Taking Care of our Kids

Bothered? Yes, I am. I'm trying not to use certain words to describe some vile people in the world today. I'm also trying to figure out, as I type, how to put this so others will understand the anguish I feel.

Kids, children, rug rats, pediatrics, infants, neonates, preemies, whatever you want to call them, they're the part of our population that happens to be one of the most defenseless bunch. They rely on us, the adults, to take care of them, to defend them, to protect them and keep them safe from harm. WE are their security blanket.

Seemingly every day I see in the local news how some poor child has been injured as a result of domestic abuse. They've been smacked, burned, smacked, or whatever. I opened the website of one of the local TV stations today and saw where one child had actually been "stomped" on. Another had been burned. Yet a third had broken arms and brain damage. Seeing these types of stories hurts. I guess one would think that certain areas of the world may be immune to these types of problems yet they aren't. They're everywhere. Abuse is everywhere.

Every time I go through a PALS or NALS class I always think about using some of these skills and knowledge on one of my kids. Would I? Could I? How could I block out the fact that I'm working on my own child? How will I react? Will I freeze up and keep mumbling over and over that this is my child? God forbid it ever happen but to others, it has. It does happen. People every day see their children or ones that they know hurt, injured, or even killed at the hands of others or some other medical problem.

My first true pediatric emergency happened on Christmas morning shortly before I was to finish Paramedic class. I was low man so I got stuck with working the holiday. Obviously not where I wanted to be as I've always been a family person and spending those times with them meant a lot to me.

I remember it was a gorgeous Christmas morning. I walked in the ER with my partner to see the entire ER was decorated with lights, tinsel hanging from the desk and counter areas, not a single patient was in any of the rooms, and the back counter facing the patient rooms was filled with tray after tray of holiday goodies brought in by the ER staff who, like me, got stuck working that day. A couple of the nurses had on Christmas - themed scrubs and tops on. Someone had a radio on in one of the back rooms playing Christmas carols and we had picked up and decorated a small 3' tree in the corner of the ER by the ambulance entrance. Hell, if we had to be there on this gorgeous holiday morning we were going to do our best to make it bearable. We were having fun all sitting down behind the counter telling stories, catching up, talking about family and what we were going to do when we left there that afternoon, and how quickly we could come back in the next day and show off our new presents.

0904 A local volunteer ambulance service about 10 miles south gets dispatched on an unresponsive infant. As was our area's SOP we were dispatched shortly after as the nearest ALS unit. My partner and I hopped in our truck to head south. Pediatric runs are never fun, regardless of the call. They induce a lot more stress since thankfully we don't deal with a lot of them. But the possibility is always there, every day, every night, all the time.

0906 We mark enroute just ahead of the BLS unit from the southern department. We're told by dispatch the infant is not breathing and CPR is in progress. Both our hearts sank. We looked at each other with a quick glance that said, "Shit. This is Christmas. This isn't supposed to happen on Christmas Day!" I got out of the passenger seat and went to the back of the truck to get things ready for my partner.

0913 We met up with the BLS truck heading north towards the hospital. We both pile out of the truck to see what was going on. One of their crew members met us halfway with a lifeless baby girl, not yet 6 months old, in his arms, coming to meet us. We had a big modular bus so we simply went in our truck; more room, easier to move around. We sat on scene for a couple minutes as two of the volunteers got in, continued CPR and were bagging this little girl. I intubated the little girl without problem and secured the tube as best I could. My partner started an IV and got on the radio to alert the ER what we were bringing in as well as telling them to get our doc ready. We got so busy doing that that we actually asked one of the volunteers to drive our truck back to the hospital with us as passengers. This was one of those "extenuating circumstances."

We arrived in the ER bay with CPR being done. No breathing, no pulse, nothing. We'd done all we could do and now it was time for the ER staff to put down their cookies that we were all enjoying less than 30 minutes earlier and work their asses off. We remained out of service as we stayed in the trauma room to help out; whatever needed to be done, we did it. We started another IV. I did compressions for another 30 minutes while an RRT ventilated. The doc barked out some orders to one of the barrage of nurses in the room. Somewhere in the middle of it we were told to stop. "Let's do a pulse check." The monitor showed something that resembled a faint sinus tach. We'd been working on her for about an hour.

Holy shit there was a pulse! A faint brachial pulse was felt. Someone else felt the other side to make sure I wasn't nuts. They too felt it. Instantly a huge smile crossed my down turned face. I heard a couple whoops and hollers in the background and in the hallway outside the trauma room. We all knew this little girl had a long way to go but we'd done our part in helping her. This was our Christmas miracle.

Everyone went around patting each other on the back, hugs were exchanged, and "good job, well done" seemed to be the phrases said to everyone by everyone else. A true team effort by all of us; all of us, who none of us wanted to be there that morning, THIS morning, Christmas morning, at work. We wanted to be at home enjoying the holiday with our families.

About an hour later we flew that little girl down to a children's hospital for definitive care. As the helicopter took off from the pad outside the ambulance bay I stood there watching, wondering, hoping that things would get better. I played the scene over and over wondering what I could have done differently. What could I have done better? Was there anything we forgot? Anything we did wrong? All I cared about was that was did our part. We helped out. We gave this little girl a fighting chance to live on this morning of December 25th. As they rose up in the air I cried. I was spent. Here I was 20 years old and emotionally worn out. I'd gone from one extreme to the other that morning; it wasn't even noon yet and all this had happened.

That was the first and last patient I've ever cried over.

She wasn't the victim of abuse or violence like the ones in today's news. But I think of her every time I see stories like these in the papers. How can people treat kids, let alone their own, with such hatred and malice? Thy can't talk back. They can't defend themselves. They can't protect themselves. They NEED us to do it for them. We are their shields. I often ask myself if there was this much abuse when I was younger. Have families changed that much over the years? Have attitudes changed? Have personalities evolved so much to bring out this much violence towards children? It sickens me. It hurts. It makes me want to find these people and beat the shit out of them. How can they do what they do? How can they hurt a child?

Children are our future. They are what we raise them to be. They emulate us as adults, mentors, and parents. We are to be here for them. We educate them, protect them, and love them. The three pictures here are of my three kids. I adore each of them and will lay my life on the line for each of them. They are what I live for each and every day. The hugs, the kisses, the "daddy, I missed you today" words, and the "I love you" that I get several times each day from all three of them.

Love your children or those close to you. Protect them. Be there for them. Educate and mentor them. The greatest form of love I've ever felt comes from my kids. They mean it when they hug me. They love to be around me and me them. There's no greater form of happiness than a smile, kiss, and hug from a child that all say, "I love you."

Good Communication Is Essential!

Huh? Wuzzat? You say something?

One thing I was always taught was to listen to what was told and confirm what you thought you heard. Yeah, I've had those moments where I "thought" I heard something and my brain played tricks on me. I'll take it as part of growing old (er).

Maybe it's part of selective hearing. Maybe it's selective listening. Maybe (God forbid) it's a combination of both. Again, I'll always use the standby of just getting old. I know my hearing isn't what it used to be and I'll blame that on my partial hearing loss. I can see myself in 10 or 15 years wearing a hearing aid if things don't get better. I'll be using a doppler in the back of the bus just to hear a patient cough.

Precepted a new Paramedic student the other day and had to laugh when we were done with our run. Older lady who wasn't feeling too hot and wanted to go to the ER. She'd just gotten home after a hx of seizures and had been home less than 1 hr prior to our arrival. We got her all loaded up and put in the bus, O2 and monitor done, lock placed and secured, cbg done, and then all was fine with the world.

Then, out of nowhere, <<bllllleeeeeeccchhhhhh>> here came the pukes. Just one easy round of it with a couple dry heaves. No projectile messes but enough to cause a little cleanup to happen. Looked over at the monitor and see her rate drop to the mid to high 50s. Her initial BP was 100 / 60. She had vagaled out on the toilet which was the reason for the call (unresponsive but breathing). She now was talking and alert but all this happened at once. I asked for another BP. It was still a little low, lower than before but not under the magic threshold of 90. Still bradycardic and I noticed some couplets beginning. She said she felt all right but still was sick at her stomach.

I'm sitting at the patient's head in the single seat while the student's on the bench seat on the patient's left side. I hear him say something about giving her some drugs. I hear "dopamine" and his question of if we should give her some or not. "Dopamine? I haven't given that in over 10 years and only used it twice in 20 years!" Huh? He wanted to give her that? For having a sick stomach, a little pukey, a little bradycardic with some couplets and a slightly low BP? Really???

So I begin quizzing him on the drug; it's uses, contraindications, side effects, dosages. All of these things he's not too sure of since they're just beginning pharm in his class. After a couple minutes I ask him why he's wanting to give such a powerful drug for these reasons and him not know everything about it's actions and reactions. It just didn't make sense to me.

His response was, "Dopamine? Huh? I was talking about Zofran." Oh dear God,... He was confused as to why I was battering him on the why fors and why nots of giving dopamine and here he was asking about something else. I was giving all the reasons why not, what sort of reactions we could look for IF it was given to any patient. I had been thinking to myself and wondering why in the hell he wanted to give dopamine, yet I didn't bother to confirm with him exactly what it was he was wanting.

Ever called in a report and a doc says one thing and you hear another? Ever asked for an order, you get one response and hear another? Ever played the telephone game as a kid to see how one sentence starts and then ends totally different?

Kind of one of those "look at the drug three times before giving it" to make sure the right one is in your hand. I know that in my 23 years of EMS I've never been in the back of ANY bus that's quiet. I've taken patients in cars, trucks, buses, ambulances, boats, and helicopters and there is no such thing as a quiet ride to the hospital anywhere in the world. If there is, I haven't found it yet. If nothing else, this one reminded me (and us) to always confirm orders or requests before doing anything. Ask for confirmation and repeat things. Document if necessary and question if something's just not sitting right.

We didn't give her zofran. She puked once and that was it. Saved another!

On A Patient's Level

One of the things I used to hear way back when was to treat a patient with respect. Listen to them and give them some dignity. Hear them for what they're saying, not just to hear them for the sounds they make. I don't hear any of those things too often these days.

Why?

Have things changed so much in just a couple generations that dignity and respect are not taught? Are they not a paramount issue on each and every patient? Do people just not think about those things anymore? I'm not saying that those things don't happen because they do or they're practiced, just sometimes I see it not to the level it should be or not practiced at all.

Each patient tells us different things about themselves, their condition, their surroundings, what they feel like, et all. Do we listen? Not always or not every detail is taken it. Sometimes those details get in to the ad nauseum and mundane that have absolutely no bearing on what's going on. Other times those minute things could be leading up to a bigger problem or could tell a story about something else that's not being voiced or give clues to what might be going on.

Go back a minute here,...

I had a run this weekend with an Alzheimer's patient. Very nice patient who can't remember a whole lot of anything. Usually upset due to the lack of memory and not knowing what's going on about the present condition or anything else around her. She's still at home being cared for by her devoted spouse. This time she fell and hurt her neck. She had had a syncopal episode which lead to the fall and the following 911 call.

After we got her packaged up and in the back of the truck she was still upset. One of the crew members began taking her blood pressure. The patient could not turn her head to see what was going on with her right arm. All she knew was someone was grabbing it, touching it, and there was something squeezing her upper arm. I stopped the process and spoke to the patient and then to the crew member. Being in the position the patient was in, c-spined and on a board, she could not see to her sides. All she could do is look up and count the specks on the ceiling of the truck's box. I slowly told her what was going on and why we were doing it. I told her who was doing it. I then told the other crew member to always make sure we tell each and every patient exactly what we're doing.

Telling our patients what we're doing helps build trust. It initiates conversation. It calms them so they know what to expect, especially if they're in a position they cannot see what's going on, like this woman was. Something simple as telling a patient that I'm putting on electrodes helps. Some people might wonder just why I'm sticking my hands under a woman's shirt, so I explain it to them. Why I'm doing it, what I'm trying to accomplish, and that it won't hurt at all, or if it will hurt, I tell them.

We all know that cervical collars and spine boards aren't built for comfort but we need to verbalize these things to patients. Let them know these things are being done for their safety since we're not human x-ray machines. It always seemed like an oxymoron that sometimes we hurt people to make them feel better or protect them.

But we need to tell these people what we're doing and why. Even for those, like this woman, who don't always understand, comprehend, or remember what happened, we still need to let them know what and why we're doing things. Let them see your face.

Talk to them in terms they can understand. I see a lot of doctors come out and spew medical terms to people who then become totally dumbfounded about their medical condition. They are now more confused about why they're sick then before. Understand that most people don't have a thorough understanding of medical terminology. Try to explain things to people where they're understand easier. It let's them know what's wrong which in turn helps to reassure them. And for those Alzheimer's patients who can't remember much? Repeat yourself. I've had patients who forget 5 minutes after I've told them what I'm doing and why. They get upset, they calm down after I tell them. 5 minutes later they get upset again so I have to tell them again and they calm down,... again. It's a vicious cycle but sometimes it needs to be done.

Finally we all have those patients who just want human contact. They've been left by family at nursing homes, they have no family left, they live at home with no outside companionship; those people. They're the ones who just like seeing people, anyone to talk to, just to have contact with the outside world.

Talk to your patients. Find out the details. Gather them all in and then toss out the ones that have no bearing on the present condition or problem. Let them tell you what's wrong. Even those who don't speak can tell you what's wrong. Sometimes the silence speaks volumes. Are you listening?