Quite Shocking (literally)

As a firefighter/EMT, even with all the blood, guts & gore we see, there are the "routine" ambulance calls, false fire alarms and other less "exciting calls" But even those can change in a hurry and without warning.
It was Thanksgiving Day, about 7 years ago or so and after finishing my annual Thanksgiving running around, I decided to spend the night at the fire house to help with staffing. You see, at a fire house that has live in members, most of them are not from the area and go home to spend time with family and friends. These same guys run a vast majority of the calls because most of their free time away from work & college is spent at the firehouse, so on holidays, staffing gets light & us "home responders" pick up the slack.
I got there around 20:00 hrs (that's 8 pm in civilian time) and it had a fairly uneventful day so the few guys there were watching a movie. I settled in, watched the rest of it with them then decided to call it a night.
At just before 0700 (7 am) we get tapped (dispatched) for a Delta 2, a 70 some year old male, unresponsive & not breathing. We spring from our bunks, and head to work. I responded in the ambulance, only we were BLS (basic life support) and since it's an ALS (advanced life support) call, we requested a medic.
We receive confirmation that one of our Medics would be in rout but a bit delayed because he was just leaving work (at the dispatch center)
We arrive on scene & we run up to the house with a frantic women screaming "He's in the bed room, hurry, please save him"
So to the bed room we went. I walk in and there's our patient laying face down across the bed in his gutchies. I make my way around to his head & upper body and roll him over to check for an airway & as I'm rolling him he groans. "He's breathing" I yell to my partner/driver Chad as he comes through the door with the first in bag followed by the engine crew.
I give the guy a sternum rub (rub his sternum hard with my knuckles...it's definitely an attention getter) and he kinda swats at me & mumbles "stop it" and opens his eyes. I tell him I'm with the ambulance, then he shoots back, kinda confused "so, what in the hell are you doing in my bed room?" I explain that his wife found him all unconscious so she called 911. He denies anythings wrong, and swears he was just sleeping. He looks at me kinda funny and asks again who I am and why I'm there, only this time, a little more coherently. His wife then chimes in and explains how she found him, and pleads with him to let us check him out. It was obvious something had happened & he knew it, but it was obviously an awkward situation for the man, after all he came to on his bed, in his underwear, surrounded by a bunch of fireman.
I ask him what's wrong & how he's feeling but he still kinda denies anythings wrong, but you could tell he was now rethinking everything. So I politely ask him to let us check him real quick to make sure he's ok if for anything, to calm his wife down and he agrees. Chad starts taking vitals (pulse,blood pressure, O2 levels & lung sounds) Then Jim, the wagon driver, comes in with the heart monitor, we start hooking him up & Jim tells me the medic is about 2-3 minuets out. I nod and continue putting the stickers & wires on the patient. Once he's all hooked up Jim turns the monitor on and I start organizing the "retreat" of the guys in the bedroom & removal of some equipment we won't need. Then I start back with the patient, telling him he should let us take him to the hospital just to be safe when I here Jim say "Uuuh, Stan!...
I look over to Jim and he's holding the monitor so I can see the screen & I immediately notice what has him so concerned. On the screen his heart rhythm is showing what are called "Tomb Stones"
Now, most of you have some what of an idea of what a normal heart rhythm looks like. It's the line with the sharp high and low points followed by a short flat line, then repeat. Tomb stones look just like the name says, it's a flat line followed by a "hump" that looks like an old tomb stone or one from a cartoon, and also, as the name suggests, they are really REALLY bad! To put it in more convenient terms, we were basically watching this guy have a heart attack.
Now it's real, we need to go and we need to go right now. I call for the reeves stretcher (a long stretcher about the size ofva back board with carry handles) then sternly but polity tell our patient like it or not, he's going to the hospital. Now, by law, we cannot make anyone go to the hospital, you have the right to refuse, but I wanted to get across the seriousness of the situation with out frightening him or his wife anymore than he probably already was.
As one of the guys brings in the reeves stretcher, he's followed by our medic, Fred, who asks "What's up guys?"
Jim shows him the monitor, and Fred says "OK then, get him out to the bus (ambulance) I'm gonna go get a line ready (iv drip) and what ever you do, make sure you print that rhythm.
We get him onto the reeves then carry him out to the regular stretcher that's waiting in the living room. As simple as it sounds, 6 guys, in gear, carrying someone on a reeves stretcher, out of a bed room, around the corner and down the stairs, is anything but simple. (look at the hallway & stairs in your home and imagine it)
So after we carefully but expediently, carry sim down stairs, managing not to fall, or drop the poor guy, we place him onto the regular Ambulance Stretcher then make a B line out to the bus.
Fred starts a line (iv) and pushes a few drugs while I monitor vital signs. We give the nod to Chad who's our Chauffeur for the trip, tell him to run it "lights" (emergency) and off to Forbes we go.
We pull in, get the patient out of the back & wheel him in. It's kind of a slow morning so the Drs are waiting for us and lead us to a room. We switch him onto the ER bed, then start giving the report the Drs are looking at the monitor strip & one says to the unit clerk to start making arrangements for a helicopter to transfer the patient to West Penn hospital because he needs to be in a Cath Lab ASA (heart catheterization lab/procedure room).
I make exit from the room and head out to get new sheets for the stretcher & put the ambulance back together.
Chad and I step outside and notice that it had started snowing & it was coming down pretty good. I turn around and head back in to tell Fred do that we can get back to the station before the roads get bad. As I approach the patients room, Fred pops out from behind the curtain and with concern and a bit of confusion says, "They can't fly....they said the weathers to bad...?"
I tell him "Yea it is, it's snowing like crazy, we should probably get back soon."
Fred says, "Yea....That's probably not going to happen, their ground transport service can't be here for one to two hours, so they asked if we would transport."
"OK then, let's get it done, I'll go tell Chad & get the stretcher." I replied.
So i go inform Chad that our job here isn't finished and we get everything together & wheel it back into the ER and on the way I pass a Dr on the phone with West Penn so they can be ready when we get there.
Now I'm starting to get a feeling of urgency and out side the room Fred pops out again and I ask "This dude's pretty bad off, huh?"
He simply replies "Bad off would be an improvement."
Then I say, "Well, with the roads & the weather the way they are, I don't think this is going to be a quick trip."
He nervously replies "I know."
At this point the seriousness of the situation hits us. This guy doesn't need to be in a cath lab now, he needed to be in one yesterday.
We all kinda take a quick quiet deep breath & Fred asks "Ready"
"Yup....let's do this." I answered.
Chad nods & gives us a "Lets roll." then heads out to get the ambulance warmed up and ready while Fred and I wheel the stretcher into the room, to again, make the switch. This time, the patient has 2 more IV's that we have to maneuver as we lift him over to our stretcher, get him settled in for the ride then wheel him out to the ambulance.
Now by this time the patient has become more comfortable with us and is cracking jokes like "Oh great, you too again.....can I get a meal on the trip this time?" we nervously chuckle and load him into the stretcher with Drs in tow giving Fred instructions.
Fred acknowledges and tells them if needs be, we'll be back. And our journey begins.
Now as fast as weather would safely allow, we head towards the parkway, lights & siren, and as we approach the parkway the patient slips into unconsciousness. Fred starts to holler his name.
Chad questions from the front "Head back (to forbes)?"
Just then, the patient comes to.
"No Chad, we're good" Fred answers.
Then as we're on the parkway on ramp, the Pt slips out again & shows a goofy rhythm for a split second.
Chad asks again "Do you want me to head back?....tell me now while I can still turn and go down the next on ramp (the wrong way)."
The patient again comes to and Fred says "Nah, i think we're ok"
"Are you sure, we're almost to the point of no return....." Chad shoots back.
"We're good, just keep going and watch the road (condition)"
Fred yells back.
"Don't worry," Chad says "the road (on the parkway) is just wet.
Which makes us fell just a tad bit at ease.
We make it a few more minuets down the road, and as soon as we get to what could be considered a "half way point" the Pt straight up crashes
Fred yells "Stan!, bag him" (use the bag valve mask to breath for the patient)
"Got it!" I say as we each switch seats.
I kinda stand over the patient and start bagging him with one hand while I'm doing chest compressions with the other.
Fred says "I know you gotta do it one handed but these compressions gotta count " as he starts pushing (administer via IV) certain cardiac drugs charging the monitor/defibrillator. Then we here the distinctive "snap crackle and pop" as a few of his ribs break from me doing compressions. (it's normal during good quality CPR)
"Never mind" he says, then "Ready?!" he asks
I give him a nod then he shouts "CLEAR!!"
I yell back "GOOD!" to let him know I'm safe and clear of the patient & stretcher then "Whack!" Fred delivers the shock...and the patient has a good heart beat again.
We continue on to West Penn, constantly check his vitals...he's kinda in and out and barely responding to his name.
Fred, tells me to move so he can intubate the patient to secure an airway (insert a tube in through the mouth down to/near the opening of the lungs) and hands me the mic & says I'm calling (medical) command, you just hold the mic.
So as he's intubating he's on the radio telling the Doc at Forbes what's going on & the doctor tells him to just follow protocol (preauthorized plan of care) and keep doing what we're doing and that he would update West Penn so they're ready.
I hang the mic back up as Fred gets the tube (successful intubation) and we hook the bag valve mask straight up to the tube and start helping him breath and bang, he crashes again. So again I go into the dual role of pumpin & blowin. (EMS slang for CPR)
Fred pushes more drugs and then "CLEAR" Fred hits him again, then looks at the monitor..."Nope!...CLEAR!"
he hits him again....looks....."We got it."
"Shit!....CLEAR!"
He drops out so Fred zaps him a third time.
This time the heart beat stays, but only for a minuet or two then down he goes again.
We would continue like this for what seemed like hours. A continuous hectic ballet of CPR, IV drugs and defibrillation. We started out following the general rule of 3 shocks followed by cardiac IV drugs and CPR but eventually it wasn't enough and we reached the end of Fred's paramedic protocol for a cardiac arrest, meaning we have performed every emergency medical intervention that we're authorized to do. So Fred says "let's just keep going" and the ballet continued, even managing to almost shock each other once or twice during the chaos and using up all of the cardiac drugs on the ambulance which only meant more CPR for us, and my arms were starting to feel like jello.
After what seemed like a few long hours, we pull into the ER at West Penn and we're still in the back pumpin, blowin & shockin.
Chad gets out and comes around back to help us get him out and as soon as he opens the door we tell him to tell security to get us help, then get in and help with CPR.
Chad screams over to the guard, climbs in & starts compressions to give Fred & I a break.
Caught up in our work, about 15 minuets goes by and we notice we still have no help from the ER. This guys feet from the door to the ER (and the rest of his life) and was in such condition that we couldn't stop even for a second to get him out of the bus. We were keeping him alive.
I switch with Chad and again start chest compressions stoping only to administer shocks, and send him to find our help.
He returns later with a nurse, she was a little thing, maybe 5'4" & 100 lbs soaking wet. She looks in the back and says "Oh My God" in utter disbelief of us administering more shocks and perform CPR amidst the absolute mess we've made in the back of the ambulance.
Fred calmly says, "Sorry hun, but I think your going to need more help" and the nurse takes off back into the ER for reinforcements.
The adequate help arrived, and we get the guy out & on the way into the ER. I'm standing on the side of the stretcher doing compressions, Fred's bagging explaining how we were originally supposed to go straight to the cath lab but he crashed & it's been chaos ever since.
We get him into an ER Room, then off the stretcher & onto the bed, and a nurse kindly relieves me of chest compressions so I switch up with Fred and started bagging again whole he continues with the report.
After about 5 minuets in the ER we get an acceptable rhythm and as soon as we go to move him to the cath lab, he crashes again.
We continued working him for another 40 minuets untill we got him stable enough to send him to the cath lab.
As they wheel him away, all that's left in the room is Fred and I. We just stand there, sort of collecting out thoughts as we begin to mentally process what had just just transpired. I notice the ER room is now trashed, with a small island of clean floor where the ER bed sat. I look at Fred, a seasoned medic, and he too kinda has the blank stare that I'm feeling. We look at each other and kinda nod, as If to say "Good job" He looks totally whooped and I'm sure I look no better. I'm sweating, my arms feel like rubber and I'm just plain exhausted. Then he breaks the silence and says "We should probably go clean up."
I quietly answer "yup...."
So we head out to the ambulance.
When we get there, to our surprise, we find the Chad had pretty much had it cleaned up. We helped him finish what little was left, then Fred suggested we head up to the cath lab to see if he in fact made it up for the procedure. so we had back in. We find our way and step into the control room to see them finishing preparations on our patient when the Dr walks in and asks "Can I help you."
"Fred tells him we brought him in how we had one hell of a fight to get him there. The Dr pats us on the shoulder and says "Good job guys, I got it from here." and then steps into the procedure room.
We stayed to watch for a little bit then decided it was time to go.
On the ride home, we light heartedly talk about the ordeal we had just went through, Fred, taking notes the whole time do that he can be sure to get everything documented on the state (ambulance) trip sheet (call report) And it wasn't until we "relived" it in conversation and looked at the printed strip (report) from the heart monitor that recoded to memory ever heart rhythm and every shock. As it turned out, we had defibrillated this guy 37 times (yes, thirty-seven) which is practically unheard of, we had done, re-done and done again every possible thing we could to get this guy where we needed to be.
Finally, at around 11:30 we arrive back at the station and we peel ourselves out of the ambulance so we can clean it and finish putting it back together to get it back in service. Then shower & head back to bed.
Later in the day we would receive a call from the Dr in the Cath Lab. As it turns out it was a curtsy call to let us know that our patient did intact make it through the procedure and would be just fine.
We had done it....We fought long and hard, faced practically ever challenge we possibly could and used every skill we had, and we came out on top, and had we not been so damn tired, probably went for a beer.
To this day, I don't think I have ever had to work that hard on any ambulance call......it was physically, mentally and emotionally exhausting, but it's the reason we do the job.