Thursday, March 10, 2011

Basic First Aid

I took my first Red Cross First Aid class when I was 8 years old. It was called Basic First Aid then, and I remember using my allowance money to buy the set of four books. Just now, I looked on ebay to see if I could find the same set, but couldn't.  I kept those books for years, re-reading them from time to time.  I got the first aid badge in Girl Scouts, and generally kept as current as I could, believing it to be important all through my life.
I've taken CPR classes so many times, I've lost count. Much like how challenging it has been over the years to keep straight how many compressions to how many breaths for what age person, until they finally consolidated it to the current "compression only" version.  I think I took at least one class for each change.  The last time I took a Red Cross class, it was somewhat amusing to see that each person in the class had originally learned CPR differently.  We had a whole smorgasbord of technique in that room.

The first time I ever had an opportunity to use CPR was when I was 34 years old.  I happened to be there when an 18 month old seized, and stopped breathing.  I immediately directed the father to call 911, and placed the child on a flat surface.

My thoughts were racing.  It had been a while since I had taken a formal CPR class, and I wasn't entirely sure I remembered exactly what to do. And all I could think of in that moment was "What if it's already too late?  What if it doesn't work?  What if there is nothing I can do?  Some things can't be fixed."

While I checked for a pulse, the child took a gasping breath, and started breathing. Shortly afterwards, she opened her eyes.
I had only once before been so relieved in my life (that's another story).
I didn't fully realize until years later that what I had done was to position her so that I opened her airway, and that was all I needed to do in that particular case.

That child was my daughter.
Some of you met her last week.

There are a lot of fears surrounding having to do any sort of emergency care of a family member, and rightly so.  The stakes are high.  The adrenalin is high- higher than on a "normal" call.  Or is it?

I've had people tell me that it is not possible to stay calm and provide high quality care for a family member.  I'm not so sure that's true.

When I first became an EMT-B, a few years ago, I'll admit that each time the pager went off, I had a somewhat heightened reaction. I'm sure you know what I mean.  This led to more than one early error, usually in forgetting to do something.  Fortunately, most of those were very minor, and after each call, we'd talk about it, and fairly quickly developed a rhythm, and a method (but not the rhythm method!) for assessments and the rest of a call.  We learned to mentally prepare en route.  We developed communication skills.  We learned to watch our ALS backup medics like hawks, to learn as much as we could from them at each call.

But mostly, what we learned was to incorporate all of this, into part of who we are. (My son and I were certified at the same time, and went to almost every call together, as partners.)  Through graduated exposure, we were much better able to stay calm and focused during a call.  We still run across new things, all the time, and have something of a learning curve to go through for that particular issue, but many of the typical calls we get, we now have SOME idea of what we're doing.

A couple of years ago now, in about the middle of this adventure, my kids and I were going to a music and arts festival near here, in the "real" town in our county, about ten to fifteen minutes away.  We had just parked the car and reached the ground level of the parking garage, starting to walk towards the festival itself, when our pagers went off.  Ah, bummer.  Terrible timing.  But maybe it's not a big deal, maybe it's something someone else could handle, or maybe, if we're really lucky, it's actually for our sister company, which had the same tones.

Scratch that thought in a hurry.
Not only was it for our department, it was for my father.
His AICD, which he had had for a few months, had activated.

I took a deep breath, and for the first time (and only time), we ran, not walked, for the car.
I had the sense to have my son drive.
I called dispatch to let them know we'd be going directly to the scene.

We got there moments after the ALS ambulance.
Short version: things were basically okay, or as okay as they can be in that situation.  My favorite three words: conscious, alert and breathing.  Sometimes, the rest is just details.

The medic let me ride in back to the hospital, which was a bit unusual, but he knew me and technically it was our call and we can ride with if necessary.  I wanted to go with because I know my father's medical history and current condition, and he pretty much doesn't.  He didn't understand all this, specially with it being pretty new to him at the time.  And he wasn't exactly in a condition to be having a lot of conversation.

I gave the medic his history, meds, allergies, etc.  Told him when and where the AICD was implanted and why, and that this was the first time it had activated.  He was able to proceed with appropriate care quickly and effectively.

But the most important thing I did was hold my Dad's hand, and answer him when he asked me "Am I going to die?"

I learned SO MUCH from that call.

The first thing I learned was that I CAN stay calm during a call for a family member.  Somehow, I just clicked over into my EMT-self, and having that to support me, I stayed calm and focused.  It felt SO much better than the experience, years before, when it was my daughter not breathing, and I was unsure.  Several orders of magnitude better.

Another thing I learned, or at least had emphasized, was how important it is for the patient to feel like they are being cared for by someone who cares about them.  It may be that their greatest physical need is for the interventions a medic can provide, but what they REMEMBER is how they were treated, and whether they felt cared for, and confident that they were being taken care of.  I still work constantly to improve that aspect of the care I provide, from working on establishing rapport, to communicating during the call, to things like getting out in the community and meeting people so that if we are called for them, I at least won't be a total stranger.

The longer I do this, the more I realize that a lot of what we do isn't just about medicine, it isn't about interventions, it isn't about remembering the protocols and techniques and what all, and it sure as heck isn't about lights and sirens. It's about people.  About reaching out and caring for people.

As if they are ALL "family."


  1. Fantastic. Absolutely fantastic.

  2. Thanks, maddog. Much appreciated.

  3. "Mitakuye Owasin" --- all are my relatives.

    Great insights. Good post.
    Thanks for sharing.