Saturday 19 May 2012

The Laws in Practice

"56 year old male, Cardiac arrest, CPR in progress"

It was the end of a very long, arduous run of nights. I was tired and only had half an hour to go until home time and, to be perfectly honest, I couldn't wait! My bed was calling me.  Due to poor time / job management by the student who was with us we were 'on the hook'; basically, at very high risk of getting a late job and thus being off incredibly late! I wasn't annoyed as I made similar mistakes when I first started, but that didn't prevent us winding her up and piling on the guilt trip! I was getting hungry so as we were at the station I decided to take advantage of having a table and chair at my disposal. I poured myself a bowl of cereal and made a cup of coffee. I sat down to enjoy this rare treat and yep... you guessed it... we got a job!
The first law of EMS: All emergency calls will wait until you begin to eat, regardless of the time.
The timing of the job was not lost on any of us. Had it been any other job we would have politely pointed out that we would be finishing our shift in 17 minutes, as it was it was a Red 1; A cardiac arrest. We might not like finishing late but no one really minds if it's for a genuine job. This was, so off we went.
The EMS law of Time: There is absolutely no relationship between the time at which you are supposed to get off shift and the time at which you will get off shift.
We began our journey through the early morning traffic. I don't know if everyone was tired and in a 6am daze but drivers seemed intent on ignoring us! (please see 'Drivers: Take Note'). If by chance they did see us they simply stopped where they were. It was a highly stressful journey and that's without contemplating the job we were on our way to.
The EMS rule of Warning Devises: Any Ambulance, whether it is responding to a call or travelling to a Hospital, with Lights and Siren, will be totally ignored by all motorists, pedestrians, and dogs which may be found in or near the roads along its route.
We arrived at an extremely lush block of apartments in a particularly lush part of town. We were the second ambulance and there was already a car on scene so we grabbed a spare oxygen and headed in. We were met at the door by the concierge (I know!) who directed us to the 5th floor apartment. Of course it was the 5th floor of 5! Why would it be anything but?
The EMS Law of stairs: The severity of a patient's illness or injury is directly proportional to the number of stairs said patient has climbed to get away from the front door. The worse the patient is the more stairs they will have climbed.
Luckily the lift was working, but as the door slid open I saw a future problem. It was tiny! Just about big enough for 2 or 3 people to stand in like sardines in a tin. It was barely big enough for a chair and certainly not big enough for a patient in cardiac arrest. Gulp! As we exited the lift we were greeted by a long, long, long corridor of least 100 meters. Guess where the apartment we wanted was?! Yep! Last one on the right! We entered and followed the noise. The patient was in the bathroom. 
The EMS law of Bathrooms: If a call is received between 0500 and 0700, the location of the call will always be in a bathroom.
A resus can appear to be chaos, organised chaos, but chaos nonetheless. There is kit everywhere; defib, lifepack, oxygen bag, suction, paramedic bag open, cannulation roll out, intubation roll everywhere. Plus, on top of that 6 of us present; 2 doing CPR alternately, 1 bagging, 1 cannulating, 1 coming and going fetching things and one writing stuff down, attaching leads and monitoring etc. There simply wasn't enough room for all of us in such a tiny bathroom!
The EMS law of Space: The amount of space which is needed to work on a patient varies inversely with the amount of space which is available to work on that patient.
As far as cardiac arrests go, the resus part was simple; 3 shocks and his heart was beating again. IV access and airway had also been easy, it was now just a case of getting him to a hospital and quickly. It's probably worth mentioning that the patient was large. Very, very large! At a guess I'd say 22-23 stone. 
The EMS Theory of Weight: The weight of the patient that you are about to transport increases by the square of the sum of the number of floors which must be ascended to reach the patient plus the number of floors which must be descended while carrying the patient.
  • Corollary 1: Very heavy patients tend to gravitate toward locations which are furthest from mean sea level.
  • Corollary 2: If the patient is heavy, the elevator is broken, and the lights in the stairwell are out.
It wasn't that the lift was broken thankfully; it was that he wouldn't fit inside. We got a carry sheet and began preparing to get him out. A few of us 'ran' back down to the lobby with as much kit as we could carry and got the bed set up and ready at the bottom of the 10 flights of stairs. Back up we then went for the extraction. Whilst 1 bagged the remaining 4 of us carried him along the corridor, watching the monitors as we went. We slowly worked our way down to the stairs, followed closely by the family. We were all sweating. Even the simplest of resus's take their toll, but a confined space and a nightmare extraction with a heavy patient meant we were all feeling it. Eventually we were at the bottom and loading him on to the truck. A short journey to hospital and he was handed over and getting the treatment he needed. We had a clear up operation and a mountain of paperwork to complete!

I didn't write about this job because it was a cardiac arrest. I didn't write about it because we saved him, nor did I write about it because we were 2 hours late off. I wrote about because it made me laugh! Every stereotype we see, joke, and moan about was all present in that one job. We can never eat properly, we are always off late, the sick patients are all upstairs, in a tiny room and if they need carrying they are heavy! That's a fact. That is of course how they became Law! (The Laws of EMS

Personally, I think Murphy was an optimist when he said if it can go wrong, it will go wrong!

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