Wednesday, July 18, 2012

Lights and sirens

I spend a lot of time in the back of an ambulance. To and from various airports and small hospitals, I am getting pretty good at working in that crazy atmosphere. My entire career as a flight nurse (7 months after training) I've never taken my patients lights and sirens to the hospital. It's dangerous and not that much faster in most cases. My last transport - we went lights and sirens.

I obviously can't talk too much about my patient transports. Their privacy is very important. The details of this post include changes protecting my patient and my job.

It was a pediatric patient. That blond hair and perfect little feet and toes. Subtle clues of the active life precluding the tragedy. I knew it was coming. I did my best to prepare for a sick pediatric patient, but studying means nothing unless you can show up and put your knowledge into practice. Keeping myself calm around a small ER that was in Mass Casualty mode for its limited resources. Dr.'s nurses, EMT's, respiratory therapist - everyone they could get was there. And boy, we're they happy to see us.

I was pretty sure I was going to pee my pants or shake so bad I couldn't function. Fake it til you make it, I always say. Children, babies! I have to do it. I can't panic. Thank god my medic was calm and confident. He admitted to me later he was just as scared and that I was so calm. Amazing.

They ran us around the corner to our patient. Around us we saw siblings, all victims. Concentrating on what we had, we went to work. I was given a rundown of injuries and interventions. Let me clarify - multiple people yelling and talking very fast giving me as many details as they could remember. All the while working around the bloodied and broken child.  My call to the accepting physician was constantly interrupted with more information, giving the receiving team a clue as to what was to come.  I was lucky, I had an awesome and calm physician on the phone giving me great information and answering any questions I had.  

Less then 30 minutes from our arrival we had this child packed and on our way to the airport.  Making a verbal "to do" list with my medic, we prioritized our care.  The most important thing was keeping our patient stable and getting to definitive care.  No more tests or interventions were going to help more then a Level 1 Pediatric Trauma Center.  

The flight was a what they call a "yard sale".  We are in a loaner plane and all our supplies and equipment that we didn't carry with us was all shoved in the back.  Getting to it was tough and then you drop things and open stuff and drop some more, all the while stressed out of your head to get whatever you need to do done quickly.  Our pilot mentioned to me later that he turned around to tell us to sit down because of possible turbulence and we had stuff in both hands and looked super busy.  He was awesome and snuck around the clouds so we could continue to do our jobs safely.    

I'm sure I'm making it more dramatic then it really was in the plane, it was probably more of a controlled chaos.  Whatever we did, we finished the list and our patient stayed stable.  

After we landed we hustled, lights and sirens, to the children's hospital.  We had done everything we could.  I re-medicated for pain, reassessed and then I said to our little patient that we were almost there and keep doing awesome.  To hang in there.   I pushed that blond hair back from swollen eyes and a bloody face.  

We arrived to the magic of medicine.  Watching 6-10 medical personnel do a specialized choreographic dance that I have seen dozens of times with adult patients.  I updated the team.  I watched them work.  My medic and I pulled it off.  Together with our combined knowledge and various experience we raced up that learning curve and did our very best.  

Children give us all a different sense of urgency and compassion.  All those wonderful ambulance drivers, EMT's and our pilot were suddenly ready to rock. Rock in a very quiet focused way.  I'll never forget this transport.  Just like I'll never forget my first code, my first trauma and my first death and withdrawal in the Surgical ICU.  If you watch TV shows like ER and Grey's Anatomy you miss the very best thing about saving lives.  It takes a village.  Sometimes it feels like we are a village of idiots, willing to do insane and crazy stuff to save lives of people we don't even know.  There is no big star doing just one thing, it's everyone. Everyone that touched that child wanted to do their best.  

Even if it means, lights and sirens.

Blog on............

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