Dealing with ped Codes

rayemtjax77

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Hi all. This is kinda hard for me to post, but I am having alot of issues dealing with several codes that I have worked since I started this profession and thought that since this is a EMS site.. I could pick everyone mind about things.

I have been to therapy and they all have told me that they do not know what I need to do to try and fix it. So I was talking to another EMT a few weeks ago and he told me to write it all out... and post it someplace. Trying to bring it out in the public. So.. here it goes...

Raymond
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Do this in memory…

On December 25, 1994 , I responded to a infant cardiac arrest call at approximately 8am. I was the first to arrive on scene. I ran inside to be directed into a bedroom to the right side of the house. There in view a lifeless 8wk infant little girl. I immediately assessed the little girls airway and begin my treatment. The little girl was breathless and pulseless. I began CPR on her until my dad, which was a Lieutenant on the fire department. He asked me what I had. I advised him to contact the dispatcher and place a helicopter on stand by and to have rescue to hurry up. When I heard the rescue unit arrive on scene, I scooped up the child and ran out the door with her and into the rescue unit. By this time I had been doing CPR on her for over 20 minutes. I laid the baby down on the stretcher and continued CPR. The Paramedic begin to get ready for a airway insertion. Once the little girl was intubated, I was doing compressions only.. and we had stopped to feel for a pulse. There was one. No ACLS was started at this point. The paramedic called for Life Flight to be enroute. I had my fingers on the little girls Brachial pulse.. when all of a sudden.. it stopped. I began compressions one more.. than the engine company arrived. Once they arrived, I stepped out and began to assist with the Landing Zone prep. I hear over the radio the med report given to the life flight crew. As Life Flight arrived, the rescue crew advised that they had gotten a pulse back. Then a few seconds later, I hear that they lost it again. By this time, the life flight crew had already gotten in the back of the rescue to receive care of the little girl. As I am standing at the back of the rescue, I see the doors fly open, and they pull out the stretcher. CPR had been started yet again. By this time, I was starting to blame myself for not doing something right. I was feeling such heaviness on my chest. I began to cry. As they loaded the child into the helicopter and took off, I listened to the med report enroute. They had gotten back and lost the pulse 2 more times. Now I was really blaming myself HARD. All I could do is replay the episode over and over to see what I did wrong… or what I could do differently.

About 2 days later, I was called by the Shift supervisor on for Rescue. She told me that the child had passed away about an hour after arriving at Baptist. I completely lost it.
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January 31, 2008

A pretty busy night in the ER. The Charge nurse was on the recue phone when she looked at me and pointed to room 20, our recess room. When I went in, I saw the pediatric crash cart in the room. My heart dropped into my stomach. While myself and about 3 others get the room ready, the charge nurse came in and told us that we has a 3 year old was found in the tub unresponsive. My mind started to race at a very high pace. Images on my last pediatric code started to come into my mind. I started to get really nervous. I thought about leaving and getting someone, but I felt obligated…. Obligated to try to make this right. When the rescue got there, we started working. I assumed chest compressions from the fire department staff. It was your "not normal" code that we have all ran in the past. Orders were being shouted, emotions could be cut with a knife it was so thick. We worked the child for an hour and a half…. And I never stopped compressions. All the time while I was doing this, all I could do is think about my children, think about that little girl that I tried to save back in 1994. I was seeing pictures of them, thinking it was them that I was doing the compressions on. I was very focused. The DR finally said that we could not do any more. There was not a dry eye in the room. We were preparing the child for the family to come into see him. One of the nurses made a sexual remark about one of the pharmacist that was in the room earlier. I went off on him telling him that "This was not the time or the place to be making dumb *** remarks like that". Then the family came in and starting crying and yelling. That is when I lost it. I ran out the department, out the ambulance entrance. I could not control it, I started crying like there was no tomorrow. I cried so hard for about 20 minutes. I could not stop thinking about my kids, the family, and the team members that helped try to save that child’s life.

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February 4th, 2008

I was doing my ride time with Jacksonville Fire/Rescue Department. We had a pretty uneventful day. I had planned on leaving about 5pm. About 4:02pm a call came in about a Cardiac Arrest. That is all we knew. We ran out to the truck, Got fastened in and headed out. It was not until then that I looked at the computer screen and saw that is was a 6 month old that was in Cardiac Arrest. My heart Started pounding… my breathing got faster… I started to panic. I felt nauseous and wanted to stop right there and leave. I started thinking about the event that I had the previous week. Before I knew it we were stopping and getting out. The Engine Lieutenant ran inside the house and brought the baby out. I had looked out the back just for a second when I saw him doing this. I started to panic. This was exactly how my first situation happened… and then images started flooding my mind. It was very hard to stay focused. I did chest compressions on the baby until we reached the hospital. When we turned care of the baby to the hospital, I went back out to the truck and wanted to cry so badly. But I couldn’t. Nothing was coming out yet my insides were tearing up. After putting the truck back together… it all started to pour out.

It was totally silent. The rescue officer said "Raymond, you did some good compressions on the baby." I answered "Thanks". After a few more minutes, I asked if it would be ok if I left as soon as we got back to the station. He said that it was ok.

I wanted to quit… I was scared to go back to work. I was scared to go home. I was scared to drive home. I was a mess.

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March 6th 2009

My 3 day back as a tech in the ER after being on light duty in the peds department as a clerk. I looked at the assignment sheet and noticed that I was in peds. I should have said something, but was not going to because I did not want to get anyone upset. I worked the department very well. A little lost as to where things were. But found my way through it. At about 0545 am, the rescue phone rang. There was an infant coming in, cardiac arrest. I did not think I would be able to make it. I started to get ready, get everything setup. About 5 minutes passed and they arrived. We slide the patient over and I immediately started compressions. I already felt the tears welling up inside my body… from very deep inside. I am looking down and seeing images of all the kids that I have had to do this to in the past. I was loosing my focus. I had to listen to what was going on. The DR in control of the baby’s airway was a young DR and I saw the hurt in her eyes well. After about an hour, my nurse manager came in and saw what was going on. She mouthed to me asking me if was doing ok. I told her no. She started to walk on the other side of the little girl and put gloves on. She asked me if I wanted her to take over. I should have told her yes, but was determined to make it through this. I told her no. We worked the baby for about an hour and 45 minutes. The attending asked if there was anything else that anyone could think of that we could do. Then the attending called time of death. I started to cry.. but held it in for a little bit longer until we got everything cleaned up for the family. After that was done, I walked outside. My wife was walking out of the parking garage and she said “Hey baby.. how was your night?” Then she said “Oh no…” My head hit her shoulder and I lost it. I started crying. And did so for a while after that.
 

Sasha

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I have been to therapy and they all have told me that they do not know what I need to do to try and fix it

Honestly, if you're this bothered that you carry it with you YEARS later, perhaps it's best you retire from the profession. If you can't handle the bad stuff, I don't see why you'd continue to submit yourself to this kinda stuff.

Also your patients and your employers deserve to have someone focused on the current patient, and not thinking about the baby that just coded.
 
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rayemtjax77

rayemtjax77

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It only bothers me in Peds cases... Not others. That is the odd thing. I can deal with everything else. But the peds cases are the ones that bother me.
 

medic417

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Please do not take this as an attack or being disrespectful. A code is a code. Child or adult no difference. I see you are an EMT basic but have based on years on the codes listed stayed at an uneducated level of EMT basic. Lack of education can lead to more questions and doubts. Perhaps a proper education would have helped you deal properly.
 

Aidey

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I think you need a new counselor, one who has dealt with other healthcare professionals and knows how to help you.

I think you need to figure out why it is that these calls bother you. It's been 15 years since the first one, that is a really long time to hang on to a call. The fact that when you have a similar call you start thinking about the other calls instead is a pretty bad sign. As harsh as it sounds, you really aren't any good to anyone if you can't focus on the patient at hand, and you may even be dangerous or get in the way.
 
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rayemtjax77

rayemtjax77

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but no matter what happens, I always do that is needed and required.. I never once not do what I am suppose to.
 

LucidResq

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I'm sure that you are an excellent care provider, and passionate about EMS. But perhaps you aren't really cut out for it... I'm not saying that you are weak or anything like that... but even if every other part of you is made for EMS... the fact that you can't deal with the death of children is a huge issue.

We all get emotional over certain patients, and maybe have weak spots for a particular population... or get that funny feeling in our stomachs when we treat someone who reminds us of a loved one. I would be concerned if someone in EMS never got worked up in any way over any patient. I have cried over a patient before. The important thing is that I did so at home a week after the incident, and came to terms with it very soon afterwards and it was not bothering me at all within a month and has not caused me any more distress in the 2 years that have passed.

If that call, or any other call, begins to cause me issues as you have described, I will leave this field.

If you are passionate about medicine, perhaps you should consider trying to get in to a field where you will never have pediatric patients.
 
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Aidey

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but no matter what happens, I always do that is needed and required.. I never once not do what I am suppose to.

So far you have, but there is no guarantee that you will always be able to. What about the next one? Just from the last case you describe that you were not doing ok, you were loosing your focus, and that you nearly started to cry during the resuscitation.

There is also the long term affect on your psyche that your reactions may cause. Ending up with PTSD, or depression, or an anxiety disorder because you didn't know when to stop is not a good thing to have happen.
 

Ridryder911

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Let's face it ped codes sucks! Yeah, I too have nightmares over ped calls that challenged my soul from a child that would de-sat and made an emergency decent only for it to re-occur no matter what we could do and a child abuse where the infant was choking and I could not retrieve the object even with magill forceps and the object was lodged into the bronchus.

Yeah, there is very few calls that makes my sphincter pucker other than the ped codes but here is the deal.. why are you purposing beating your self up? Obviously, your counselor has pointed this out to you? I agree maybe a new counselor in assisting why it is you choose to punish yourself over only certain calls (peds) and for some reason your psyche is not able to comprehend you did well and there is NOTHING else than can be done in most arrest alike you described. Kids die and it's a female bow-wow.

May I suggest maybe even some intense therapy such as working or assisting in an Children's ER. Maybe your psyche will overcome the fears as you realize even children emergencies can become a routine thing. It is the unknown and not being able to control the outcome we fear the most.

I wish you the best of luck and hope you continue your search for better mental health.

R/r 911
 
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rayemtjax77

rayemtjax77

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Believe it or not everyone, this is actually helping me out alot. Everyone is giving me different things to think about... from a medical prospective. I am really taking in everything that is said.
 
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rayemtjax77

rayemtjax77

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May I suggest maybe even some intense therapy such as working or assisting in an Children's ER. Maybe your psyche will overcome the fears as you realize even children emergencies can become a routine thing. It is the unknown and not being able to control the outcome we fear the most.

I work in an hospital that has a peds side as well as a adult side. We are the level one trauma center in the area. So we get both age groups. My managers have pulled me from being able to go into the peds area as an assignment until this is gotten under control.

Ladies and gentlemen, I love my job to the billionth level. I love taking care of patients. I know I can over come this. I just need to find the way to do it. This is my calling. I tried to get out of the EMS field, but always found my way back into it. This is my life.. my choice.. my calling. I just have this one area that gives me trouble. That is why I am here talking to you people. I have a feeling with everything that is being said, this is going to help me most of all.
 

CAOX3

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You need to stop focusing on it.

Children die. It sucks. They also live. The majority of the children you bring in will live and keep living. Those are the ones you focus on.

I remember my first pedi code like it was yesterday. The name, the date, what she smelled like, the weather outside, what she was wearing, everything. It bothered me for a couple of weeks. I dont know how many I have done since then. I really only remember that one.

You need to gain control over it. Its alright to think about these calls but you do it on your terms.

If you spend any time in EMS you will eventually going to experience this.
 

nomofica

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I'm going to agree with everyone in this thread.

Pull up your socks and move on. "**** happens". If you can't deal with it, and it gets to you in the middle of a code, perhaps it's time for you to leave the profession.
 

Ridryder911

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I work in an hospital that has a peds side as well as a adult side. We are the level one trauma center in the area. So we get both age groups. My managers have pulled me from being able to go into the peds area as an assignment until this is gotten under control.

Ladies and gentlemen, I love my job to the billionth level. I love taking care of patients. I know I can over come this. I just need to find the way to do it. This is my calling. I tried to get out of the EMS field, but always found my way back into it. This is my life.. my choice.. my calling. I just have this one area that gives me trouble. That is why I am here talking to you people. I have a feeling with everything that is being said, this is going to help me most of all.

Why have they "pulled" you? If it does not effect your performance level; then I would not see the harm of "exposing" you more and more. Kinda like the old analogy: "if you fall off the horse, get back on"... . Are you having such experiences after in-hospital, contolled setting circumstances as well? I believe you are rationale enought to know when such exposures may harm your pysche.

If you do continue to have problems; then I do wonder if you may have deeper issues for some reason that you may not be aware of & professional help is needed.

Again, wish the best to you and hope you can overcome this.

R/r 911
 

VentMedic

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I work in an hospital that has a peds side as well as a adult side. We are the level one trauma center in the area. So we get both age groups. My managers have pulled me from being able to go into the peds area as an assignment until this is gotten under control.

We do not know you personally, it is hard to make any comment that accurately fits you and thus, you will get people telling you what you may want to hear or not.

Since you have used the plural for "managers", it seems more than one may have observed some issues. Your responses, actions or reactions to various situations may not even be evident to you since you want to work in the medical profession. Nor, may you realize that your responses or reactions may not be appropriate for a health care provider.

Even though a hospital environment is more controlled, there is also potential for more interaction with the patients and their families. Death is always a reality and sometimes watching someone die slowly can be more devastating than sudden death especially if you have gotten to know those patients. A code is sometimes easier to work than just making a dying child comfortable in bed when you know there is little you can do to make them comfortable. You will see a lot more of the pain, suffering and emotional turmoil for many, many patients and their parents in a hospital than you would with a few minutes in the field with one patient with peds not being that common of a call. Of course, that is not to down play what those in EMS see, but, every patient seen by the many EMS providers do end up at a hospital for those staff members to continue care or pronounce death. I have worked as many as 20 pedi codes in one month in the hospital between the ED and the PICU, so even though it is a controlled environment, you will still be exposed to these situations if that is a part of your job description.

You could try advancing your education so that you will have a better understanding of medicine, disease processes and dying. If in clinicals, you feel uncomfortable, you might explore other opportunities in medicine that do not require a lot of direct patient emergency interaction but still provide a vital service to patients.
 
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Mountain Res-Q

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I'm kinda shocked by some of the replys here.

If your problem is that you care too much, that isn't a reason to get out of the biz. Those that say, "Get over it" are the ones who need to consider getting out. We all have our pressure points; things that hit us harder than others. Maybe you are one of those people that is solid as a rock, but I would hazard a guess that one day you will break over a simple call and all the past horrible calls come flooding back. That is how a lot of healthcare workers break. I believe that the CISD sustem is great and exists to prevent the type of problem you have now. I too have had those calls that hit me hard. You can try to hold it back and don't deal with it, but eventually you are gonna have to. One of my experiences like this happened just last fall (http://www.emtlife.com/showthread.php?t=12216). Thankfully, some one called me on my "down in the dumps" attitude a few weeks latter and it all came flooding up and I lost it. Could I have done something different to save this person? Why couldn't make a difference? I now know that I did it all right, but that doesn't make it easier. The only way to get over it is to continue on and deal with teh emotions. I believe that talking about it with those that understand is the best medicine. That's why debriefings with a compasionate crew that knows what you feel are the best thing. There is little use in talking to people who have no clue what you experience on a daily basis or people that will say "Get over it" or "Get out of the field" or "Calls like that happen". I don't mean to get all "Chickish" on you, but the best people to talk to on this are the ones that jsut listen and say, "I understand." In my personal opinion, based on your 4 calls: You never dealt with the feelings of "did I screw up" back in 1994. And all the recent calls just provide an opurtunity for those emotions to resurface. Posting the stories is great. Keep talking about them. I found that telling the stories in the form of training for new EMS people helps me and helps new people to prepare themselves. There are those that hear your words, understand, and won't judge you or tell you to "get over it".
 
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VentMedic

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I believe that the CISD sustem is great and exists to prevent the type of problem this person has now.

Judging by the dates on his experiences, CISD may have been part of the problem. In the 1980s and 1990s, EMS just relied on each other to get through difficult situations and it wasn't cool to seek outside help "because EMS is so different" or "no one knows what we do" or "they don't understand us like we understand each other". Thus, professional help was rarely sought by individuals.

CISD only gives some the excuse not to get professional help. It is not always wise to have minimally "trained" people mess with complex psychological issues that are sometimes perplexing even to well "educated" professionals with expertise in that field.

Everyone handles these situations differently and brings their own personal package to the table. No two people in a room will process a situation the same. It is best to seek individual counseling from those that do have expertise and education in psychological issues. While one can still talk about the event with their co-workers, the "just have a beer" mentality or the fear of showing weakness will just further suppress the issues of both the current situation and all the others in that person's life as this person attempts to fit in.
 
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Mountain Res-Q

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Judging by the dates on his experiences, CISD may have been part of the problem.

CISD only gives some the excuse not to get professional help. It is not always wise to have minimally "trained" people mess with complex psychological issues that are sometimes perplexing even to well "educated" professionals with expertise in that field.

Everyone handles these situations differently and brings their own personal package to the table. No two people in a room will process a situation the same. It is best to seek individual counseling from those that do have expertise and education in psychological issues. While one can still talk about the event with their co-workers, the "just have a beer" mentality or the fear of showing weakness will just further suppress the issues of both the current situation and all the others in that person's life as this person attempts to fit in.

Granted. However, based on the year of 1994, I wonder if any servcies were offered. CISD, department cousolers, etc. I hve only been around since 2001 in EMS, but based on some of the older folks I have worked wiht, emotions of any kind on a call are not allowed and "talking about it" is looked down upon. That's probably a reason why so many of the older EMS people I know are burned or burning out. For a profession that supplys so much compasion, often all that is needed is some in return, whether that be from people you work with, trainind counsolers, or a listening ear on forum pages...
 

reaper

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I am going to guess that you work at Shands? They should have councilors there to help you deal with your issues. You need to figure this out and talk with someone that knows how to deal with. The councilor you have, may not work for you. Talk with the Hospital about getting more help.

I agree with Rid, you need more exposure to the peds side, not less. Only you can work through this and decide if this is what is best for you. Shands has one of the best peds ED in the south. You will see major traumas come through there. That is the place to find out how you will handle it.

If you find that you cannot get past this, it will eat you alive. You will then either need to quit all together or move to a side of medicine that will never have you around peds.
 

VentMedic

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Granted. However, based on the year of 1994, I wonder if any servcies were offered. CISD, department cousolers, etc. I hve only been around since 2001 in EMS, but based on some of the older folks I have worked wiht, emotions of any kind on a call are not allowed and "talking about it" is looked down upon. That's probably a reason why so many of the older EMS people I know are burned or burning out. For a profession that supplys so much compasion, often all that is needed is some in return, whether that be from people you work with, trainind counsolers, or a listening ear on forum pages...

By 1994, CISD/CISM has already been around for more than a decade and there were many studies popping up to call it Bu*%Sh&&.

Us "old folks" that have stayed in EMS and other medical professions for 30+ had wiser mentors who directed us to professional counselors and away from CISD unless we just wanted to watch people trying to express emotions with little expert guidance or just expressing the things that "were expected" of them just for a good show or to impress. Some also mistook a formal or informal debriefing session as CISD/CISM. These sessions should have been used as an information session to remind providers how to seek help and from whom.
 
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