I join the fire medic, my partner (who happens to also be a medic), and the fire captain for a quick huddle near the kitchen.
The fire captain starts, “Okay, here’s the deal. He’s on the list at University Hospital for heart and liver transplants – his base problem is the heart but it’s cascading to other organs and is causing liver failure. Mom wants him to go to University because they know his history. He’s had six cardiac surgeries in the last three years with the cardioversion two weeks ago. But I know you guys probably have to go to Kid’s Hospital because it’s in-county.”
“Yeah, we have to go to Kid’s, but even that is 30 minutes away doing code-3 given traffic. If he starts to crash out I’ve got to take him to the nearest receiving hospital, he’s compensating right now so we have few options. Either way I could use a rider if you can spare your medic.” He nods without having to say the words, we all know how this could play out. It takes at least two people in the back of the rig to effectively run a code.
I do some quick math and take stock of what I have in front of me. Josh’s cardiac history is so complex that even Kid’s Hospital would be calling for a transfer rig as soon as I walk in the door, yet county protocol says I need to take him to Kid’s. He’s still compensating, and therefore somewhat stable for the moment. Yet kids stop compensating very suddenly and he has a very complex medical history, so it’s tough to gauge his compensatory stamina. I can get to Kid’s in maybe 30 minutes; going to University would take 45 minutes, out of county, crossing a very long bridge.
“Do you want a helicopter?” asks the captain. Hell yes I want a helicopter! Let the flight medic take this call, they have more training and a few more cardiac drugs at their disposal. Not to mention he can get to where he needs to be faster than I can do it. But didn’t they just fly out that motorcyclist? Crap!
I decide it’s my call to make. Josh is getting to University Hospital one way or another – they know his specific history, they have a cath lab, they have a pediatric department, and that’s where the transplant team is in case he gets bumped up on the list because of this. If Josh’s little heart is beating its last few beats right now he needs to be in the hospital that is equipped for the transplants.
“Okay Cap, can you call for an ETA for a helicopter? If it’s too long we’ll see about driving him there.” As the fire captain turns around to talk into his portable radio, I ask my partner to call our Base MD (the doctor that we call to get permission to break or exceed protocol when we need to) and make the case that we need to drive this kid out of county if we can’t get a helicopter. I ask the fire medic to start getting Josh ready to go, unhook his monitor and secure the IV.