Saving lives...

Recently, my partner and I attempted to resuscitate a twenty-something year old who had succumbed to some bad life choices. The individual was found by family, who began CPR. CPR was continued by the police and then by my partner and I. Lastly, the BLS (basic life support) crew arrived and continued the efforts with us. We had done everything that we could have -- and we did everything that an ER (emergency room) staff would have done for this patient -- all in the field. But like many unconscious and unresponsive encounters, this resuscitative effort was terminated in the field, that is, we discontinued our efforts at the direction of a medical control physician.

One of the members of the BLS Volunteer Ambulance Corps that was on the scene with us was a brand new EMT (emergency medical technician). As I have learned over the years, I made it a point to ask this young individual how they were feeling afterward about this particular call and what was their view of their contribution and performance on the call. When I began my conversation with the EMT, I asked how long had they been doing this and how many cardiac arrest calls had they been on. I came to find out that this EMT had just recently received their certification card and that this particular call had been their first cardiac arrest call.

I was immediately taken back to a clear, sunny, and mild day in April 1988. I was on a clinical rotation aboard an ALS (advanced life support) ambulance as part of my requirements for my original EMT training. The paramedics that I had the priviledge of working with that afternoon informed me that we were responding to an unconscious patient at home with CPR in progress by a family member. My classmates and I had just recently been certified in CPR and I was excited to put my new training to use, to save a life. After all, that is what I was training for and that is what we were supposed to do in EMS, save lives. Upon arrival, I was overwhelmed by everything that was going on simultaneously.

The patient had gone to answer the door and collapsed unconscious. The daughter, who happened to be a nurse, began CPR (immediate bystander CPR, check -- I recall thinking). The BLS crew arrived in under 4 minutes and applied an AED (automated external defibrillator) and continued CPR (BLS and CPR in less than 4 minutes, check). We, the ALS paramedic unit arrived within another 4 minutes and began advanced procedures (ALS intervention, check). I got my first opportunity to do CPR on a person. All I could notice was that the patient's eyes looked glazed over. We worked on her for nearly a half hour between the scene and the ride to the hospital. She was pronounced dead on arrival (DOA).

I was shocked, "How could this be," I asked myself. We had done everything according to the textbook. This was an ideal situation for a resuscitative effort in terms of resources and timing of interventions. I was in EMT class the next night and continued to discuss this with my peers. I eventually spoke with my instructor (who I will never forget) during a break and he helped me to come to terms with the fact that we save some lives, not all lives. I learned early on that despite our best attempts, under the best of circumstances, we cannot save everyone and that death is and will always be a part of our profession. Some will be as young as a day or two old, while others will be over a century old when they die.

I relayed this memory to my young peer and they seemed to take it well. They still felt bad regard the death, but they understood that they had done their best and that we cannot save every life. I told this peer that they should hold on to their humanity, that sense of feeling bad at the loss of a life, and never lose it. I told them that I was always available to listen and the share my experiences. After the EMT had left, I turned my thoughts to the also recent death of a 23 year old FDNY EMT at his own hands -- in the midst and height of the COVID-19 pandemic. John Mondello had graduated the FDNY EMS academy just a few weeks earlier and was thrust into all of this death.

The warning signs of suicide risk, according to cigna.com include:

• Making direct statements about ending one's life.
• Making indirect comments like, "What's the point of living?" "Life is meaningless," or "No one would miss me if I were gone."
• Talking or writing about death or dying (one's own or the topic in general), including social media posts.
• Mentioning having the means and/or a plan for self-harm such as access to pills, guns, or other weapons.
• Giving away possessions.
• Asking about life insurance policy details, especially as it relates to cause of death.
• Showing interest in end-of-life affairs, such as making a will, discussing funeral preferences, etc.
• Noticable changes in behavior or mood. The person might appear uncharachacteristcally sad, quiet, depressed, or withdrawn.
• You might see neglect of work, appearance, or hygeine.
• Voicing hopelessness or helplessness.

I wonder how many signs were present in young John. I wonder if his partners or supervisors had noticed them. I wonder how much was discussed in his original training regarding our duties in EMS with regard to saving lives and was he given real expectations. I wonder if he had someone to go to who would listen to him. I wonder if he had someone who took the time to notice him and his job performance. As a leader, whenever one of my people were not up to par, I would ask, "Is everything ok?" and follow up with, "You don't seem like your usual self, do you want to talk about what's bothering you? If not, just know that I'm here for you." Saving lives...it might be our own or our colleagues.