1 – a condition of harmonious, orderly interaction
2 – a group of interacting, interrelated, or interdependent elements forming a complex whole
3 – a set of principles or procedures according to which something is done; an organized scheme or method
1 – a social or professional position, condition, or standing to which varying degrees of responsibility, privilege, and esteem are attached
2 – a state of affairs or a change in social standing
Beep, beep, beep. “Medic-20 copy Code-3. Respond Code-3 to 123 Main Street for the three year old unconscious.” The dispatcher’s voice comes across the radio interrupting me as I am filling out my status report. I glance at the computer to see where the address is in comparison to where Medic-20 is posting. Medic-20 is about a mile from the call location and I’m another mile further than they are from the call. I put the SUV in drive and start heading that direction. There is a certain advantage to having the entire system status on my computer in the supervisor’s rig.
There’s a sixth sense to interpreting the description that the dispatcher gives to a call and actually knowing what is going on before arriving on scene. The wording in this call and the location put the little hairs on the back of my neck on end and I feel it’s something that I should get involved in today. For one thing, a three year old doesn’t know how to fake going unresponsive. We see it every day with adults who just plain decide to shut down and let EMS pick up the pieces. But a three year old isn’t quite that devious. Besides that, the address is an indoor swimming pool and water park and there is nothing good about a kid who’s unconscious near water.
I’m catching too many red lights as I head in the direction of the call so I remedy the situation. “Dispatch, S-4, can you attach me to Medic-20’s call and show me en-route?” The dispatcher comes back at me in a monotone response, “S-4 copy, showing you en-route.” The computer on my console starts making tones and a green line is routing me to the location where I’ve already started driving. Now that I have clearance to run hot to the call I can turn on the lights and siren and make better time. I take my little SUV through the red lights without a partner to help clear intersections. It’s still a bit unnerving to drive Code-3 without someone to help navigate, but it’s necessary. The traffic backs up in front of me and I switch tones in the siren to activate the rumbler; a low harmonic pulse that literally rattles the inside of the vehicles in front of me until they pull to the right. Unbelievably traffic clears, allowing me to make good time to the call. As I’m pulling into the parking lot I see my crew walking through the doors at the main entrance with a gurney and the fire engine is already sitting in front of their rig. I park my little SUV behind all of the big boy toys and casually stroll into the building without any equipment and not wearing my gloves.
It’s a strange experience to enter the scene of an emergency without equipment or protection, but the fact is that I’m not here to work on a patient or bring tools to the scene. There are two Paramedics ahead of me and the entire complement of advanced life support equipment has been carried in by others. My job is to support the team and ensure that patient care is seamless in regards to agencies and environment.
I walk solo through the water park and just keep the others in sight as I follow in silence. Screaming kids and teens are playing in the water and on the slides, lifeguards are watching from elevated chairs, chlorinated water splashes my boots. Finally I catch up to the crew in the lifeguard office where the child is sitting in a chair.
I know the paramedic from my service who is Medic-20 today. She was a new Level-1 Paramedic that was assigned to mentor under one of my old partners last year. My old partner was assigned to mentor under me a number of years ago so it seems the cycle continues. My teachings have passed to my partner who passed them to this wide eyed young Paramedic standing in front of me who is now on her own and making her own calls. She takes the report from the fire medic as I listen over her shoulder.
“So, apparently the little girl was pulled out of the water without a pulse and not breathing. They did CPR on her and then someone brought her here when she started breathing and they called us. She’s doesn’t speak English, her parent’s aren’t here, and all we have is a neighbor who is basically no help at all. Right now she’s just lethargic but she’s alert, at least, as much as I can tell she’s alert, but she’s really not talking much at all.”
I’ve been looking at the little girl while listening to the report. It seems to fit her presentation. With all of the strangers poking her and taking vitals right now I would expect her to be a little more agitated. Yet she’s looking like she just woke up from a nap. I slip an ungloved finger up to her eye and touch her dark skin while pulling her lower eyelid down a bit; bright white. Okay, good enough for me, she had a hypoxic event and she’s recovering. The mucus membranes of the eye shouldn’t be that white yet if they are the person is either very dehydrated or recently had a hypoxic event; that seems to fit the story. As the EMT from Medic-20 and the firefighters are transferring the patient to the gurney I catch the eye of the Paramedic. She looks over with big round eyes and a bit of a question.
I quietly lean into her ear. “You have to treat it like a near drowning with return of spontaneous circulation. Your only question is do you want to drive close or far away and how fast to drive.” With kids you don’t take chances. Presumably the life guards have their CPR cards and should know what to look for in terms of breathing and pulse. If the kid truly had neither and now she does she needs a full work up and some chest x-rays looking for water in the lungs and ensuring that the CPR didn’t displace any ribs. The driving close or far away only refers to which hospital to go to. The kids’ specialty hospital is 45 minutes away in rush hour traffic. The local hospital is just seven minutes away.
She looks undecided for just a few seconds and then comes to a decision. “I want to drive close and I’ll start off Code-2 and upgrade if I need to.” It’s half a statement and half a question as she looks to me for approval in her decision.
“Sounds good to me. I’ll run interference with the neighbor so you can get out of here.” I would have said any decision sounds good right now. The patient is doing fine and she, as a new medic, just needs the exercise in making a decision and sticking to it. But in this case she made the same decision that I would have made – I guess my old partner taught her well.
As the Medic-20 crew starts to push the gurney with the patient towards the front of the building I step in front of the neighbor and start asking her questions. She’s a heavy set woman in her late forties who walks with a walker and moves slowly like she’s in constant pain. As I question her she’s distracted as she looks over my shoulder at the patient disappearing in the crowd as they head towards the rig. I know the Medic-20 crew just wants to transport as soon as possible. All medics are the same when it comes to kids in this situation. If the kid is fine they just want to get them to the hospital and out of their charge before something changes for the worse. Had I let the neighbor follow she would have delayed them another ten minutes on scene with her slow moving and a long production of climbing into the truck. Not to mention the liability of helping her climb out of the truck on the other end and the overall delay in getting the kid to a doctor is unacceptable in this situation.
Having intercepted the neighbor long enough to give Medic-20 a clean getaway I walk over to the head lifeguard and ask to talk to the lifeguard who pulled the girl out of the water. I want to get a better understanding of how things happened. She’s a very emotional fifteen year old girl. She can barely catch her breath from the sobs and stuttered gasps for air as she attempts a retelling to me. After three or four minutes and a few stops for tears I finally have a story that makes sense and I feel I can leave.
Pulling out of the parking lot I glance down at my computer on the console. Medic-20 is about half way to the hospital and they are still driving Code-2. So the kid is probably doing fine. I punch the Medic-20 identifier into my cell phone and get the driver.
“Hey, so I finally got a good story and some contact info for the family. The little girl was on a water slide between two bigger kids. They went down the slide and the two big kids came up but the girl didn’t. She was under water for approximately twenty seconds when a nurse pulled her out, found her to be pulseless and apneic, and started doing CPR on her at poolside. After 30 seconds of CPR she started breathing again and was taken to the lifeguard room. All I have is a first name for the kid and the parent’s first name and phone number – the neighbor really didn’t know much. I called the father who speaks enough English to understand what’s going on and he said he’s on the way to the hospital.” She thanks me and hangs up. No doubt she is now relaying the information over her shoulder to the medic in the back of the rig so she can tell a better story to the doctor when she does a hand off.
I take a slow drive to the hospital and once I arrive I see Medic-20’s rear doors open and the patient compartment trashed with all sorts of bins and wrappers strewn around with a disheveled monitor propped in the corner with all of its wires hanging out. I spend ten minutes wiping down the interior and putting everything back into place. I then walk over to my little SUV and pop the cooler open to pull out two ice cold gatorades and prop them in the front cab so the crew will find them once they get out of the hospital.
I drive off before they can get out of the ED so they don’t think I’m interfering in their day too much. It’s a fine line to be involved in the call and supportive of my crews yet still allow them to function as the independent Paramedics and EMTs that we value in this service. I try to tread lightly and reward often. If I do my job right they may even forget that I was on the call yet they will remember that everything ran smoothly. I find a quiet corner of the parking lot in some shade and go back to updating my status report.