Wow, Bad Call all Around.

[MJordan2121]

Well, I've read this forum for quite some time and I've always read how others mention the difficulty of a bad pediatric call. Well, I got the first of my career. We got a call for a cardiac arrest, unknown age. We had a short arrival time, considering the dense fog that cut our visibility down to 20 yards or so, made it there in 5 minutes. Upon arrival, we threw the bags on the stretcher and was about to dash out when all of a sudden, the mother of a 6 month old runs up screaming that her baby is not breathing and throws the baby into our arms. The baby was pale, cold, and cyanotic. We threw the bags off the stretcher and the infant was placed down and we began to work her. We had a great on-scene time of 10 minutes and that includes an I.O. being started, intubation, CPR, placed on monitor, bagged, etc. Unfortunately, it was just me and my partner, fire did not respond to this particular area. I knew I needed to get to the hospital fast and safely, considering my partner was having to push drugs, bag the pt and do CPR all on his own and I had a hysterical mother hyperventilating in the front seat talking on the cell phone about how her child fell off the bed (I'm thinking head trauma or maybe suffocation and the baby has been down awhile before noticed). Trying to calm her down while doing Priority 1 to the hospital, she passes out in the front seat and her head lands in my lap and her body is slumped inbetween the seats. Finally at the hospital she wakes up and walks to the back of the ambulance and hits the ground hard right in front the doctor. The baby was worked by the ER staff and pronounced twenty minutes later. I only wished the best for this child and we did everything in our capabilities, but I know in EMS you have to learn to deal with difficult situations, such as this. Just wanted to share my first pediatric cardiac arrest story and hope that I don't have to get a call like this in the future, but if so, I feel I would be better prepared.

 

[karaya]

Welcome to frontline EMS. The more you learn how to handle a call without all the extra help from fire or other first responders, the better you will be able to cope with situations as you just described. I can't tell you how many times I've been with crews who were constantly accustomed to having a plethora of fire personnel at their disposal and then "fold" on a tough call when fire couldn't respond.

Just curious, what was the rhythm when you placed the infant on the monitor?

 

[MJordan2121]

Asystole. Did not change once between the scene and the hospital.

 

[firecoins]

I just had a 5 year old who walked in front of a car. He is in critical condition. We brought him to the closest hospital which was a level trauma 2 center and they flew him out to a level 1. Not a good call by any means.

 

[Arkymedic]

Well, I've read this forum for quite some time and I've always read how others mention the difficulty of a bad pediatric call. Well, I got the first of my career. We got a call for a cardiac arrest, unknown age. We had a short arrival time, considering the dense fog that cut our visibility down to 20 yards or so, made it there in 5 minutes. Upon arrival, we threw the bags on the stretcher and was about to dash out when all of a sudden, the mother of a 6 month old runs up screaming that her baby is not breathing and throws the baby into our arms. The baby was pale, cold, and cyanotic. We threw the bags off the stretcher and the infant was placed down and we began to work her. We had a great on-scene time of 10 minutes and that includes an I.O. being started, intubation, CPR, placed on monitor, bagged, etc. Unfortunately, it was just me and my partner, fire did not respond to this particular area. I knew I needed to get to the hospital fast and safely, considering my partner was having to push drugs, bag the pt and do CPR all on his own and I had a hysterical mother hyperventilating in the front seat talking on the cell phone about how her child fell off the bed (I'm thinking head trauma or maybe suffocation and the baby has been down awhile before noticed). Trying to calm her down while doing Priority 1 to the hospital, she passes out in the front seat and her head lands in my lap and her body is slumped inbetween the seats. Finally at the hospital she wakes up and walks to the back of the ambulance and hits the ground hard right in front the doctor. The baby was worked by the ER staff and pronounced twenty minutes later. I only wished the best for this child and we did everything in our capabilities, but I know in EMS you have to learn to deal with difficult situations, such as this. Just wanted to share my first pediatric cardiac arrest story and hope that I don't have to get a call like this in the future, but if so, I feel I would be better prepared.

What happened with the mom?

 

[Onceamedic]

First of all, you did nothing wrong and that baby was doomed before you got there. My paramedic instructor has worked 300+ peds codes. ROSC on them? - 0
Kids are respiratory driven. ( unless they have congenital cardiac issues). They do not have heart disease like grownups. Their little hearts stop when they cant oxygenate. Once their little hearts stop, they will not start again. That is the reason we work so hard to prevent them arresting. One estimate (AHA I believe) says that for every minute a child is down, they need a minimum of 7 minutes of AGRESSIVE rescusitation. Do not beat yourself up. Learn everything you can from this call (for example, if any alternative is available, I will avoid taking parents along on a pediatric code 3) and honor the memory of the little one by using what she/he taught you on the next one, even if it is just how to handle the bad calls.

Take care.

 

[MJordan2121]

The mother ended up passing out behind the ambulance and hit the ground pretty hard. I called the hospital on the radio ahead of time and asked if they could meet us outside to assist us with everything. She actually fell right in front of the ER doctor, so the doc and another family member got her inside to a separate room in the hospital to be taken care of by a nurse. We were lucky to have run into some policemen outside the hospital who was able to guide the stretcher and move it,while I bagged the pt and while my partner was performing CPR.

 

[VentMedic]

My paramedic instructor has worked 300+ peds codes. ROSC on them? - 0

That would be about 1 pedi code per month for 30 years. Even in large cities, there may be a month where no pedi codes occur with EMS involvement. Hopefully he wasn't at the same station or in a small community for all those years. That would be bad stats for a neighborhood especially if the other Paramedics were also working the same number of pedi codes.

While some pedi patients are asystolic, there are situations where they are not. Hence, the reason for AEDs in the schools. ROSC is not impossible and our ICUs have some examples. Some of these patients were revived in the field. Our pedi sub-acutes also have patient that show ROSC is possible in the field even if it leads to a trach and peg. It largely depends on the mechanism as children normally have strong hearts. Fortunately organ procurement regulations are changing.

The baby was pale, cold, and cyanotic.

Asystole. Did not change once between the scene and the hospital.

However, this discription pretty much says it all.

considering the dense fog that cut our visibility down to 20 yards

With the above description of the baby, weather conditions and an emotional parent, my concern would have been for the safety for the living. 2 more minutes would probably not change the outcome.

There will be calls you can not change the outcome regardless of age. But, there will be something to learn from each call.

 

[Onceamedic]

That would be about 1 pedi code per month for 30 years. Even in large cities, there may be a month where no pedi codes occur with EMS involvement. Hopefully he wasn't at the same station or in a small community for all those years.

He is #5 in the national registry for paramedic and #2 in Wisconsin only because his last name starts with "C" and his student's last name starts with "B". He taught the class that he also graduated from. His name is Jeffrey B. Clark and he has been honored by many national programs as one of the pioneers of paramedicine. Northeast Wisconsin enjoys one of the finest pre-hospital service in the country, due in a large part to this man's efforts so no - he hasnt been at the same station all those years.

 

[VentMedic]

He is #5 in the national registry for paramedic and #2 in Wisconsin only because his last name starts with "C" and his student's last name starts with "B". He taught the class that he also graduated from. His name is Jeffrey B. Clark and he has been honored by many national programs as one of the pioneers of paramedicine. Northeast Wisconsin enjoys one of the finest pre-hospital service in the country, due in a large part to this man's efforts so no - he hasnt been at the same station all those years.

Yeah there's a few of us old folks still around in EMS.

Can you post some stats? I wouldn't expect Wisconsin to have that high of an incidence of death for children. I could probably just email Jeff Clark. If would be interesting to hear why he had no ROSCs in 300 pedi codes. I wonder what his ALS protocols were like when he initially started. Ours were fairly well developed in the 1970s but that is largely because Florida, unfortunately is in the top five in the country for pedi deaths due to drownings, gangs and year round outdoor activities. This could be a good paper from a historical point of view. The Children's Hospital may also have the statistics readily available.

Thanks for the info.

 

[Onceamedic]

I could probably just email Jeff Clark.

I think it is super cool that you know Jeff. I love the guy. He has been a tremendous source of support for me. I don't have the stats but if you ask him about the notes I took in his classes, the info is a direct quote. I do not want to hijack this thread so I'll leave it at that.
Cheers

 

[artman17847]

I have been a medic since 89'. F/T and P/T on and off since then. These calls can be some of the most emotionally draining calls we will ever respond to. If you find yourself having a hard time dealing with this call, I urge you to seek out a CISM counselor. The first pedi arrest I had was very difficult for me and my cheif strongly suggested I talk to someone. I did and it was very helpful.

It sounds like you and your partner did all that you could.

 

[tydek07]

Hey,

That call sounds like it was rough. I am sure that you and your partner did all that you could in the circumstances. Ped codes are always hard on a person and the outcome usually isn't for the best. Again, I am sure you did all you could and good job!

Take Care,