, which was enough to generate a trauma team activation. And before I said anything, my medic student was down on the ground with the patient doing his primary survey while one of the firefighters took cervical spine stabilization.

That was the first of a few flashes of light; this particular medic student had been quietly doing what he needed to all along to get his skills so that he could move forward. But I also knew this guy as he’d been an EMT for approximately 10 years, and he understood what what needed to be done. And he did it here without being told what to do.

That impressed me.

So we got the patient packaged for transport and aboard the ambulance. Once we got in the space we could work in, things moved pretty fast. First, my partner and my student – again without me having to say anything – had the heat cranking and the patient stripped of everything but his underwear and were looking for further injury. They picked up on his deteriorating mental status and the CSF that was leaking out of his ears as well as the multiple injuries to his thoracic cavity. Again, before I could say anything, my student had his airway secured; he intubated the patient without any difficulty as he’d lost his gag reflex. Between my partner and me we had IV access in both of his arms in place and were on the road to the hospital maybe a minute later.

The second of these insights came as we were on the way to the hospital. It was a fairly short ride– maybe 6 or 7 minutes at most – but my student asked me if we should consider having medication out in case the patient started to seize. I asked him why he’d think seizure activity could happen – after all, being the clinical preceptor I couldn’t not ask what I thought were reasonable questions about things to consider. And just as I got the words out of my mouth the patient started to seize. Severely enough, in fact, that the board started to levitate off of the stretcher in spite of the straps that held him down. My next question to him was, “what’s your drug of choice"?”, and all he said to me was “Ativan.” So I broke out the drug box and handed him a pre-filled 1 mg Ativan syringe which he promptly administered. Within a minute or so the patient settled down.

The third flash happened right about then. I thought that this kid might actually have it together much better than I’d initially suspected, but he showed me that he had good control of what was happening. It occurred to me at that point that while he was still going to be learning while he’s on the job (as do we all) there really wasn’t much more that I could offer him. He didn’t really need me for anything other than skill validation and signatures.

The outcome for this patient actually turned out much better than any of us had hoped. While he did have a traumatic brain injury as well as some substantial damage to his spleen (it had to be removed), he recovered. And he went back to work 4 months later, although it is my understanding that he won’t work in high places anymore.

I don’t blame him.


Susie Hemingway said...

I think the medic student did so well and the call-out went so smoothly because the young medic had your confidence behind him and knew that you would step-in to correct, should things not be going in the right manner. You allowed him space and the time to build his knowledge which as we all know is oftened only achieved by 'hands on' This flawless day was a combination of many things and is what in MHO propels you on in your desire to study and with your knowledge create many days such as this particular day again and again in the future.
I say it again - how we need you guys - respect!

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