An Apology to Those We’ve Lost

To expand on last week’s posts about the evolution of cardiac arrest, I got thinking about how things have changed over the centuries.  I remember watching Killing Lincoln on the history channel a few years ago.  In the moments after President Lincoln was shot, an army surgeon who was at Ford’s Theatre stepped up to care for the doctor.  He instructed people to “lift his arms up and down” to help facilitate respirations for the president.  Its something that today, we would look at as being ridiculous.  The funny thing is, as I look over my career and a lot of the treatments that I talked about last week, I see a lot of what used to be cornerstones of resuscitation only a few decades ago as being equally as ridiculous.

It makes me wonder how many life saving events that I could have been a part of had our approach to cardiac arrest been similar to what it is today.  The changes that we have seen in the last 20 years have been simple ones.  We have changed compression rates.  We’ve prioritized compressions.  We have realized that getting that tube is not nearly as vital as we once thought it was.  17 years ago, if I delivered a code without a tube to the ER, it was seen as a badge of shame. You did everything you had to do, the rest of the care be damned, and you got that tube.

What if we had stayed on scene and played for some of those codes instead of just throwing a backboard under them and whisking them away to the hospital morgue?  What if we had admitted defeat to a difficult tube and stuck with a BLS airway since that was working anyway?  What if we had done compressions in between my stacked 200, 300, and 360 joule shocks?  How many more lives would have been saved?

The first CPR save pin that I ever received was when I was 16 years old.  The patient was 80-something and she collapsed at home.  22 years ago, New Jersey was doing some things right.  If we didnt get them back we did not go anywhere.  This patient though, this patient saw a return of pulses.  We transported her to the hospital, and kept her alive until we delivered her to the waiting ER staff.  She died in hospital, but we saved her before that.  Or so my squad thought.  So I got a save pin.  I was proud of it.  Looking back though, I would have wanted more.

In 2000, I was doing my ride time searching for that elusive cardiac arrest so that I could get myself closer to putting a medic card in my back pocket.  I got that code on a Saturday afternoon.  We got pulses back pretty quickly, and threw up some Dopamine to bring her pressure up, but the pulses did not last long.  Half way to the hospital we were pumping away on the chest again.  ROSC was short lived, the response to that ROSC was rushed, and we were right back to doing compressions.

As I look back over my career, I am proud of the fact that I have five confirmed CPC 1 saves in the recent years of my career.  In the 12 years prior to that though, I honestly have no idea how many that I had, and I do not think that it was that many.  I thought that I was doing the best that I could for my patients, and I thought that it wouldn’t make much of a difference anyway because nobody in cardiac arrest survives anyway.  We did not see the ROSC and survival rates that we see now.  We did not know what we knew now, but imagine what would have happened if we did.

It also makes me wonder where we will be in cardiac arrest care in 10 years.  The changes so far, like I said, have been simple ones.  What happens once we start to raise the bar little by little?  What it comes down to is personal dedication.  It is up to us.  As paramedics and EMTs, we need to be resuscitation experts.  We need to be the ones who can run a code to completion in the field, whatever that outcome may be, whether its ROSC and ROSC care, or pronouncement.  We need to own that call, and we need to work as hard as we can to get a positive outcome regardless of the situation.

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