As a paramedic, we have the opportunity to impact an individual and their family’s life everyday. However, it’s not often we get a real save. What do I mean by that? I mean, finding someone dead or in medical terms, in cardiac arrest, then reviving them and giving them an opportunity to walk out of the hospital doors days later to live again. There is no word to describe the feeling. It is a mixture of euphoria, overpowering adrenaline, and relief. It renews your interest in the job, it brings about satisfaction like no other, it makes all those bad calls worth it because there is nothing more powerful than to give someone and their loved ones the chance to live and love again.
I have been working as a paramedic for about a year and a half when I got a call that would be my first save. It was 07:05. It didn’t start out glamorous. I wasn’t even in my uniform, in fact, I was in my pajamas. I had just managed to have breakfast when my pager made that dreaded static noise.
“99 Kilo, Code 3 page. 99 Kilo, Code 3 page.”
Code 3 is an emergency code. So I slipped into my uniform quickly.
Landlady (who is also a paramedic): “Must be a cardiac arrest.”
Me: “I hope not, but it is that time in the morning…”
As I got into my car, I wondered what the call could be. It didn’t take long for me to reach the ambulance station since I lived real close. Close as in a minute drive away. As I pulled into the station’s driveway, I noticed my partner was already in the driver seat and ready to roll. She seemed relaxed.
Me: “So, what do we have?”
Partner: “Oh, a lift assist.”
Me: “Lift assist? I thought it was a code 3 call.”
Strange, I swear I heard Code 3. No wonder she was so laid back.
We arrived to help out our Bravo car for the lift assist.
Partner: “You want us to follow you to the hospital?”
Other crew: “Yeah that’d be great, we could use a hand getting the patient out.”
Partner: “Ok I’ll let dispatch know.”
Me: “Ok cool, mind if I ride with you so I can grab a few more information for my paperwork?”
Just as I was about to close the ambulance doors, my partner shouts at me.
Partner: “We got a Code 3, Cardiac Arrest!”
Me: “I guess you (Bravo crew) gotta find someone else to help you at the hospital. Clear fast, so you can help us out.”
So I hopped out of the other crew’s vehicle and back into our vehicle. I looked at the CAD (Computer Assisted Dispatch system) for the call’s information as my partner turns on the sirens.
Hmmmm guess that code 3 call I conjured up in my head earlier came true…
Partner: “It’s just around the corner from here.”
We were on scene within a minute or two. I can immediately tell that something was wrong as a pale looking lady waves at us on the driveway. I got out of the vehicle as my partner gathered the equipment required to work an arrest.
Me: “I’m gonna go in first with the jumpkit.”
Partner: “Okay, I got the rest.”
I approached the stricken lady, who was struggling to keep herself composed.
Me: “Hi, what’s going on today?”
Wife: “It’s my husband, he just suddenly collapsed. He’s not breathing.”
Me: “What happened?”
We headed up the driveway.
Wife: “I’m not sure, he was complaining about not feeling well earlier this morning, but then he just collapsed.”
Me: “Approximately when did he collapse?”
Wife: “Ohh…I don’t know…. a few minutes?”
When I reached the front doorway, I found a gentleman doing CPR on a man who was lying on his back.
I introduced myself to a very pale face obviously in shock of the current situation.
Carpenter: “Hi… he’s breathing, I was told to do CPR…”
I took one look at the patient and saw that he was agonal breathing (many people who are not trained will mistake this as adequate breathing).
Me: “Okay, I just need you to stop for a moment.”
I checked the patient for breathing and a carotid pulse. I found agonal breathing and no pulse. I immediately started CPR.
Me: “Do you know first aid?”
Carpenter: “No….I was just following instructions on the phone…”
Me: “Do you know when the patient collapsed?”
Carpenter: “I don’t really know…I was just working here, and saw that he had collapsed and I called the wife who called 911. Maybe one or two minutes before you arrived?”
I saw how much of a shock this incident was to the man. He wavered as he stood, it looked like he could barely keep himself standing.
Me: “Thank you for your help, we will take over from here. If you could let the wife know to stay nearby, I want to ask her a few questions later.”
By now, my partner was by my side with the oxygen tank, AED, and suction unit.
Me: “Found him with agonal breathing, bystander was doing CPR, no pulse. He needs suctioning.”
Saliva bubbled out of his mouth. It was easily cleared with suction.
Dispatch: “99 Kilo. Update please. 99 Kilo.”
We had no hands to toggle our radio, my partner was busy maintaining a clear airway, her gloves filled with wet saliva, and I was busy doing compressions. We looked at each other and carried on what we needed to do.
Partner: “I already told them it was a full arrest.”
Dispatch: “99 Bravo, advise, unable contact 99 Kilo.”
I started to sweat as I pounded on this man’s chest. I looked at his glazed eyes, it reminded me of my last patient who arrested on me. I was determined this patient wasn’t going to go down that same road.
Partner: “Nothing like working an arrest first thing in the morning.”
Me: “Yeah, good thing I ate breakfast.”
The patient’s jaw was clenched and we had difficulty getting an OPA in, but we managed to get one in and started bagging the patient on 15 litres of oxygen per minute. By now, the man’s shirt was cut and AEDs were in place. It was time to provide the first analyze. Everyone stood back as the AED analyzed. The patient’s ECG was in the right rhythm for a shock. As the AED charged, yelping a crescendo woop, my partner continued CPR, maintaining adequate chest pressure for circulation of blood to the vital organs. I quickly jotted down important notes of the call during the short time frame I had, such as time the patient was found down, time when the bystander started CPR, time of when we arrived, time I started CPR, time for the first shock…
Beep beep beep!!
The AED screamed that it was fully charged.
Me: “I’m clear, you’re clear, everybody’s clear!”
I took a look around me, making sure no one was touching the patient. I pressed the shock button. My patient’s chest rose up to meet the air as the electricity coursed through his body. CPR was continued as there was no sign of life. Now I’m on the end where I’m bagging and suctioning the patient. I have a brief moment to talk to the wife, as my partner counted out the compressions and I bagged in between every 10 compressions. If I had the chance I would bring the wife to a quiet area to speak with her, but there was no opportunity since it was just my partner and I on scene.
In the background, I can hear dispatch sending 99 Bravo to help us.
Me: “Do you know approximately when your husband collapsed?”
Wife: “Maybe five minutes before you got here? I’m not sure, I was upstairs when it happened. He said he wasn’t feeling well this morning. That he was feeling funny. But that was all.”
Me: “Any medical history I should know of? Like heart disease, lung disease, high blood pressure, etc?”
Wife: “Oh…no… no. He has always been healthy.”
Me: “Any allergies?”
It has been two minutes. The AED goes into analyze. Once again we delivered another shock. This routine in resuscitation continued for what felt like eternity.
Suddenly I can hear sirens in the background. Finally! Someone’s coming to help us!
I was now doing chest compressions, as I had switched with my partner. As three firefighters walked through the door. I asked one young firefighter to take over compressions for me. At this point we have shocked the patient four times to no avail. I got the king airway out and lubricated it. I had the syringe ready by my side to inflat the balloon, but our patient was clenching down harder than before and it was impossible to get a good placement. I decided to fore go the advanced airway since the patient was ventilating well without the device.
Bravo: “Hey, how are things?”
The second crew had arrived.
Me: “Hey, we delivered four shocks, still nothing. Tried a king airway but wouldn’t go in due to clenching.”
The call seemed to be running well overall, my partner now had three firefighters to assist her as well as another paramedic crew. As my partner continued to run the call, I needed to go speak with the wife. I found her by the doorway along with a friend who had come to comfort her. I can’t imagine the thoughts that must be going through her mind. Seeing her loved one collapsed on the ground, shirt cut off, people thumping on his chest. Despite all this she appeared to be very composed for the situation at hand.
Me: “How are you doing?”
Wife: “How is he?”
Me: “Your husband’s heart has stopped and we are doing CPR to manually help his heart continue to pump blood around. I have to say that the situation is grave, but we are doing everything we can for you husband.”
Me: “It was very good that the carpenter was able to start early CPR, he gave your husband a very strong fighting chance.”
I can hear that my fellow paramedics and firefighters were charging for another shock.
Me: “If you can, I need you to write down your husband’s name, PHN, and birthday here for me. If there are any medications he is taking, please also write it down. I will be back with you shortly.”
I handed her a piece of paper from my notepad.
Partner: “We got a pulse back!”
I can see the crew was packaging the patient to be taken to the hospital. It was a bit of a whirlwind what happened next as things moved so quickly. I remember briefly speaking with the wife again, updating her of what was happening, where we will be going, and taking the information she has gathered for me. I hopped into the back of the ambulance with two firefighters and off we went lights and sirens to the hospital. En route the patient once again lost his pulse. Doing compressions in a swerving ambulance was difficult as I struggled not to face plant onto the patient.
When we finally arrived at the hospital, we quickly wheeled the patient into the trauma room while continuing CPR. I gave a report to the doctor and moments later, I hear that the patient had regained his pulse. Those words didn’t seem real. I couldn’t believe this was happening. The nurses gathered around the patient and began attaching monitors and leads. I stepped outside of the trauma bay to let them do their part. It has been a crazy call, and I didn’t know what to feel. Perhaps dazed was the best word to describe me. I was sweating, with too many thoughts whirling inside my head. I got a few slaps on the back from my colleagues for a job well done. Everyone was in good spirits. I was floating on a cloud. This can’t really be happening. He’s alive! But there was no time to relax or really think things through, there was still work to be done. As I finished passing the admitting form to the unit clerk, I noticed the wife by the ER door along with her friend.
I offered her a smile to dissipate some of her anxiety.
Wife: “How is he?”
Me: “The doctor and nurses are currently looking after your husband. Your husband has regained his pulse and his heart is beating on its own. However, he has gone through a very traumatic event and there is still a long way to go. He is not quite out of the woods yet. But, he is doing much better than when we first arrived on scene.”
She lets out a long breath, her hands still at her chest, one arm holding onto her friend.
Wife: “Ohhhh… that’s good. That’s good. Thank you so much.”
Me: “The person you really need to thank is the carpenter. He’s the one who really helped bring your husband back and gave him a good fighting chance before we got there.”
Wife: “I will definitely thank him.”
Me: “That reminds me…I never really did get a chance to thank him.”
Wife’s friend: “I have his business card somewhere…”
She picks through her wallet, pulls a card out and hands it to me.
Wife: “Can I see him?”
Me: “I will let the nurse know that you are here and if you can see him now. I just want to let you know in advance that when you go in, you will see that there are many wires and catheters on him. It is for monitoring his heart, providing medications, and a ventilator to help him breath.”
Wife: “Thank you so much.”
After speaking with the nurse, my partner offered to help take the wife to the patient’s bedside as I sat down to finish my paperwork. It is not often I get to tell good news to the family, so the moment spent with the wife was extra special. In many ways, I wished I could have spent more time with her on scene, and more so, I wished I could have spent more time with the carpenter. He was truly the hero, he pitched himself into a situation he had never signed up to do, he didn’t even know how to do CPR, yet he placed himself in a vulnerable situation and gave the husband one more chance at life.
We somehow managed to contact the carpenter after the call and he dropped by the station. All the paramedics who attended that call welcomed him in, showered him with hugs, and thanked him. His face was still pale and he was still shaken by the event. However, the good news that the patient is doing well at the hospital offered him some relief. We also told him that his CPR was the real lifesaver. Before leaving, he said he will definitely enroll in a first aid course. We told him to take the day off, after all, he deserved it, he’d saved a life.
I can’t ever stress how important it is to acknowledge a bystander’s effort to help in emergencies. I always do my best to reassure them and thank them for their efforts, even if it is just to stop and call 911. In this era, there are so many people who continue to walk on, who pretend what was happening in front of them isn’t real. I believe as paramedics, it is part of our duty to create a warm atmosphere for those who are willing to put themselves in a vulnerable position to help another person, and for us to acknowledge them for their efforts. It is so easy to brush someone aside, to scowl at them for doing a poor job, we don’t think that maybe, next time because of a bad encounter with a paramedic, that they will be one of those who turns a blind eye and continues to walk past an emergency instead of staying to help.
Two weeks later when I was on vacation, I get a text message on my phone from a colleague and it said:
“FYI chicky. Letting u know that your full arrest pt is doing well and went home this week. He is totally fine. U rock.”
Let me tell you, seeing that text message gave me a euphoria like no other. More joy than after resuscitating the patient in the hospital, when I knew he was alive, but unsure if he’ll be going home safe with no deficits. Just thinking of him being reunited with his family puts a smile on my face. What more could I have asked for?