Cardiac & Resuscitation, Columns

Released to the Street

I m sure each department has its own term for that remarkable moment when the freshly minted paramedic has completed orientation and is found worthy and competent to take responsibility for total patient care. In our department, we call it released to the street, which conjures up, for me anyway, a vision of some wild beast in captivity being sprung from its cage to ravage the unwitting townspeople. The drama would begin with the clinical director sending out an all points page: Greg is released for street duty. One could almost hear a collective sigh or anguished moan, depending on the subject of the page.

In Greg s case, it was a sigh he is smart, competent, washed regularly and showed up on time. What more could one want? It was Greg s misfortune to be stuck with me on the downtown rig on his first shift after his release.

Our first call, of course, was a cardiac arrest. Fire arrived first and started CPR with the patient lying in his bed. When we first pulled up, we saw the firefighter bobbing up and down in the window with each compression and knew we were going to have to move the patient to a harder surface. We entered the house, dragged him to the middle of the living room, and took the first steps of the sad choreography of The Code.

How about that just released to the street and Greg gets his first tube. He did a perfect job. Slide, hold, squeeze, listen, listen, listen, listen, inflate, tie, EtCO2, fog, 02 sat. EKG flatline, IV, atropine, normal saline no change.

Then the classic question from the wife: Is he going to be alright?

We are all so cynical, and so used to the culture of sarcasm in the firehouse or agency, it s really hard sometimes not to answer a question with yeah, he s just fine, we re just pumping him up a little before we go. Of course, we resist the temptation; though my eyes glanced over the patient, and I noticed Mike, one of the first responders, clench his jaw to stifle what was most likely an inappropriate reaction.

In times like this, I always remember what one of my teachers, Ed Jerin said to wife in a similar situation. It was my very first code as a paramedic student, and I was at a total loss for words. He said, Ma am, his condition is very grave, and we are doing everything we can for him. In the 22 years since, I have not found better words. So I said that phrase one more time. She hesitated and then said, But he s breathing. I can see it. No ma am, I m afraid he s not breathing, we are breathing for him with this bag here, I replied. He stayed flatline.

Now the teacher, I thought Greg did a great job overall, and I told him so.

Our next call was a 10-50 PI, motor-vehicle crash with injuries. We approached Adams Street on the west side of town, and had to squeeze the rig through a very low and narrow trestle to get to the location. Half a block away we saw the flashers of the city cruiser that beat us to the scene. The involved vehicle was a 24-foot U-Haul truck. It was pulled over to the curb, and the entire top of the box, from front to back, was crumpled. The driver, a woman in her thirties, was experiencing chest pain, nausea and was hyperventilating (I think I would too if I had just opened the top of my rental truck like a sardine can). We got her out of the cab, treated her hyperventilation and anxiety, and eventually released her to her husband when he arrived.

As we were driving away from the scene, Greg said, That was amazing! I wonder how she managed to flip that truck, and how it landed on its wheels and she wasn t injured.

I had to pull over. Say again? I said. And he did. Did you hit your head or were you born this way? I asked. I got that slack-jawed, incredulous look. So you didn t notice that incredibly narrow and LOW trestle we squeezed through half a block from the scene? I asked. You know the one with the big yellow sign that said CLEARANCE 10 3 ? The light finally went on. Ohhhhh, right, he said. Tunnel vision – literally, I chuckled to myself.

Our last call before quitting time was for a man down in the bathroom. We arrived at the address, and from the aroma wafting through the open door when we got out of the rig, I would have to rate it a seven out of 10 on the FTS (Funky Trailer Scale) 10 requiring A Level protection or, at least, a swipe of Vicks VapoRub under the nose.

As Greg was sliding our patient out of the tiny bathroom by the legs, I noted the soiled pink satin nighty, which then slid up to reveal the, well, what do you call those things? Bloomers, I guess. Frilly pink bloomers. Quite the fiesta our fellow must have been having in there.

Other than being dehydrated, groggy and suffering from a 10-lb. fluid filled blister on his butt where he had laid on the heating vent, our festive fellow had no major complaints medical complaints, anyway.

As we were writing up our paperwork in the report room, I asked Greg, So what did you think of that pink satin nighty and bloomers that guy had on?

Greg looked up from his report. The what he had on?”