What a way to start a shift

katgrl2003

katgrl2003

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Well, I experienced my first ever code two nights ago, something I hope to never experience again. What makes it worse is that it was a pediatric code. This little girl was only 6 months old, and had just been discharged from a local children's ER. We were transporting her back to a state run children's nursing home.

It was about an hour transport. She was vent dependent and on a monitor because she had coded twice in the past two months. Five minutes from our destination, her heart rate dropped from 150's to below 60. My medic and our BLS preceptee started working her, but never got anything back. The hospital worked her for 20 minutes before calling it.

I feel really bad for our preceptee. He's been out of class less than a month, and we get a pedi code. We work for a private service, so the entire company averages maybe 3 codes a year. I don't think there's been a pedi code the entire time I've worked there, about a year and a half.

I guess my whole point is: How long do you remember a run like this? How long does it take to get back to your normal self?

-Kat
 
My pedi code was a drowning of a 7 year old boy in the public pool. Just a few days befere the boy was out at my husbands shop chasing my turkey. When we arrived CPR had already been started,however; the boy had been down too long and there was nothing we could do. I still have problems with it if I let myself. Two weeks before I worked a wreck where 5 teenagers were playing chicken 4 were killed.
 
To Ktgil & Emtlady,

It is never nice do to a code call, where the result is negative. Consedirng you have workred hard and done everthing that you can. Like you said, it may have been a kid, or an extremely visaul call, which tend to make things a lot worse... I don't know what your believes are, but not all patients can be saved, if it is someone's time to go, it is time to go.

Should you experience "problems" such as sleeping difficuilties or mood changes as result of this, is suggest you seek proffesional help, it is not a shame. Contrary to popular belief, we are not "bulletproof". We are humans with our own feelings too, and need to learn to work through these situations, as you will for sure come accross something like this again, if you stay in the EMS. Have you talked to any of your peers, or even your own family structure (And i mean not boasting about the call as a lot of people do)??

Do not let the "problem" linger, it has a tendency to build up and get progressively worse, almost a snowball type effect.

Good luck.
 
Codes

You asked: I guess my whole point is: How long do you remember a run like this? How long does it take to get back to your normal self?

You never forget about these calls, because you care. It will take some time for you to feel normal again, but thats only normal. Look for emotional support from your fellow workers, they know how you feel.

Keep up the good work
 
Ops Paramedic said:
Have you talked to any of your peers, or even your own family structure (And i mean not boasting about the call as a lot of people do)??
Click to expand...

I tried not to talk about it the first night. I just wanted to think about everything that had happened. My medic pretty much just pulled me aside and told me to talk. I don't thing "woof" was what he was wanting. I'm actually doing alot better than I thought I would. I've got several people that have called me and told me if I needed someone, they would be there. Hopefully things will get better soon.

-Kat
 
It Unfortunately Will Happen Again, And In 20 Years You Will Still Remember It. It Sucks But People Die, And We Try To Do Everything We Can And Sometimes It Doesn't Work. I Remember My First Infant Code, Secondary To Shaken Baby Syndrome. Also My First Job Working An Interfacility Ride. Going From One Hospital To A Children's Hospital For Brain Surgery. It Sucks When You Are Teary Eyed Bagging An Tiny Little Baby. You Will Be Fine, Stay Strong, Remember Treatments And Talk About Calls.
 
These are very tough calls to be on, but allways remember, we are ordinary people in extraordinary situations and the feelings you are going through are normal, we are caring people or we wouldn't be doing what we are doing. i bet the other people involved in the patients care are having some of the same feelings, talk to them and maybe you all can hellp each other. I don't know if your service has acess to a "critical incident stress debriefing team" if so i recommend setting up a meeting. our service has these for any traumatic calls such as fatalities. It gives all involved a chance to vent and yes shed some tears if need be, doesn't matter new members or seasoned veterns , all need some form of release. These meetings are kept confidential.
Wish you and the others involved with this call all the best.
 
There is a lot of good advice here. Take advantage of it and don't be afraid to get CIS help. It does work and you won't be alone. The thoughts will never go away, but you can learn to manage them. In the six years I've been working full time I've done a couple of dozen codes. I've got two saves, as in walked out of the hospital. I was in the right place at the right time, my partners and I did our best and it worked. I did one ped code 32 years ago. I part timed as a lifeguard and my friends and I went to a local swiming hole after work one hot day. Long story short an 11 year old boy drowned. We worked him,(then it was mouth to mouth and a heimlich type manouver, not CPR as we know it today), for a long time as we were well outside of town. By the time the police and an ambulance got there we were knackered, and the decision was made by the policeman to stop. The ambulance in those days couldn't do anything but scoop and run. Twenty six years later I found myself in Paramedic school.
You will never forget but someday, somewhere, someone will need you. You will give your best and it will work. And you will feel AWESOME!!
 
There's a gift in traumatic experiences like that. They live inside you. You, of course, have the choice to determine HOW they live inside you. There are a million things that happened in that brief exposure of yours that will pop up in other calls throughout your career, and, tangentally, throughout your life.

Experiences like that are a gift because they will inform everything you do. You responded as best you could, and you learned. Now, not only do you have a special sensitivity to that particular kind of call, but any life situation that has a remote resemblance to what happened.

Your only job is to build on what you've learned, and keep building better.
 
You are going to go through a process as you deal with this call. It will bother you, cause you to dream weird, re-live the call, second guess everything you did and everyone else did or didn't do. With time, it will fade. It won't go away, but it will bother you less with time.

The rule of thumb is that if you are still bothered by physical symptoms, sleeplessness, irritability, mood swings for more than a few weeks, then see someone. Most agencies have a list counselors who are experienced in dealing with EMS issues.
 
Bad news is that it doesn't go away... i had a call of a simple transfer of a very unstable pt who was in bad shape from the hospital we picked her up in all the way to the ER of the other hospital, they coded the pt no more than 5 min after we transferred care. The pt didnt get any better during transport obviously. Turned out it was the grandmother of one of the other students in my class. Makes ya feel like total **** when something like that happens, where you dont feel like you really accomplished anything and have the outcome be like that. Being able to learn something from the call and not letting it ruin your life is about the best thing that can happen after that. It's gonna make ya feel like crap each and every time you think about it. But if you cant get over it there are plenty of people and organizations that can help you.
 
As they say, with time it will pass.
During the call the best thing to do is concentrate on tx and patho, if you can come up with a treatable cause you can reverse, may see a miracle.

Unfortunately, when ped's code, in most cases the brain is already irreversibly damaged, in which case, the most you can help for is parts for some other sick kid.

Black humour helps...everything.

In my service when we have a vented/paralyzed patient we are supposed to have two Critical Care trained attendants. This doesn't always happen, but it is at the discretion of the attending medic if they want to do a call depaired.

What is your policy?
 
Our policy is send a medic truck (medic/basic, sometimes dayshift has double medic trucks). We can always ask for assist, but we don't always get it. What makes it even harder is that we only have 2 vents for the entire company. Since we work nights, we usually manage to get one of them.

This patient had her own vent, and wasn't paralyzed. She had muscular dystrophy and a GCS of 6:4,1,1. She could only move her eyes. Luckily on this run we had a bls preceptee, so my medic did have some help in the back.

-Kat
 
Tough luck, sounds like the pt should have had a DNR, having coded twice previously. Was the eye movement purposeful?

I gather you turned around, only being 5 minutes out.
 
Life and death has such a fine line, when dealing with any pedi call.
All one can do is look at the call from this point, what did I do well, and what could I have done better. This is not the time to beat up on one's self, instead this is the time to see how you are couping with the job and how someone's else's life can throw some pretty mean curve balls at you. I am a very strong believer in counseling, it never hurts to talk with a neutral set of ears. -_-
 
bonedog said:
Tough luck, sounds like the pt should have had a DNR, having coded twice previously. Was the eye movement purposeful?

I gather you turned around, only being 5 minutes out.
Click to expand...

Actually, it was about a 60 minute transport, so we diverted to the only hospital in the city we were transporting to. Eye movement was purposeful, she would look at us, and around the back of the truck. She had no other movement.

-Kat
 
katgrl2003 said:
I guess my whole point is: How long do you remember a run like this? How long does it take to get back to your normal self?

-Kat
Click to expand...

It all depends. Usually I can remember if there were circumstancing circumstances or not.

How long do I remember it and get back to normal?

I usually remember the usual ones until the paperwork is done, after that I dismiss it. My next patient deserves my full attention, anything less is not fair or right to the next patient.

Not to be rude but blunt. Unfortunately life sucks and is not fair, and again unfortunately get used to it. You had a job to do, and you did the best you could. You will have bad calls and good calls (which will be more seldom than the latter). Again, unfortunately you will have to learn to deal with bad things and truthfully toughen up, if you want to last in this business. I am not describing being jaded, rather learning on how to appropriately deal with the bad events, stress, and common working environments.

Good luck,

R/r 911

R/r 911
 
katgirls partner:

We were 55 min into a 65 min transport. 5 min from a small hospital that due to where they are in relation to the state run pedi facility they the deal with alot more pedi's than alot of small hospitals.

pt had no chance at a future life: with her first code she went into resp arrest and never started breathing again; that was why she was vented and trached.
she was 9wks preemie; had muscular dystrophy; had a heart defect but she wasn't strong enough to survive the surgery. she was GCS 6:4,1,1; not sure if it was a purposeful eye movement or not;
but even with all of that it was still a hard code: Katgrl is upset, thinking if she had driven faster we would have been closer to the hospital or even had dropped the girl off already. but it was icy and probably would have put us in a ditch if she had driven faster to that point, she did great, didn't throw us around in the back gave a safe, steady ride once the pt coded.

pt went from 150 sinus tach, to 100; took her off the vent and bagged her, hoping that the vent was acting up. breath sounds clear, good chest rise. pt down to approx 70 and started compressions. down to 0 she never went into V-tach or V-fib; just bradied to zero.

I have been doing this for 10 year, ALS for 3 years: and I am having a rough time with this one.
 
thank you

sorry meant to say thank you for all of your support on this and with my partner.
 
Kat - it sounds like there wasn't anything you could do, especially as the driver. Remember, as the driver, your job is getting the crew, vehicle, and patient to the destination safely. This pt. sounds like they were fighting a loosing battle for some time, and their death probably wasn't unexpected.

If you'd driven faster... you might have gotten to the hospital faster... or been at the nursing home... but the patient would have probably still been dead... an ALS ambulance has most everything a hospital code cart has, and you said you had 2 providers (EMT-P and preceptee) in the back... if they couldn't get the patient back... there probably wasn't anything else that the hospital could have done.

I know that driving an ambulance can be stressful... because there isn't anything you can do to help the patient in the back... except to get to the destination.


As for the memory:
You will probably remember this one for a while. I can still remember the 2 fatal pediatric cases I've had... 1 was almost 7 years ago. The memories fade... but they are still there.

I remember bits and pieces from my first DOA, as well as parts of my first messy code, etc... But I can only remember the name of 1 of these fatal patients... and that is because I was 16, and the kid was a freshman at my high school when he got struck while skateboarding home from the school (at 6pm, in the dark, wearing dark clothes, no helmet, and riding all over the road).

Rid has been doing this for a lot longer than I have, and he works in a busy system full-time. So he's seen many more calls than I have... Still... I bet he can remember his first code. As Rid said... the normal calls fade away... I can't remember calls from the other day... but I remember some of the unusual calls. Some of these calls were funny, some were disgusting, some were sad. All have some element that comes back to me... be it how disgusting X,Y, or Z was, or some REALLY demented dark humor from one of my preceptors. I think we all have some calls that we remember... for one reason or another.


In short - it will get better... but you need to listen to your partner and realize that there wasn't anything you could have done better. Once you stop obsessing and blaming yourself and accept that you did the best you can, you can move on (in a way, you are going though the grief process... you seem to be stuck on "Guilt"). Once you accept it, move on and you should be fine... No matter what, tomorrow the doors will go up, and the trucks will go out.

Anyway... I hope this helps.
 
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