Got a call in the middle of the night. A big motor vehicle accident with two patients, one with ineffective respirations and the other not breathing. We sped, lights and sirens, down the highway. One senior and one junior paramedic, and myself.
We arrive on scene. A vehicle had been rear-ended by a truck, its back-end folded in like a tin can. Glass everywhere on the road. My senior paramedic yelled out, “Get the spinal board!” and I rushed to grab it. Another paramedic from a different crew was inside the vehicle; he called out, “Someone help me pull him out!” He was talking about a man lying in the back, unconscious and incontinent with urine. We pulled him out from the vehicle and onto the spinal board, where he lay lifeless.
Firefighters put the man on the board onto our ambulance stretcher. He was pulseless and not breathing. I began compressions—on the fifth compression, I heard and felt his ribs break. It was my third cardiac arrest, but first one caused by trauma.
My senior paramedic obtained one intravenous access. The junior and I attempted a second IV and didn’t manage to get it. I vaguely registered the others moving in the background: priming a bag of fluids, administering adrenaline via the IV, getting blood products ready, inserting an i-gel (airway adjunct) down the man’s trachea.
We suspected the patient’s chest wall had been impacted which meant a possible tension pneumothorax. This is when air gets into the space surrounding your lungs, squeezing your lungs and major blood vessels. A paramedic performed a needle decompression, which is like poking a hole in a balloon with a needle so the air can escape. We also suspected the man had a severe head injury, which meant his prognosis was poor.
Another paramedic took over compressions from me and I moved to the man’s head so that I could perform assisted ventilations with a bag-valve-mask. I put my focus into maintaining a good seal.
We did a heart rhythm check. The rhythm showed some non-shockable electrical activity, the kind that we don’t defibrillate. Four of us checked various pulses; I detected one at the man’s right carotid artery. It was faint but present. His heart continued to pump, but his brain couldn’t tell him to breathe.
At some point, somebody detected blood coming up the i-gel. The man had a haemothorax: blood in the cavity surrounding the lungs. I took over compressions while a paramedic performed an incision at the chest wall to insert a chest tube and drain the blood. Every compression brought a spray of blood that splashed the paramedic. His pants and the ambulance floor quickly became covered in blood.
We reached the point where the man’s heart lost its ability to pump at all. There was no electrical activity for a long time, so the senior paramedic called his death.
A couple of the paramedics stood around afterwards, starting to relax and cracking jokes. I debriefed with my crew, then called my friend. My senior paramedic smoked a cigarette by the ambulance while we waited for a coroner to show up for the body.
—
I had gone to three arrests at this point in my career. The first, a man had drowned after diving off a cruise ship and been successfully resuscitated by other paramedics. The second, my paramedic crew and I had been the first to respond to a cardiac arrest in the middle of a train. I remember it all in still frames. The patient being dragged up the train steps by police. Briefly locking eyes with the paramedic who was ventilating while I did CPR. The sting of my palm as I compressed on a sensor device which sat atop the patient’s sternum, designed to measure the effectiveness of compressions.
I felt the same as I did then: dispassionate, single-minded but able to step back and see the forest for the trees. I felt that everyone I talked to, my friends and peers, expected it to affect me emotionally. Truth be told, it had already become a blur of distant and fragmented scenes, a whirlwind of muscle memory and cold, calculated communication.
—
Once I had called my friend and the adrenaline had worn off, I waited outside the ambulance and watched the others process the termination of life in their own way. The night air was cold and biting, and the sound of passing cars faded into a murmur.
The Bearable Blog 