09 June 2009


Shift starts at 09:00. I like to arrive early, check my truck &
equipment. The adage when I worked in theater was 'early is on time,
on time is late' as it should be even for emergency services.

Dispatch supervisor greets me at the supply officer's desk. "How soon
can you go available?"

Me: "I just walked through the door, my partner is not here, I don't
know what truck I'm assigned to and I have to check my equipment &
supplies. After that I'll be available as soon as possible."

DS: "Methodist Hospital has a vent patient who is crashing and the
other medics are on runs."

Me: "Find me a partner and give me a minute to check my truck."

I am sensitive to emergent runs and meeting requirements of our
contract with the facilities. If someone needs my help, I want to meet
that need. I notice a paramedic graduate who was in my class and I
asked if she had a partner yet. The scheduler screwed up and did not have her on for the day. I told her I needed a partner immediately (get schedulers permission) for a priority 1 run. I grab the ventilator (LTV 1000) do a quick once over on my ambulance and we head towards Methodist Hospital.

The CCU unit was a flutter with activity. Nurses racing around trying to get orders. The patient's nurse told me that the patient coded last night, they got her back after 20 minutes and she is being paced TCP (trans cutaneous pacing). We are transporting the patient from Methodist to Metro Hospital CCU for pacemaker implant. Levophed drip, Epi drip, Sodium Bicarb drip ventilator and TCP. A lot going on with this patient. First trick was to switch from their pacer to our pacer. Could have been easy, but we did not have the same brand and the connections are all different. Three people helped, lift the patient, turn off their pacer, my partner slapped our pads on the patient and I started pacing again. I studied the lifepack 12, looking for signs of capture. Finally got capture. The nurses combined all the drips to one multi pump, and we transferred the patient to our stretcher. I set my LTV and transferred to my ventilator. After a minute or two of letting everything settle, and checking to see if the patient was stable, we headed for the ambulance.

Code 3 to Metro Hospital, luckily it was less then 3 miles away. We arrive, give report to their CCU nurses and reverse the procedure. The had the same brand of monitor/pacer making that transfer easier. Vital sign check BP 86/52. Very not good. At this point the patient is in the care of the nurses I offer to help in all ways I can. Unit secretary places STAT pages for the patients doctors. I am released by the nurses, I leave the room to complete paperwork. Several minutes later they get a doctor to the floor and he is not happy that the patient was transferred in this condition. My partner, after cleaning our cot & monitor, watches the activity inside the room. She comes over to me and tells me that Doc has taken the patient off the pacer four times to see the underlying rhythm. Easy guess, it's asystole (didn't take me long to figure that out). I finish writing, get my signatures and head towards the elevator. We stepped on the lift with one of the CCU nurses, going to pick up a patient from the ER, and hear "Code blue CCU, Code Blue CCU" to the same room we just left.

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