Editor’s note: Our “I Was There” writing contest for EMS Week earlier this year attracted a host of excellent entries, including Jenny’s Story by Ben Sande. We’re pleased to introduce another personal article written by Ben, this time on the subject of a pediatric trauma call.
By Ben Sande
Paramedic (Wash.)
“City Medic, County Fire Respond level three, 18 month old car vs pedestrian! Repeat, City Medic, County Fire, level three response for 18 month old ran over by a large pickup. Airlift is already in route from Big City Trauma Center, Repeat sounds bad, already launched a bird.” Click.
Silence.
I look at Sarah. She looks at me.
We run, and I mean run, for the ambulance.
This is the call that no one wants — the severe child trauma. It’s the call we dread, the one we all hope to avoid but know that sooner or later our number gets pulled and the call is ours. For me, it was becoming routine. I had been a medic for about a year and a half and I had been on so many dead and dying kid calls by that point that I almost threw in the towel.
It all started with my very first field code as a medic — an 18 month old drowning. One that didn’t survive, one that I didn’t run perfectly. I forgot things. I lost my tube as we got to the ER doors and the Doctor refused to believe that I ever had one, even though I insisted I saw the tube through the vocal chords and we had good chest rise and lung sounds. I was unable to get the I.O. on her, I just kept bending the needles. I never gave her any meds due to not getting the I.O. We stayed and helped work that little girl for three hours in the ER trying to warm her little body enough, just in case. She still died. I still remember her name.
After that I had at least one very sick kid weekly. I delivered premature babies that couldn’t breath on their own because mom was trying to dodge CPS. I had severe car accidents with critical kids and even kids in traumatic arrest. Children in septic shock from infections that didn’t get attended to in time. I ran code several times from our little town to the big pediatric hospital two hours away with kids that were crumping, even having to intubate them en route. Sick asthma kids that had to be tubed. A double pediatric trauma resulting in a double airlift without another medic unit to help, they were all on calls. The list goes on and on.
Doubting the job
That was my story, kids, kids, kids. When I was really doubting whether I wanted to keep doing this or not, some of the local medics took me out for beer. They talked to me, told me this was not normal, that it would slow down and might be a year before I had another dead one. We had a good time. I have great friends out here.
I decided that I was going to be the best medic there ever was at pediatric patients. I started studying daily, reading anything medical I could get on kids. I chased down the old timers and had them run me on scenarios of kid calls they had. I watched videos about pediatric emergency medicine. I studied websites, and took tests.
A very short time later we get toned to the pediatric car versus pedestrian.
Back in the ambulance, Sarah has got her foot to the floor. It’s about a 30 minute drive out to the scene running code and we did it in 15. We don’t normally drive this fast but the circumstances warranted a little speed.
On the way out there I talked with Sarah and we made a plan. I would get the volunteer FF/EMTs and scoop with a back board and get the kid in the back of the rig so we could do everything else inside. Sarah would set up all the equipment in the back while I grabbed the kid. We also spoke of possible injuries and interventions we might need to perform.
A smoother response
Assigning tasks ahead of time, especially on a call like this, can help it to run smoother. We arrived on scene to find several upset volunteers that were keeping him still and had him on a back board. They don’t run a lot of calls in this district and rarely anything like this. But what they had done was perfect, exactly what I needed. The bystanders/family were all on the porch crying, on the other side of the truck, they didn’t want to see what was happening.
I got my first look of the little guy. Blood in the mouth, nose, ears and eyes. A giant black tire track running from the middle of his abdomen, across his face and to the top of his head. His head looked misshapen. I grabbed the portable suction, clicked it on, it’s vibrating hum coughing to life, then used it to clear his airway. He was ghost white with peripheral mottling, he’s in shock I thought to myself, ataxic respirations meaning probable head injury and there was increased ICP pushing against the breathing center of his brain.
Lungs were clear. Pulse was really fast. Time slowed. It is odd how time slows down during an emergency. How other things that happened that day, and often days preceding and following it, fade from your memory.
I once read that the reason time slows down is because we relate to every thing according to it’s relativity to every thing else, time included. When something terrible happens the mind starts over, going back to the beginning of life. Since we have nothing else to compare this period to, it seems to crawl. This is called existential slowing.
During emergencies the brain resets to default, time stretches out almost painfully. I can not say how many times I have climbed out of the ambulance to have someone ask what took so long, when our response had been fast enough I was sure to get an email reminder of our code speed policy from the boss. As EMS providers we are not immune to this drawing out of minutes.
When seconds count
I told a volunteer to grab the foot of the backboard and we headed to the rig. Once in the back Sarah and I went to work, only interrupted by the Fire Chief asking if we needed help. Knowing that he was a very experienced EMT, I said “Yes, you, please get in now and give us a hand.”
I grabbed the tiny laryngoscope and intubated the boy, no gag reflex. Securing the tube, Sarah already had all my I.O. stuff out, and I cleaned his shin and found my landmarks. I didn’t even bother trying an I.V.
It went in smooth and I got marrow return and good fluid flow. In that time the Fire Chief had the back boarding all finished up and Sarah had gotten him on the monitor, sinus tach 130, no ectopy. About what I would expect for a kid in his situation. I went ahead and gave him a 20ml/kg fluid challenge to treat his shock while Sarah got in the drivers seat and we headed to the landing zone, where the helicopter was already waiting for us.
The LZ was only a mile away. I sat there running over my treatments and the kid’s vitals, scanning to see if I missed anything while the Fire Chief bagged and Sarah drove.
All of the sudden we stopped and the flight nurses were crawling in. I gave report and they transferred their gear in, and mine out, and in minutes the kid was on his way to a pediatric trauma center.
Eleven minutes later...
I hopped out of the ambulance with mixed emotions. We rocked the call. Thanks to phenomenal dispatching and good scene time our total time spent with the kid, including transport time was 11 minutes.
But I knew the prognoses. He was just too damaged to survive this as anything other then an invalid. Miracles do happen sometimes, so who knows. As I started to tell the volunteers what a good job they had done a car pulled up, it was the family. They asked me what I thought and I had to be honest. I could hear several people in the car sobbing as they pulled away.
Back at the scene I got in an argument with the State Trooper heading the investigation. He wanted me to draw blood on the man driving the truck (not related to the kid) so they could run it for alcohol and drugs. Our protocols had recently changed to say that we cannot do this unless the person is a patient and needs an IV for their treatment. This came down because of being woken up at 3am to do these kinds of draws all the time.
Our MPD didn’t think it was fair to us for this to happen when we get so little sleep anyway. So the officer told me I was lazy, and after an emotionally charged scene like this I was in no mood. It ended with me and the cop nose to nose yelling at each other.
Sarah, being the awesome partner that she is, saved me from a tasing and dragged me away and made me stay in the rig while she explained it to another officer. On a call a few weeks later the stater apologized and said it was his first bad kid call, I apologized too. Also the drug/alcohol screen came back negative. It was an accident, the man driving just didn’t know the kid was there and never saw him.
A week later I received a letter from the airlift company. Four days after the call the family stopped all treatment and the kid died. Even with all we did, and with everything going right, it was not enough. I felt good about the call though, not like the drowning. I knew that if the kid had had a chance we gave it to him. Not to mention the family had four days to say goodbye and prepare themselves for the outcome.
Thankfully that was the last bad kid call I ran for a long time.