Wednesday, April 25, 2007

The Neighbor

I heard the EMS tones from room 1. I was in the middle of cleaning up a Code Brown (for those of you not in the know, a Code Brown is a poo-poo blowout), and I knew Lucy was taking a break in the report room. There was noone at the desk to listen to the call.

"Crap," I thought.

Out loud.

"Oh honey, I'm sorry, but I have the diarrhea, ya know," my patient replied.

"Oh no, Mrs. Smith. I didn't mean you. Sorry. I just need to hear that call."

I finished washing her up, snapped my gloves off, and threw them in the wastebasket as I headed out to the desk.

"Did anyone hear that call?" I said loudly - hoping any other nurse behind a curtain or door would hear me. I was met with silence. "Shit. Shit. Shit." I have an issue with not hearing EMS calls. I must hear them. I must. I HATE not being prepared. I know that ER nursing brings surprises every day, but I try to limit them with knowledge. If I don't hear the EMS call, I am sure to be cursed with a cardiac arrest, open chest trauma, or out of control schizophrenic. Maybe all 3 at once. It never fails.

Lucy heads out of the report room, licking the cupcake frosting off of her fingers. "Hey Lucy! Did you hear that call?" I ask, knowing full well she probably didn't, but hoping none the less.

"You missed a call?" she asked.


"I'm going on break," she said as she turned and went back through the door. "I know what happens when you don't hear a call."

"CHICKEN!" I yelled. She didn't hear me because the door happened to close in my face at that very moment.

I walked into the trauma bay and started checking the equipment. The static of the EMS radio caught my attention again. Stumbling over a mayo stand and running toward the desk, I reach it just in time.

"Dispatch to Nurses Station"

"Nurses Station, go ahead" I replied.

"Medic 93 en route to a 12 year old who has been thrown off a horse. Bystander states CPR in progress."

Shit. Double Shit. A kid.

"Copy Dispatch. Any further info?"

"Neighbor on phone with me currently. He says he is watching them across the pasture. He sees blood on the gate and the patient is on the ground. CPR in progress."

"Copy - NS out."

I called the Code Team in to prepare for a pediatric code. Kids in crisis are the worst patients - not because they are obnoxious, but because you never want to stop working on them. EVER. You feel like you are always missing something - that if you would just try one last thing, you might be able to save them. Kids are usually very resilient, but there is always "that one" that just doesn't pull through.

The Code Team arrived (meaning the second ER nurse, the ER physician, Xray, lab, and Respiratory Therapy - all of whom had been sitting in the break room with Lucy) and I gave them the information I had. Equipment was checked, ET tubes pulled and ready, the Broselow tape was out and open on the stretcher..............we were ready.

10 minutes - no report.

12 minutes - no report.

15 minutes - no report.

What the hell? SOMETHING had to be happening. Lucy and I stood reviewing the PALS cheat sheets, waiting for the radio to crackle again. The doc and the RT were getting antsy and wanted to get back to their snacks in the break room.

Finally - the radio makes a noise.

"Medic 93 to Nurses station."

"NS - go ahead"

"ETA 2 minutes, report upon arrival."

WHAT .................. THE ................ HELL? It must be bad if they can't even give us a report.

Everyone looked a little on edge. Last time this had happened, we were met with an 11 year old with a flail chest who ended up with a couple chest tubes and quite a few units of blood.

We heard the loud beeping reverse tones of the ambulance. We were ready - hands on equipment, ready to go. Hearts beating just a little bit faster, breathing a bit shallow. My fingers were just starting to shake. I really didn't want to see another bad kid.

The ambulance door popped open.

The lead paramedic jumped out of the back and threw open the second door. He grabbed the end of the stretcher and started to pull it out. I saw 2 feet (always a good sign), a couple of IV lines, and ........................................

A cute little blonde girl sitting up talking to the crew.

My body sagged with relief. She was sitting up talking. Phew.

Then I was pissed.

"You get us all psyched up, ready for the worst, expecting a pedi code or trauma and you bring us a cute bubbly little girl? ARE YOU SERIOUS?????" I (politely of course) yelled.

"What? Huh? What do you mean?" he replied.

I told him about what dispatch had told us and how not receiving any report just confirmed our assumptions. He looked at me like I was stupid. "I never said we were doing CPR," he said.

"The neighbor did. The neighbor saw them!" I replied.

"The neighbor was 60 acres away Julie. He was also 92 years old and couldn't see anything further than the sagebrush 10 feet in front of him."

"Well, time give me a report," I stuttered.

"Next time, don't rely on the neighbor," he shot back.

A lesson learned.


ERnursey said...

Well when it comes to peds I'll take this outcome any day.

Bohemian Road Nurse... said...

I'd still have whupped the butts of those EMS...

VF-Arrest said...

I encourage paramedics to contact us at A&E direct and not go through control. That way we have real time hands on info. Works well, although some inexperienced or ott techs and para's sometimes get excited and give wrong stuff, but they work under difficult conditions and who am I to judge.