It’s the Basics, Stupid

The most media attention ever given to a call I was on was a house fire with children trapped.  Two toddlers were pulled out by firefighters who were doing CPR.  My patient was a three-year-old girl, and we rushed her to the ambulance.  After a few chest compressions, a few squeezes of a bag valve mask, and suctioning black secretions out of her mouth, she started breathing again.  She was still unconscious and I wanted to protect her airway from the secretions, but she bit down when I tried to intubate her.  Her teeth were clenched, but we were able to maintian a pulse-ox in the 90’s, an end-tidal (connected to the BVM) in the 50’s, and equal breath sounds.  What we had was way to good to risk losing with RSI, especially 15 minutes away from our children’s hospital. 

After being hospitalized for several weeks, both she and her brother made full recoveries.  While our treatment was guided by an expanded knowledge of respiratory physiology, it was BLS interventions done well that made the difference.  I learned this the hard way, which is how the title refers to me. 

Several years ago I responded to another house fire, with another toddler who was having CPR done when we arrived.  I had been a medic long enough to know better, but this was my first child pulled out from a house fire.  I spent about 15 of a 20 minute transport with a laryngoscope blade in his mouth.  I felt better when an anethesiologist had difficulty intubating him, but horrible when nurse was able to bag his pulse-ox up to 100%.  Getting the tube seemed more important, and the media only had a tragedy to report about.

We have been called heroes about what we did at the last fire, but we just did our jobs.  Any of my coworkers would have done the same thing and had the same outcome. 

We all have calls that don’t go well, and we’ve all made mistakes.  Even Superman has Kryptonite.  We owe it to our next patient to learn from those calls, and to let the next EMS generation learn from them. 



  1. […] of our rigs. I recently remembered this while reading a blog post on The EMS patient Perspective: . I remembered that sometimes we can do more by sticking to the basics. I could have gone further […]

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