Dispatched to a combination elderly/low income/disabled residence for the omnipresent “Difficulty Breathing”. As the astute reader might have noticed, it’s been more than a little snowy this winter and some places have been less than stellar in clearing the snow from the parking areas. After all, why would a building with a high percentage of elderly or disabled people want to clear the parking areas and walkways of snow and ice. But I digress.
We arrived before the BLS unit and at the same time as the FD first responders. This particular building has two addresses on the same street, but only one entrance for both. That entrance is at one end of the building. Would anyone care to guess if it’s the end near to or far away from the apartment we were going to? You get three guesses, the first two don’t count.
As my partner tried to maneuver the ambulance into position, I jumped out, grabbed our equipment (about 50 pounds worth) and trudged through the snow to the entrance where the fire fighters were waiting for me. We went in to the lobby and called the one elevator that was working. When the doors opened, we were met with the visage of a small elevator into which our stretcher would not fit without being bent, folded, and probably mutilated. The officer on the engine took one firefighter with him and told the other two to wait in the lobby. “I’ll call you if we need you.”, said. “With luck, we won’t and I’ll send these guys back down so you can go back to quarters.”, I reassured them. Luck wasn’t with me. Or them. Or the patient for that matter.
We alighted the elevator and walked all the way down to the apartment in question. We knocked on the door and after a slight delay were told to “Come in.” So, we did.
Our patient was sitting on the floor, leaning against the couch. He wasn’t having difficulty breathing, he wasn’t breathing at all. Shit. We laid him out flat, opened his airway, checked for a pulse, and started compressions. My partner was coming up in the elevator and I notified dispatch that we had a cardiac arrest. The FD officer called for his other two men to come up and give us a hand. The BLS crew was on scene, but waiting for the elevator.
Did I mention that the patient was naked? No, well the patient was naked. He was 70+ years old and 300+ pounds. I don’t know what it is, but over the last couple of months I’ve had a number of elderly, obese, naked patients. Let me tell you, that will put you off your feed every time. Think Jabba The Hut, only not quite as attractive.
The patient’s wife (I think) told us that about half an hour before she called 9-1-1 the patient had stood up, said “I’m dying.”, and then proceeded to collapse to the floor. For you new to EMS, here is a clinical pearl. Most of the time, when a patient says “I’m dying”, they are in fact dying. This patient was no exception.
Continuing the theme, the airway was difficult and filled with vomit, the IO drill bit hit the patient’s knee replacement, and of course several doses of Epinephrine. After our ministrations the patient started to generate pulses and got a blood pressure. Which meant that we had to start our cooling protocol and prepare for transport. We wrapped the patient in a sheet and lifted him onto the stretcher while I fervently hoped that the sheet would hold his weight for the short move to the slumber king.
At which point the patient lost pulses again, and went into ventricular fibrillation. Which necessitated a defibrillation. Which resulted in the patient getting pulses back.
It was now time to go to the ambulance. Remember the slightly larger than a phone booth elevator? Getting the patient into it required sitting the patient in up into a semi Fowlers position, while I tried to keep ventilating him. It also meant that it was the patient, me, and one EMT in the elevator, with everyone else hoofing it downstairs.
I should mention that the fire department did a great job on chest compressions. The officer was doing all of the coaching stuff that the AHA says that someone should do. He was reminding them to do compressions at a minimum rate of 100 a minute, press deep, and was changing out the guy on the chest every two minutes. They also shagged all of our gear, leaving us free to concentrate on moving the patient. Far different than the old days, that’s for sure.
Outside, we had to drag the bed through the 3-4 inches of snow on the sidewalk and then muscle him into the ambulance.
Where he once again lost pulses, this time going into an Idioventricular rhythm. Time for more Epinephrine, since we really don’t have many other options these days.
Off to the hospital which was only about three minutes away from the scene. I got on the radio to give them a heads up that we were going to be rolling in the door. No answer to the first call. No answer to the second call. No answer to the third call. Now we were about 45 seconds away and I was ready to just roll in the door and yell “Surprise!” when someone decided to answer the radio. If for no other reason than to silence the alarm tone that goes off when we call the hospital. I related the information about the call and told them we were now about 30 seconds away from their door.
We arrived with the still pulseless patient to find the resuscitation team eagerly awaiting us, for a change. At this particular hospital the resuscitation room is about as empty as a Tropicana Field when the Rays are playing the Orioles. For some reason they wait until after we have the patient on their bed until they put out the Bat Light. I gave report and walked out to have a smoke, do some repacking of gear, and then write my report, although not in that order.
Not surprisingly, once again a patient rewarded our hard work by insisting on dying anyway.
That’s just the way it goes sometimes.
I’m curious. Where was dispatch during this? Why were they not still on the line walking the caller through CPR instructions?
At least that way you would know what you were getting into.
I don’t want to make any negative comments about dispatchers, but some of them aren’t the brightest cookies in the box, if you get my drift…
That’s much nicer than what I usually say about them.
Look on the bright side: with your current weather, initiating the cooling protocol is as simple as foregoing the blanket, and scooping a couple handfuls of snow under the groin and axillae on the way to the rig. 😉
TOTW, once again the axiom you can’t win them all comes to mind, but you did your best under trying circumstances. At least you didn’t have to try to maneuver him down a narrow flight of stairs with a turn in the middle! Glad the FD was helping too! Those chest compressions get old quickly when done right!
I tried, and tried, and still I’m completely stuck at Level Cliche. You don’t have to read the next bit:
“That sucks. I’m sorry. Thanks for doing great at a hard job.”
I know. It’s about as original as Jello.
I swear you are writing in disguise from Rescue 6 in Olneyville. Your stories are strangely familiar. Strong work, anywhere.
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Perhaps the patient’s wife refused CPR instructions. Perhaps the wife thought that her husband was only having difficulty breathing. Perhaps she was too overwhelmed to give anything more than the address where the ambulance was needed. We call takers/dispatchers can only give you as much as we get, and sometimes that’s next to nothing.
I did your job, maybe even before you were born. I’ve heard all of the excuses, probably used most of them. As I’ve said before, I’ve come to feel myself lucky if the call taker can get the address right. On two recent occasions we were sent to addresses in other towns because apparently reading the ALI/ANI data was too much of a challenge.
I didn’t mean to start a discussion about dispatcher quality control.
I was just curious as to how the call came in and what the follow up was.
I know that in our center we are only as good as the information we are given, but every single one of us (in our center) FIGHT for the correct information, to get as close to the patient as possible, and give life saving pre-arrival instructions.
If we don’t, we get in serious trouble. But much worse, patient care is delayed.
It came in as breathing difficulty, but about 60% of our calls come in that way. That’s because dispatchers insist on asking every patient if they are “breathing normally” and if the answer is no, the call becomes breathing difficulty. Which is stupid, but it’s the way they do it. Even stabbing and shooting calls used to be entered that way until the police and the FD put their collective feet down.
We also get a fair number of calls from people who are not at the scene and thus can’t give good detail or provide any sort of first aid.