# routine transfers



## johnrsemt (Mar 12, 2008)

watch out for those routine transfers:

   Last week we were taking a 6 month old from our childrens hospital back to a long term care facility that specializes in children with major medical/mental issues that can't be taken care of at home.

    infant had trach, vent dependent; she had 2 cardiac arrests in last 2 months and was a full code still:  GCS was 6: 4,1,1;    She was diagnosed with a viral URI; needed suctioning more often.

   transport was approx 60 min,  pt on monitor Sinus tach at 150, no ectopy; great cap refill.  no biox probes on the truck for an infant.

   approx 50 min into transport pt started to brady down.  at approx HR of 100 min I took her off the vent and started bagging her; hoping it was a vent issue and it would help.  It didn't.  good breath sounds, no congestion, did a quick suction of trach, no problems, no change.   started compressions at approx HR of 80: still bagging with 100% O2.  pt still going down.  EMT-B preceptee took over CPR, I put shock pads on her,  CPR for 2 min (protocols before attempting to shock).  did quick check:  asystole.  (Code summary showed sinus tach, NSR, Sinus Brady and asystole).
    we had already diverted to small town hospital:  phone report was basically:  "6 month old, cardiac arrest, not shockable, CPR in progress IV/IO attempt en route, see you less than 5 minutes".
   Wiping leg for IO, (no IV sites found); when we stopped at ED.   they worked her for 30 min with our help (small hospital, busy, short staffed).  3 rounds cardiac drugs; pediatrician came from home,  he jogged, (faster than driving through parking lot).

    We did everything right, started fast; she still died.
   my partner has been EMT-B for almost 2 years,  it was her first arrest in truck and first death (and had to be a 6 month old)   she is taking it hard:   "if I drove faster, etc".   Our preceptee is taking it better than she is.
   trying to help her out is tough;  I have been doing it for 10 years, and is probably 15-20 infant arrest and it is tough on me to.

     any ideas to make it easier on partner?


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## Ridryder911 (Mar 12, 2008)

Ped arrest suck. Period. Now, everyone can agree upon that, it is hard to convey that to your partner. I would suggest maybe allowing her to vent a little and attempt to answer her questions. Reassuring that this is usually somewhat the norm and that it is okay. Usually time and experience will resolve most of the problems.  

Possibly educating that the child was pre-doomed and giving some information about respiratory problems and thus they have dismal outcomes. Numbers do not mean much too many EMT's, but emphasizing the child was already circling the drain of life with previous history of prior cardiac arrest, trach, etc. I would emphasize that the quality of life versus quantity of life might be addressed at this time. Discussing not only this pediatric patient, but also addressing geriatric and terminal patients. A good discussion of living wills, DNR, etc might be talked about at this time, since this will occur at some time as well. 

Doubtful that even if you had a pediatric intensivist along with you the outcome would be changed. 

There is no real set way of attempting EMT's to understand the bad parts of the business. Recall upon how you had to learn to deal with such, sometimes some have to learn upon their own. 

Good luck, 

R/r 911


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## Ops Paramedic (Mar 12, 2008)

Thes are never easy, and it would appear difficuilt to take anything good from such a call.  If you and crew can take only one good aspect of the call and apply it to another call to make the difference, the passing of this patient would not have been in vein.  One has to talk about such a call, and it might be a good idea to relate to calls whereby the outcome was positive as result of your work.

You are not alone when it comes to these type of calls.  We often have to transport patients with a poor prognosis, or very unstable, to other facilities.  This being due to the transferring facilty wants to get rid of the patient, or you know that by putting the patient in the back of your bus, he will be recieving better care already. 

Good luck.


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## Guardian (Mar 13, 2008)

I feel for you.  I hate those types of calls myself.  Time heals all.


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## Airwaygoddess (Mar 13, 2008)

As other folks have said, peds calls are so hard, please remind her that she did everything that she could, and PLEASE tell her driving any faster could have been with dire results, putting herself and her crew in extreme danger, I know that people deal with grief in their own way, it sounds like she needs to talk to someone more about this difficult call......-_-


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## firetender (Mar 13, 2008)

as Shakespeare said, "Let Death be your advisor."

Quite bluntly, we, of all people, get to know first hand that we're all gonna die. At some point, you, your partner and everyone in this forum will have to come to terms with that fact that we're just temporary players helping other temporary players lengthen the short time we have on this planet.

All that's left, then, is lessons. The moments you spent with that doomed child brought you closer to death, but they also were instrumental in helping you to embrace life. Now, you are alive with concern for your partner.

There is only one focus, really...to help the time we pass here be less painful, and when the time comes, honor the passage that we all will eventually take. Can you see how there can even be vast appreciation for the shortness of the journey of a child so technically challenged?


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## Tincanfireman (Mar 13, 2008)

Probably a poor analogy, but you and your crew were in the bottom of the ninth, two out and two strikes down when you left your origin facility. With a GCS of 6, that little one was facing some long odds as it was. From up here in the cheap seats, it sounds like you did everything you collectively could to give your patient every chance to make it. Get your partner to someone who can help her make sense of the baby's passing and explain to her that all the diesel fuel in the world wouldn't have made a difference in the outcome. My sympathy and prayers go out to all of you; that was a tough one...

P.S. Firetender, your words were incredible, as usual...


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## certguy (Mar 13, 2008)

No call hurts like the loss of a child . Years ago when CA EMT's could finally honor DNR's in the field , my first one was a 4 y/o girl with terminal CA . It tore me up . After years of saving lives , now legally , I had to let this little one ( about the age of my son ) go. Like Rid said earlier , I considered quality and length of life , which helped some , but not much . I believe God's got a plan for all of us and in both of these cases , he may have decided these kids had suffered enough and simply brought them home to end the suffering . The child's in a far better place now . 


My thoughts and prayers are with you and the pt's family .


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