Saturday, June 28, 2008

- Arrest

We're minding our own business, getting off what seems to be one of the infinite number of transfers they have in this area, when they page us out to Redneck Central for a code.

We give a whoop of joy, and head off to the scene.

I've talked about that excitement with my aunt, who's a NICU nurse in North Carolina. I think from an outsider's perspective, it's ghoulish, This rush of endorphins and adrenaline the fuels my rebel yell, that lights my senses. Really, I'm not sure I can compare it to anything I've ever experienced in drug-free living. Maybe the excitement of finally asking a crush out and them saying yes, or that gut wrenching surge when you're sure that someone is standing on the other side of the shower curtain, only multiplied by 1000.

I have an addictive personality. They told me when I left treatment to watch out for the emotional highs and lows of the job. It was the consensus of some of the staff that I not go back to this gig at all, that it would be too dangerous and might cause me to relapse. I think the people at the place I went to knew what they were doing, for the most part.

It would be to their dismay that I don't agree with them.

But excitement turns to frost in my veins as we hear the fire department, two minutes ahead, radio back to us : "Advise unit XX patient is 7 month old, repeat 7 months old, hurry it up guys, he don't look too hot!"

One thing most medics know is that paradox Red and I have suddenly entered. when you know you're going fast, too fast, but it feels like you're driving that crawler that moves the space shuttle in position, barely creeping along.

We arrive on scene to find the fire department carrying the kid out to me. I can see the kid's limbs sticking out roughly, ramrod straight, it seems, from his car seat. I have barely had time to walk to the rear of the unit.

Someone might mistake the condensation on my head for sweat, but really, it's all glacier inside me.

Icy calm has descended. A far reach of the creative, emotional part of my brain realizes this is the first time this has ever happened. Several times I've watched sick children be carried from the household, and I've always had what I now realize is the luxury of turning to someone else and asking them "What do you need me to do?".

The smokies are ten feet away from me now, and Red turns to me. "What do you need me to do?" she asks.

"Get in the back. Grab a pedi bag and set up fluid. Pull the IO out."

A tsunami in navy clothes and black boots, the fire department surges into me, breaking around the rock of my unit. The firefighter with the kid in hand starts spitting out a report as we step into my unit.

"7 month old, has had a cold and fever past two days, found having severe difficulty breathing by his mother. When we got here he looked like a fish, wasn't moving any air. Mom couldn't get us no history. She's that lady rolling around in the grass."

I pull the baby out of the car seat and lay him on my stretcher, flat. he is a mottled, ugly pale, like something you'd see on the cap of a mushroom you'd find in a deep cave. His limbs are sticking out, his head is turned to the left, his eyes looking left, through my side door. He is seizing. White mucus is all around his nose and mouth.

"Suction and bag him!" When this call is all said and done, we will have pulled out over 70cc of mucus from his lungs.

We do not take the time to play with an IV. I slap our pediatric paddles on the child, and my backup drills in an IO needle.

I remember thinking how cute the little needles and pediatric paddles used to look to me, when I was ignorant of their ugly functionality, the brutish nature what we use them for. Seeing only the outside, not the potential inside the sterile wrapping.

"IO is good."

"Versed, check the tape for the dose."

The baby's heart rate is in the low sixties. Oxygen saturation is lower than that. I can feel a pulse. We lay out the tape, pull up some versed, pump air, do math. The versed goes in and the baby goes flaccid after a few more trembles.

I pull out the tiny tube, the baby blade, and peer into his mouth. I can't see, and pull out. There is still a lot of mucus. We bag and I suction a little bit more, and finally I think I can see cords. The baby squeaks once, and with the noise the cords, feather quick, move toward and away from one another. That clinches it.

I get the tube. The kid's sats don't jump instantly, but we get an End Tidal CO2 reading of 20. I'm in. We secure the tube, and when his sats do begin to rise, it is rapidly, all the way to 100%.

My backup calls in a report as I continue to breathe for the kid. We bring him to the hospital.

And after they get him stabilized, we bring him to the local PICU hospital.

His color has returned, and he is now a uniform light brown, the color of good coffee and milk chocolate.

Red is crying a little when I walk back to the unit. She wipes her eyes.

"It's different when you have kids," She tells me.

I nod, but inside, I disagree. As she walks to the front, I walk to the back, and let out a shuddering breath.



Loving Annie said...

The endorphin rush and then the drop are exhausting. It IS addictive, and yet frightening all at once. Totally understand. It's the two sides of the job.

Glad the 7 month old is okay, thanks to you --

NJ EMS said...


Rogue Medic said...

Great job with the kid.

Pediatric are some of the make or break calls for medics. Some just can't deal with them. Now that you know that you can do it well, the next time will be much easier.

brite69 said...

And that is why I won't take the classes to become an EMT and, eventually, a medic. Had I been on that call, I honestly think I'd have lost my shit.

I'm glad you were able to help that baby. Sounds like you did an excellent job.

Ben said...

Great story!!

I think everyone did a "HAAAWWW cuute!!" with the pediatric stuff in school.

Gertrude said...

Terrifying to say the least. Good job with the little one.

Bernice said...

I fear this day in my career. Good job!

Rogue Medic said...


While it is difficult to control your fear of dealing with unstable children, there are ways you can prepare for it, so that you are less fearful. Take PALS or PEPP or any other emergency pediatric course, but read the book thoroughly before hand, know what questions you wish to ask during the class. Be the best pupil in the class and ask about becoming an instructor or assisting with the class so that you are repeatedly exposed to the material and have opportunities to practice skills. Know the book inside and out. Ask questions about everything that you would like to know better. Practice with the mannequins - IO, intubation, BVM, Broselow tape, so that you are comfortable with the procedures. Very, very few people take advantage of this opportunity. Many schools will allow you to practice more - they are there to teach and appreciate a receptive audience. Read about pediatric emergencies - journal articles, books, text books, . . . . Get to the point that you feel good about going on this kind of call - not because you are happy something bad has happened to a child, but because you feel that you are the best prepared person to care for this child.

Trusty Trocar said...

By the time I get the children they're beyond help.

HollyB said...

Great read. Had me on the edge.
When you're good, you're awesome.

Brick City Medic said...

Strong work. Kids don't bother me anymore; I lost that fear after my first pedi arrest. On Mother's Day, 2002.

Even I still get the adrenaline rush after 14 years, not that I like to admit it.

Be safe.

Mrs. Who said...

Thank you for doing this job.

chuckr44 said...

OMG. When I was less than a year old my parents tell me they had to call an ambulance. I had stopped breathing due to an asthma attack. Same thing happened when I was less than 2.

This really hit me hard. I barely remember those times. I want to say thanks to the ambulance and the staff. If you didn't get there fast I would not be here.

I know you deal with a lot of regulations and sh!t, but this is one guy that is very grateful for your caring, despite getting paid peanuts.

chuckr44 said...

Gotta add, those happened in 1969 and 1970.