No Ordinary Day


Thursday, August 28, 2014 started out as one. We had some space in the lab schedule for our second semester paramedic students, so we decided to do a pit crew resuscitation workshop. I modified a con-ed presentation that I put together a few years ago, and added YouTube videos of a witnessed cardiac arrest on the Discovery Channel show Paramedics that was on in the late 90’s, and the security-cam video of a successful resuscitation in Portland from AMR Medicine.

I was approaching my one-year anniversary of teaching full-time, and of the last time I cared for a patient on the ambulance. I got choked up watching the paramedics in those videos work. I thought abut how I don’t do that anymore, or at least not right now. I find education very rewarding, and this was a good career choice for a number of reasons, but I do miss patient care.  I imagine this is a normal process that athletes who moves into coaching experience.

After the presentation we did drills that focused on compression quality, minimizing off-chest time, and coordinating rhythm checks with compressor changes. We emphasized that a short peri- and post-shock pause was critical, and that compressions must be done immediately after defibrillation. Even if they have a pulse after defibrillation, I explained that the patient still needs compressions for two minutes so that the heart has a chance to recover. Unless they wake up and ask you to stop (I have cared for patients who survived neurologically intact after arrest, but never had one wake up after an arrest I did not witness), I half-joked that it was okay to stop.

I cleaned up the lab after we let the students go. As I was walking from the lab to my office, I saw several constables running through our building. They looked concerned. Most of them are been there/done that former cops and corrections officers, and I’ve never seen any of them run before. Then I heard over one of their radios a the frantic voice of someone saying they need an ambulance. I thought that maybe this was something I could help with, so I followed them into the the building next to ours. We went around a corner and into a hallway, where I saw a co-worker lying face-down, with purple skin, against a wall. A constable and I rolled him onto his back and I started compressions, just like we had practiced earlier in the day. Suddenly I was a running a code as a paramedic again.

I asked one of the constables to cut the middle of his shirt. He pulled a knife out and carefully cut around my hands. Then I asked if 911 had been called (it had), and asked another constable to call back and tell them CPR was being done. A minute or so later an AED appeared next to me, and I asked a constable to take over compression while I opened it. I turned it on and applied the pads around his hands. I pushed “analyze,” and after what seemed like an eternity of off-chest time, it said that a shock was indicated. I resumed compressions while it charged (against the machine’s advice), and pushed the shock button.

I resumed compressions after the shock. His color immediately improved, and his eyes opened a little more with each compression. The AED counted down the seconds until the next rhythm analysis, and at the 30 second mark he reached up, grabbed my arms, and asked me to stop “beating on his chest.” So followed the advice I gave my students and stopped.

After we all caught our breath for a few seconds, I asked him the information that the paramedics would need. He said he remembered feeling dizzy all of a sudden and feeling like he was going to pass out, but never had chest pain. His only medical problem was reflux that began a few months ago, which persisted despite different medications he had been put on. The paramedics arrived a short time later, and to our surprise his ECG was non-diagnostic and his vital signs were perfect. The constables and I wished him well as he was wheeled to the ambulance, and hoped for the best.

After the ambulance left I was in a daze. I had no idea how long everything took, or what time it was after. At first I thought that was strange because a cardiac arrest was not an unusual occurrence at my last job, but then realized this happened in a different context to someone I knew. I headed back to my office and met my boss outside of our building. He had heard what happened and was on his way to find me. The first thing I said to him was “do I have to write a memo about this?’ which is an inside joke from the EMS service we used to work for. I didn’t have to.

My coworker had gone to his doctor for epigastric pain a few months before that. He had ECGs, blood work, and a stress test, and all showed no heart disease. He also did not smoke, have diabetes, or high blood pressure before collapsing. Despite a non-diagnostic ECG and blood work at the hospital, and never having chest pain, a cardiac cath showed blockages that required bypass surgery. He coworker made a full recovery, with no damage to any heart muscle, and returned to work three months later. We pass each other in the hallway each afternoon and say hello, and he has come to our paramedic class and shared his story.

The constables and I received several awards over the following months, which I have always been uncomfortable about. As a paramedic that was my job, and that day it was just the right thing to do for someone who was sick. I think it is important to recognize cardiac arrest survival to celebrate and share the good work that EMS does, as well as to promote the importance of bystander CPR and AEDs. However, I, and many of my coworkers who have been involved in these, feel uncomfortable getting awards for doing what we are trained to do. I often thought that my colleagues would have done just as well in those situations, and I just happened to be closest. I think that applied to this situation as well, and am just glad I was able to be a part of it.

 

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