Coarse Asystole and Life Saving

Coarse Asystole is a new blog written by Sean Hulsman, a paramedic and educator in the Buffalo, NY. area.  I happened to do my first ride-along with in EMT class with him, and was fortunate enough to work as his partner a few times after. His clinical knowledge, the way he interacted with patients, and the way he managed scenes made him the paramedic I tried to be the most like when I went on in my career.

In Sean’s I Don’t Save Lives post, he discusses how few lives we save, if life saving really matter if everyone is going to die anyway, and if life saving along makes it worth working in EMS.

Let me explain what I mean by that. When we “save a life” it is patently obvious. One minute the patient is dead or dying, and the next they are alive and well.

I first thought about this sixteen years ago in EMT class when my instructor showed an episode of the 90’s TLC reality series Paramedics. It took place in Detroit, and after a call a paramedic discussed how he never took credit or celebrated saving lives. If you do that, he explained, then you have to take responsibility for all of the patients who do not survive.  We talked about that for a bit in class, and I’ve thought about that statement for years since. We enjoy credit when things go well, and we use plenty of often legitimate excuses for when they don’t. They were down too long. Their injuries were incompatible with life. Their airway was difficult. The firefighters/police officers/supervisors/whomever else did CPR poorly. Now I separate the process of the call from the outcome. I analyze what went well and work on what can be better next time.

I now also realize that no one person can save a life. Kelly Grayson stated this well in his comment by describing how instead of EMS saving lives, we can give the hospital good field position to do it.  I think that the cardiothoracic surgeon who performs a successful CABG on a post-arrest patient deserves at least as much credit as the paramedic who defibrillated him in his house. In between was a pit-crew of responders who performed CPR, and ED and ICU staff members who juggled multiple medication infusions and ventilator settings for days to supported his breathing, blood pressure, heart rhythm, and body temperature. A mistake by any one person in the chain could be fatal, and celebration for success when it goes well should be shared.

I also believe that we sell ourselves short by defining life saving only by resuscitation. EMS recognition of STEMIs, strokes, and sepsis, transporting patients to the right hospital, and notifying the hospital to mobilize resources before arrival is proven to be life-saving. Twelve-lead ECGs were a tough sell for many people when they were implemented years ago, just as more detailed stroke scales and lactate are now. Because EMS has no magic bullet to fix those conditions, there is no immediate gratification from learning about those things. It goes back to what Kelly wrote about giving the hospital field position, however, and EMS can help save more lives by helping the hospital prevent patients from arresting later than we ever will with resuscitation ourselves.

Sean writes that there is much more to EMS than true, critical intervention life saving, and the impact we make just by showing up and treating patients with dignity.

The more I considered this the more my mind began to churn and it finally spat out this idea: We don’t save lives. We Grant Moments. I was shocked at this notion because it almost came from somewhere outside of my head – as if someone had spoken it into my ears. I knew it immediately to be true, however. We indeed hand out moments.

One moment I remember with Sean was on my first ride-along when we were sent on a maternity call for a 15-year-old. Our patient was having contractions and looked scared. I had never seen anything like that before and had no idea what to say. Sean looked her in the eyes with a calm expression on his face and told her it would be okay. The tension immediately left her face. It wasn’t what as much what he said, but how he said it. Then he pulled a stopwatch out of a bag he carried, taught me how to time her contractions, and explained why there was plenty of time before she would deliver. That’s the compassion he displays, and the kind of medic he is.

Sean’s  post made me think about some of my darker periods when I was not as nice as I should have been to patients. Those were lost opportunities to make a connection with someone who was suffering that I am sad I missed. After reading books like People Care, and some maturity with age, I really began to enjoy just taking care of people. My enthusiasm for EMS returned and my clinical skills improved at the same time.

Sean has a lot of wisdom to share, and I look forward to reading more from him.

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