Ambulance Driver Files A Day in the Life | Kelly Grayson
The latest incidence of EMTs stepping on their talleywhackers comes from Little Rock, where MEMS paramedics mistakenly pronounced a woman dead, not just once, but twice:
“We had a unit respond initially and assess the patient, leave, another unit was called in,” says MEMS Executive Director Jon Swanson.
Both paramedics said the woman was dead, but when a detective and a deputy coroner arrived, they found otherwise. That’s when another paramedic showed up to get the woman to a hospital.
Whenever a story like this hits the news, the general public, aghast, asks how such a thing can happen.
And their brother EMTs, who should know better, start talking out their ass rushing to judgment without all of the facts. In my 16 years of EMS, two lessons have been driven home many, many times:
- EMTs eat their own young.
- Everyone is an expert about someone else’s patient.
Normally, it’s pretty obvious to a trained medical provider when a patient has shuffled off the old mortal coil. You know, eating their salads from the roots up. Admissions to the Eternal Care Unit. Assuming room temperature. Or as Miracle Max put it:
“There’s a big difference between mostly dead and all dead. Mostly dead is slightly alive. With all dead, well, with all dead there’s usually only one thing you can do – go through his clothes and look for loose change.”
And most times when someone gets sent to the morgue by the EMTs a bit prematurely, the mistake can be traced to complacency and poor assessment.
Most times, that is.
Just to demonstrate how easily such a mistake can happen, let me tell you a little story, which may or may be fictional, which may or may not have occurred at PGHNSTRACH, which may or may not have involved a certain rakishly handsome paramedic/author/columnist/smartass.
Paramedics were called to a local nursing home for a patient with lethargy and fever. The senior medic rightfully suspected sepsis, did a quick but thorough assessment, and determined that the patient was FTD*. He quickly loaded the patient into the ambulance and initiated a rapid diesel infusion to the local hospital, PGHNSTRACH.
The medic managed to establish an IV along the way, and started a judicious fluid bolus to prop up his patient’s dangerously low blood pressure, with a dopamine drip the next item on the menu. Alas, before he could intervene further, his patient Went Into The Light.
He rolled in the door doing chest compressions, and effectively ventilating the patient through a laryngeal mask airway. He’d not even had time to administer any resuscitation medications. He gave report to the rakishly handsome paramedic/author/columnist/smartass, and moved the patient over to the ER bed, where the resuscitation continued unabated.
The rakishly handsome paramedic/author/columnist/smartass ordered his nurse co-worker to establish a second IV, put the security guard to doing chest compressions, and checked the patient’s rhythm.
Slow, wide complex PEA at a rate of 30.
“Well then,” thinks the ER paramedic aloud, “some epinephrine and atropine might be in order.” While the nurse is administering the medications, the rakishly handsome medic – hereinafter referred to as “guy who might be AD” because typing all that shit is tiresome – initiates transcutaneous pacing at 70 bpm, surmising that hey, the pads were already in place, and pacing couldn’t hurt.
He then removed the LMA, intubated the patient, and confirmed the tube placement via auscultation, clinical assessment, and colorimetric CO2 monitoring. Ordered a chest x-ray, too, on the doctor’s behalf.
Another round of drugs was given, CPR compressors were swapped out, and the pacer was discontinued briefly to check the underlying rhythm, which had degraded to asystole – flat line.
The guy who might be AD started digging through the nursing home chart for the patient’s medication use and medical history, searching for clues as to what caused the arrest.
Well, other than suffering from an advanced case of TMB**, that is.
About then, the ER doctor moseyed into the room, took the chart from the guy who might be AD, and concluded pretty much what he had: train wreck. Waving at the guy who might be AD to continue running the resuscitation, she announced, “How many rounds of drugs has he had? Two? Okay, we’re gonna run this for another round of drugs, and then I’m calling it. This is futile, and this poor man hasn’t had a decent quality of life in years.”
So the guy who might be AD ordered another round of drugs without change in the patient’s status, checked to see that nearly half a liter of fluid had been administered, and ordered the pacer turned off.
The rhythm was asystole. The guy who might be AD confirmed it by checking a carotid pulse, and even listened to the guy’s heart sounds. Just to be sure, because his ears suck, he had his nurse co-worker listen, and to be doubly sure, they both listened for heart tones with a hand-held Doppler.
There were none.
The ER doctor nodded matter-of-factly, and said, “That’s it. Time of death 1340 hours. Good job, everybody.”
An unbroken monitor strip was printed, confirming asystole in Leads I, II and III. The crash cart and its monitor was moved back to the hallway, and the guy who might be AD busied himself tidying up the body for viewing by the family, should they arrive before the funeral home guys. He left the endotracheal tube and IV lines in place, and carefully cleaned up all the bodily fluids and excretions that inevitably leak when a person dies. During this time, the patient was still attached to the ER telemetry monitor, and the rhythm displayed there was a long, unbroken line of asystole.
The guy who might be AD looked for a sheet with which to cover the body, but finding none, wandered down to the linen cart on the inpatient wing of the hospital to fetch some linens. He bullshitted with the charge nurse for a bit, hit the vending machines for a snack, and inquired of the nice hairnetted ladies in the cafeteria what was being served for supper.
He then sauntered back to the ER, covered the body with a sheet, and as a final step, removed the telemetry monitor leads and turned off the screen. The rhythm was still asystole, and in case you’re wondering, the telemetry monitor only displays Lead II, and the cables do not detach without pulling a module out of the machine. There is no question that the rhythm displayed was the patient’s true rhythm.
The medic who might be AD wandered back into the nurse’s station, told his nurse co worker what was for supper, and at her request, called the cafeteria to order two supper trays. The nurse would have done it herself, but she was on the phone with the Louisiana Organ Procurement Agency – useless in this case, but still a required call.
He walked back into the resuscitation room, looking for the spare clean laryngoscope blades, when he noticed something curious. The colorimetric CO2 detector, still attached to the endotracheal tube, had changed from a dull tan to a bright, vivid yellow.
“Hmm, that’s weird,” he thought. “Takes a goodly amount of exhaled CO2 to make for such a pronounced color change… wait a minute. Exhaled CO2???”
He flipped back the sheet, intending to check a carotid pulse, only to discover that it was unnecessary. With the man’s emaciated frame, he could see the carotid artery throbbing. He was breathing too.
Time of resurrection, 1352 hours.
The medic who might be AD walked back into the nursing station, where his co-worker was still on the phone with LOPA, and whispered softly in her ear, “Ixnay on the eth-day. He’s baaaaack!”
Dumfounded, she dropped the phone, followed him into the room, and discovered that yes, their patient indeed alive, and looking livelier by the minute. He had a blood pressure of 78/40, a respiratory rate of 10, and a sinus tachycardia rocking along at 128 beats a minute.
Or at least, he might have had, if this was a true story, which I’m not admitting it is.
In the end, the old man died for real later that night, and stayed that way right on through burial. And the medic who might be AD learned a very powerful lesson:
Don’t judge if you weren’t there. Even good medics make mistakes, and one mistake does not make a dangerous medic. And even then, weird shit happens sometimes.
* Fixin’ To Die
** Too Many Birthdays