Tuesday, August 18

What do you mean Shock Advised?

Not every rural community can afford to keep a Paramedic on full time shifts. Sometimes a couple of volunteers can help, but when the bigger FDs are hiring, these folks often move on. But what happens when a woman experiences cardiac arrest 40 minutes from the nearest Paramedic?


Community volunteers are calling for an ALS intercept.


Back in the old ambulance we're rung out for an ALS intercept with a volunteer ambulance crew screaming towards us with a cardiac arrest. We're getting broken updates, they're still out of range of our County repeaters so we take our place at the top of the pre-determined freeway exit, lights flashing and prep the back of the rig. My intubation kit is out, I've decided to do everything in my rig on my terms, we'll do a "hot load" and take whoever is in charge with us.

The 25 year old chevy ambulance comes limping around the far bend in the highway, a single 4 reflector beacon slowly turning on top, smoke spitting from the muffler and being passed by the commute traffic. This rig hasn't been run like this in a long time.

They pull up and a younger fellow climbs out of the cab shouting, "She's conscious!"

We spring to the back door, now even with our back bumper and can hear that familiar AED voice stating "Shock Advised, stand clear."

"STOP!" I shout when I see the patient sitting up in the cot, pads placed one on top of the other on her partially exposed chest and a look of fear I have yet to see since.

"Are you OK, miss?" I ask as the 3 EMTs climb out of the back of the old chevy, stretching their legs and smiling at one another.

"I think I had a panic attack." She responds, catching her breath on the brink of crying.

"Report?" I ask the group, hoping someone will step forward.
"Chest pain. We applied the AED for monitoring, I've taken a few classes," the driver responds. The driver.

"We were told cardiac arrest. Was she ever unconscious?" They respond in the negative and point to the AED.

We got her to walk over to our rig and talk about what happened and she told quite the story.
The first EMT at her home, when she was experiencing what she defined as an anxiety attack, gave her oxygen and took her vital signs and radioed for an ambulance.
The ambulance arrived with 3 First Responders who applied the AED and transported, the EMT now standing outside our rig talking about how crazy "all this ALS stuff is."

In the end she was fine, if not frightened about the care available in her community. We ran her to the local ER for a quick once over and had quite the talk with the EMS supervisor from the rural area, who responded that he can only get a small amount of people to even respond, but he'd look into training on the AEDs.

We discovered later that the community had recently had their primary ambulance involved in an accident and the only Paramedic on staff, a volunteer, was on a family vacation.

I never did see that old chevy ever again and I have doubts as to whether it even made it home.


Ckemtp said...

Heh heh heh. Now Happy, you have to say that this happened like at least 15 years ago... right? Right?!

Oh man...

I do a lot of ALS intercepts. All of the services that I go to have much better standards than that. Some better than others... but um (gulp) the government has regulated the really bad ones out of existence. (Whew! that was hard for me)

I'd like to say that my service has resuscitated like the last 5 or so codes we've been called to intercept

The Bus Driver said...

wow.. sounds like someone needs AED training again... i'm glad that AED isnt like one of those AED's we have in our school system. Some AED's have a button to push for the shock.... our AED's in school are all automatic, no button pushing required.

Bernice said...

Wait... WHUT? So the tools had a tool that they weren't even trained to use properly? That just plain old bad management.

And dang if it doesn't give us 'backwoods' EMTs a bad name. ;) I swear I know how to use an AED! Then again, we are only 20 minutes from Paramedic intercept... maybe I'm not as backwoods as I originally thought.

crs224akameema said...

While I am sure that your post was meant to be tongue-in-cheek, and was indeed humorous, you did, as Bernice said, give us 'backwoods' EMS folks a bad name, and do us a bad service by lumping all of us under one label. While this may be based on, or even a true or partially true account, please don't assume that just because a service does not have 24/7 medics, or is not in a large metropolis that we are all without knowledge and training. Also, please do not assume that just because we are a few miles from the nearest over-populated suburb, that we don't have medics. At a recent call at my paying job (as opposed to my 'hobby' EMT time with the local rescue squad) the rig was called, staffed by a 24/7 career medic and EMT, for a patient who had vomited and was losing consciousness but kept saying he felt fine. An onlooker, who had identified himself as 'I used to be a paramedic!' when I was trying to get through the crowd around the patient to make a preliminary evaluation, looked at the patient with the 12-lead attached and the medic treating him and asked 'do you folks have medic service out here?' "Yes, and he's one of them,' I said, admittedly a bit tersely, pointing to the career staffer. I did stop myself from saying 'and we got indoor plumbing a few years ago, too'.
Please, all you big-city folks, stop making yourselves feel superior by selling us short. We do a lot of good out here in the sticks. And we like it here.

The Happy Medic said...

I apologize if you took this post as a swipe at volunteers or the "back woods" EMS folks, but this was a call from my career that made me smile and I still think about glowingly.
I am well aware of the abilities of rural systems, I used to serve alone on a 1000 gallon water tender without even an AED and was being called out for medical calls in a rural farm community.
I know career folks also make "mistakes" but this was more an example of the inexperience of the young folks instead of the incompetence of a certain region.
I work in the City now, but am well aware there are folks doing more with less far from the resources I take for granted.
If this is not a good enough explanation of my views, please email me thehappymedic@gmail.com and let's discuss it.

"And we got indoor plumbing recently too..." Hilarious. You should have said it.

Thanks for reading,