My first code...

It's finally time for me to tell this story.

My first code happened when I was home from school for break about nine months ago, though it seems like longer than that. At first, as I was trying to remember the exact details, so that I could write them here, I had difficulty recalling the time of year, and the order of events. However, as I dwell on them, I now surprise myself by just how much I do remember. I know it was the summer since it was a warm sunny day, it must have been between 3 and 5PM. Those were the hours that I would consistently hang out at my volunteer fire department after my internship at the chemical plant. The call came out as an elderly person having fallen. I remember because I was chatting with the Asst. Chief, Jose we'll call him, and the tones dropped, and we both took the ten steps into the bays and got into our truck. He drove even though he's the ranking officer, so I sat in the officer seat. Our truck for routine medical calls is an older E-One box mounted on a newer 1997 Chevy 2500 frame, with a duramax diesel. The cab seats five, and the box holds all manner of small rescue tools, including a jump bag, heavy-duty first aid kit, suction, AED, etc, etc. It's got a nifty (and broken) stem light, cribbing, high-angle rescue gear, fire police equipment, and more. R-410. We took off with just the two of us.

Our system works such that the local volunteer FD (us) provides first response BLS service to about half my town. The other half is serviced by the paid fire district. We contract out to a commercial ambulance company who does our transports and ALS. The nice thing about this arrangement is that we always have ALS coming to us. The downside, of course, is that we don't transport, though that can sometimes be a nice thing. Depending on how busy the service is, they can run a little slow. Today was a mediocre day. They certainly didn't beat us to the scene, which when that rare event happens they rub in our faces, but they weren't the 30 minutes they've been known to pull (extraordinary for a mostly suburban part of the state).

As we're driving down the highway, it wasn't especially congested, about forty-five seconds after our departure from our house -- maybe two minutes after the call came out, our Fire Police Lieutenant gets on the horn (as I would find out later, he lived next door to the patient) and informs us "410-C to Fire Control, be advised that this is a full arrest. Full arrest! Put an expedite on [Generic Ambulance Service]!"

Fire Control: "7-5. Full Arrest acknowledged."

410 (us): "410 redirects." Suddenly I find myself propelled against the rear of my seat as I watch my Chief floor the gas pedal. I look up from the PCR I was starting and stare out the window.

Jose asks me, "Polarbear, did you hear that?"

"Yeah," I reply meekly.

Out of nowhere a police car approaching from the opposite direction turns across the highway in front of us. Blinkies and woowoos. We follow with a right hand turn ourselves. I now realize that that was a very nice coordinated and skillful piece of driving by the officer and my Chief for neither of our vehicles to slow down as we took that turn. Of course, Chief cut the turn short several feet so that we sliced out a nice portion of lawn.

We followed PD all the way to the scene, the Chief barely able to manhandle our larger truck and maintain sight of the far more agile police cruiser. We end up parking on the lawn of the neighbor across the street from the patient's house. I open the door just as I spot the police officer starting to race into the house, AED in hand. The medical equipment is on the passenger side compartments of our truck, so I yank open the cabinet's metal doors and grab the suction, AED, and jump and airway bags. Chief rounds the corner of the truck and we both run up the slight hill into the patients house. Elapsed time is probably no more than five minutes from the time of the initial call. At this point, I seem to be moving without thought. Acting but not comprehending.

The patient has fallen in the kitchen and I am greeted by the sight of our Fire Police Lieutenant, who is also the only advanced provider in the department (EMT-I, New York 'I', not NREMT, so like NREMT-I/85 or whatever they're called). His name will be Red. Red and PD (whose name I actually don't know) have just finished cutting the patient's shirt and applying PD's AED pads. PD hits analyze. Beep beep beep. Analyzing rhythm. Beep beep beep. Analyzing rhythm. Don't touch patient. Stand-by. Beep beep beep..... Enough already! Just let me hit the shock button. Beep beep beep. No shock advised. @%#$!!

We start to resume CPR. The BVM and O2 are broken out. My Chief points out that we need to take PD's pads off the patient since they're incompatible with Generic Ambulance Service's Lifepak 12. I rip off the pads, and apply new Medtronic pads, and power up our trusty old Lifepak 500 (Which I neither know whether it is trusty or old). We run through the routine again. I know, I know. Should have done a couple minutes of CPR, but hey, what's the harm. I hit analyze. waiting waiting waiting. "No shock advised. Start CPR." @%#$!! Again!

As Chief starts pounding and Red handles the ventilations, I find myself without a job. I will soon learn that Jose likes chest pounding, and as this story will play out, he was probably the one pounding away all the way until the MD called time of death at the hospital 30 minutes from now. Oh yes, this story doesn't have a happy ending. I remember a few days later after Jose has downloaded the AED traces into the computer, the nice steady rhythm he was producing all on his own. Anyway, I was without a job for a moment and just as I was thinking that someone should have thought of three-man CPR, I notice a nice steady distention of the abdomen. I look a little closer and see Red pumping the BVM at a rate close to 40 breathes per minute, full bag, and over the course of about a quarter of a second. Sweet! I'll play airway coach.

"Nice and easy" I say to red.

Immediately you can see the anxiety and tension come off his face (remember, he was on scene by himself for several minutes doing one-man CPR) as his training kicks in again. He immediately slows down the breathing. We all take a second to expel the air out of pt's abdomen, and resume once again. I think, what can I do to stop this form happening again. We reposition the head, I slide in an OPA, and Red vents. At this point, a couple more members of the FD have arrived, some in their personal vehicles and a couple in the department flycar. One member picks up the PCR I have long abandoned. I apply cricoid pressure. Someone asks, "Anything I can do." Jose pounds away. Where the @&!$% is ALS?!?

Turns out ALS is another 3-5 minutes. Must not have gotten the message that this was a true MEDICAL EMERGENCY! The first man from the Generic Ambulance Service rig is a kid, a EMT-B, definitely younger than me, and the look on his face was priceless. I can still remember it today: Stunned silence. He literally stopped moving. Someone had to grab the drug box and tube kit he was carrying and out of his hands and place them on the table. He basically stood off to the side for the rest of the call. ALS provided from GAS was slightly better, walking in to the room and starting patient care, but certainly not taking control. Someone suggests hooking up that nifty Lifepak that she bothered bringing into the room. Good idea! All this time we haven't have a shockable rhythm. The Lifepak-12 goes into AED mode (I really know nothing about these things. I didn't even know that was a choice). No shock advised. @$%%@&! What's the point of these bricks if they're not going to deliver 300 Joules of life-saving electricity when you expect (and want) them to? CPR is resumed. The medic, an AEMT-CCT (that's NREMT-I/99, I think), begins attempts to start a line. This provides me with ten minutes of amusement.

About 4-5 minutes into this attempt one of our kindly volunteers inquires as to whether he could be of assistance in tubing the patient. Medic, surprised, nods and points to the tube kit. Our heroic volunteer, whose day job is work as the head respiratory therapist at a local hospital (and an expired paramedic, that's right, full NREMT-P), works his stylet and plastic tube magic, and a tube is in place. Ventilating begins. Jose still pounds away. Tube guy begins ventilations. I once again am obsolete. Red and I run out and grab the stretcher and backboard. The cot won't go up the front steps into the house. The board is brought in. Resp. guy suggests some meds down the tube. Medic lady, still trying to start a line nods and atropine is produced. Jose pounds away. Lifepak, neglected for so long (probably only four analysis provided since we've been on scene, nearing, if not over twenty minutes now) suggests a shock. Wonderful! ZAP! Shocks no longer advised. CPR resumes. Patient is transferred to the board and carried outside and set on the cot. I lift one end of the stretcher along with Jose who has the other end. Medic grabs her stuff. Where is that Generic Ambulance Service kid? The bed is wheeled down to the bus and Jose immediately hops in back and begins to pound away... again.

Off they go. Blinkies and woos. I inhale. I look up. I'm outside.

My head turns a couple times. There are now three police cars. The fire truck I rode in on. A FD flycar, and the FD pickup, and two personal vehicles. Lights blinking. I exhale. I look at the front of the house. Bystanders are around now. Neighbors are milling around. People have heard what's going on. Red comes out of the house, along with the other members of the department. I need to call Fire Control and let them know the situation. Technically, I'm now in charge of the scene, since I rode Officer on the first responding apparatus and there are no real line officers around (Jose off to the hospital, and Red doesn't really count). I realize I don't have a portable and actually turn in my place a few times as if one will magically appear. I see a blue uniform and some stripes, the PD sergeant. I call to her to ask her to radio dispatch and update them (Fire Control and PD dispatch is all one person on different frequencies). Red yells to me and tells me that he still has his portable. He calls in the conditions report. Equipment is put away. I'm the one who has to drive the truck back to the station. I get in an argument with the neighbor whose lawn I'm parked on. I want to back up while he wants me to pull forward. Whatever. I make sure everyone has a ride and call us back in service. Drive. Stop. Reverse into the bay. Close the door. I sit around a little and drink a couple sodas. Jose calls from the hospital and says he has a ride back and we're all dismissed. Good. I get in my car and go home.