Rookieworld: Death, Learning, (and life) in EMS
Let me set the scene.
You are dispatched to a house for leg pain. You walk up the steps and you see your patient sitting in a chair.
You put him on oxygen and help them move to the stair chair.
After securing them, you and your partners start the process of navigating the stairs to your waiting stretcher.
And then they stop breathing. On the stairs. In the chair. Face to face with you.
As my partners, the police, and I were carrying our patient down the stairs as fast as we safely could, the paramedics showed up, mildly annoyed that they were originally cancelled (due to the nature of the dispatch); then re-dispatched because of the code.
We moved them onto the stretcher and brought them out to the ambulance so we could start CPR and using a BVM. I remember sitting at the top of the stretcher, ventilating them with the BVM and along with watching for adequate chest rise, seeing what seems to be their soul leave their eyes. Many of you who read this know instinctively what I mean. Maybe some of you haven’t, yet. But all of us in EMS will see this in their time as a clinician.
The commotion from my partners and the medics didn’t faze me at all.
It was the scariest thing I’ve ever seen.
This was what happened on my first call as an EMT.
And I stressed over it.
“Did I do something wrong? What am I going to do? We can’t start CPR on the stairs! And the LUCAS won’t fit! Oh no, oh no, oh no…”
You know the quote from The Office where Michael says, “And I knew exactly what to do. But in a much more real sense, I had no idea what to do”? That was me.
It’s only a natural human response to express emotion when anyone passes. But in that moment for me, it was more of an initial shock. After the call, I just felt numb. I had to leave the station right after we returned from that call, and I immediately called my family.
And I started bawling my eyes out.
I replayed the entire call, going back to literally every small detail, trying to figure out if I did anything wrong or if I could have done something better. Their nasal cannula got disconnected from the oxygen tank during the move down the narrow staircase, and I was holding the tank; was that my fault? They didn’t teach us THIS.
I remember as we were bringing the patient out to the ambulance to do CPR, the family was standing in the doorway. They were holding each other, watching us, crying, wishing that their family member would come back.
It was such a bad call that my partners and I had to discuss it throughout the rest of the day. My partners were really supportive, knowing that it was my first call, and they kept asking me how I felt. When I told them, they agreed with me, but they said, “You did nothing wrong, and we did everything we could for them.”
A week later, we had another call where the patient coded right next to my partner. I remember their airway filling with blood as I suctioned out the airway to clear it just enough that the paramedics could see while they were intubating the patient.
Again, those same feelings came back, but this time, not as vividly.
After the call, we all talked about it. Again, that line was said: “You did nothing wrong, and we did everything we could for them. Sometimes things don’t work out the way we want them to. It’s sad, but that’s the way it is sometimes.”
But I still was internally stressed. Was there anything I could have done better?
Could I have saved that patient?
As EMTs, we all get the idea that we are here to save people’s lives, and that single thing is the sole purpose of our existence. But what if we can’t? What if we do everything we can, and we do everything right, but they still die?
In EMT school, they teach you that you should remain professional and not really show emotion when you encounter any uncomfortable situation. But they don’t really teach you how to react when you actually see someone die. Or walk into a room to find someone who has died.
Bad outcomes are inevitable in our job, no matter what we do to prevent it. But a lot of our training (or mine, at least) emphasized how much of a hero EMTs can be. The most that we talked about was what not to say to the family of a patient who died (which is important, but not necessarily the point I’m trying to make).
I wish that in my initial class there was more of an emphasis on just making sure that you were doing the best you can for your patient; with the patient’s intentions in mind, instead of just pretending that bad outcomes don’t happen and just telling us to suck it up and be professional.
Throughout my year and a half as an EMT, I have learned that both ALS and BLS have a large array of things to utilize to treat patients, but sometimes, all of that just isn’t enough.
Our job as BLS, more often than not, is making our patients comfortable and stable so that we can bring them to the hospital to get the continued care that they need.
I also realized that having emotions is natural. On your own, it’s okay to be frustrated with how a call went. It’s okay to be sad when a patient dies. It’s okay to smile and laugh with a patient when you’re talking about your favorite movies and childhood TV shows.
Having these emotions are what makes me a human. It ensures me I’m not completely burned out, and that I still have a passion for this job.
I was lucky because I had a great support system. I had my partners and my dad, who have been in my position before. They were able to check in on me right after the call (and even hours after) to make sure that I was okay. They were able to listen to my concerns about the call and validate my feelings about what had happened. But other new clinicians aren’t as lucky as I am.
These are the type of calls that make brand-new people leave the profession. For good. And as a profession, we need to realize that all of our new people, and a lot of our not-so-new people, need this type of follow up care. Yes, it’s care.
Older EMTs and medics will tell you that the “Just suck it up” mentality is what they were trained with, and that’s the way it always was, and thus what it should be. So although the stigma around mental health in society is going away, the stigma in EMS is still very much present. Even being empathetic is somewhat frowned upon by too many still.
After their first code, new EMTs should be able to have a strong support system through their squad or workplace that can allow them to voice their feelings without being ashamed of them. If that “just suck it up” mentality continues, it’s going to hurt the profession. If new EMTs see these types of calls (and see them frequently), and are told to suck it up, they are going to suffer silently and leave the profession. Or worse.
Experiencing the loss of a patient is inevitable, especially in EMS. But if new EMTs can be given the tools to both help process and move past the loss, they can become better clinicians.
The next time that a patient codes, I will still have these emotions, but I won’t be panicking.
I’ll do the best I can, and I’ll talk to my support people. I’ll keep learning.
And I’ll be okay.
