The Gift Of Life

The Gift of Life It was an unusually warm Winter day in Florida, but the feeling was the same, Christmas was just a week away. Thoughts of my family and children celebrating the holidays together, the excitement of my young daughter and son opening their gifts, listening to music and drinking warm apple cider are times I hold most dear. Today I’m at the fire station as a Paramedic on duty for the local Emergency Medical System. My partner and I have just finished our morning duties of washing and stocking the ambulance, for what we hope to be an uneventful day. The holidays are always hard times for EMS personnel, don’t take this the wrong way, we are without a doubt affected by all of the emergencies we care for every day. It’s like how a child death seems to touch you differently than an adult,They both have meaning, but you can’t help but to think the child has not had a chance to live life to the fullest, it’s mother’s lost opportunity to see them grow into the man or woman that they would become, or the grandchildren she will never see. For the most part the day was uneventful, a few minor car accidents, fender benders most of them were NPU’s (no pick up). Some were transported to the local hospitals. Walking around on scene complaining of minor aches and pains, with not even paint exchange at the cars impact point. All State-itis we call them looking for a clam, the hope of money from the insurance company. It was later in the evening around 5:00 pm when the call came in over the paging system, the one call we did not want to hear so close to Christmas. Respond to an unresponsive person possible code 99(cardiac arrest) at a resident’s location just off Lake Ring. Fire and Police were dispatched also, We were at the station about three to five miles down the road, just minutes away however it felt like an eternity while responding to the scene. Upon arrival my partner Joe and I gathered up all of the equipment oxygen, monitor, jump kit (tackle box with all the medications and intubation tools inside) and placed them on the stretcher. As we entered the doorway I could see the patient lying supine on the floor with family members doing CPR. Quickly Fire Department personnel took over the job of CPR checking for a pulse, there were none, compressions and ventilation with a bag value mask was continued. I asked what lead up to the event and the wife stated that he was sitting on the couch watching television and started to complain that he did not feel well, “chest discomfort” then all of a sudden he fell forward onto the floor, she called 911 and followed their instruction for CPR. He has a history of hypertension and cholesterol problems which are under treatment by his doctor.

The patient shirt was removed from his chest, he was ashen, pale, and cool to the touch with noted diaphoretic (sweaty) skin. I then placed the quick look patches to his chest one just under the right clavicle and the other at the apex of the heart (left lower chest wall). The monitor showed a slow sinus rhythm rate of 40’s with out a pulse we call this PEA (pulses electric activity) no shock was needed at this time. I quickly position myself at the patient’s head and used the intubation equipment to place a number 8.5ETT (endotracheal tube) in to his trachea to ventilate his lungs, checked for breath sounds and equal chest rise with ventilation from the bag value device all was well and the tube was secured in place. My focus now was to place a large bore 18gauge needle into the right antecubital fossa (fold of the arm) and infuse normal saline along with medications needed to help with the patient pulse rate and pressure. The first drug of choice per ACLS (advance cardiac life support) guidelines would be Epinephrine, a strong vaso constrictor, and catecholamine that would help to increase blood flow to the heart and improve the patient blood pressure and heart rate. Shortly after giving the medication the patient rhythm changed to Ventricular fibrillation, which means the heart was shaking violently in the chest cavity and unable to pump any blood, a shock of 200 joules was given to the patient his body jerk in response to the energy that was forced through the chest, no change noted on the monitor. I increased the joules to 300 and shocked the patient again with even a more forceful jerk noted to the body. The rhythm changed to normal sinus with a rate of 70 complexes per minute but no pulses, still in PEA I thought. I gave the patient Lidocaine to help stabilize the rhythm and keep it from returning to v-fib. More Epinephrine and fluids was given this time the pulse shot up to 120-140 beats per minute with a bounding pulse noted to the carotid. “Thank God he just might make it” was what I said to myself. However no soon did this thought cross my mind when I noted a decrease in the rate and the pulse became weaker. Back and forth the pulse and blood pressure would wax and wane the rate would soar to the 100's and back to the the 40's and the pressure would bound to the 180’s and then within a few minutes the fire fighter would call out the BP 120’s, 80’s, 60’s, then nothing again. My heart and mind were racing at a feverish pace trying to keep ahead of the condition, “God please help me save this mans life” was the thought in my mind. The drug Dopamine which should help control the blood pressure, had no effect on the patient. As I was rethinking all of the events that had transpired up until now an idea came to me it was not a part of our normal protocol. However, time was of the essence so I quickly mixed a drip of Epinephrine and titrated the rate for a BP of greater then 80 and pulse greater than 70. Slowly the patients vital signs began to stabilize. The feeling of relief came across my heart and I then felt that the patient was stable enough to be transported to the hospital.

It was only at this time that I realized that we were surrounded by the patient's family and friends, the neighbors came over to help, along with family members who drove to the scene. They were holding hands in a semi-circle around us praying for a good outcome. I was so focused on the patient with tunnel vision that I was not aware that a gathering had occurred. During the transport to the hospital I started a Lidocaine drip and continued to monitor the patient's condition. Upon arrival we moved the patient into Emergency Room # 9 and the report was given to the nurse and doctor, to the surprise of all, the patient had started to breath on his own and some movement was noted to his hands. All of this after having no pulses for nearly forty five minutes. I returned to the hospital three days later to check on the status of his condition, I was told that he was stable and responding to his surroundings, He was expected to be extubated soon. The next shift, My partner Joe and I went to see the patient, he was sitting on the edge of the bed, looking up at me and with a bewildered stair and asked “Do I know you?”, But before I could answer the question his wife spoke up and said, “These are the gentlemen who drove you to the hospital”. I wanted to correct her and say “we were the ones who saved your life” but I did not say a word except yes and you are welcome. The fact that he was well and would be able to go home to his family for Christmas was all the thanks we needed. We (EMS personnel) do this job because of the difference it makes in the lives of the people around us. It is said that the worth of a man is not measured by the money or belonging he owns, but by his actions alone. If this is true then I am one of the wealthy few who are proud to call themselves public servants, Fire, Police, and EMS. P.S true story from my days as a paramedic. Jason M Cooper