“Don’t worry about it, just head for the bridge and I’ll get you the address.” This is not the thing that Mom needs to hear right now. We’ve got twenty minutes before we get on the bridge so I have time to make it work.
I pull out my cell phone and call our dispatch center. One of the dispatchers answers and I ask her to send out the University address to our pagers. A few seconds later my pager is vibrating on my hip. We’re on a pretty straight freeway so John is able to program the address into the GPS while driving. I hear the dry female voice of the GPS say, “In fourteen miles take exit on right.”
Moving back to Josh and the fire medic I grab my “Oh Shit Bag.” It’s the bag I clip to the net in the back of the ambulance every morning that has my seldom-used but really critical in a situation like this personal equipment. I pull out the Broslow tape and county protocol book. The Broslow tape is a measurement tool for pediatric patients – you stretch the tape out along the length of a child’s body, and it tells you approxmiately how much the child weighs based on height. Most drug dosages, as well as joule settings for defibrillation and cardioversion, are determined by weight for children, so getting a reasonable weight estimate is really important.
The Broslow tape tells us that Josh is 30kg, so his specific dose of Epinephrine is 0.3mg (as compared with 1.0mg for an adult). The fire medic and I pull out a strip of two inch cloth tape and write down Josh’s specific doses on all the medications and joule levels we could possibly use if we have run a code. In times like this it’s extremely helpful to have two medics double checking math and procedures. A misplaced decimal point can result in the patient getting ten times the dose they should get.
Glancing at the monitor and Josh every few seconds I can’t help but wonder if he is aware of what we’re doing: making a cheat sheet of medications in case his heart stops. I place the tape on the cabinet over the gurney so we can both see it. Josh looks up at the tape with its cryptic abbreviations and numbers, his eyes follow the IV tubing as it winds its way down the wall and into his little hand. “Josh, how ya doing buddy?” He holds up his tiny thumb. Wow!
One last thing to do: open the pediatric defibrillation stickers. It’s just precautionary but if I need them I don’t want to waste time attaching them, much less interrupt CPR to do it. The fire medic leans Josh forward as I place one on Josh’s back and then one on his chest, covering all of the cardiac surgery scars.
I’m keeping a mental note of our position in the county and which hospitals are closest in case Josh decompensates or codes and we have to abort the plan to go out of county. Looking out the back window I see the land fall away in the distance and our freeway turn into a bridge. Well, we’re committed now. Once on the bridge, University is now the closest receiving facility.