My Worst Call Ever as a Paramedic

I have a weird hobby. Although I have been in IT for 30 years, I am also a certified paramedic and RN. It started about 15 years ago when I became a volunteer firefighter and I went to EMT school. One school begat another (paramedic, critical care, etc) and after finishing my associates in nursing, I am now working on my?bachelors.

When people hear that I am a paramedic they typically ask one of two questions: 1) Where do you find the time? and/or 2) What’s the worst call you ever went on? Regarding where I find the time, you simply make time. There are a lot of people that have time consuming hobbies and luckily EMS is open 24x7 so there are plenty of nights and weekends available to catch a shift.

Regarding the worst call ever, people are often disappointed at the answer. I have run my share of shootings, stabbings, car wrecks, and heart attacks, but those are not the ones I remember. The ones that stick out to me are the ones where I didn’t do my best.

One call in particular is always top of mind. In my first year as a medic, I ran a call for breathing difficulty. When we got there the fire department had him on oxygen already. I did my standard field triage, but the only thing he would say is “I can’t breathe”.?His oxygen saturation (SPO2) was 100% so he was getting plenty of oxygen. I ran a 12 lead EKG and started an IV, but I could not figure out what was going on.

During the IV set-up my partner accidentally pulled the drip set (IV tubing) out of the bag and half a liter of cold saline rained down on this guy. Here he is, naked from the waist up, wired up for an EKG, straining to breathe, and now he is wet, scared and pissed. Not knowing what else to do, we lit up the lights and siren and tore off to the hospital. The whole ride in he just kept saying “I can’t breathe”.

When I called the hospital, I am sure they heard the panic in my voice and the siren in the background, because when we got to the ER the whole trauma room was full of doctors, PAs, nurses, x-ray techs, etc. We got him transferred over and the doctor said “What’s going on?” and the patient looks at the doctor and says “I am a?diabetic and I haven’t taken insulin in 4 days…”.

The whole room deflated. While low blood sugar is life threatening, you have time to treat high blood sugar. I had asked this guy if he had any chronic illnesses, and all he said is “I can’t breathe”. I had asked him if he took any medications and all he said “I can’t breathe”. In all the commotion, I got tunnel vision. I had everything I needed to figure out what was happening, and had I taken my time and worked all the steps, I would have figured out the issue. He was suffering from diabetic keto-acidosis and the reason he couldn’t breathe is that his body was trying to breathe off CO2, and I was flooding the guy with oxygen.

I called the guy who had mentored me as a young medic, and he laid it out for me: “You let his emergency become your emergency”. Tunnel vision; I got locked on to one problem and excluded other possible complaints. It happens to everyone, especially young paramedics.

Like a pilot learning to trust their instruments, I had everything I needed to identify the issue but I ignored all the signs. As a general rule (there are a couple exceptions) people who are satting at 100% are getting enough oxygen. No matter what they say, keep looking for the real issue.

I have run hundreds of calls since then. Over time I have developed the experience and the perspective to allow myself to slow down. Slow is smooth, smooth is fast. That is why you don’t see us running from the ambulance when we pull up. It is the patient’s emergency, but we are just showing up for work.

I have a routine set of steps I work on every call. Circulation, Airway, Breathing, and then look for life threats. This guy’s heart was beating, he had an open airway and he was breathing. I should have kept looking. In addition to all the other rules I have created over the years, whether it is a stubbed toe or a gun shot, I never move the ambulance without getting a blood sugar first.

When people ask about the worst call ever, I think they expect to hear about the blood and guts. The truth is that EMS is hours of boredom punctuated by moments of terror. For every life-threatening call there are 10 (or 50) boring ones. But I try to learn something on every call. Work the steps, Slow is smooth, smooth is fast.

We get tunnel vision in the corporate world as well. How many times in retrospect has the answer been there, but we missed the signs? At Amazon one of the leadership principles is Bias for Action, but it is paired with Dive Deep and Think Big. We have to meter our conclusions in light of the data we can collect. Sometimes we need to act immediately, but often there is the chance to solicit more feedback if we just take an extra second.

In addition to “always get a blood sugar”, I could tell you 10 more lessons I have learned the hard way. I think that is why I keep going to school. During my first undergrad I was learning just to learn; now I am learning because there are things out there I still don’t know. Ask 10 paramedics about their worst call and you’ll probably get some great stories. This job hits everyone differently. I don’t hold on to the gory ones, or sad ones, although I can probably remember some of the funny ones. I hold on to the ones where I could have done better, and then I resolve to do just that.