Newbie Blues
by

I work 8p-8a shift at a rural EMS, a schedule change had left me at the mercy of the part-time list, with no permanent partner.

Working one night with a newbie, who had only been on the trucks about two months, never worked a cardiac arrest, and the worst she had seen had been a DOA she got on her first shift.

We were dispatched to a local nursing home for an unresponsive/man down, our response time was all of two minutes and I explained what we were going to do as we pulled up. " We'll take in the airway bag, monitor, and a board, and we wont hang around long."

When I got to the room of the patient probably every aide in the building and two RNs were hovering over an elderly gentleman, who they had sitting bolt upright in bed with a nasal canula on at 2lpm,breathing about 4 times a minute. They had found him unresponsive with labored respirations.

One look at this guy told me he wasn't long for this world, and I suggested we place him on the cot, he had a carotid pulse, with agonal respirations, I figure secure the airway and move to the truck, keep him from arresting and transport.

God had other plans, the patient still had a gag reflex so I decided to knock him down with some Versed and intubate him (the only thing we have on protocol right now for such situations) I asked my partner, who was very busy trying to secure the straps on the board, to get me the narcotic drug box, and eager RN was attempting a line, while an aide continued to ventilate the patient, things are slowly sliding South from here as my partner brings in the very large drug box - of which does not contain our locked narcotic box which is kept in a separate compartment.

I jog out to get the narcs, swearing under my breathe death wishes to my director.
Long story short, I couldn't get the patient intubated because of and old trach scar and I fled to the truck knowing he would arrest without a patent airway.
Well the inevitable happened, the same nurse who got an AC on the first try has now pulled out the only IV I had.
We had to have lifting assistance from the NH staff, and I nearly killed myself loading this guy into the truck, and as if God granted my a nonredeemable coupon, he was asystole when I rechecked him inside, I yelled for the posted truck to meet with me and tried multiple times to gain a patent airway, even trying the Combi-tube, my partner meanwhile who is only an EMT- basic wants to know what I want her to do. Uh, compressions would be nice.

At this point I'm frustrated with myself for not being able to intubate this guy, frustrated at my partner who has stood by with her hands in her pockets for most of the call, the NH staff RN for refusing to ride to the hospital with me,(they had always been so eager before) the only thing thats working for me in a positive note is that I just stuck the most beautiful EX J that I have ever seen, he is still in asystole, still no airway, AHHHHHHHH, and where in GODs name is the other truck....,

I finally get backup, make the EMT mad for putting her off the truck, the other medic cant get him intubated either, I have the roughest ride to the ER known the Medics, you kinda get the picture, the ER doc couldnt get the intubation either, and finally after working this poor man for 45 minutes, called the time of death, I felt sooooo responsible.

Other medics told me not to feel bad, I had the deck stacked against me, newbie partner, the nursing home staff from hell, and a tough patient, that didn't change the way I felt when I had to go into the directors office for QA on this call, although I did what I had to do and excepted responsibility for the entire clustered up call, mistakes made, lesson learned.
MM