Street Lessons # 6 Don’t Always Believe Your Own Eyes

When I was a new EMT, I responded to a call for an unconscious person.  In the basement of a house, I found a woman in her thirties unconscious of the floor and her husband shouting frantically that his wife was dying and that he had in fact done CPR on her  for several minutes.  “Help her,” he demanded.  “I am,” I said.  I was kneeling beside her and feeling her pulse, and watching her breathe.  While she was in fact unconscious, her breathing was even and her pulse was steady.  Her skin was warm and dry and she didn’t have a scratch on her.

My partners had told me stories of people doing CPR on living patients and always laughed at them, and while in my career I would encounter this phenomenon again and again, this was first time seeing it, and I thought, I am an EMT, the person is breathing and has a good pulse.  This man is just a layperson who is very panicky and I think it is a good bet she did not actually need CPR when he was pounding on her chest.  Perhaps she is on drugs.  Her husband denied that when I asked.  To this day, I am surprised he did not beat me for suggesting it.  I guess he was clinging to the belief that maybe I could help her.

Well, we got her on the stretcher and out to the ambulance, and wouldn’t you know, ten minutes later, she stopped breathing and we were doing CPR.

A wise person told me once when I arrived on scene to always acknowledge the first responders or the bystander if there were no responders and get a report.  Some reports would be excellent, some would be crazy.  The point the wise man made was to simply show respect.  “I did CPR on her for a couple minutes and then she came around,” the woman would say.  “Great,” I would respond.  And then get on with managing the syncopal victim with the now bruised sternum.

But let me tell you this now.  I would add a caveat to the acknowledge the first responder advice, and that caveat would be “Listen to them.”  I know sometimes in the past, while pretending to give my full attention, my mind has been going yadeedaa.

Now I say this because in my career, while I have had first responders or bystanders describe what seemed like crazy things compared to what my eyes were seeing when I arrived.  I have had those same seemingly okay patients suddenly revert back to what the bystander or first responder described.  “Sure, you were doing CPR, great Job!” I’d say, thinking that’s a laugh, only to find myself doing compressions five minutes down the road.  Or to have the responder describe the crazy seizure they witnessed, only to have the patient startle me with the same earth-shaking tonic-clonic  seizure later on down the road.

Don’t assume because the person is fine now, that they were fine when 911 was dialed.

I am not saying to take everything a first responder or lay person says as gospel, only to consider it.  Never dismiss any information outright. If someone says the little girl with the polka dot dress’s head spun around three times and fire came out of her mouth, I will store that nugget in a small, but retrievable place.

In EMS the hierarchy on a call goes something like this.  Bystander, first responder, EMT, paramedic, with each higher level of care assuming command as they arrive.  The hierarchy continues at the hospital.  Nurse, Doctor.  Although some of us paramedics would argue the nurse is not above us, most hospitals are structured where the paramedic turns the care over to the nurse, who makes the decision where the patient goes next – a regular room or a critical care room.

Has it ever happened to you where you have described the extremely sick patient you encountered who now seems fine, and had the triage nurse or the doctor be somewhat dismissive of your account because of what their own eyes are telling them?  I am sure it has if you have worked any amount of time.

Doctor, he was pale and diaphoretic.  Nurse, she was in full seizure.  Doctor, he was completely unresponsive.  Nurse, he was blue.  Doctor, I know it isn’t on yours, but I have ST elevation on my 12-lead.

Waiting room.   Or a bed in the hallway.

Later, you hear:  Hey your patient coded in the bathroom.  Or they found your patient seizing by the coke machine.  Or perhaps:  Yeah, didn’t you hear?  The hospital burned to the ground with only one survivor, a little girl in a polka dot dress standing in the midst of the rubble, unharmed.

1 Comment

  • Bill Young says:

    Great post. I remember as a young EMT doing CPR on a gentleman and him becoming responsive as I was doing compressions. I was horrified that I had really messed up. As soon as he stopped, he went unresponsive again. I had my partner check for a pulse…no pulse there. As soon as I had given about 12 compressions he came around again. Strange.

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