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[A THREAD] EMS: It's A System - 29 years ago this month, I ran my first 911 call as a paramedic. The month before, I had graduated with the other survivors of UCSD's Emergency Medical Services Training Institute Paramedic Class 40, following eight arduous months of training.
![[A THREAD] EMS: It's A System - 29 years ago this month, I ran my first 911 call as a paramedic. The month before, I had graduated with the other survivors of UCSD's Emergency Medical Services Training Institute Paramedic Class 40, following eight arduous months of training.](https://pbs.twimg.com/media/Ehup2fIVkAM6oJe.jpg "[A THREAD] EMS: It's A System - 29 years ago this month, I ran my first 911 call as a paramedic. The month before, I had graduated with the other survivors of UCSD's Emergency Medical Services Training Institute Paramedic Class 40, following eight arduous months of training.")
To say that my first call was remarkable is a bit of an understatement; it was extraordinary. The likes of which I would never experience again in my 29 years as a paramedic. It was also (eventually) reenacted on network television.
After her husband was struck by lightning just outside the front door of their home, the women dialed 911. Her call was answered by a Fire/Ems Dispatcher.
As soon as he had a minimum of information, the dispatcher typed a few keystrokes and the nearest fire engine and paramedic ambulance were dispatched. He kept her on the phone.
While the EMS crews (we) were enroute, the 911 dispatcher calmly gave the wife CPR instructions.
While the EMS crews (we) were enroute, the 911 dispatcher calmly gave the wife CPR instructions.
She performed effective CPR on her husband in their driveway until we arrived and assumed care.
We continued CPR and rapidly moved the patient to our ambulance. Once inside, our cardiac monitor was applied and an IV inserted. A brief pulse and breathing check revealed none.
We continued CPR and rapidly moved the patient to our ambulance. Once inside, our cardiac monitor was applied and an IV inserted. A brief pulse and breathing check revealed none.
Asystole was noted on the ECG monitor, an ominous finding in cardiac arrest. We readied the "Cardiac" meds and treated our patient per standing orders. We also placed a breathing tube.
Concurrently, our "Radio Man" hailed the Base Hospital. Our call was answered by a Mobile Intensive Care Nurse (MICN). These highly-trained emergency nurses provide paramedics with Medical Direction and help direct the care of patients.
The MICN charted what had been done and gave direction for additional treatment.
Despite the aggressive care, our patient remained without a pulse and breathing. Due to the nature of the call, The MICN had notified the Base Hospital Physician (BHP), who came to the radio room.
Despite the aggressive care, our patient remained without a pulse and breathing. Due to the nature of the call, The MICN had notified the Base Hospital Physician (BHP), who came to the radio room.
The Base Hospital Physician is an ER Doctor who provides medical direction to paramedics operating out of his/her base.
The BHP on duty that day was one of the most experienced docs at that Emergency Department.
The BHP on duty that day was one of the most experienced docs at that Emergency Department.
Upon hearing the mechanism (lightning strike) and the lack of response to treatment so far, he ordered another medication, a variation from our protocol, i.e., a medication we would never have given in this circumstance.
We quickly pushed that med into the IV. In seconds, Sinus Tachycardia replaced Asystole on the ECG monitor. Our patient developed a strong radial pulse and also started spontaneously breathing. We had achieved ROSC (return of spontaneous circulation).
The nature of this call dictated that we transport our patient to the closest hospital Emergency Department (which was not our base hospital). Within minutes of ROSC, our patient was under the expert care of an emergency physician and a team of nurses and allied personnel.
They worked hard to stabilize our critically ill patient. And they did stabilize him.
When it was medically prudent, our patient was transferred from the receiving hospital to another larger hospital for longer-term, more specialized care.
When it was medically prudent, our patient was transferred from the receiving hospital to another larger hospital for longer-term, more specialized care.
With intensive, highly-professional, state-of-the-art medical care, our patient eventually "woke up." He was a "Save."
The Emergency Medical Services System worked for this man. 911 access; Emergency Medical Dispatch; "Bystander" CPR; ALS (paramedic) First Responders; Base Hospital Medical Control; Emergency Department Care; Specialized Hospital Care.
All of the system's parts have value and contributed to success on this call. We were privileged to play a role in the extraordinary outcome for this patient
And, the answer to the most common question I got after the "Rescue 911" episode: I did not get to meet William Shatner.
And, the answer to the most common question I got after the "Rescue 911" episode: I did not get to meet William Shatner.
