# First Code (observed)



## Dundee85 (Oct 17, 2017)

I had my first code as an EMT-b yesterday. It was my third shift as a volunteer. As there were many other providers present on scene I didn't actually get hands on with the pt but I watched the whole thing. I thought I'd be more excited for a first code but I dreaded it from the moment we got the call. Newborn, cyanotic and lifeless. I guess I'll feel more comfortable the next time I see something like that but I have to admit I felt totally helpless and worthless as an EMT. Like everything I knew just evaporated. I could have taken direction from someone (here, do two thumb compressions at a rate of 120 per minute). But I felt incapable of thinking clearly enough to volunteer my help.

That's what bothers me the most about it. Obviously seeing that dead baby and knowing what his family is going through is horrible, and it's been on my mind since yesterday. But I can accept that. I can't accept feeling like this call shook me up to the point of feeling like "OMG, what do I do?" 

Is it normal to react that way the first time you see something like that? I never want to put a patient at risk because I get overwhelmed. Can you feel this way as a newbie and still get to the point of being a calm and competent provider? This has been the first thing to really rattle me. We dealt with a scalded 11-month old last week and I did pretty well on that, I was able to recall what I knew about burn care (for the most part). Anyway, thanks ahead of time for your thoughts.


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## mgr22 (Oct 17, 2017)

It's too bad your first arrest had to be a ped -- even worse, a newborn. Pediatric arrests are uncommon. I don't know any medic who'd consider them routine.

Feeling overwhelmed in that situation doesn't mean you can't do the job. You were unlucky. Unless you're working in a critical care environment, most of your calls will be much, much less grim than what you just had. Give it a chance to regress to the mean.


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## Dundee85 (Oct 17, 2017)

Thank you mgr22. Your reassurance is very helpful. It was a huge learning experience and something I'll never forget.


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## StCEMT (Oct 17, 2017)

The first code is always stressful, even more so considering it was a newborn. You will get better at handling the stress and commotion so you can filter out the background stuff and focus on the task at hand. It comes with time, experience, and reflecting after a call to learn how you can improve, then making the necessary changes. 

I've found a few things that helped me when a lot of stuff is happening in a very short time. If you get lost, go back to the beginning. ABC's good? Cool, move on. Communicate openly with your team. I try to make sure everyone understands their role in an arrest and that I clearly communicate the plan along with anything I find, need help with, etc. The same goes for the people working with me. I want their input on what they see, where they are in compressions, anything relevant they find, treatment suggestions, etc. so we are all on the same page. Also, slow down. Rushing causes mistakes, mistakes take more time. Take your time, do things step by step, and do them right.

So the TLDR version 1. Go back to square 1 2. Open two way communication 3. Slow and smooth. Those 3 things have helped me a lot in terms of staying moving in the right direction.


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## Dundee85 (Oct 17, 2017)

Awesome. Thank you so much for this. I will take it to heart.


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## Chimpie (Oct 18, 2017)

StCEMT said:


> The first code is always stressful, even more so considering it was a newborn.


@Dundee85 Let me add to @StCEMT sentence by saying, 
"... and not being hands on." 

There have been scenes (non-cardiac) where I was the fourth or fifth person to arrive. Not much for me to do except help maintain the scene, ensure safety, start planning for removing the pt from the scene, etc. It can be frustrating because you want to help, you want to learn, you want to experience.

Volunteer as much as you can. Get the experience. Learn the rhythm. Practice teamwork.


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## johnrsemt (Oct 19, 2017)

All of the advice above is good;
also talk to the crew that was there with you;  and others, and tell them how you are feeling and thinking.
I have had a lot A LOT of rough runs,  and have always done better just talking to coworkers than even stress debriefing.

Good luck


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## rujero (Oct 22, 2017)

*TALK TO PEOPLE ABOUT THIS! *At most a professional, and at the very least more than just expressing it in a forum online. This was a traumatic event for all involved, and anyone who can shrug that off is too burnt out to be in this business. BLS codes are a matter of protocol and muscle memory. With practice, you will react faster, think clearer, and feel less helpless. But make no mistake, you will _hopefully_ never get used to a pedi code... especially an infant. If you want to talk more about this feel free to message me privately.

-r


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## Dundee85 (Oct 22, 2017)

Thank you. I've talked to a few people about it, mostly non-EMS people. But people at my agency have been incredibly supportive and I've had two superiors come to me and ask how I'm doing and have said time and again that they're there if I need them. 

Thanks for your reply, it's good to have reassurance that my rxn is normal.


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## NewMedic11b (Oct 24, 2017)

Wow, first code and it's a newborn. That's rough... I have been lucky and have never worked a pedi code, and I dread having that day come. But honestly, even when I experienced my first adult code as an EMT, I froze up and thankfully my medic just started telling me what to do and it all fell into place. Just the process of learning, being new, and getting used to it all. I mean hell, I'm still a new medic (didn't choose my username just for fun haha) and I constantly worry about freezing up on a call that is completely unfamiliar to me. Personally, I re-live calls in my head for quite a while to think about what I could have done better or will do next time. I don't beat myself up over it, but we all strive to be better right? Just do what you can with the best intentions, and be open to constructive criticism from those who have been in the field for a while.


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## Dundee85 (Oct 25, 2017)

This is very helpful to hear. I also go over calls later, thinking about how things went and what I might do differently the next time I see it. I have been worried about freezing up on a call so I'm glad to hear others have the same fear. Thank you for taking the time to reply.


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## Jon4010 (Nov 21, 2017)

My first full code sucked, I was so nervous. My take on it though, whatever bad call you get makes you stronger. You will think over and over of what you've could've done, and make you more confident for your next one. I don't mean to sound insensitive, but it's true, atleast for me.


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## wtferick (Nov 29, 2017)

I remember my first arrest. 17 y/o at the high school. Call came in as a seizure. These type of calls will always be a learning experience.


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## that guy (Nov 1, 2018)

Had my first this week. Hard to even call it a code since the POLST was found after about 30 seconds of compressions. I volunteer for search and rescue so I've been on recoveries before, so that part wasn't as shocking, but having the family there and having to witness the whole thing was pretty awful.


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## DesertMedic66 (Nov 1, 2018)

that guy said:


> Had my first this week. Hard to even call it a code since the POLST was found after about 30 seconds of compressions. I volunteer for search and rescue so I've been on recoveries before, so that part wasn't as shocking, but having the family there and having to witness the whole thing was pretty awful.


In my experience those calls where the patient has a DNR/POLST usually aren’t bad. Family has been expecting it and it generally is seen as a relief from suffering.


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## gotbeerz001 (Nov 2, 2018)

Pediatric fatalities don’t really get better… They are just about the most unnatural thing there is


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## wtferick (Nov 2, 2018)

Had my "first code" working as an ER Tech outside in the parking lot. Brought a wheel chair for this family member requesting it and found the husband in cardiac arrest. Straight to the ground he went and administered CPR. 

Pulses were regained and Emergency pace maker was placed. 

Different type of code..


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## Old Tracker (Nov 4, 2018)

IF you have a lot of more experienced people on a scene like that and the medics are administering drugs you could be very helpful by making notes of what time they gave the drug, what drug, and how much.  Be it Epi, or whatever. write it down and the quantity etc.  It will be appreciated by whoever gets to write that report up.  You could help bagging also, the every 2 minutes thing.


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## EKUEMT (Nov 4, 2018)

This is completely normal for this type of call. Peds codes are absolutely HORRIBLE, no matter how many times you’ve worked them. 

Now that you have your first one out of the way, the next one you’ll be able to think more clear in. 

As for thinking about it, you always will. Mine still lives with me. I can still see the house, the baby, the mom, the dad, I can even tell you what kind of onesie it had on in extreme detail. But I took it as a learning lesson. Something can always be taught in every experience. I can even still tell you how it felt to ride in on the stretcher doing compressions and bagging the baby. 

I reverted back to neonatal protocols as a last resort to get something back. But we didn’t get ROSC and we watched them call it in the ER. 

You’ll get to the point of being a competent provider. Everyone gets nervous and has those moments. We all have and still do. Analyze every second of that call and see what you could do better. Talk to someone who was on the run with you. That’s a great way to learn things and become more confident and competent. 

You got this!




Dundee85 said:


> I had my first code as an EMT-b yesterday. It was my third shift as a volunteer. As there were many other providers present on scene I didn't actually get hands on with the pt but I watched the whole thing. I thought I'd be more excited for a first code but I dreaded it from the moment we got the call. Newborn, cyanotic and lifeless. I guess I'll feel more comfortable the next time I see something like that but I have to admit I felt totally helpless and worthless as an EMT. Like everything I knew just evaporated. I could have taken direction from someone (here, do two thumb compressions at a rate of 120 per minute). But I felt incapable of thinking clearly enough to volunteer my help.
> 
> That's what bothers me the most about it. Obviously seeing that dead baby and knowing what his family is going through is horrible, and it's been on my mind since yesterday. But I can accept that. I can't accept feeling like this call shook me up to the point of feeling like "OMG, what do I do?"
> 
> Is it normal to react that way the first time you see something like that? I never want to put a patient at risk because I get overwhelmed. Can you feel this way as a newbie and still get to the point of being a calm and competent provider? This has been the first thing to really rattle me. We dealt with a scalded 11-month old last week and I did pretty well on that, I was able to recall what I knew about burn care (for the most part). Anyway, thanks ahead of time for your thoughts.


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## johnrsemt (Nov 5, 2018)

I have worked well over 100 codes, I don't remember many of them  but I remember in detail every pediatric code:

Like they said above,  if nothing else grab something to write on, and take notes, time everything that something was done; drug, shock, etc.   I have had people taking notes, that didn't do times,  I have had people taking notes that did great times, but not what was done at each time.  2 people doing notes is great. 
Rotate in to do compressions, or bagging, etc.
Talk about it at station after,  ask questions;  for me being able to talk about bad runs helps;  it helps more than CISD has ever done.  In fact the first time my FD brought a counselor in to 'help us' we made the counselor cry.  Didn't help the crews much.
even talking about bad runs in general helps  no runs in particular,  just 'remember the arrest that nothing went right,  couldn't do anything correctly except the guy comes and thanks us every year for saving his life?' 

I really miss being able to do that.  It has been 10.5 years since I worked on my old fire department and were I work now we don't do that and it is hard  Counseling helps a little but nothing like that did


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