Wednesday, May 21, 2003

I have been in this very situation numerous times, both as a bystander and a medic. First, four minutes waiting can seem like three days. It's simply human nature, kind of like when a wreck victim says that everything went into super-slow motion.

If family or bystanders investigate, they'll find that everything we do is scrutinized in the most minute detail, especially our chute time (time from call to unit), response time (time to get to the scene), down time (how long we're on scene providing care), and transport time.

And, just in case they fear a cover-up in the recording of these times, nearly every EMS call in the nation is recorded and time-stamped. If anyone tries to doctor the times recorded on the log in order to appear in a more favorable light, they'll fall victim to the unalterable time stamp.

Secondly, care rendered on scene can take many forms. A lot of the variation is simply a medic's own habits. One thing that is overlooked by civilians is the fact that whatever you take from the truck to the patient must be brought back again, along with the added weight of the patient.

Most of the equipment we use in a code (cardiac arrest) is very heavy or bulky to carry alone, and carrying it can actually cause more delay for the patient. Personally, I prefer to work codes in my truck. It's just a more controlled environment in a place where everything else is out of control.

The article didn't say specifically, but I would imagine that the patient received CPR along with ventilation on the way to the ambulance.

Your article did mention the fact that the rhythm was un-shockable. There are only two shockable rhythms in the field. Simply put, by the time a medic reaches a patient the rhythm has usually deteriorated into asystole, or flat line. You don't shock that. A heart's rhythm can't be diagnosed outside of the ER without some kind of monitor, only whether or not a pulse is present.

Finally, most people don't understand what it is that we actually do. We're not just "load and go" services anywhere. We can do nearly everything in a medic unit that can be done in the ER, except for suturing.

A unit's downtime on the scene of a code is not normally cause for speculation of "what if." On a code, we push the same drugs, intubate the same trachea, and shock the same rhythms that are done in the ER.

It's also mentioned in the article that since there were a lot of people carrying the stretcher, the patient should have been loaded faster. Unless I know a person on scene who's known to be an EMT or medic, no one but me and my partner handles the stretcher.

Why? Those things have collapse triggers which can be very tricky. An untrained person making one wrong move can send it crashing to the ground. Not only does this raise the chance for further patient complications, it can, and often does, hurt one or both of the medics.

If I'm hurt, I can't help anybody and I have to wait for and tie up another unit for the same call. Not to mention that my injury may also require a trip to the ER.

These situations are extremely tragic. And it's much worse when the patient is a young person. I know of NO medic with whom I've ever served who didn't bust a gut to save a life.

But the medical director for my medic class told us to always remember that some patients, no matter how skilled the medic nor how fervent his effort, simply insist on dying. Rule #1 is that people die. Rule #2 is that medics aren't allowed to change Rule #1.

Ben Wyles, medic

Natchez, Miss.