Bad call

[8jimi8]

Regardless of participating in a CISD, your employer should have an Employee Assistance Services, or some like-named resources who can assist you with finding someone to talk to.

The important idea here, is that you let these things out of your head and process them.

 

[firetender]

I have a Dream!

First off I want to acknowledge everyone who stepped up to the plate for this first timer...Good Work, with lots of heart!

Now, I have a question:

If the culture of EMS was such that we were accustomed to really participating with each other as support systems in doing the work we do, would this Brother even have to be writing here?

I'm not pointing the finger, but I have a point. Could you picture a work environment that recognizes stuff like this is part of the job and (at the very least) talking about the more haunting aspects of it to our peers would be the FIRST line of recovery?

The people involved in the call would be the most logical place to begin, but there would have to be a feeling of safety, don't you think? EMS has yet to outgrow making judgments on one's ability to do the work based on the possibility that human emotions are experienced before, during, or after a call.

I know that means each of us might be asked to really look into him/herself, but wouldn't that seem a small price to pay for more evenly distributing the weights we carry doing the work?

Honestly, I really only see scattered evidence of any system-wide attention to stuff like this, which is the precursor to burnout, the very thing that I believe makes us NOT a profession.

Therefore, my conclusion is, we need to handle this ourselves, FOR each other. Why? Because we're the only ones who can really understand.

And I don't think this is a big deal; we just have to start doing this ourselves before sending our peers to others.

What do you think? (and I hope we haven't lost him because that was his first and only post!)

 

[canadianpcp]

Just like everybody on this post has suggested, talk to someone about the call. I have done some bad calls and the best thing to do is to talk to somebody!

 

[firefighter_jer]

Thanks everyone. We had a CISD since my post. It helped a little. My brothers that were with me on the engine that day have all got together a few times and we are getting through. I appreciate everyones input on my situation. I've made it a point to not let this effect my personal life, and at the station, all the brass have been great with helping us out. Any more suggestions would be great.

 

[firefighter_jer]

One more thing guys... the call was bad enough. Significant facial and cranial trauma, massive blood loss. Her injuries were so severe, I couldn't get a good airway until the medic arrived and intubated. Her family was there the whole time, and watched us wheel her to the rig with me riding on the gurney doing compressions. That being said, one of the things I can't stop thinking about is the decisions my captain made as soon as we arrived at scene. SO was at scene before fire was ever dispatched, so when we pulled up, my captain jumped out and ran inside. He said he made contact with a SO deputy, and the deputy said "I think its an 11-44 but I need you to confirm. My captain then checked her pulse and "confirmed" it. He stoped us before we could even make it in the building. Cpr was delayed until the medic showed up and told us to work the code. Now, my fire dept is BLS only. And here, an EMT can only withhold cpr for 5 different situations.... none of those were met.

This is why I can't get passed this call. I should have ignored my captain and gone in.

 

[usafmedic45]

And here, an EMT can only withhold cpr for 5 different situations.... none of those were met.

What are those five situations? I would assume decapitation, rigor and decomposition would be three of them.

Hmmm....I would not have started compressions because of injuries not compatible with life in concert with a lack of vital signs. This honestly needs to be discussed with your medical director.

 

[Foxbat]

What are those five situations? I would assume decapitation, rigor and decomposition would be three of them.

Probably would also include incineration and being frozen (as in actually frozen solid from exposure), at least that's what PA protocols say...

 

[abckidsmom]

What are those five situations? I would assume decapitation, rigor and decomposition would be three of them.

Hmmm....I would not have started compressions because of injuries not compatible with life in concert with a lack of vital signs. This honestly needs to be discussed with your medical director.

Valid DNR needs to be on the list.

 

[usafmedic45]

That's true, but I can't ever recall a trauma patient with a DNR. I was speaking more to the trauma side of the equation.

 

[CAOX3]

What are those five situations? I would assume decapitation, rigor and decomposition would be three of them.

Hmmm....I would not have started compressions because of injuries not compatible with life in concert with a lack of vital signs. This honestly needs to be discussed with your medical director.

No it shouldn't, I like provider discretion in these cases. Not everone fits in a nice little policy box, I have worked multiple traumatic arrests that have survived from no defect to minimal. It should be at the providers discretion, there are always extenuating circumstances that need to be taken into account.

I understand the survival rates of traumatic arrest are dismal, but I would never second guess a providers decision from a million miles away given limited facts, it sounds like an airway issue address it and give her a chance to fight. Medicine is far from exact and until the percentages are 00.0 I give them every opportunity. No I don't work every traumatic arrest, not even close, but if there are circumstances that I determine need to be addressed before I leave them with the cops, you bet your behind I am going to.

We some times get caught up with science but the fact is there are always exceptions and if that kid has a chance to walk out of the hospital with her parents with minimal deficit I'm going for it until the day I put in my papers and nothing short of a study that confirms 100% fatality rate or debilitating deficit will change my thinking.

 

[firefighter_jer]

For my area, its decap, decomp, incineration, dnr, and rigor. None of those were met by this pt. When we started, she was warm and had a rythem. Don't ask me which one, because I was focused on airway, after a minute or so she went into asystole. It was a 7 year old girl with none of our criteria met to withhold cpr, and family on scene.

 

[usafmedic45]

No it shouldn't, I like provider discretion in these cases. Not everone fits in a nice little policy box, I have worked multiple traumatic arrests that have survived from no defect to minimal. It should be at the providers discretion, there are always extenuating circumstances that need to be taken into account.

Well, I am implying discretion but to me a crushed head with no vitals is- at best- a potential organ donor.

nothing short of a study that confirms 100% fatality rate or debilitating deficit will change my thinking.

Just for the sake of debate, what is the trade off that you are willing to except between resuscitating....say, 10 or 15 massively handicapped if not flat out vegetative kids for every one you get that is at or close to the pre-insult baseline? To me, saddling the family with a crippled child or the human equivalent of a very expensive paperweight is far more of a departure from good medical ethics than the often >1% chance of letting a child who otherwise would likely have been severely crippled not be resuscitated.

 

[usafmedic45]

When we started, she was warm and had a rythem.

Was there a pulse with it? Our protocol was if it was a pulseless rhythm with a rate of <40 we could terminate resuscitation efforts in trauma patients after we ruled out reversible causes.

It was a 7 year old girl with none of our criteria met to withhold cpr, and family on scene.

Honestly, to me it matters naught whether the patient is seven or seventy or whether the family is on scene or not. Dead is dead. Mortally wounded is mortally wounded.

 

[firefighter_jer]

I understand. But here, when none of the BLS criteria are met, I can't stop cpr. And as an emt, I don't have the luxury of thinking about quality of life. Like I said before, if one of the five items are not found, im doing cpr. This is not something I am ready to debate about, its still fresh for me. Im not mad at all. But if this is where this conversation is headed, im not going to post anymore, but i'll see you guys on another thread!

Once again... brothers and sisters. Thank you all so much. You guys made this a little easier.

 

[usafmedic45]

And as an emt, I don't have the luxury of thinking about quality of life. Like I said before, if one of the five items are not found, im doing cpr.

A lot of "decapitation" criteria also include a caveat about "functional decapitation" where the head is still attached but you have brain matter exposed or the head is deformed in such a way that it's overtly obvious that the patient is non-viable. Perhaps discussing such an option- or at least seeking clarification regarding it- from your medical director might be a good idea to minimize the chances of having to go through this again.

This is not something I am ready to debate about, its still fresh for me.

Duly noted. I'm sorry to have turned this into a debate.

 

[firefighter_jer]

No worries brother.

 

[CAOX3]

I understand. But here, when none of the BLS criteria are met, I can't stop cpr. And as an emt, I don't have the luxury of thinking about quality of life. Like I said before, if one of the five items are not found, im doing cpr. This is not something I am ready to debate about, its still fresh for me. Im not mad at all. But if this is where this conversation is headed, im not going to post anymore, but i'll see you guys on another thread!

Once again... brothers and sisters. Thank you all so much. You guys made this a little easier.

I apologise, I played apart in turning this into a debate.

Also remember transfer of information is also part of the healing process, there is a ton of experience on this forum that will help you get to where you need to go and to have a successful career in EMS both physically and mentally.

Yes your wounds are freshand they will heal, we have all been to thst place and there is no better solution then discussing the matter with others who have experienced the same pain.

So I agree with the premise of your statement, but you deal with it when its fresh, success is gained by addressing it now not burying it until you determine its necessary. I have ben there on more then one occasion unfortunately I had to go to some lonely places before I learned.

So deal with it now even if its painful and save your loved ones the hassel of trying to pull you out of the hole your going put yourself in.

 

[firefighter_jer]

No need to apologize, I understand a debate is healthy. It just doesn't feel right. I may be letting this call get to me a little too much. We are having a follow up cisd tomorrow, so we'll see how that goes.

Im not letting it get my down at home, im not sure if I should tell my girlfriend about it or not.

On a lighter note, im getting promoted to driver/operator tomorrow, so im focusing on that for the time being.