“I’ve told people what happened but never discussed how it changed me”
An AEMT recounts his first pediatric code, which occurred outside his home while off-duty
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I had just got off a shorter shift at the trauma I center ER where I work. It had been an easy one, only covering someone for half of their twelve-hour shift. I drove home in a pretty good mood, like most days, looking forward to ditching my scrubs and taking a warm shower. When I got home I did exactly that. My friend from high school was headed over pretty soon, but I took my time unwinding in the shower.
The shift had been decent, as the ED I work in is busy, one of two adult trauma centers in the state. It had been a productive day, splitting my time between the trauma bays and patient’s rooms in the more critical section of the ED. I’d started a lot of lines, talked to a lot of patients, heard a lot of stories, and by the end of my shower, I had forgotten it all. It was put behind me, just as most shifts and I was comfortable with that, looking forward to seeing my friend and kicking back with my roommates.
It was around 10 pm at this point and I dried off, put on some khaki pants and a gray shirt and started walking up the stairs when my friend texted that she was at my house. That’s when I heard it. A loud crash that shook the entire house- I felt it in my bones. It didn’t sound like someone had fallen upstairs, but I walked into the dark living room and peered out the window. There was an SUV rammed into one of the thick trees catty-corner to my house. It looked pretty serious, but not unlike most car accidents.
I figured someone probably broke a bone and would want to be transported to the hospital I work at, but there was likely not too much I could do. Regardless, I quickly walked back downstairs and got some shoes on, a green jacket, and my trauma shears from my room along with my car keys. My gloves, stethoscope, and pretty basic trauma kit were out in my car. As I walked out the door, my friend called me. She witnessed the crash and had rushed over to help.
With no medical experience and only basic first aid training, she called me as soon as she saw what had happened, even before calling 911. I picked up the phone and heard her say, in a shaky, panicked voice, “You need to get over here right now. There’s a kid in the back seat and I think she’s bleeding from her neck.”
I broke into a sprint to my car. This had just become a real emergency, one of those 1% calls and patients you see that are time-sensitive, critical patients that you can actually help. I snatched my gloves, kit, and stethoscope and ran across the street to the car where a small crowd was gathering. My pulse was racing, and I was more focused than I feel I’ve ever been in my life. There was a girl standing next to the opening of the back seat, door open, reaching inside. I threw my stuff on top of the car, and as I was gloving up I asked her who she was and what was going on so far. She replied that she was a student nurse and she couldn’t find a pulse. I asked if she tried for a brachial and switched with her, telling her to get some gloves on.
When I looked into the back seat, what I saw still sticks in my mind some nights. It was a little girl, what looked like 3 or 4 years old, in a car seat. As I felt for a brachial and carotid pulse, I scanned her body. She was wearing only a diaper, someone had undone the restraints on her car seat but it didn’t look like she had been thrown forward, and she was bleeding heavily from her nose and mouth. When I couldn’t find a pulse, I told the nurse to attempt c-spine while I extricated the child from the car. She was limp, slippery with blood, and growing colder.
I hustled her over to the grass and laid her down, attempting at least some minor support of her spine. As soon as I laid her down, I began compressions. After just one round another bystander approached the patient lying on the ground. He was wearing a shirt with the logo of the local private EMS that covers the city for transport. He had a pocket mask with him and kneeled at the head of the girl. When he went to tilt her head, I told him he needed to do a jaw thrust maneuver because of the risk to her cervical spine. A crowd had gathered in the street watching us work in anticipation. I ordered them all to move, with the familiar statement of, “Don’t make more patients.”
After two rounds of CPR and breathing, we did a pulse check and the student nurse took over compressions while I quickly went to check on the driver. It was her mother, and she was disoriented but had a patent airway. After introducing myself, she started complaining of ankle pain and I cut her off, which is something I rarely do with patients. I asked her if I had her permission to treat her daughter and got her name. I asked if she was intoxicated, or having trouble breathing, and if the child was on any medications or allergic to anything. She gave permission and answered my questions, followed by a nervous, “Is my daughter OK?”
In those situations, it’s difficult to make a choice on how to answer. If I tell her the truth, she could injure herself further by self extricating and only cause more chaos over the already uncontrolled scene. On the other hand, it’s difficult to bring yourself to lie to the mother of the kid you’re mostly sure won’t live through this. I chose the latter and lied, saying “I don’t know, but I need to get back to her.”
I told her to stay in her car and went back to the kid. The EMT said he wasn’t able to ventilate her at all, meeting resistance. I considered an OPA, one of the only useful things in my trauma kit, but figured it would take too much time to find and drop in before fire arrived on scene, and there was a significant risk of severe maxillofacial trauma. I took over the airway and repositioned with a stronger jaw thrust, attempting to ventilate every 30 compressions. About then was when the fire department arrived on scene and one paramedic took over compressions, asking me what I knew. Another took over ventilation, and handed me suction.
It was futile to clear the airway of blood. She’d suffered massive internal hemorrhaging, her stomach distending with blood. It looked to me like a sheared aorta, and her pupils were fixed and dilated when I checked. I told him how many rounds of compressions we’d done, and we both knew the outlook was grim. The ambulance took another few minutes to arrive. They quickly loaded and peeled off code 3. We have a pediatric trauma I center that’s only a block away from the center I work at. The girl was pronounced shortly after arrival, while the mother was hospitalized with a shattered ankle and broken tib/fib. She had mentioned a history of seizures in my brief assessment, and it was discovered she was not intoxicated and likely suffered a seizure while driving.
That was two months ago. I’ve told people what happened but never discussed how it changed me and what it did. For weeks afterward, I didn’t sleep most nights and was welcomed with nightmares the few hours I was allowed here and there. I ran through those maybe 15 minutes in my head hundreds of times, and I still do to this day. I’ve seen a lot of people die before, and most of them don’t bother me all that much because it’s just part of medicine. Something about this one really got to me.
Maybe it was the stress from being in charge of a pediatric code for the first time, maybe it was that it was so close to home, or maybe it was because I had just relaxed and let down my barriers from work. Now, when I see a young girl in public and hear their voice, I tense up and my mind wanders back to that day. I plan on going to visit the gravesite soon to hopefully find closure, and I hope my future isn’t riddled with sleepless nights due to similar situations. This job changes a person, and some shit, you just can’t talk about with people because you don’t want to remember it and they won’t understand. But for anyone who’s gone through something similar and is having some trouble, I hope you can reach out to someone you trust and know that what you do makes a difference.