Monday, June 04, 2012

The Bike Crash

I haven't put up an EMS post for a while, but I have one now. It started off like this:

"Engine 3, Ladder 2, C-2, Medic 2, respond to the intersection of _____ and _____ for the reported auto versus pedestrian with unknown injuries."

When I heard the call, my first thought was, "okay - another BS auto-pedestrian." Kind of a bad thought to have, but there are so many we have responded to that have been a whole bunch of nothing. Although this time around, for some reason, I had a niggling thought in the back of my head that said I should also go. There was no good reason for me to even think this, but I decided to respond anyway. The other reason I went was that I was in the area, and I figured that if it was minor I'd just cancel myself off of the call and stay out of the way

As it turned out, it was a good thing that I went. Not because of anything I did while on scene - I did very little, and both my guys and the firefighters from the engine company did all of the work. It was all of the aftermath-related stuff I did afterward that sort of made my presence mandatory, at least after the fact.

While I was en route to the scene, fire arrived and confirmed a man down. They also reported that the victim was in cardiac arrest and CPR was being initiated. The medics, who happened to be in front of me, immediately took off when we all heard that report - they were moving pretty fast as it was but their speed increased considerably over the span of about a second. So I jumped as well, and as I picked my speed up, the police shift commander pulled in behind me with his cruiser all lit up and noisy. So here we are, three emergency vehicles, moving at a high rate of speed down one of the primary roads in town. Shortly thereafter we all arrived on scene.

When I got to where the patient was, I saw what turned out to be a 58 year-old male, pulseless, apeneic, incontinent (the front of his jeans were soaked at the crotch), and compressions were being done. Just before our arrival he had been defibrillated once. And I noticed a couple of other things that caused later questions: first, there was a bicycle - a brand-new one, in fact - not 5 feet away from where everyone was. Second, there was no vehicle with damage anywhere near the scene. Third, there were no apparent traumatic injuries to the patient - he was awfully gray, but had no obvious gross bleeding other than some road rash on his arms. Plus, to his credit, he was wearing a really sturdy helmet.

When the medics got their cardiac monitor onto the patient, v-fib (ventricular fibrillation - a chaotic, lethal arrhythmia) was showing. Patient was defibrillated again, compressions were resumed, and vascular access was obtained. Patient was given a first round of Epinephrine. He was then loaded onto the ambulance while compressions were continuing, and a subsequent rhythm check showed v-fib again. He was defibrillated a third time and compressions were resumed. Patient was given 300 milligrams of Amiodarone. Over the next 4-5 minutes he was shocked two more times and was given a dose of Vasopressin in between. After the fourth shock patient regained pulses and an organized rhythm. This is known as "Return of Spontaneous Circulation", or ROSC. The crew began post-resuscitation care and transport was initiated into Boston.

When we all got to the hospital (there were three vehicles in this little convoy: mine, the ALS unit, and a BLS unit that was requested for manpower) and got him into the treatment room, he still had pulses and an organized rhythm. The crew, as part of of post-resuscitation, started cold IV fluids and packed the patient's pressure points (his armpits, his groin, and around his neck) with ice packs. It is part of the protocols in Massachusetts now as it is in-line with what the AHA recommends. Once the patient was at the hospital, this was continued by the medical staff.

I got a chance to meet the patient's wife. One of the medics on the truck and I spoke with her to see if we could get some additional medical history, as we knew absolutely nothing about him. Turned out that he was a diabetic and had stents placed 3 years earlier. And he was on a boatload of medication.

Later on I went back and found his wife to check with her and see how he was. He had been admitted by then and was in the Cardiac ICU. The cooling was continuing, he'd had occlusion to his left anterior descending coronary artery that needed to be stented. He was still on the ventilator as he had not regained consciousness at that point.

His wife was remarkably composed. I suspect she probably needed to scream into a pillow or a vacuum or something like that later on, but she was incredible. A picture of strength and grace. I was extremely impressed with that. She shared some things about her husband with me that I didn't expect to hear, some of it rather personal in nature. But all I could do was listen. And I did, for about an hour.

When I went home that night a number of thoughts went through my head. First, I am incredibly proud of my guys - this particular crew has a couple of highly talented medics, one of which I will be losing in the next few weeks. I was thankful for having good health. And I said a prayer for this patient and for his family. If he survived (as of this writing I don't know the outcome) he has a long road ahead of him.

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