Editor’s Note: Lights & Sirens is Kevin Grange’s memoir of becoming a paramedic in Los Angeles. Aspiring paramedics will appreciate Grange’s in-depth explanation of learning, studying and training at the UCLA Center for Prehospital Care Paramedic Education Program. Experienced EMS providers will be reminded of the stress of becoming a paramedic as Grange rides with LAFD and perhaps reflect on how they might best mentor new providers.
Following my fourteenth shift evaluation, it was an unusually quiet afternoon and evening at Station 38. Was the black cloud above Wilmington finally dissipating? I was hopeful, but at 4:39 the following morning, Dean Molino, who lived on West Anaheim Street, went to wake his six-year-old daughter, Jolita, and found her in the middle of an uncontrolled seizure.
The call woke me from a deep REM sleep, jolting my heart from resting to racing. As we sped to the scene, I suspected it was a febrile seizure, triggered by a high fever. They were quite common in children below the age of six, were rarely life-threatening, and often only happened once. But as I opened the door, Mr. Molino literally threw Jolita into my arms. She was still in her purple-footed pajamas, decorated with blue and yellow flowers, but her eyes were rolled back into her head and her arms and legs were rigid.
“She’s still seizing,” I announced, racing to the couch and setting her down.
Since febrile seizures rarely lasted longer than a minute or two, this was a true medical emergency, so we jumped into our pit crew approach to get the job done and save her life. Nick put Jolita on high-flow oxygen and I directed Tim to start an IV.
“Got it,” he said, pulling out a catheter.
“What do you need from me?” asked Eddie.
I told him to get Versed, a sedative used to stop seizures, from the lockbox in the ambulance. “Done,” he said, hurrying out.
I quickly checked Jolita’s ABCs—her teeth were clenched and drool dribbled out the corner of her mouth. Her back was arched, her skin pale, and she couldn’t take a deep breath.
I grabbed the Broselow tape—a color-coded tape that measures a child’s height and provides the accompanying weight and medication dosages—from the first-in bag and laid it out beside her. She fell into the “blue” box, typical for five-to-six-year-olds who weighed between nineteen and twenty-two kilograms. I called out the appropriate dose of Versed. “Slow IV push,” I said, “and we can go internasal if we can’t get a line.”
The Broselow tape also listed the type of equipment that should be used to intubate and the level of shock dosage for defibrillation if a pediatric patient went into cardiac arrest. Sadly, as Jolita continued to seize, such a scenario seemed imminent. “Seizure deaths are hypoxic deaths,” Mr. Wheeler had told us in one of his lectures. “And kids go into cardiac arrest secondary to respiratory arrest.” Jolita had likely been seizing before her father found her, seizing as he called 911, and seizing as we responded from Station 38 to the scene. You didn’t need med math to know that was a long time.
“How’s my O2?” I asked.
“Her pulse oxygen is rising,” Nick said.
“I’ve got an IV,” said Tim, inserting his needle into a red sharps container.
Eddie returned with the Versed and handed me the syringe. I cleansed the administration port of the IV and slowly pushed the medication, keeping an eye on Jolita. Would her rigid, doll-like arms become human again?
Jolita continued to seize for twenty seconds and then her extremities relaxed and her eyes rolled back into the sockets, to hide behind heavy lids.
“What now?” Eddie asked.
“Rapid transport to closest pediatric medical facility,” I replied, picking her up.
I told her father we’d meet him and his wife at the hospital. A parent could ride in the ambulance on a less-critical call, but, with this one, we needed space in case Jolita went into cardiac arrest.
“Good,” he said. “Get it done.”
En route to Harbor-UCLA, I continued Jolita on oxygen and reassessed her vital signs. Her skin had “pinked up,” her blood pressure and pulse were good, and I didn’t see any oral trauma or incontinence from her seizure. But we weren’t out of the woods yet. Jolita was still sleepy and lethargic. Was this the normal postseizure, postictal (sleepy) phase? Or had she sustained permanent brain damage?
“Come on, Jolita,” I said, gently tapping her shoulder. “Wake up for us.”
My words had no effect. Her eyes weren’t tracking me and her body swayed with the motion of the ambulance.
“Two minutes out!” Eddie yelled from the driver’s seat as we exited off the 110 Freeway near Harbor-UCLA.
I quickly switched the oxygen tubing from the house tank in the ambulance to an oxygen bottle on the gurney and took another set of vitals. Jolita was still out of it.
“Should the postictal phase last this long?” I asked Tim as we parked at the hospital. “I hope she doesn’t have brain damage.”
Tim told me the postictal phase could last up to thirty minutes in some patients.
“Come on, Jolita,” I said again as we unloaded the gurney. “Wake up for us.”
Despite the early hour, the parking lot at Harbor-UCLA was teeming with ambulances and police cars. It was always rush hour there.
As we wheeled Jolita toward the ambulance entrance, I noticed her arms and legs begin to move slowly, as if she were crawling back into her skin for the first time.
“Hey, Tim,” I said excitedly, “I think she’s coming around.”
Doctors passed us wearing white lab coats with stethoscopes dangling over their shoulders. As they did, Jolita’s eyes subtly began following them and squinting in the bright light.
“I think she’s coming around, too!” Tim exclaimed.
What we saw was a six-year-old girl in her purple-footed pajamas, becoming more alert and oriented. But what Jolita saw was a bunch of firefighters pushing her on a tall gurney. Suddenly she burst into tears and my heart danced. I’d never been so happy to hear a child sob in my life! Crying meant not only that Jolita had an airway and was breathing, but also that she was awake enough to realize she was at the hospital, in the company of strangers, and her parents weren’t present. I was so thrilled I damn near started crying myself!
Already I couldn’t wait to get off shift and text people to say that today we’d saved the life of a six-year-old. But not only that—we’d also saved all the potential that resided within Jolita. I was overjoyed, but now Jolita was really bawling and people were beginning to give us strange looks, so Tim unfastened her seat belts on the gurney and took her into his arms, and there it was—a firefighter in yellow turnouts cradling the child he’d just rescued. I know of no better image of America’s commitment to its people.
When we arrived at the pediatric ER, a team of doctors and nurses waited. The nurses wore lavender scrubs and had panda and monkey face snap-ons for their stethoscopes. Tim set Jolita down on a bed. I gave a report and the nurses rushed in to do their assessment. Jolita continued to improve, her vital signs remained normal, and she was laughing by the time we left. There was a good chance she’d make a full recovery.
Later, as I cleaned up the back of the ambulance, I didn’t feel so bad about the prospect of being extended to twenty-five shifts. Sure, it meant five more days with the potential to fail out, but it also brought more opportunities to help people, saves lives, and learn from two seasoned paramedics. Bringing Jolita out of her seizure was a strong field save but, as the final month of paramedic school arrived, I didn’t pretend to think the sky above Wilmington was suddenly filled with blue sky and white clouds. For the moment, I was just happy it wasn’t raining.
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Reprinted from Lights & Sirens by Kevin Grange with permission from Berkley a member of Penguin Random House.
Copyright @ 2015 by Kevin Grange.
Available on Amazon and wherever books are sold.
About the Author
Kevin Grange, NREMT-P, is author of the memoir, “Lights and Sirens: The Education of a Paramedic.”