I found myself sitting in the back of the squad catching my breath.

It truly did look like a bomb had gone off back there.  Countless plastic wrappers, empty med vials and much of the contents of our formerly pristine cabinets were tossed about.  Three different drug boxes were open with some of their contents missing.  Our stretcher sat outside of the ambulance, the lifepak and a mass of cables (hopelessly tangled) sat on top of our backboard on the stretcher.  All of the cabinets had broken tags.

It had been a very long day already, and we had a few more hours of work ahead of us in an attempt to piece together our truck.

**********

It was one of those days where you don’t get to do a lot of sitting.

I think that’s probably the most positive spin I can put on how I was feeling.  I was cold, tired, and getting a little cranky.  We had been running the stripes off the side of the truck… Back to back to back transfers with few and far between opportunities to learn about the new equipment I now have available to me at this service.  After almost 13 straight hours of teching all but one run (and squeezing in driving time when I wasn’t teching) and I was ready to throw in the towel.  Figuratively and literally.

We were posting in a quiet area… If there is such a place… I turned the lights in the mod off and reclined the captains chair.

Bring on the power nap, baby.

I had barely managed to close my eyes when I heard the high pitched tones go off.  OOOOEEEEOOOOOOOUUUUHHHHHHHH!!!!  Unit 427…. 2122 Blackhawk road… Cardiac arrest… Unit 427…2122—”

*Blink*

I leaned forward into the driving compartment and strained to hear the rest of the dispatch.  ”They just said Cardiac arrest, right?”

“Sure did,” My FTO replied as he threw the truck into drive and lit us up.

Airway bag.  Monitor.  Drug box. They’ll all need to go in.  What are the ACLS drugs and dosages?  Crap, I can’t remember the dosages…  Uhm… SHIT!  Where are the IO needles and pressure infusers kept? Do we have an extra roll of paper for the monitor?  ET or King?  Where’s the vent?  We’ll need a backboard too…  I tossed my field guide in the action area, just in case.

I had a good seven minutes to complete my mental checklist and load the stretcher up… My FTO had barely managed to hit the brakes before a Volunteer Firefighter was throwing open the back doors to the squad.

“It’s an ARREST!  BRING IT ALL!!!”  He sounded significantly more rattled than I did, which is an odd feeling for me.

I’m usually the shaky one.

I shook my head in an effort to clear my mind and jumped out of the back of the truck. The volunteer and I dragged the fully loaded stretcher across the gravel driveway towards the front door of the home.  Bright red, amber and blue lights from various vehicles bounced off of the houses.  It was a little disorienting… Kind of like stepping into a crazy nightclub environment and feeling dizzy from the light show going on inside.

**********

A man I recognized as being a fellow coworker from the last service I worked at was kneeling next to the AED while another pumped furiously on the patients chest.  ”Clear… CLEAR!!!”

The patients arms jerked like someone had just scared the life out of him.

Hrm.  I’ve never seen that happen before outside of TV or a movie…

The living room of the trailer was at capacity.  Three guys in turnout gear were mixed in with three others volunteers in jeans, sweat pants and shorts.  The patients wife sat stone-faced in a rocking chair while his two Sons held back his hysterical Daughter.  A curious neighbor hung out with the two Sheriff’s deputies outside.

“What do we have?”  I got a good look at our patient… He looked pretty good for a man in cardiac arrest… Diaphoretic, sure, but very pink.  Good on ya for the fantastic compressions, mate!

“VFib.  That was the second shock.  He was out doing some work in the back yard, came in the house, complained about some chest pain, and just dropped right here.  His son started CPR.”  The firefighter doing compressions on the large man was doing his best to give us a run down, it was very clear that he was running out of steam.  ”Someone switch with me,” he asked, a little deflated.  I’m sure his back and shoulders were screaming at him.

The next few minutes was filled with some organized chaos.

Switched to our monitor.

King LT placed with ResQPod.

Another shock.

Bilateral IO’s drilled in.

Epi pushed.

More compressions.

Another shock.

Epi pushed.

More compressions with a fresh set of arms.

Another shock.

Amiodarone pushed.

More compressions.

I was furiously scribbling down notes and reaching for another Epi when something caught my eye.  It looked like our patient with the previously dead eyes was now attempting to chew on his tube. Others noticed it too.  Three of us simultaneously reached towards pulse points on the patient.

Hey, that’s a strong radial.

“Stop… Stop for a minute,” someone yelled.  All of the activity in the room ceased for a few brief seconds while we held our breath.

That’s definitely a pulse.  That’s a good pulse.

“Oh my GOD, DAD?  DADDY???” The grown woman broke past her brothers and rushed us.  ”Is he going to live?  Did you get him back???”  She grabbed on to my arm and pleaded with me to make a promise that her Father was going to live.

I froze.  I was standing there holding the IV bags looking much like a deer trapped in headlights.  ”Uhm… We’ll do everything that we can, Ma’am… He has a long way to go, but his heart is beating on it’s own.”  I didn’t know what else to say.  I didn’t want to give her any false hope, I just wanted to get her Dad into the back of the truck and haul ass to the closest ER.

**********

He survived, and the last I heard he was neurologically intact.

We ended up doing a few 12-leads that revealed a massive inferior MI.  We kept his BP up and packed his groin and axilla with ice packs.  He got fentanyl and chilled saline.  When he started bucking the tube we RSI’d him.

A STEMI and ICE alert was called in with the report.  Luckily (if there is a way for an arrest patient to be considered lucky), we only had a ten minute transport to a STEMI center.   The patient was heading to the cath lab within a few minutes of arrival at the ER.

This was the first arrest that I’ve been able to take part in since becoming a paramedic, and it was a hell of a learning experience.

Here’s what I really picked up on during this run.  And this is in no order whatsoever….

I’ve learned that these runs work best when egos are left at the door.  I thank God that wasn’t an issue on this run.  Everyone worked together.  It was the best case scenario for the patient.

I’ve learned that there is no ALS without BLS.  We’re told this in school, and we know it in our heads, but when you see it in person, when you see that arrest patient with pink skin… because of good compressions, a BLS skill… Well, that kind of cements it in your head.  Make sure your basic skills are excellent before moving up in certification levels.

I learned that getting amped up on a run like this is best handled by remembering to breathe.  Seriously.  Keep breathing.

I learned that it’s a good idea to know if family is riding up front during transport. We often have a coping mechanism during stressful situations that most people don’t understand.  We make jokes, we say things that lay folk would find a little… well… inappropriate.  If positions were switched I can’t say I’d feel differently.  It’s all said in an effort to break the tension, and there’s absolutely no disrespect meant, but the average person isn’t going to realize that.  Just be conscious of who’s riding along.

I learned how important it is to keep track of your equipment. Equipment like thermometers, for instance, tend to disappear rather easily in the back of a squad with five people and a patient.

I know I’ve said this before… Multiple times, in fact, and I’m going to say it again.  Know the back of your truck. Know the back of your truck. KNOW THE BACK OF YOUR TRUCK. This was only my 4th shift with this service, and honestly, I thought I knew where everything was… Or at least what cabinet it was in.  I was wrong.  It wasn’t anything vital, and my FTO wasn’t upset over it, but damn if I wasn’t angry with myself over it.

So there it is, ya’ll.  My first code as a medic.  And he not only lived, but he’s still the same person.  I was a part in that as a member of a team that really did work well together.

It’s a feeling that can’t be beat.

One more thing… I made ya’ll a promise well over a year ago that when I finally pushed epinephrine as a medic that I’d do it with my people in mind (it was a little quirk of mine given my namesake).  For every single person who listened to me while I was in school, for every person who gave money (which I still can’t wrap my head around) so that I could actually go back to school… For every person who told me that I could do it.  For every person who told me that I had the stuff to reach this goal… For every person who let me start an IV on them.  For every person who was… There.  In any way shape or form.

I’m finally there.  I’m where I should be.  Thank you.  And that field guide… Never looked at it.  Not even once.