"Of each particular thing, ask: 'What is it in itself, in its own construction?'" -- Marcus Aurelius
There are patterns in all that we see. Streets are set up as grids, bridges are oft times constructed as arches, and you can be assured that when the noontime sky darkens (such as in the Northeast today) bad weather soon will follow.
Can we make predictions in our patients based on patterns? Let's look at this month's case to find out.
You're working the paramedic first responder vehicle in the department you occasionally work for. A volunteer department that pays paramedics to be first responders 24 hours a day, seven days per week, it's a good job.
You have a paramedic student with you today. In addition, the dispatcher tells you that "Jason" is available in the district. Jason, is a volunteer member of the department, is an EMT-I first responder who is available most weekends.
The day starts out quietly enough. You check the vehicle and equipment. You also go to the other stations and check the ambulances, making sure the equipment is on board to handle any and all major incidents and conflagrations that may befall the residents of a suburban fire district.
You also review, with your student, what your approach will be to any patients. (You realize one of the things that they do in any EMS class is to try to teach each student to be a "team leader". The only downside of this approach is what happens when two or three of these "team leaders" show up on the scene. Who is the alpha dog when three alpha dogs are on the scene? Our classes don't do a good job teaching us all to play nicely with the group.)
While you're speaking to the student, the activation tones sound and the dispatcher announces an "EMS Alarm"; elderly female unconscious, at the "J wing" of the Gardiner Assisted Living Center, Rt. 743 and Atria Lane. Time out is 10:03. As you tell the dispatcher you're responding, your mind reviews the possibilities.
Gardiner is one of several assisted-living/adult homes/nursing homes that have been established in the district over the past several years. The dispatcher tells you Jason is responding in the duty vehicle from his home. You also know he lives rather close to the incident location.
You get more information that the patient is located in the cafeteria in the facility. At the same time Jason tells the dispatcher he's on the scene.
Your sport utility vehicle makes the turn onto Rt. 743, and Jason is on the air stating he has an elderly female in "cardiac arrest, please tell the medic to step on it!!". You inch your speed up and tell the dispatcher you're two minutes out.
You and your student arrive and head to the cafeteria to find Jason talking to an elderly female lying on the ground. She's responding appropriately, and Jason tells you he found her in cardio respiratory arrest at a table with four other older women. He pulled her to the floor and had to bag her twice. She then started to breath again and had a pulse.
You ascertain that the lady's airway is clear and have the student secure the vitals: BP 148/90, pulse of 100 and regular and strong, respirations of 12 with clear lung sounds. The student begins to secure the IV line, and you look at the 12-lead ECG, which demonstrates sinus rhythm at 100. You haven't seen post-cardiac arrests come back with such good vital signs, much less be alert and oriented after, so you decide to ask some questions of the ladies who were sitting at breakfast with the patient. You discover they're all friends and are intimately familiar with each other's medical history.
They state the patient has epilepsy but no heart or lung problems and has never had a stroke. You ask, "When she has her epilepsy, does she go to ground and shake or does she just seem to slump over with and black out?" The ladies all answer that she slumps to the side like she did earlier.
The lady has petit mal seizures. This is what Jason saw, not a cardiac arrest. All in all, a good outcome. No cardiac arrest, up triaging of a potentially serious case and another EMS secret revealed to the student and Jason.
Just to be safe, you take her blood glucose (it is 118) and obtain a 12-lead ECG (it's normal) and ride to the hospital, monitoring her for the 10-minute ride. Another life saved.
In many ways, EMS isn't much different than any other pursuit. Much of what we do, at all levels, is recognizing patterns. As a teacher of EMS, it's of primal concern that my students learn to pattern recognize. However, they must keep an open mind while doing so. This is the process of experiential learning.
A Zen Buddhism story concerns a young man who passionately wants to become a master swordsman. The young man seeks out a Kundo master and begs to be taught, but the master puts him to work in the garden instead. The student is isn't but obediently works the garden. Every time the student isn't looking, the master sneaks up behind him and whacks him with a stick. Although terribly frustrated, the student stays and this continues for years.
No matter what the students tries, he can't seem to sense when the master is behind him. As a result, he's constantly covered with welts and bruises. One day, the young man is tending to the garden when the master sneaks up behind him and swings, but the student ducks and the master misses. The student is overjoyed. He grabs the master and shouts "now will you teach me swordsmanship?"
"Now you don t need swordsmanship," the master replies.1
Till next time.
1. Gonzalez, L: "Deep Survival, Who Lives, Who Dies, and Why." W.W. Norton and Company:New York, 2003.