My Last Run
of My First Day

My Last Run
of My First Day

Someday I'll try to write up the earlier part of the day, but for this story I'll start at the end of the day.

My Paramedic partner for the day was "Moose". I don't remember why we called him Moose or what his real name was, another victim to the black hole that is degrading memory. He wasn't a mountain of a man, but he wasn't a shrimp either, but we called him Moose and that was that. We also had a Paramedic student with us for the day (I have no idea what his name was). We had finished our shift for the day and had gotten clearance to stand down and return to the barn. We were on our way back when we heard a call go out to respond to an assault. The dispatcher announced that they had reached "level zero" meaning that there were no available units in all of Oakland to take call. The dispatcher asked over the radio if there were any units that would be clearing a call in the next few seconds that could take the call, and no one answered. Since we were already off and on our way home were not obligated to take the call, but since there were no units available, and we were the closest unit anyway, we decided to take the call. What a call it would turn out to be.

Right from the start things didn't seem right. We got the address over the air, but when the address came through on the pager, it didn't match up. We were already rolling code 3 with our lights and sirens and since the two locations were sort of in the same direction, and since we still had a ways to go we didn't think much of it. Over the air the dispatcher said that the location had changed, which we sort of expected, but what we didn't expect was that the new location didn't match either the old location or the location on the pager, but at least all 3 were in the same vicinity, so we kept rolling. We were still a few minutes out, but off in the distance I could see a ton of flashing red, blue and strobe lights. The lights still weren't corresponding to any of the locations we had been given, but we would end up going through the lights to get to the nearest possible location anyway. As we got closer to the lights I started to get the feeling that regardless of what addresses we had been given, that our call was going to be at the lights.

As we rolled up, I could see that there were about 4 OPD (Oakland Police Department) units and a Fire ladder company on scene. The police had put out wooden barricades in the street but moved them as we came up. The place looked like a zoo. There was a crowd of people gathered, probably at least 30 or 40. People were running back and forth through the scene, people were yelling and some were wailing. Right dead center in the middle of the street and in our headlights lay a woman. She was face up, black, and about 20 years old. I threw on my gloves and jumped out to try and figure out what was going on. Since Moose drove I knew the patient was going to be mine, but I was hoping to have some idea what I was going to be looking at before I reached her. I could hear people yelling and picked out a few words as I grabbed the airway bag and the monitor and started towards the woman. I heard people say something about “I can’t believe he shot her!” and “He shot my baby! He shot her in the head! he shot my baby!” Moose grabbed the drug box, and the Paramedic student caught up and took the monitor from me. I got up to the patient and took a look. It didn’t look good.

I knelt down and tried to feel for a jugular pulse while I tried to listen and feel for respirations. When I look at her face I could see something coming out of her nose and a small bullet wound that looked like an entrance wound to her temple. The Paramedic student knelt over too and asked what was coming out of her nose. It was grey and a little bloody. I knew right away that was brains, and told him so. I didn’t feel a pulse which was kind of a relief in a morbid sort of way, but I knew that one way or another we were going to end up having to transport her because of how nuts the scene was with all the bystanders.

In the background I could hear people wailing and someone yelling “don’t let my baby die, you’ve got to help her, don’t let my baby die!” I told the Paramedic student to start bagging, and started to do chest compressions. I looked around for Moose to take over so I could get the monitor and intubate. Moose grabbed the monitor and started to put the leads on when one of the cops came up and told him that we had a second victim in a nearby building. With no one else to take the call Moose said he’d go check it out. He dropped the monitor and ran off in the direction the cop was headed. Talk about trying to juggle too many balls at once. The Medic student was struggling with the bag valve mask and trying to hook it up to oxygen, I was doing chest compressions with one hand, trying to use the radio to call for a second unit, and trying to kick the airway bag closer to me so I could reach it and trying to hook my heel in the strap of the monitor so I could hook it up, the whole time being watched by a crowd of people and slack jawed cops. I needed help.

One of the people wandering through the scene was still yelling the “you’ve got to do something” thing, but there wasn’t much I could do while I was still doing chest compressions myself. I looked at the yelling bystander and said, “You want me to help her? Then I’m going to need some help. Do you know how to do CPR?” The bystander a woman shook her head. I looked around and announced, “Does anyone know how to do CPR?” All I got was silence, which was a rather nice change from the yelling and wailing. I looked at the nearest OPD officer and said, “If you aren’t going to give me scene control, I need you to do CPR.” Reluctantly he agreed and pulled some gloves from his pocket and started doing chest compressions.

I hooked up the monitor and was very disheartened to see PEA. “She’s got a rhythm, but no pulse, we’ve got to go” I cursed. Dispatch called over the radio and asked why I had requested another Paramedic unit. All I could blurt out was “Multiple shootings, multiple victims.” I didn’t listen hard enough to understand the response, but I figured I was going to get help sooner or later. In the background I could hear people shouting, “I can’t believe he shot her in the head! He chased her down and shot her in the head!” I started to wonder where all the Firefighters were that were on the Ladder truck that we passed. There should have been 4, and at least one of them should have been a Paramedic, and where was Moose? I got out the intubation roll and got set up to place the ET tube. When I lifted up on the blade and took a look all I could see was blood and brains inside her oropharnyx. I repositioned her head and lay down to try to get a better view, but knew I wasn’t going to get one. Moose came running up and said that he had a second victim and was going to have to intubate. He asked for the laryngoscope, but I kind of needed it at the moment so I told him so. He improvised and grabbed a #3 miller blade and the pediatric handle. He grabbed a couple of tubes and asked if he could have the monitor. Since I now knew we had PEA I told him he could take it, and he dashed off to the other patient. The second attempt didn’t look any better, so I grabbed the Combi-Tube and attempted a blind insertion with laryngoscopy. The combi-tube went in smooth till the last 2 inches and then sort of hung up on something. I twisted the tube a little right and left and felt the resistance go away and slid the tube so that the marks were at her teeth and inflated the balloons. I checked the tube placement and was surprised that I had actually achieved a blind endotracheal placement. I didn’t really have much time to celebrate. When I looked up the OPD officer had been replaced by a firefighter and another was putting down a blackboard so we could move her to the gurney. Apparently even though the ladder truck had parked at the right location, they had the same confusion over where the call was as we had and had gone to the wrong address. When I stood up my supervisor was behind me asking me, “What the hell is going on?” I tried to explain and push the gurney with my patient at the same time back to the ambulance.

While all this was going on Moose wasn’t doing much better. Apparently when he went to find the other victim he found a black man about 30 years old lying in the doorway to the beauty saloon where this shooting had started. According to Moose the patient had a bullet wound near his groin and was laying in a puddle of blood about 6 feet in diameter. He had been shot in his femoral artery. When he knelt down to feel a pulse he felt,”ba-dump, ba-dump… then nothing.” He had felt his last two heartbeats. At this point was when he ran back to get the laryngoscope and the monitor. He returned and intubated him with the pedi blade and was hooking up the monitor when firefighters and a second unit showed up to take over. He ran back to our ambulance as my patient was being loaded.

I told the Fire Captain that I needed to take two firefighters and he reluctantly agreed since it meant that he would have to drive the tiller, but I wasn’t going leave without the manpower to do what we had to do (I completely forgot about our Paramedic student). Once we were loaded and rolling I was able to get a 16ga in her arm running wide open, got the monitor hooked back up and was starting to think about what else I should do. My mind was racing ahead to arriving at Highland and with all the excitement I could only focus on the PEA.

I knew she still had a regular rhythm, with a rate at about 48. We still had no pulses, so I started working off the PEA protocol (which was a mistake, but in a way wasn’t. I’ll explain later.). I pushed an amp of Epi, and asked the firefighter at the head to check if we now had a pulse. We didn’t, so I kept working off the PEA protocol and broke open an amp of Atropine. I had the needle in the port and was about to push it when it suddenly occurred to me that I was following the wrong protocol. I cursed aloud and everyone froze. We had 3 paramedics and one paramedic student on board, and no one noticed that I had been following the wrong protocol. I wasn’t supposed to be working this as a cardiac PEA, this was a TRAUMA PEA. I wasn’t supposed to give drugs at all. I explained what I was thinking and no one said a word for a few seconds. Moose broke the silence and said, “Never mind, we just won’t tell anyone.” (I include this part because that was what happened and I want to tell the story the way it really was. I don’t mean to tarnish Moose in any way. He was a great Paramedic and probably still is. I respected him a lot and will continue to do so. His willingness to cover up my mistake was a credit to his character in looking out for me, not because he wasn’t a good Paramedic.) As I sat there with the atropine in my hand trying to figure out what I should do since I had just made a medication error, the firefighter at the head said, “We’ve got a pulse!”

The whole time I was so focused on the PEA I never stopped to think about the situation as a whole. She had been shot in the head. Her brains were coming out her nose, were down her throat, and on the pavement. Her injuries were incompatible with life before I got there. In the grand scheme of things it wouldn’t have mattered what drug I had pushed or not pushed. The only possible good that was going to come out of that run was that maybe, possibly she could become an organ donor. By restoring her pulse (although accidentally) I had made her a better organ donor candidate, but that was all. She was still going to be dead.

When we rolled into the Trauma bay I did my routine and gave my report. I don’t really remember much about it. After we moved her over to the care of the trauma team I walked over to the Trauma Attending and told him what had happened. I felt an overwhelming need to tell someone about my medication error, so I told him the whole story. Whether he did it to help me, or whether he did it to cover it up, or whether he really did believe it, he looked me right in the eye and told me that I had done no wrong. He explained that the protocols aren’t rules, that they are guidelines and that we are given latitude within them to deviate when situations arise. He told me that the patient had been shot in the head, and so her connection between her brain and her heart was obviously severed. Even though the protocol says no drugs to trauma patients, what I had done by giving her the Epi was just replace the bodies’ natural response to the injury anyway. He told me that I had done the right thing in his eyes, and that he would report it as such. I felt relieved, but a part of me is still stuck with the feeling of screwing up, whether I did or not.

Even though I had restored her pulse, there was no question that she was going to die, and a few hours later she did. Because her blood pressure was too low they were never able to send her for a CAT scan, so she stayed in the Trauma bay while they tried to resuscitate her blood pressure. In that time her family was able to come and see her and say goodbye. They consented to donate her organs, but I don’t know if there were any successes from transplantation. The other patient that Moose found also died, but was never transported to the hospital. He was declared in the field.

Later I found out a little more about the story of what had happened. The woman was at work in the beauty salon, when her ex-boyfriend came by to fight. The other patient, the man was a friend of hers who had stepped in when the fight became too heated. The ex-boyfriend pulled a gun and shot the man and the woman fled into the street. The ex-boyfriend followed and caught up to her. He shot her in the head in front of dozens of witnesses, all of whom knew who he was. I have no doubt he was later caught but have no idea what happened after that.

I know this story isn’t the happiest, but certainly shows some of the problems that can be faced by a Paramedic in the field, and illustrates some of the chaos that both draws and disgusts people from Paramedicine. I can say that I learned a lot from the experience and will carry it with me wherever I go. It would be wrong to say that no good came of the day, because at least in some small ways, some did come. Someone may have gotten an organ that they desperately needed, and a rookie paramedic cut his teeth on a wild call, on the last run of his first day.

Based on Fluidity css adapted by Dan Delcollo