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By Kyle McCoy
We have all run cardiac arrests in weird places, but I was definitely unprepared for what we encountered on the night of Jan. 28, 2023, at a local bowling alley in Columbia, Missouri.
The night had already started out ... bizarre, to say the least. Right at shift change, we had a patient who was overdosing in the bathroom at McDonalds. After resuscitating him, he proceeded to become violent and required both physical and chemical restraint to keep him from harming himself or us.
At the same time, several other unusual calls were coming out. As the night went on, we were getting busier and busier. One of my ambulance crews called me while they were out at a barricaded subject call, asking me to pick up their food order before the restaurant closed. While I was headed there, a cardiac arrest call came out.
I was probably about a mile away from the bowling alley and the ambulance they dispatched was stationed on the other side of town, so I responded, knowing I would be the first paramedic to arrive. Once I got there and headed inside, the patrons pointed me down this small walkway to the back of the lanes. I thought “back here?” Heading back, I assumed I would find an employee in some sort of break room. Nope.
I turned the corner and saw this narrow walkway with big machines on one side. A group of police officers and employees were gathered about halfway down. An employee passed me, and said he was on the machine. “Hey is he trapped?” I asked. Luckily, he responded with a firm “no.”
Columbia Fire Department was right behind me, and we arrived at a step ladder. There was a Columbia police officer up on the machine doing CPR. We climbed up to relieve him and found that this machine is mostly open on the top. It had some railing and small plates to stand on – that’s it. So, we began doing CPR and ventilating him with the BVM.
Around this time, the ambulance crew arrived, and the paramedic and EMT joined us on top of the machine. As they began further ALS treatment, I started talking to the captain of the engine company about getting him down. I asked him if they had a Stokes basket, but they did not. Next question – do you have any webbing or straps? I already knew the answer to that; every firefighter carries webbing in their turnout gear.
We landed on a backboard with some webbing to make sure the patient was lashed on the board securely to get him down. Good idea, right? The firefighters took it one step further. They lashed the patient to the board and used more webbing to create handles on one side. Genius.
Left: The patient’s head and torso were fortunately on the metal plates above the machine. There was very little room to stand, squat and place equipment. Right: The edge of the machine that the patient had to be lowered over was tall enough that several police officers had to guide the patient and board from well over their heads.
Photo/Courtesy of Kyle McCoy
At this point, we are getting him on the board, which was extremely difficult, due to the machine design. Once we had him on the board, the monitor showed V-fib. We charged the monitor and when I cleared everyone, a question was posed about being on a metal machine. I shrugged, and told everyone to stand up. I counted and delivered the shock. Of course, everything was fine. I knew it would be, but, never passing a chance to break the tension, I looked at the growing line of police officers below us and said, “I wasn’t quite sure how that would turn out.” The sergeant, knowing better, cracked a smile and said, “sure,” all of this, of course, with no bystanders around.
At this point, we are almost ready to move. The officers asked what they could do to help, and we said “hands.” One of the officers asked if we could put the cot next to the machine and raise it all the way up to lessen the distance. We said, “of course, that’s brilliant.” I got down from the machine and helped fetch the cot. We moved down this walkway and raised it all the way up. Up top, the firefighters were fastening the patient and creating the strapsto lower him. The rest of us stood below and raised our hands all the way up. Now they have him at the edge. As they guided him, he dipped just enough to one side so we could grab the board. The three firefighters stood up and he came over the side gently. As we held on with as many hands as possible, they began to lower. He was slowly guided onto the stretcher. The stretcher was then lowered, and CPR started immediately. Once strapped to the cot, off we went to the ambulance.
The patient was transported but was eventually pronounced dead.
Forging relationships with public safety counterparts
Despite the outcome, we came together and completed the task safely, successfully and without incident. Everyone had a job to do and was able to have input. I think that it is key to consider what all people have to suggest, despite their job title. Once the discussion began, everyone made suggestions that ultimately led to the final plan.
It just so happened that the fire captain is a guy that I used to work with years ago on the ambulance, who I get along well with. Over the years, we have run into each other on EMS calls frequently. We have always enjoyed working together.
For the police, our schedules are set on the same rotation, meaning I see the same officers, sergeants and lieutenant often. We see a lot of each other, and I have been able to work alongside them at some interesting scenes, e.g., MCIs, multiple shootings, etc. This has created a form of familiarity.
Coming together actually begins well before an incident. Making meaningful professional relationships with counterparts of other branches of public safety will allow for easier, open communication when you really need it.
About the author
Kyle McCoy is an EMS supervisor for MU Health Care Ambulance Service in Columbia, Missouri. He has 18 years of experience in EMS. He received his fire, rescue and EMS training at Central Carolina Community College in North Carolina.