Dumb moment...

Had a very dumb, but funny, moment not too long ago...

I’m a full-time EMT and a full-time medic student now This happened at one of the stations I ride at for class.
In my county, County Fire Rescue is the cream of the crop. It’s where everyone wants to be. Fire and EMS are combined, so all firefighters are also EMTs or medics or both (most often both).
Engine is where it’s at for most employees. It’s what they strive for, as not to get the all-night tones that Rescue gets. Also, most joined up the job to be firefighters, not medics. So a lot of them don’t want to be on the Rescue at all. But Engine is a spot earned here, by way of “serving time” on the Rescue.
On the front of the Engine at this particular house, is the phrase, “Look busy ‘til we get there.”
When I first saw it, I was under the impression it was meant for people experiencing structure fires. You know...look busy until the professional “badasses” get there.

So I’m on a ride at this house and we get toned out to a “difficulty breathing” call. We get there and the pt is unresponsive. We get her on the monitor and see the pt is in v-fib. So we hustle her to the rig to start ALS protocol. Long story short: pt codes. PEA and then asystole.
So the Recue Co and I are working this pt trying to bring them back. The rig doors are closed because all four of us are in the rear while still in the parking lot trying to get this pt back. Meanwhile, the pt’s family is outside, sometimes knocking on the side door to hand us the pt’s meds or confirm the hospital.
We’re doing compressions. Starting an IO because the veins were shot. Getting the scoop and the LUCAS device out. Pushing meds. Establishing an airway. The whole nine yards.

The back doors open and there’s Capt — who’s on the Engine — asking for an update. For a second, as I was bagging, I was stunned thinking one of the family had the balls to open the back doors on their own (this was my first code). So, one of the Engine guys gets in the cab and drives to the hospital while we’re still working the code.

We got the pt back — cardiac arrest secondary to respiratory arrest, back in SVT still needing ventilations — but as we were leaving the hospital after transferring care, it hit me:

“Look busy ‘til we get there.”

I never felt dumber than that moment.

 

If she's in VF she has already coded - you should start compressions and try to shock right then and there. Fire is always too eager to move the patient.

On some calls "hustling the patient to the rig" is the right thing to do, but almost never on a cardiac arrest.

 

I'm always frustrated with fire rushing transport in my area, especially cardiac arrest. We could be 5 minutes into a code "Are you going to think about transport or calling it?"

 

Yes correct. Not dissing on firemen but it’s true. V-fib = CPR and shock. This is a stay and play situation until the rhythm changes. Consider this a teachable moment.

 

So much wrong I don’t even know where to start.

1) We(competent providers) work codes where they fell unless circumstances dictate other wise. You can move the body to a more accessible location(the bathroom at the end of a bottleneck hallway to the living room for example, or from the pool deck to the grass etc), but you don’t stare of life a code front he bedroom out to the truck. Work them where they fell.

2) Your timeline of events is all jacked up. That’s probably more because you’re reporting to us is chaotic, but with how you say you folks opened the code, I’m hesitant to commit to that idea.

3) FIRE ISNT IN CHARGE ON A MEDICAL and if this isn’t the policy where you work, your system is all jacked up and needs to change. We all have our roles. Mine is to manage patient care. Theirs it to put wet stuff on hot stuff. If I’m on a fire call, you're in charge. If you’re on a medical, I’m in charge. In my system(career fire/contract EMS), a battalion chief with 30 years of FF experience works for me on a medical. The same holds true for my side gig(single role medic in a municipal fire based service).

 

Why would you not defibrillate and start CPR while you're in VF?

 

I always cringe when people put slogans like that where the public can see them, it's one Facebook warrior away from being on the evening news (even if they were misconstrued). Not that we haven't had our quote board of dumb things patients say or our private facebook groups, the the PR risk is not something I would want to risk. Often it is more professional to keep all the bad*** sayings on the wall in the dayroom where nobody can see it.

I do agree that you should have shocked her the moment you saw v-fib, its a terminal rhythm and needs to be treated with electricity. I'm guessing that if you were bagging when there was an engine and bus and you were not running the call

Depends on where you work, around here the highest level of care who is first on scene and has a legitimate patient care responsibility keeps the call. If fire is BLS and there is ALS transport then the bus runs it. If fire is ALS it is there right to keep the patient, though typically they have no interest in that. If I get a call in the field then I keep it regardless of who we get to transport because I have an legitimate established relationship with the patient, am board certified in emergency and pediatric emergency nursing, and our service is state licensed as a non-transport EMS agency. If flight was called out to scene but they are going to ride it in instead of flying then the flight nurse still has a right to keep the patient even if the bus has a medic.

 

Sounds like a fluster cuck. Why not work the code in the house where its open? Why not defibrillate v-fib? So many whys, yet it seems we already know the answer by these simple statement(s):

and this:

and this...

As one of the few who are going into or who are currently in the fire service who actually cares about being a medic I absolutely hate this mentality. I wouldn't call this a dumb moment, I wouldn't even call it a WTF moment... its a speechless moment...just when you think you've heard it all on here.

 

Theres literally nothing funny about this.

 

The patient WAS coding. V-Fib = code/cardiac arrest. Next time, don't move them: start CPR and defibrillate. Immediately.

This sort of crap is why FDs get a bad name when you talk about them with professional, care-driven EMS providers.

 

Never move a dead person to your truck, unless you get ROSC. Because if you do, and work them there and finally call to get permission to stop CPR (if you need to do that) then your truck is a crime scene; you can't unload the pt and put them back where you found them, and you can't take them to the hospital. They are in your truck till the coroner or the ME takes the body.

 

'Nuff said.

Also, you mentioned this was your first arrest, and you're in medic school? You're going to have a hard time both in school and if you pass. Most people recommend much more experience before going to school.

 

How much experience should someone get before medic school?

Friend of mine/coworker was an EMT B for 11 years FT in a busy county service, before he went to medic school. Then worked as a medic for 8 years. So almost 20 years in EMS.
He was my responding medic on a cardiac arrest, on my 3rd run as a cleared EMT-B on his FIRST Cardiac Arrest in almost 20 years in EMS.

So if people shouldn't got to medic school until they get experience in everything very few people should go to medic school

 

That's quite the anomaly, and I think you know it.

20 years in EMS and get never worked a cardiac arrest?

 

In my field internship of like 4 months I had 8 working full arrests...

 

Only 8?!?!
I'm just kidding. I think I only had 4 or 5.

 

If only.

 

So, I've read the OP like 30 times, and I still don't get it. Is "look busy 'til we get there" a fire thing? I swear none of the FD trucks here have that on their rigs. I'm genuinely confused.

 

damn, 19+ years of FT EMS without a cardiac arrest? he's either a major white cloud, his "busy county service" isn't 911 or isn't busy, or....... dumb luck?

I've been in NC almost 3 years, and spend half my time on at a rural fire station and half my time in an urban one.... and I've been on 2 working codes and two DOAs since I moved.

19 years of full time EMS without one...... something doesn't add up.

yes, we are in agreement there.

 

Definitely not a fire thing, my service would never have put something like that on our apparatus; or at least not a professional fire thing. None of the lieutenants I know would have thought it was a good idea, our captains would have had a conniption, and it would never gone any higher than that.

That is bizarre, my department was (and probably still is) the lowest volume EMS service in the county (compared to either private or other transport departments, some of the fire only departments were slower). Our station typically ran 2-5 codes a month between the three shifts.