Hell in a Handbasket

Ever had a run go to hell in a handbasket? The kind of run that makes you sit and stare out the window of the ambulance, with report finished, your mind trying to piece together the utter chaos that just unfolded? The job that made you work so hard you sweat soaked your job shirt? When you’re looking at a scene that looks like a bomb exploded and you’re the first unit to arrive with a serious mass casualty incident developing and your first thought is “man, someone should really call 911…”

If not, you ain’t doing this right.

I’ve had 2 over the past few days, one at side job and one at regular job. Both times I was driving, and both times less experienced medics were in the back.

The first one was a seemingly simple CHF episode dispatched as respiratory distress. My partner picked up on it slower than I did (experience) and the transfer of care from basic providers to advanced providers was slower than I usually like (ride with me working by myself and you’ll see how quickly I like to move) so I decided to give my junior partner a few nudges in the right direction. We got CPAP and nitrates on board as soon as I was able, and we were packed up and ready to go. That’s when things went pear shaped.

The patient tripped out and started into a panic, ripped off the CPAP and was fighting my partner. I put the pedal as close to the floor as company policy would allow (see what I did there). Despite our best efforts, she went back on CPAP at the hospital. Current outcome is unknown.

The next one occurred VERY recently. In short, dispatched as a simple diabetic emergency. The first company to arrive, an understaffed engine (due to illness, not intentionally, yet) found a 500+ lbs patient full nude face down on the floor. Pulseless, apneic, blood glucose 420+ mg/dL, and the sheer mass and the engine company’s limited manpower had them call for a truck company for extra muscle.

We couldn’t get a tube, no IV access led to an IO, regurgitation from the BVM and simple adjunct, made this extremely challenging. Not to mention getting the massive man to the cot through a long twisty hallway. It seems that when you want to get the cot close in to make it easy the cardiac arrest is always in the farther point from the door and the cot doesn’t get closer than the front door. We didn’t get much traction, and despite the return of ROSC in the field, the patient died during a resuscitation effort by the closest hospital.

My partners were very dismayed at the outcomes, or how they felt about how the job progressed. Something that they hadn’t seen before was something go south that quickly, and from the 500 pounder, the medic on the engine even said “I’ve worked lots of cardiac arrests, but that one was near the top of the bad ones.” Despite the bad outcomes or issues, I think they are filled with teachable moments about the nature of our work.

Bad stuff is going to happen, lots of calls will come where we can’t get traction and we don’t hit all the protocol points or all the goals or benchmarks on the checklists. This alone can throw a new medic who’s been taught that those rules or rigid and are required for everything. I know, I once thought that way too. The bottom line is that sometimes we just start so far behind the ball or events occur that put us off track and the it snowballs and we never catch up. It happens in the so called invincible hospitals, it will definitely happen in the field.

My only advice is don’t let your mistake or how you felt about that call affect the next patient, have a short memory for the details but remember what you need to do the next time to catch up or get ahead. We all have jobs where we just never get caught up or we get set back or we forget something.

Go read what Kelly says. Relax. Breathe.

Some days will just go to Hell in a handbasket.

When that happens, well, I trust you will know what to do.

This article was written by rstine