Found the List

On my previous blog I had several readers who had sent me questions that they wanted me to answer. After shutting down the blog I lost the list...The list is now found. I will try to answer at least one of these questions each week. You too can join in the fun of question/answer by emailing me or commenting. (It goes without saying that all of the names and identifying information in my blog have been changed, including call numbers/signs.)

Reader question: "Can you tell about an ambulance run for a small child? Can you please expain the terminology you use?"

Before answering the question directly, I'll need to tell you (just this once) how our service works. When I started as an EMT we were a BLS (Basic Life Support) service and we were in the middle of transitioning into a part-time ALS (Advanced Life Support) service. The difference, in a nutshell, is the availability of a paramedic. If there is a paramedic on the rig it's ALS. Back then, the only medic was our director, Eugene. (We now have a full-time ALS service.) Enough background, onto the question...

It had been a relatively quiet spring day. I had a new EMT on with me, and the few runs we had been on that day had been pretty routine stuff and I had been able to walk her through patient care, only doing the tasks that she hadn't yet been certified in (things like starting the IVs and giving nebulizer treatments).

The pager goes off: "Dispatch to ____ ambulance, you are needed at 123 Sesame Street for a baby who is seizing; repeat you are needed at 123 Sesame Street for a baby who is seizing. Dispatch clear 1456." (1456 is the time stamp.)
I jog across the street from the hospital to the ambulance garage to find Sally leaning against her car. She is white as a ghost. I continue jogging to the rig and tell her, "Let's go!" She climbs in next to me and says, "I can't do this."
As I start the rig and reach for the radio, I calmly explain that we don't have a choice. We have to do this, and that I will run the call and she can assist. I also have her check her own pulse...It gives her something to focus on. There's a saying, "Once you find your own pulse, then you can look for your patient's." Or something like that.

"102 to dispatch, we are enroute code 3." (Code 3 means with great urgency--Lights and sirens.)
"10-4 102 1457."
"102 to dispatch, please page out for Eugene, 102 requesting ALS intercept at scene." (An ALS intercept means that we don't have a medic with us, but believe we need one. The younger the child, the faster they can crash. Only a medic can intubate (insert a breathing tube) in an infant, and in our area only a medic can start an IV on an infant, and I don't want to take any chances that aren't absolutely necessary. )
"10-4 102." (Pager goes off again, requesting Eugene at the scene.)
The call is outside of town, and it will take us a couple of minutes to get there.
"Dispatch to 102"
"102, go ahead dispatch"
"102 be advised, caller states infant is not breathing."
Shit. We all dread this call.
"10-4 dispatch, what's the status on our intercept?"
Just then I see Eugene pulling up to a stop sign at an intersection about 100 yards in front of us.
"Intercept is en route."
I stop to let Eugene in, then continue towards the scene.
"102 to dispatch, we have the medic on board."
"10-4 102 1459."
After driving a bit farther, I see the house we're heading to. "102 to dispatch, we are on scene."
"10-4 102 1501."

We arrive on scene to find a mob...Mom, grandma, neighbors, and a lone deputy trying to maintain order. We skip the cot, grab the jump bag, cardiac monitor and drug box. Sally has brought the ped bag, which we don't need but at least she's thinking again. Eugene gives Sally the job of helping the deputy. It is her job to talk to the mom and grandma, explain what we are doing and keep them far enough back that we can work.

The baby, who appears to be approximately 2 years of age, is breathing on it's own, but is lethargic. I begin connecting the cardiac monitor, Eugene starts an IV. As Eugene continues assessment, I get the cot. Ironically, mom and grandma are much calmer after our arrival--but the neighbors are not. Eugene decides to "load and go". (Load and go...pretty much what it sounds like. We'll finish stabilizing the patient en route to the hospital. Load and go's usually occur when either the patient is exceptionally critical and field stabilization is unlikely or the scene is unsafe. One of the neighbors is being physically restrained by the deputy, which is what triggers the decision in this case.)

We load our patient. I explain to Sally that I will drive us to the hospital and ask her to assist Eugene in the back. (Rookie drivers tend to be a bit erratic, which can lead to all sorts of unpleasant things like accidents with other vehicles or the medic/EMT in the back getting tossed around like a rag doll.) Mom and grandma both want to ride with the child. I explain that ONE of them can ride up front with me, but only if they are very, very quiet and don't bother Eugene. Mom agrees and climbs in. I ask her to buckle up as I do the same.

With adult patients we typically do not return to the hospital code 3, but this is a child. Because children can crash quickly, we generally do return code 3 if it's anything potentially life-threatening. I tell Mom that we are going to drive fairly quickly, and that she will hear the siren. (I tell her this so that she understands that her child is still okay, that it's our protocol. When an average person hears the siren, they tend to panic, and I don't want her to do that.)

"102 to dispatch."
"dispatch, go ahead."
"102 enroute code 3 to ____ hospital with one."
"10-4 102, 1506."

Eugene calls in report to the hospital, we drop off our patient, check in with Mom and clean and re-stock the rig. It all takes about 20 minutes from start to finish.

Yes, Sally is still with the service. She is a fantastic EMT. And yes, we still tease her...Because every EMT/medic has thought exactly what she said, "I can't do this." There is one run in every emergency responder's history that has triggered that phrase, most of us just don't say it out loud. Our experience, training, and partners do exactly what they're supposed to do in this situation--They kick in. Our partner reminds us that this is what we've trained long and hard for, to make a difference. Our training has given us algorithms and protocols to follow. And our experience reminds us that we've done other things we didn't think we could do and it turned out just fine.