# Cardiac Arrest. Your first time..



## 62_derick (Apr 28, 2010)

I am new to the ems world been an emt for 10 months and employed for 9 months. I have had 4 cardiac arrest in the 9 months of employment and 1 while going through school.

Now with the company I work with we get our fair share amounts of Codes and the schedual I work is 4, 10 hours days my medic and I just ran our first code this past saturday and the most recent one on this past Monday. 

The first one was getting called out for Breathing Difficulties at a residence, we arrive on scene and find a female in her 80's that looks sick, she had SOB low bp of 74/40 and we moved her from the house to the rig in 2 mins, get her to the ambulance and the pt goes unresponsive cpr and acls started immeditly and another unit called in to assist. 

Now on monday we get called out to one of our local Nursing Homes for breathing difficulties again. We respond with about a 2 min response time go up the floor and find out the that pt has become unresponsive. immediatly go in to cardiac arrest mode I strap the pads on and the four lead and start compressions and so on. 

Now what I wanted to ask everyone if they could give me some advice on how to deal with the after affects of working a code. Of all my 5 codes I have been on none of them have been able to be brought back. Monday was the first time I had been there to be the first to start compressions and still have the feeling of the ribs breaking while doing cpr. Does that feeling always stay with you? and How did everyone react to there first time? 

I have never thought about quiting and going onto a stright BLS truck where we do transports and a few emergancy calls. I know that I am new to being an emt and have started off working pt on a als truck and now full time on an als truck. I like being on an als truck to be able to see different calls and to help out different types of illeness. So if anyone could give me some advice would be greatly appreciated. 

Outta the 5 codes I have worked 4 of them 1 of them was a pediatric cardiac arrest that was pernouced prior to our arrival.

Thanks


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## Shishkabob (Apr 28, 2010)

I've only had 1 code, and it was working as a Paramedic during my internship.


It was 4 in the morning when the tones went off for an unconscious person.  We get in the ambulance and head off and the quint leaves behind us.  Right after we get on to the main road dispatch relays that it's a "full code, CPR in progress".

Arrive on scene at the nursing home and find the 'nurses' doing 'CPR' on the guys Xyphoid process, with the BVM not touching the patients mouth.  I tell them to stop CPR as we assess.

No breathing, no pulse, but no obvious signs of death that would prohibit us from doing the arrest.  I have the EMT start compressions as I hook up the monitor... asystole.  We package and take to the ambulance.

Once in the rig, I start an IO on his tibia as one of the medics attempts to pass a tube, which was a no go due to the ability to see inside his trachea just by looking at his neck.. we just bag and get decent chest rise.  I pushed 1mg Epi 1:1 and 1mg Atropine, and due to the suspected long down time, I pushed a full amp of Bicarb.

I alternate compressions with another medic while the EMT drives to the hospital, pushing another couple mgs of Epi and Atropine.  We arrive and take the patient in where I give a report to the doc and time of death was called right there.  Remained in asystole the whole 30 minutes we had him.




I still have the full code summary on my desk.


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## 62_derick (Apr 28, 2010)

Wow thats interesting. The very first one I did was on an elderly female found by neighbor unresponsive, I was with the fire department at the time while I was going through my emt class and was certified in cpr/aed and we did cpr on her until the ambulance arrived. 

So how did you feel after your first code?


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## Epi-do (Apr 28, 2010)

Honestly, I don't even remember my first code.  I do remember a couple of the "early" ones in my career, but I haven't got a clue what my first one was.  

As for the feeling of breaking ribs when you start doing compressions...  Everyone is different, but that feeling never "stayed with me," but, since I feel like I am employed by the grim reaper, it isn't something that I have forgotten.  That's mostly because I seem to average 1-2 cardiac arrests every month, and it seems like about every 3rd one I get has to be worked.  (And trust me, I don't work them unless I absolutely have to.  There is no point in transporting a corpse, especially red lights and siren, in my book.  I would much rather leave them where I find them, even if I do have to work them on scene before I can call them.)

Also, don't feel bad about not getting most of them back.  Honestly, at least in my experience, that is the norm.  Most people go into cardiac arrest for a reason.  Even though there are some reversible causes, I personally haven't had that many that would fall into one of those categories.


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## viccitylifeguard (Apr 28, 2010)

i still remember  my  first full code :  i was a 17y/o lifeguard   and it was a 92y/o male in the swimming pool. 615 am he starts freeking out in the   hottub i thought it was a seizure at first once i ran the 20feet to get him out  he was fully unconsious no breathing no pulse.
we  put in an  opa put on a pocket mask with o2 and started cpr . the part i remember most is  that it took 30 min for the ambulance  to get  to my location (the base was only  1km away  and it was a straight road with no lights ) when they did arrive i was  asked to keep compressions going and then once we started to transport i was  told to get in your comming with us. it was an experience ill never forget  . i saw  it through from  start to  prouncment of death at the hospital.


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## trevor1189 (Apr 28, 2010)

The only thing about a code that bothers me is the crunchy compressions and vomit (luckily the majority I've been on no vomit has come up).

After the first round of compressions the crunching stops and its all good from there. *Just remember, if you feel crunching or hear snapping and you are going the depth you are supposed to keep going, it happens. I've seen people back off on the depth after feeling those pops and cracks. Broken ribs is a very small price to pay for a chance at ROSC.*


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## truetiger (Apr 29, 2010)

My first code took place during my first medic clinical at a big hospital. As I was hopping from room to room doing assessments, I walked past a room in which a full code was in progress, and everyone was wearing masks. Initially I figured I'd just catch the next one, as I see they're all wearing masks and she's dead, I don't want what she has.... One of the nurses noticed me peeking in and grabbed me. I was told she was tubed and to take over compressions.

After the code, the charge nurse asked for my info, as I would be contacted by the hospital pending the results of the PT's blood work, to see if I needed to receive tx as well.


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## Shishkabob (Apr 29, 2010)

EDIT:  Read incorrectly what Trevor said.


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## ZVNEMT (Apr 29, 2010)

my first was my first day ever on an ambulance, during my clinicals. got a call  to a "skilled nursing facility" for an elderly female in respiratory distress. it was a few years ago so i don't remember the vitals, but i do remember the pulse was very weak, very slow, shallow respirations. I also remember the medic not being given the paperwork because the nurse was busy on the phone talking about the previous nights american idol. As we loaded the pt up, she just stopped breathing. I didn't realize it until the medic asked me how well i know my cpr. i started compressions, the driver drove like a lunatic, i whacked my head against the cabinets pretty good, must have broken every rib in that poor woman's body (she was very small, emaciated looking, and frail. but full code). it sucked, i was just kind of shocked for a while. had 2 more codes on my next 2 clinicals. since school i've only had 2 codes in the 2 years ive been working here


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## MrBrown (Apr 29, 2010)

No cardiac arrest in 3 years :unsure:


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## CAOX3 (Apr 29, 2010)

MrBrown said:


> No cardiac arrest in 3 years :unsure:



Your done now. 

Thats like saying its awful quiet in the ER.


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## Melclin (Apr 29, 2010)

I've had 2 (four if you count the DOAs) in roughly 2 weeks on the road. I attract death and misery on placements  

My first was a bloke who'd been run over by a tractor (I'm sure I've posted this before). It was pretty intense. I remember getting the pads out and thinking, s**t I've never actually seen the real pads because in training we use those click on dots on the manequin. Did compression, ventilations. MICA called it after about 25 mins of varrying PEA and asystole. I also remember cleaning the bloke up a bit after the mess we made so his family could spend some time with him. I found that to be oddly intimate and a nice way to feel like I could do something positive in a bad situation. 

My third was a young girl who hanged herself. Off a towel rack. I remember thinking that all she need to do was put her hands out to save herself. She must have really wanted to die. It was the most god awful thing I've ever seen in my life and the only job I've ever done, that I wouldn't want to do again. Looking after the people who found her and counseling them afterward was a very rewarding experience though and all in all, I'm glad I had the experience. It only makes me wanna be an ambo more. 



MrBrown said:


> No cardiac arrest in 3 years :unsure:



That bones. I should come over and do some placements on your truck. I'll kill half the bloody town just by being there, but at least you'll get the experience


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## firetender (Apr 29, 2010)

My first few probably involved mouth-to-mouth because that's what we did back then until we actually got used to and trusted the new-fangled equipment (much of which broke down at first...no joke here), but I don't remember so it must not have been as traumatic for me as it was for them because apparently I'm the one who survived!

On one level, it's simple; you're buying time for the person. Sometimes, things get knocked out of whack and they can still get back to function. Sometimes, they need a kick in the pants. You're the kick. You don't know; you never know, but you're the one that got called to the scene so you do what you can, which is what you were taught.

And those ribs do break! Sometimes it's because you slip, or because there was something there you didn't know about, or whatever shut down the heart set you up, or... But ribs break, nothing feels quite as creepy, and more than likely it only takes a couple times before you're SO aware of how you're doing compressions it's almost certain if it happens again it's because of circumstances way beyond your control.

...and that's something you learn to live with because ultimately, it all boils down to moment-by-moment knowing you're giving it your best and when the inevitable mistake comes, you learn from it and what you learned then becomes part of your bag of tricks.

And, by the way, right now nobody beats death. But it's important that we have an army out there trying. Think of what a miracle it is that anyone gets "saved" at all. And now and then, you get to be part of it! You can look at yourself as a Sacred Soldier or a Flesh Mechanic, the end result is the same; you're a participant in life's longing for itself.

See...but that's just the way I look at it. What if you took the time to develop your own Mission Statement of who you are in relation to the work you do? It can go anywhere. It's something you can return to to remind yourself why you got into this whole mess in the first place!

There's a percentage of medics (yes, in this Forum!) who become better medics by looking at themselves and what they do from different perspectives and on different levels. It takes all kinds and I just want to encourage everyone to share their explorations of "self" here as well.


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## CAOX3 (Apr 29, 2010)

First medical arrest:  Pretty uneventful.

First traumatic aresst:  MVA with ejection followed by severe deceleration: Sheer terror followed by a few expletives whispered under my breath, followed by the distinct feeling I wasnt going to be upright for much longer if I didnt sit down and I may have vomited. h34r:  

When I got home a conversation with my mother about what a terrible mistake I made choosing EMS as a career and I dont believe I slept that night, other then that it was pretty uneventful. 

First pediatric arrest:  I was little more experienced however I recall a few of the same feelings I discussed above.  Back then they were quick to remove you from the truck and CISD was common practise.  I dont remember participating much, I do remember the begining of a thirty pack of red white and blue, a pack of smokes and there may have been a bottle of wild turkey involved or maybe it was mad dog 20/20.  

I was young when I started in EMS and I was emotionally unprepared for what I encountered.

I have matured since then.  Now I drink the good shiit.  

Kidding  

A solid support structure is extremely important, being able to recognise the signs that a provider isnt in a good place mentally is also a part of this job.


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## AnthonyM83 (Apr 29, 2010)

Can't help you much with getting over the feeling of ribs breaking, as I never got that "feeling". Just the thought of "wow, ribs are breaking, glad they warned me about it or I'd be scared". Then turned my attention to everything else going on.

I can though share that during intense calls, I tend to dissociate with any emotions about the call or myself. Everything is very robotic, cold, calculated, academic (as best as possible, there's always snags that come along). This allows me to do the best work and the patient wants me to do my best work.

During a code, it's all about how well I can do the skills. If I start thinking about "saving the patient" I might psych myself out, distract myself with emotions, worry, and brain power that should all be going toward what I'm doing (physical skills, academic thinking, on-scene communication).

I will say that all our "saves" had great compressions, started early and continued efficiently throughout.


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## Smash (Apr 29, 2010)

62_derick said:


> So how did you feel after your first code?



Hungry.


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## Shishkabob (Apr 29, 2010)

Smash said:


> Hungry.



Agreed. I was STARVING that when I got back to tge station I just ate.


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## Euclidus (Apr 29, 2010)

firetender said:


> My first few probably involved mouth-to-mouth because that's what we did back then until we actually got used to and trusted the new-fangled equipment (much of which broke down at first...no joke here), but I don't remember so it must not have been as traumatic for me as it was for them because apparently I'm the one who survived!
> 
> On one level, it's simple; you're buying time for the person. Sometimes, things get knocked out of whack and they can still get back to function. Sometimes, they need a kick in the pants. You're the kick. You don't know; you never know, but you're the one that got called to the scene so you do what you can, which is what you were taught.
> 
> ...



Excellent post.

I had my first code a few days after I got my certification. It was winter and just after a very heavy snowfall... we were called to a VERY large 50-something female who was outside laying on the snow and unresponsive. She had her shovel still in hand and a little path that looked to be leading to her car. I remember that everything in my brain seemed to click over to some... robot mode or something... everything sort of just worked like clockwork. I also remember having that thought, "wow, I'm glad they warned me that the ribs were gonna do this." That part was definitely odd at first, but I can't stay that it stayed with me. It was like there was just no time for emotion to enter the equation.

The medic I was with must be related to Melclin because he seems to have more than his fair share of codes & DOAs! We actually say Mikesystole instead of asystole because his name is Mike. This being my first code I was expecting her to start gasping for breath and looking around at us after we did CPR for awhile, but that didn't happen. I suppose this call was a reality check for me! After the call I asked Mike how many times he has seen ROSC on a code, and he told me less than 10%. We do what we can, when we can. If you feel like there was something more you should have done or that you fumbled the call, learn from the experience and take it with you. Make sure you're better on the next call. If you followed your protocols and did the best job you know how to do, add it to your experience bank. We can't save them all!


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## EMTinNEPA (Apr 29, 2010)

In two years I've had 5 or 6 codes that were worked.  My most recent was definitely my most memorable though.

I was on clinical time as a student paramedic on a single medic squad.  The MICU in the town over from us was dispatched for a cardiac arrest and because the dispatcher had a brain, he sent us as well.  In addition, a second MICU was on their way back from the hospital, so they swung down to help.

By the time I got there, the tube was in and the IV was halfway in.  Since I wasn't allowed to push medications yet, I resigned myself to doing CPR, ventilating, and putting stuff together.

43 year-old obese male on the second floor of the residence.  Due to the tight stairwell, extrication with a reeves was impossible.  About thirty minutes into the code, the fire department placed the patient in a stokes, secured the stokes with rope, and lowered the patient down a ladder through the second story window.  It was like something off a TV show.

In total, the patient was coded for about an hour, received multiple rounds of epi and atropine, 4mg of narcan, endotracheal intubation, a 16 in his LAC and an IO in the left tibia.  Asystolic the entire time I was there, but apparently he was initially in a fine v-fib.  ER doc pronounced on arrival.

Despite the outcome, this code will always stick with me as my most memorable, if only for the fact that it was the first code where I had an idea what was going on ALS-wise and the one that rescuers went through the most extraordinary measures I've ever seen.  Definitely one I will never forget.

Aside from my first code, which was a 28 year-old female OD, the others were all, for lack of a better term, routine.


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## Melclin (Apr 29, 2010)

EMTinNEPA said:


> 4mg of narcan,



Um...why?


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## Piper76 (Apr 29, 2010)

My first code was on a rotation a few weeks ago. 2 yr old girl hit by car. I ended up bagging her and started suction. 

We got to hospital and they did 5 or 6 rounds of epi/atropine/bicarb. She was worked her for about 1.5 hours total. She didn't make it. It turned out she had broken her neck and severed her spinal cord. 

It was a tough call...that was my first code and death in the field. There were a lot of teary eyes that day....

 I didn't shy away, and I did what I have been taught. I got credit from the fire-medics and my preceptors for how I handled myself during a tough and hectic situation. Running that call taught me a lot about myself, and served to show to me that I am making the right decision to pursue a career in EMS/Fire Service....


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## jgmedic (Apr 29, 2010)

1st as an EMT-B- in a strip club, pt was getting a lap dance, according to dancer, had a seiz and then collapsed. Worked him in the rig as the club refused to turn the lights on or the music down, dancer then asked us to get her 40 dollars from the pt. Classy.

1st as a medic- in a con home, pt was on the floor, with 2 CNA's there, one stroking the pt's hair, other placing a pillow under his head. He didn't make it.

Last shift bid I ran 13 FA's, 11 no go, last two walked out of the hospital. couple of weeks ago, there were 2 codes on 10 min. at the same con home, one of our medic called the 1st one, worked on the 2nd one and called that pt just before the 2nd unit arrived.


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## MrBrown (Apr 29, 2010)

jgmedic said:


> ...pt was on the floor, with 2 CNA's there, one stroking the pt's hair, other placing a pillow under his head....



Those updates are in the 2010 AHA Guidelines right?


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## EMTinNEPA (Apr 30, 2010)

Melclin said:


> Um...why?



Patient had a prescription for morphine for chronic pain, per the wife had been depressed recently, and when the bottle was checked there was a buttload of pills missing.

Hs and Ts...


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## EMSLaw (Apr 30, 2010)

MrBrown said:


> Those updates are in the 2010 AHA Guidelines right?



Yeah, I'm sure that's right up there with chest compressions.


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## MonkeySquasher (May 1, 2010)

Okay, I'll bite.  This is mostly aimed at the newer guys out there.

Some things never leave you, especially for certain types of calls.  Dates and smells seem to trigger memories the most for me, but that's different for everyone.

My first Code was, in fact, an easy one, because we didn't do anything.  It was a 3-vehicle high speed MVA, where one of the vehicles burst into flames just after impact.  NYS Troopers were able to drag two of the people out, but an 18y/o female in the back of the Geo Tracker was wedged and they couldn't get her out.  She was unconscious from the accident and, we're hoping, already dead.

This was also my very first call.  I then drove a half hour away and barged into a friend's house at 7am to share a couch with my girlfriend and cry like a baby for over an hour.

I love this job because it requires 110% from you- mentally, physically, emotionally- All day, every day.  I also hate it for the same reason.

You will be called to see things you never imaged.  Things you never asked to see.  Things that will make you think, things that will make you laugh, and things that will make you just shake your head, either out of stupidity of others or disappointment at mankind.  At any given time, you can be thrust into a chaotic situation, way over your head, and be asked to do the impossible, with 100% accuracy, and have it done 5 minutes ago.

You'll experience things that, in "normal" society, people don't even think about.  You'll feel ribs break as you do compressions.  Ever done chest compressions while watching Oprah on the tv next to you?  Or confirmed a GSW to the head while the guy's cigarette was still lit in his hand?  Things that your mind will have a hard time comprehending.  At any given time, you will doubt your skills, your faith, your profession, your coworkers, and even society as a whole.  Questions like "Why?" or "How?" will eventually come up, either in conversation or in your mind.  Sometimes those two words will haunt you.

Sometimes, these feelings may overwhelm you.  Maybe you can't sleep.  Maybe you don't feel like "going out".  Maybe you drag yourself into work, "burnt out", and half-*** your job.  Maybe you get angry, upset, nervous, or sad at seemingly minor occurances.

We (EMS/Fire/Police/Military) are taught to be brave, and many- both male and female- are taught to be tough.  Nothing bothers us, we're rocks.  We help people, we don't need the help.  Despite what some people expect, you are not a robot.

These after-effects are called "Critical Incident Stress" and, while perhaps mentioned off-hand in class, are rarely fully covered or discussed in normal curriculum.  A CISD meeting is usually a one- or two-time ordeal, as a group.  This can help deal with the acute after-effects of a "bad run", but does nothing long-term.  Some CIS may not develop for a few days, a week, or even a month.  How does one deal with stress past the end of the call or the AAR?

First, be honest with yourself and others.  Be receptive to anyone who notices changes in you, and take an honest look at yourself and the way something has affected you.  This is, above all, the first step.  

Second, find an outlet.  And no, booze and Burger King aren't the answer.  Talk to people.. Talk to your partner, your coworkers, your friends, your significant other.  Talk to a Supervisor.  Try exercising and turn that emotional stress into physical energy.

Third, know your limits.  Know when to step back and slow down, or take a break.  Sometimes you need a couple weeks or a month to just clear your head.  And know when to ask someone for help, or talk to a professional about the stress you're experiencing.  It's not weakness - Everyone experiences it at some point in their career ('On a long enough timeline, etc'), and it's a completely natural human response to exposure to completely unnatural circumstances.


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## firetender (May 1, 2010)

MonkeySquasher said:


> Okay, I'll bite.  This is mostly aimed at the newer guys out there...
> 
> First, be honest with yourself and others.  Be receptive to anyone who notices changes in you, and take an honest look at yourself and the way something has affected you.  This is, above all, the first step.
> 
> ...



MonkeySquasher, your post is exceptional! Thank you.

Your prescription to forestall burnout is right on and needs to be drummed into the head of every medic NEW OR GRIZZLED: *Take personal responsibility and ASK FOR HELP!*

There's only one glitch. The "culture" of the paramedic, not to mention allopathic medicine as a whole, has still not evolved into something transparent where there is reinforcement for medics to experience the work as human beings as well as Flesh Mechanics.

I've been on this site for five years and you know what? I'm actually encouraged 'cause there's a lot more guys like you out there -- who deal with the trauma of the profession directly -- than there has ever been.

Yes, I'm pushing for medics to broaden their perspective of themselves and the work they do. Personally, I've been out of the field for 25 years but my EMS experience has been the cornerstone of all the work in the healing arts I've done since. This site has actually been major momentum for me to find a way to influence that evolution. The book should be available in June. I wrote it for all of us.

What I've come to understand better, through this site, is that most of the medics are quite competent technicians, truly committed to the work and the welfare of their patients, and not terribly interested in exploring the more human, personal, aspects of the work.

BUT, and it's a big one, there are maybe 25% out there who get satisfaction out of such explorations (or at the least, acknowledgment of their human experience) and the dominant culture _*discourages*_talk beyond, "Yeah, that sucks, that happened to me, too, now get on with it."

...and that's what I like about this site. For some reason there's enough safety here for many medics to bring out such issues; issues that have been closeted in the past. More heartwarming is I see many stepping up to the plate, sharing their own paths, and offering support.

But all this is on-line. We need to build safety nets for each other right in our own stations, up close and personal, human to human.

I believe medics can take more personal responsibility for the emotional, psychic, spiritual support of their peers, as you are doing right now. I encourage everyone to take more risks in that arena so we can make room for MANY points of view and support each according to his or her own leanings.

Let's expand the conversation and develop a "Culture of Mutual Support".


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## MonkeySquasher (May 1, 2010)

firetender said:


> ...and that's what I like about this site. For some reason there's enough safety here for many medics to bring out such issues; issues that have been closeted in the past. More heartwarming is I see many stepping up to the plate, sharing their own paths, and offering support.
> 
> But all this is on-line. We need to build safety nets for each other right in our own stations, up close and personal, human to human.
> 
> I believe medics can take more personal responsibility for the emotional, psychic, spiritual support of their peers, as you are doing right now. I encourage everyone to take more risks in that arena so we can make room for MANY points of view and support each according to his or her own leanings.



As you say, this is online.  The anonymity of a computer screen does wonders for loosening the tongue... er...  fingers?

Just over a year ago, I wouldn't have said that.  Or, I would have said it, and not practiced it.  But, we all have our tipping points, and I hit mine this time last year.

Personally, I don't like the term "burned out".  I think it's frequently misused as a selfish, cop-out answer, and a reason to be lazy and complacent.  At my job, I have Basics who have 6 months on their card and in the company, who will stand around outside an ER smoking and talking and dodging calls because _"Oh I'm so burned out"_.  Or call in because _"I just can't work today, I'm so burned out"_.  If you ask them _"Okay, why are you burned out?"_, they'll answer with _"Because everyone else is"_, or _"Because I work too much"_, or _"I must be, because that's what others say"_.

"Burn out" is, I believe, merely a state of mind.  If you can rationalize what you do, maintain a positive attitude, talk to/relate with your coworkers and have an active hobby or social life, you won't be "burned out".

(firetender, just I'm not jumping on you using it, only commenting on the phrase in general.   )


There's this girl at my volly company...  It's no secret that we don't get along.  And yeah, there's a story involved, but that's for another time.  haha    We took a Code once at the University within our district.  Male, mid-twentys, was playing basketball, fell backward, struck head, seized, apnea.  Worked into the ER, ER tried for an hour, no luck.  At the hospital, it was just a bit too much, and she left the ER hurridly.  I went out to find her bawling her eyes out behind the ER.  And, if it wasn't coming from my own mouth I wouldn't believe it - I walked up and hugged her.  And the (term for female dog) got eyeliner all over my shoulder.  But that's not the point..  She hugged back.  I asked if she was okay, and she just said that it was hard because he was our age, and "it's not supposed to happen like that".

A few months ago, one of our newest guys took his first Code.  He's a tall tough-looking kid, in ROTC, ready to take on the world.  They get back, and we're talking about it, and he remarks how he broke her ribs, and how weird he felt, and just sort of stared...  You all know that look, where you're just lost in your head.  And I asked how it made him felt, and if he was okay with it, and reassured him that he was doing the right thing, and it'll feel weird afterward, but know that his feelings are natural and if he ever wanted to talk, my number is on our personnel board.

At my paid company (name withheld to protect the guilty! lol), there's this rule..   To any pediatric cardiac arrest, whether it's a BLS or ALS rig responding, they always dispatch another ALS flycar, and our Supervisor.  After the call, the Supervisor takes aside all members involved, talks to them, and assesses how they are.  Then, they've given the open to clock out and go home if they feel they want some personel time.    ....The Supervisor, however, is then expected to go back and finish his shift like nothing happened.  I know a Medic who, as Supervisor, took THREE different Ped Codes in one day.  He was expected to do all three, and continue his shift.  He quit the next day.

Because in my experience, you almost never get help from your paid company, and your volunteer companies rarely have the facilities or money available for counseling.  Not to mention, like we've said, the "culture" behind our profession isn't always the most condusive to open conversation on our "feelings".

Why can we effect changes in emergency healthcare, theories, and treatments, yet we can't just talk to each other about how we feel?

The change has to start with us, guys.


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## reaper (May 1, 2010)

Just wondering why the medic would not be expected to finish his shift? That is part of the job. If he didn't have a problem after all three then he can continue working.


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## MonkeySquasher (May 1, 2010)

reaper said:


> Just wondering why the medic would not be expected to finish his shift? That is part of the job. If he didn't have a problem after all three then he can continue working.




That's the thing though, he doesn't have an option like the other crews do.

Just trying to highlight how, especially in some paid atmospheres, no emotional assistance is provided.  You're expected to be infallable.


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## reaper (May 1, 2010)

Funny, My service will provide real therapy. Not talking the CISD crap that most push.


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## Seaglass (May 2, 2010)

reaper said:


> Just wondering why the medic would not be expected to finish his shift? That is part of the job. If he didn't have a problem after all three then he can continue working.



My volly squad has a tradition of letting someone have the rest of the night off after their first code, or something that hits them really hard. Usually you'll get a bunch of offers within the hour after things go bad. Most people don't take them up on it, but some do. Sure, traumatic stuff is part of the job, but I'd rather see that than someone who's too upset to function staying in the field.


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## iamjeff171 (May 2, 2010)

also something i find interesting is that there is little/no CISD for those of us who are students. so, those of us who are new and have the least coping skills have little access to assistance. i could see this leading people down the path of developing poor coping skills.

also, on my first code, i found that i wasnt bothered at all by anything related to the direct care of the patient. instead it was the hysterical grandaughter distraught that grandma was dead that got to me.


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## MonkeySquasher (May 2, 2010)

iamjeff171 said:


> i found that i wasnt bothered at all by anything related to the direct care of the patient. instead it was the hysterical grandaughter distraught that grandma was dead that got to me.



Same.  When I'm on a Code at home with family present (someone has to find the person, right?  haha), I make sure all pets are locked into a room far away from us, and then have someone from my crew approach the family.  And it'll go one of two ways.  If they're distraught or getting in the way, someone escorts them to another area out of view, sits them down, and talks to them.  If they're coping well (relative term..), I have no problem with them standing to the side and watching with someone explaining what we're doing.  I've found that can actually be rather therapeutic, because they can see we're trying everything we can, and they can understand what we're doing, and the gravity of the situation.

Ped Codes are a little different.  First, you will never, ever get the sound of a mother's scream out of your head.  And it's a sound that you cannot describe, but also can't mistake for anything else.  And it is the worst sound in the world.  Conversely, after a Ped Code, a crying baby will be the greatest sound in the world to you.

For Ped Codes, excepting cases of possible homicide/abuse, we always transport, and either a Supervisor or PD bring the parents to the hospital.  This is not because of the usual "oh, they're a baby, they can still be brought back!"  No, chances are they'd be brought back with some sort of horrible retardation or palsy.  But, no one in my crew is trained to handle the emotional needs of the parents...  The hospital is.  In a Ped Code, you don't have 1 patient, you have 2, or 3, or more, depending on people present.  They'll all need emotional support and treatment, and the hospital has those resources either on staff, or on call.


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## LanCo EMT (May 2, 2010)

I am a pretty fresh EMT-B in PA. I just finished my orientation training, and will be crew chief on my next shift. I am pretty confident about it... But I am nervous about getting a code; especially since we have a nursing home in our district that we get calls to almost daily.


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## LucidResq (May 2, 2010)

Held a patient's hand on Friday as she peacefully took her last breaths in hospice.


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## MonkeySquasher (May 2, 2010)

LanCo EMT said:


> I am a pretty fresh EMT-B in PA. I just finished my orientation training, and will be crew chief on my next shift. I am pretty confident about it... But I am nervous about getting a code; especially since we have a nursing home in our district that we get calls to almost daily.




It wouldn't necessarily be a bad thing.  At a NH, they could have a DNR*.  They could have been down for hours.

As "Crew Chief", does that make you in charge of the crew, or the patient?  If you're in charge of the crew (all Basics, or AEMTs too?), your job is management...  "Nurse, continue compressions.  John, attach our AED.  Sally, start BVMing.  Charles, grab the backboard." etc.  You help, of course, but mostly just assign jobs and make things run smooth (see ICS).

I believe that's half of a Medic's job at a Code, where you have Fire present too.  Delegation of duty.  Someone compress, someone monitor, someone bag/tube/airway, etc.  Then you do line and drugs, and everyone starts working together to check off the Hs&Ts.





* Note - Yes, I've been called to a NH for a Code and been presented with a DNR, and asked to transport the patient.  I could have slapped her.


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## FLEMTP (May 2, 2010)

First code ever was at 15 years old.. barely through my medical first responder course for the volly service I gave time to...one of my neighbors dropped into cardiac arrest..

my first code as a solo medic was also my first call as a solo medic.. came in as trouble breathing.. and lemme tell you.. she was having trouble breathing alright.. she wasn't!

it went as smooth as a first code can be expected.. and the outcome was very predictable... she was dead upon arrival to the ER.

Now I get a code on average of about one every 2-3 weeks..just part of the job now I suppose...except I usually don't end up transporting. We don't transport dead bodies here.


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## DarkStarr (May 4, 2010)

Was doing my 3rd ride along with the local ambulance service.  Pulled into the driveway and caught the ambulance on the way out the driveway.  2 minutes later we arrive on scene to an 78yo unresponsive female.  Long story short, she didnt have a shockable rhythm and I got to do some CPR.  Medics did their stuff and I did compressions.  She didnt make it.


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## MGary (May 7, 2010)

I'd been running for about 5 months at 60hrs/week (Volunteer) before I got my first code. Luckily, we had myself (a still very fresh EMT-B at the time) my Medic partner, and an EMT-B with approx 5 years experience that jumped on as a third. We also had a deputy who is an Intermediate and who volunteers with our service when he has time, that responded in his capacity as a deputy, but luckily was not above managing the airway for us (Basic management; OPA, suction and BVM).

I've since lost track of how many codes I've seen (1 w/ ROSC, I responded POV on that day and beat all of the other medics and just managed w/ CPR and BVM until they got there, something's to be said for basic skills, even in a code)

I can still remember that guy's face, his wife's cries, and his wife repeatedly asking "Is he ok?" obviously in shock/disbelief. She didn't want to stay in the other room and said she was a nurse, so we let her watch from a distance. In retrospect, it might have been better to ask her to stay in the other room, I don't know. To this day I remember exactly where his house is, exactly where his body lied in the doorway, I even remember what color the jackets were in the coat rack that I threw our IV bag on so that nobody would have to hold it. I was first to start CPR on that guy and though we had radial "pulses" from my CPR so I'm sure the ribs were pretty well broken (Large guy), I don't remember feeling ribs break. However, I don't remember ever feeling ribs break. I guess I concentrate more on what I'm doing and rate and everything and watching the monitor while I'm working so that I don't feel them break. 

But know what the weirdest thing is? Even though I remember everything and can replay the whole scene like watching a Youtube video in my head, I never felt that depressed or saddened by it. I knew we'd exhausted every option we had. We'd followed ACLS protocols, pushed 3 rounds of drugs, and worked him for a total of 45 minutes. We got online med-direction to call it. We went back to the station, cleaned up and restocked the rig, and opened up a bag of hotwings and that was that. I've still yet to feel too saddened or depressed by a code. I make sure we exhaust every option we have (Epi, Atropine, Bi-Carb, etc.) do the best CPR possible, and work it with all we've got. Then if we lose him, his creator called him back and I move on.


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## LanCo EMT (May 17, 2010)

Well, had my first code last night. FD rescue was on scene by the time we got there and had initiated CPR. I took over compressions and a firefighter EMT was bagging. Medic tubed her and pushed 3 rounds of drugs, but according to the family the Pt was last seen alive about an hour ago so down time could have been significant.  When we first showed up, the Pt was very cyanotic which tells me that down time was more than a short while. Online medical command called it after working her for about 25 minutes.


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## emtstudent04 (May 17, 2010)

I had a similar code to that. Shift started 0730 get our first call at 0800 comes up on the computer as pt in cardiac arrest not breathing no pulse so we leave the station code 3 half way there we get an update cpr in progress. FF's already initiated cpr we arrive, Cpt. tell's me to get in the rotation. I start bagging for 2 min and then switch with the other FF and start compressions for 2 min and then back to bagging for 2 min then back to the chest for 2 min. I then got rotated out and we got on the radio and the pt was pronounced 25 minutes later.


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## BlakeFabian (Oct 16, 2011)

Those pediatric calls are hell, for even the most experienced technician; especially in a code situation. I don't really think anyone here can tell you how to "deal" with the emotional aftereffects of a code. You're going to have to find what works best for you and stick with that.

I find, for myself, it's easiest to emotionally detach myself from my patients. I  pump on their chest, splint their bones, or simply lift old grandma off the floor then I go home and sleep soundly knowing that I did the best I could with the situation at hand.


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## Adsy (Oct 16, 2011)

Hello, one from the UK for you with a (typical) arrest. About 4 months through my placement as a Student Paramedic. 

Working with an Ambulance Nurse (AN) on an RRV got called to a male who suddenly stopped breathing in a car. Lights and sirens on the way up, other road users not yielding. 

Got there, male cyanosed, CPR in progress in the back seat of the car by a relative. Had to move the patient out of the car onto the road, AN took the road side while i got the patient's head. Manoeuvred him out of the vehicle, where upon i managed to fall out of the car head first. Started CPR while the AN prepped for airway management and defib, one of the relatives runs over shouting "mind his head!" Look down to see during CPR that the patient's head was bouncing up and down hitting the tarmac. A few minutes in we get backed up by a different ambulance service with an EMT and Paramedic, they load the patient up while I get some details from the family. 

En route we had had a bit of reckless driving from the driver, resulting in the patient nearly coming off the stretcher, me ontop of the patient and the AN ontop of me. I remember feeling a few ribs go, and what could only be described as a look of horror, i looked at the EMT, and just said "I think...i've just broke this guys ribs..." 

Patient didn't make it but despite the shortcomings we gave it our best.


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## dstevens58 (Oct 16, 2011)

First one was back in the 70's, mouth-to-mouth at first until EOA was put in.  All I remember is doing CPR the 14 miles to the nearest hospital.  Van-type ambulance, dripping sweat, the cracking ribs, the abdominal distention.

Been on a couple throughout the years since, usually not witnessed or started by a bystander......but it wasn't until a few months ago I went to a call and the patient was fine, AOx3, then coded in front of me (she didn't make it either).


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## EMSrush (Oct 16, 2011)

I enjoyed reading some of these. I wasn't going to contribute, but I changed my mind.  My experience wasn't particularly glamorous or special, but I remember it well...

My first code was during my first hospital clinical rotation for medic school. Apparently, a 46 y/o female had walked into the ED (difficulty breathing) with her husband, and coded right then and there, in the doorway. I didn't see it happen; I was busy starting an IV in another room at the time. A nurse walked in and discreetly told me to go help out with the "code blue". I walked into the room, and was shocked to see that the Pt had been "code prepped"- that definitely took me by surprise! I switched between compressions and bagging, and I remember looking at her open eyes, seeing her carefully applied eye make up, and thinking to myself, "Wow... she didn't plan to die today..."

The doc finally called it, and I left the room. I watched on the security camera as the doc went in to talk to her husband in the waiting room, who was completely unaware of the finality of the circumstances. There were a couple of other family members there, anxiously awaiting to hear the fate of their loved one. I watched them collapse into each other and cry. I felt a lump in my throat; the emotion was quite raw. It was similar to things that I had seen on TV before, only this time it was real, and this time, I wasn't watching actors. My preceptor walked up behind me and asked if I was okay. I replied that I was, and he said, "Good. Now get in there and help make her presentable."

I cleaned up the room, and prepped the body for her husband and family. I tried to make her look as peaceful as possible. I left the room as the husband and nurse walked in to give him some privacy.

Just when I thought my job was complete, I was asked to help place her in a body bag and help bring her down to the morgue with security, down in the basement of the hospital. I helped lift her body into her temporary resting spot. Talk about running a code from beginning to end! I needed a few minutes to decompress and process it all, but I was fine. Subsequent codes got easier for me. 

As much as I had disliked continuing my "relationship" with my first code, from beginning to very end, it was a very humbling experience. In hindsight, I think it was a great experience for a paramedic student.

I later learned that she was 1 week post op from having a bunion removed. She died of a PE.


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## Fish (Oct 16, 2011)

My first arrest was when I was an EMT at 19, on a 40 y/o in his driveway that we pronounced on scene. Since then I have become a Paramedic and I have worked my best friends dad, a friend from high schools mom, a Pediatric Drowning and somewhere in the hundreds for Adult codes. For me, the worst part of the code is the families reaction, when I was still new this bothered me a lot more than it does now. I think with time the "emotional" effects of the call will get to you a lot less. It was really hard for me to see family members cry and say things like "My poor wife, 56 years together now what? I am all alone" I don't know if it is just me, but I find that working a 85 y/o Cardiac arrest at a Nursing home with multiple health problems has a lot different of an affect than the 42 y/o mother of 3(on scene) that coded infront of us with no known health problems. I guess this is just because it is an expected for an Elderly person with Multiple Health Problems than the Mom who still has kids in HS and no known health problems.


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## Yarbo (Oct 17, 2011)

Arrived for pt. c/o gallbladder attack continued to assess the patient of course. During the vital signs/ecg application the patient was so diaphoretic, we needed a cloth to put on the leads. The paramedic had taken this call over and just getting into his questions the patient goes into vtach on the monitor. Patient starts to do some really funky agonal breathing and once we get the patient on the ground I'm delegated to BVM.

As I start ventilating the patient the arms are moving up towards me but the patient is in vfib now. After rounds of cpr and shocks the patient is conscious and starts talking to us. Transport the patient in a sinus rhythm but once we arrive at the hospital the patient goes in and out of vtach as they're wheeling her to the cath lab. (LAD Blockage)

The next day the patient is in the coronary care unit with her family.


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