Sunday, May 1, 2011

A Tale Of Two Unresponsives...

Just to illustrate how much this job is "like a box 'o chocolates... ya never know what yer gonna git"... we had two different calls this week that were dispatched as the same condition... "unresponsive..." but which had vastly different outcomes.

The first call was for an "unresponsive" in the response area right next to ours.  Now... we don't usually get too excited about this call, even though it sounds ominous.  And it can be... but usually is something very different, so we take a "wait and see" attitude.

We happened to be in bed at the time trying to sleep (never happened that night), when I heard the call go out.  A fire engine arrived on scene first, and I felt my adrenaline kick in a little when the officer on the engine immediately requested ALS.

This generally means that whatever is going on is not pretty.  ALS stands for "Advanced Life Support," and it means that a medic or paramedic has been requested, which is moi... I was the only medic on that night in the entire county.  So, I got up and started pulling on clothes... as the tones dropped for the ALS Assist, the dispatcher put us on the call, and we started for the truck.

The other crew that had been dispatched was a BLS truck (BLS stands for "Basic Life Support," and is staffed by EMT's), and they arrived on-scene shortly after the engine.  At this point, we become glued to the radio, because that is our only source of information about what is going on.  The dispatcher gives us an update on the situation when we call in that we are on our way (we refer to it as "marking up"), and we received the following information:

"Medic 4-3, you're responding for a 33 year old male... caller advises that patient experienced a seizure and is now unresponsive.  CPR in progress."

Anytime you hear "CPR in progress," your nether-region's sphincter tightens up a little, because it means that this is no "eye-rolling" type of call... which we affectionately refer to as a "BS call."  The other crew arrived on-scene, packaged and loaded the patient, and started out for the hospital.  We met them en-route, about halfway in.  Typically, on ALS Assists, the medic unit meets the Basic unit en-route, stops somewhere (usually in the middle of the road), and the medic jumps off his truck, and gets on the other truck, which then proceeds to the hospital.  Medics can provide more advanced care than normal EMT's... we can start IV's, push life-saving drugs, use electrical therapy (defibrillation) and place advanced airways.


Sure enough, CPR was being performed by the very anxious, very overwhelmed EMT crew.  The patient was a 33 year old male that looked like he had been ridden hard and put away wet.  As I bustled about doing my thing, the story started to dribble out from the crew, inbetween gasps of air (CPR, by the way, is exhausting).  Turns out the guy was as coke head... habitual cocaine user... who was playing video games, talking to someone in his family, when he just fell over dead.  It's like his heart said, "Game over, man!"  He twitched a couple of times, and that's what they mistook as a "seizure"  It was most likely post-arrest neurological activity... kind of like when someone "twitches" after they die on some bad TV show.

We did everything right... good compressions, zapped him 3 times with enough electricity to drop an elephant, dropped an airway, started a line, pushed the right drugs... the ER was ready for us, and worked him for 15 more minutes... but there simply was too much damage to his heart or brain.  We never got him back.  His family was, understandably, devastated.  No one should die this young.

Contrast that with a call we had yesterday.  Same dispatch reason... "unresponsive."  Same concern.  Same adrenaline rush.  Yet, this time when we arrived (as is often the case), the "unresponsive" patient is sitting up, talking to us, and quite indignant that we are even there.  Usually they're just too drunk to stay conscious, and whoever is with them panics.  And we breathe a huge sigh of relief, as we tell the dispatcher that we're back in service and available for calls.

It's actually one of the reasons that I truly love this job... you really never know what you're gonna get... or who you're going to wind up helping.

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