Airway & Respiratory, Patient Care, Trauma

Chance Encounters

Issue 3 and Volume 37.

Life in EMS often takes strange twists and turns. We cross paths with some interesting patients. We occasionally become patients ourselves, in need of care from our friends and colleagues. I had just such a chance encounter in November 2010, when I blew my nose one afternoon in a 17th floor bathroom in our office complex, and blood began to rush out of my right nostril.

“No problem,” I thought. “I’m a medic. I’ll just press on the nostril, and it will stop.” I did that, but as soon I applied direct pressure to the right nostril, blood began to free-flow from the left.

Once again, I thought, “No sweat. I can stop this.” So I squeezed both nostrils tightly, but the bleeding didn’t stop. Instead, I began to feel a river of blood run into the back of my throat.

“Uh oh,” I thought. “This isn’t good. I can’t reach whatever the source is deep inside my nasal septum, and a cervical tourniquet isn’t an option.”

I leaned over the sink and watched as my vital fluids flowed down the drain. I thought to myself, “Wow. This is the first time in my career that I don’t feel I can control a hemorrhage source—and it’s my six-quart tank that’s draining rapidly!”

I finally decided to do something EMS providers hate to do—call for an ambulance—because we like to think we can handle any incident, including those that involve us.

So I reached for my Blackberry to contact our receptionist to call 9-1-1 for me. However, my Blackberry was password protected and I had to carefully enter in 11 letters and numbers in the proper sequence to be able to reach help. My initial attempt to enter the password correctly failed, so I had to force myself to relax and forget my predicament for a minute so I could enter the correct number string.

When I reached the receptionist, I told her to call an ambulance for a severe epistaxis and asked her to advise them that “the patient” was outside at the ground floor lobby entrance to the building. The last thing I wanted was an ALS engine and EMS crew to come up to the 17th floor and “stretcher me out.” So I grabbed a small waste basket to bleed into and took an elevator to the lobby.

While bleeding away at the curb, I could hear San Diego Fire-Rescue ALS engine 1’s Federal Q siren roaring as they approached. I suddenly realized what that sound represented to patients who are desperate for assistance—that help was a short distance away.

When the engine arrived, a female paramedic/firefighter approached me. I expected the customary “Hi, I’m paramedic XYZ,” introduction but instead, heard her say, “Hey, I know you. You spoke at my graduation from paramedic school at Southwest College.” I tried to smile but, concerned about my blood loss, anxiously walked toward the arriving ambulance.

As I sat down on the ambulance stretcher, the female paramedic, with a strange look on her face, said, “Gee, I’ve never seen anybody bleed through their tear ducts before,” I suddenly began to wonder not only what precipitated the eruption but whether its cause could be determined and corrected before I exsanguinated.

It turns out that I had a severely deviated septum from nose fractures I experienced years earlier while playing football and a weak area in my nostril that, coupled with a sudden increase in my blood pressure, caused the rupture to occur. It was managed in the emergency department, and I was referred to an otolaryngologist who operated on me and corrected my deviated septum.

I thought this strange case was behind me until I learned that the paramedic/firefighter who cared for me that fateful day, Andrea (“Dre”) Dominguez, nearly died four months after caring for me from what started out as a mild asthmatic attack.

Her incredible story is significant not just because of our chance encounter, but also because a team of dedicated pulmonologists refused to give up while resuscitating her. The team of specialists made a decision to place Dre on an extra-corporeal membrane oxygenation (ECMO) unit, a highly sophisticated bypass machine that they had never used before on a critical asthma patient. Their decision and Dre’s strong will to survive saved her life.

Dre decided to share with you her close encounter with death and the successful use of ECMO to treat what appeared to be irreversible complications from acute asthma. Her story is presented in “Breathless,” pp. 36–41. Read it and share it with the critical care coordinators at your region’s specialty facilities. The next life ECMO saves could be yours. JEMS

This article originally appeared in March 2012 JEMS as “Chance Encounters: You never know who, when or how you’ll meet again.”