Rescue Reflections

Lessons Learned from an EMT: Adapting when a Patient Loses Consciousness

A 60-year-old male with multiple chronic conditions experienced a witnessed cardiac arrest during EMS transport, requiring immediate advanced cardiac life support measures. The incident highlighted the importance of rapid response, adaptability in challenging environments, and the need for specific training on patient transport and handling unexpected complications.

1. Medic 1 dispatched to a residence for a 60 year old male reportedly having a diabetic problem.

2. Upon arrival, fire was already on scene. Fire obtained a history from the family indicating the pt had hypertension, chronic kidney disease, coronary artery disease, hyperlipidemia, diabetes, and congestive heart failure. Fire said the family called due to the pt’s mental status deteriorating in the last 20 minutes, most likely due to hypoglycemia. Fire tried to obtain blood glucose levels (BGL), vitals but couldn’t due to the patient being in a disoriented state and initially the scene proved difficult for a BGL due to the house being so cluttered. The patients mental status displayed incoherent sentences and flailing of the extremities. Fire and EMS wanted to get the pt to a more controllable environment so decided to put the pt on a stair chair to get the patient to the ambulance. The patient was secured to a stair chair. While moving the patient from house to ambulance, he was still flailing. The patient then grabbed his chest, went limp, and fell over in the stairchair on the porch. He then became unconscious. Stair chair was quickly removed. His pulse was quickly checked and absent (witnessed arrest). Chest compressions were commenced. A Mega-mover (portable transport device) was used to get the patient to the ambulance. Advanced cardiac life support (ACLS) was started in the ambulance (chest compressions never stopped, AED applied, king tube inserted with bag valve ventilations / high flow oxygen therapy, intraosseous venous access applied and epinephrine started, BGL read low with dextrose 10% (D10) started with no improvement in mental status, narcan given via IO with no improvement. (Not sure of the cardiac rhythm or if we did any defibrillators. Pretty sure he was in PEA the whole time) Medic 1 had about a 15 minute emergent transport to the hospital. Pulse checks were done every two minutes with no return of spontaneous circulation (ROSC). Upon arrival at the hospital, hospital staff were able to get ROSC. He was then taken to the cath lab and made a full neurological recovery.

3. We did a good job at noticing the rapid decline of this pt and initiating cardiac arrest protocols. Initiating compressions soon with minimal time off compressions was vital to this pt’s success. Also, getting the pt on the mega-mover and into the ambulance in a fast manner helped a lot.

4. This call was a big learning opportunity for everyone involved. This pt was probably not a good candidate for the stair chair. More thinking could have been done to figure out how to get him into the ambulance. When he fell off the stair chair he actually sustained a hematoma to his head (and that’s embarrassing). I was complacent because I thought it was a simple hypoglycemic episode. A call I’ve run hundreds of times. So I was in the ambulance getting the IV supplies ready. The pt looked like a routine hypoglycemia call, until he wasn’t! So, I was behind the curve when the pt got to the ambulance and it was suddenly a totally different call.

5. The house we were in was a big factor, it was hard to do anything in there due to how cluttered it was. It was a borderline hoarder house. We needed a more controlled environment to work to help this pt.

6. Having training in which calls go side-ways to be better prepared to switch gears would’ve helped. Running through these scenarios once a week could go a long way. Interagency training is also important since fire is usually always with EMS. This call really opened up my eyes in that things may not always be as they seem and to stay on my toes - ask more questions.

7. The biggest thing on this call was the utilization of the stair chair. Knowing what I know now, maybe we could have used a mega-mover from the start or simply have carried him to the stretcher. There could be training made specifically for moving people from point A to be B with the stretcher to help others prevent this scenario. Other than what went wrong on the stair chair, I think the curve ball was handled well and the pt received great care, fire/EMS had a big role in a good outcome.

1. Critical Learning Points:

   • Rapid initiation of cardiac arrest protocols and minimal interruption of chest compressions were vital.
   • The cluttered environment complicated initial efforts and emphasized the need for a more controlled workspace.
   • The use of a stair chair was questioned; alternatives like a mega-mover or carrying the patient could have been better.
   • Training on handling unexpected complications and better inter-agency coordination could improve future responses.

2. Reflection and Improvement:

   • The importance of remaining vigilant and adaptable during calls was highlighted.
   • Specific training for moving patients and preparing for sudden shifts in patient condition could enhance preparedness and response effectiveness.

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