Lessons I Learned From My First Cardiac Arrest

It strange to think that it’s been almost 20 years since the first time I did CPR. I still remember it so vividly. How the time flies.

I was fortunate to have good mentors and teachers in my early days in EMS. One of them was Phil Rigardo. As an EMT student, Phil had invited me to come do a few ride-along’s with him. I owe a lot to Phil. He was one of the first major influences I had in EMS and he framed the job in a fun and exciting way. I’ve managed to carry that initial frame (EMS is fun) for most of my career.

I had been riding with Phil for a few shifts when we got dispatched to a cardiac arrest. This was the first really sick person I had ever seen Phil treat. My first chance to see him in action. That was a big deal to me.

The engine crew arrived before us and the three man crew had been working for a few minutes prior to our arrival. I remember the narrow staircase that lead up to the crowded upstairs apartment. Clothes and furniture and bags and the stuff of crowded people living crowded lives filled the place. Three firefighters were crammed in to a bedroom made for one doing CPR on the bed. The Captain was speaking in a raised voice and stress was evident across his forehead. Our patient filled the bed and bounced with each compression.

Phil walked in and did something I never expected.

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What Is The Good Samaritan Law?

The term “Good Samaritan” comes from the gospel of Luke. In the parable told by Christ, a Samaritan helped a Jew who had been beaten and robbed. At the time, the Samaritans and Jews were mortal enemies. Through the parable, Jesus attempts to redefine what it means to be a good neighbor.

Reading some recent conversations on the good Samaritan law in a few online forums, I’m reminded not of the biblical parable, but of the parable of the six blind men describing an elephant. Remember that one? One guy feels the side and thinks an elephant is like a wall, the other feels the tail and thinks an elephant is like to a rope? Initiating a discussion on the good Samaritan law in an online forum of EMTs is an invitation for confusion and scorn.

“It only applies to bystanders.”

“No it doesn’t! It only applies to EMS personnel.”

“And only if you’re off duty. Unless you’re a volunteer. And then only … no … wait.” And on and on.

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What Is The Duty To Act?

This week I’d like to explore two related topics that tend to create a bunch of confusion – the duty to act and the good Samaritan law. If you want to see a room full of EMTs argue with each other, ask a question like, “So, when does an EMT have a legal duty to act?” or “To whom does the good sam law really apply?” These are subjects where myth and confusion are more common than fact so lets jump in to these two, often confusing, legal tenants.

Today we’ll look at the duty to act and on Thursday we’ll dive in to the good samaritan law.

On duty or off duty, paid or volunteer, in or out of uniform, when do you, as a professional rescuer really have a legal duty to act? Once you have a duty to act, what does that mean for your care and your liability? The true meaning of the duty to act can be confusing.

One of the things that make legal definitions like the duty to act so hard to nail down is the fact that they are not elements of federal law. They can’t be applied universally to caregivers around the nation. If they were we could say, “Here in the United States the duty to act is defined as … This is different from Canada and Great Britain where …” But it isn’t that simple. Depending on which country, state or territory you live in, the duty to act can mean very different things.

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The Oklahoma State Trooper vs EMS Mess

This has gone on long enough and gotten big enough that I feel compelled to say something about it. By now I’m sure you’ve seen and heard all about the Oklahoma State Trooper / EMS roadside circus.

First we had the cell phone video of an upset family member recording an odd looking scuffle between an Oklahoma State Trooper and an ambulance crew on the side of the road. It starts with a narrative by the family member and ends with the ambulance dude in a disturbing looking choke hold.

Then the driver of the ambulance went public and started giving news interviews, stating he was compelled to do so by the statements of the trooper in his report. Somehow he felt that the media spotlight would be the best place to get this off his chest. He was followed by his partner, calling for the officers badge on The Early Show.

The OSP finally released the dash cam video showing an ambulance yielding appropriately to the officer and never taking the aggressive swing at the trooper as initially reported. Then the biggest clown of all chimed in when the OSP lawyer held a press conference to say that everything we saw on the tape was normal and appropriate except for the gross negligence of the ambulance crew failing to yield for a full 24 seconds. What?

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What Is Nystagmus?

When we think of testing for nystagmus, medical personnel and lay people alike, we tend to think of the horizontal gaze nystagmus test performed by police officers as part of the standard field sobriety test (SFST). It’s true that the police have taken this useful neurological exam and put it to good use to identify folks who may have had to much to drink. There are other good uses for the nystagmus test as well.

I use the horizontal gaze nystagmus test as a part of the basic neurological exam that I do any time I’m uncertain of how well a patients brain is talking with their body. Head injuries, altered mentation, syncope, dizziness and headaches are some of the common complaints that make me want to check out how well the patients brain is doing its job. So this test gets pulled out of the tool box frequently. But what is nystagmus anyway? How do you really test for it and what does it tell you when you find it?

What is nystagmus?

Imagine that I took a large drum and I painted it white with black stripes running evenly down it. Then I set the drum on an axis and spun it slowly in one direction. As you watched the drum your eyes would focus on a black stripe and follow it across the surface of the drum until the stripe moved out of visual range. Then your eyes would jump backward to acquire a new stripe and follow it. This repetitive cycle of smooth eye pursuit interrupted by fast twitches (saccadic movement) is what we call nystagmus.

This peculiar tracking of the eye can be induced by spinning in a chair, riding on a roller coaster or observing a spinning object like in the example above (AKA Opticokinetic nystagmus). It can also be caused by a wide variety of medical and pharmocological conditions. Most causes of nystagmus point to an abnormal condition within the nervous system. It is a physical finding that calls us to pay attention and look deeper.

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What Makes A Great Partner?

Everyone has their own idea of what makes a shift a good shift. Each of us carries our own magic recipe. Perhaps a little trauma with a dash of cardiac thrown in. Add a choice rig from the fleet and a dispatcher who still remembers the last burrito run you made for her. Sprinkle liberally with just the right amount of down time and voila!

Wait. We’re missing the most essential ingredient. A great shift can never be a great shift without a great partner. That’s the best thing about EMS, all the awesome characters you get to work along side. Some would say that when your mixing your recipe for a great shift, your partner isn’t the most important factor, it’s the only factor. I tend to agree.

Think about it. You could give me the worst shift schedule and the crummiest rig in the fleet. Make me run the worst calls that come. Hold me over late. But if you give me the right partner, we’re going to have some fun. There’s just no stopping us.

The inverse is true as well. Put me in the best medic unit on a prime shift. Dispatch me to the most cherry-picked calls and send me in early when I’m done. But if my partner’s some serious, stick-in-the-mud who couldn’t find fun if you stapled it to his forehead, guess what? It’s going to suck. There’s just no nice way to put it. The partner makes all the difference.

So I got to thinking … no really. What makes an awesome partner? Here’s my list.

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What Is Epinepherine?

A quick inside tip on field instructors; we all have our favorite questions to ask new riders. Those questions that help us get a more firm understanding of where our students knowledge base rests. What kind of practical knowledge are they carrying out into the field? Some of them are fair questions. Some of them aren’t. That’s life.

One of my favorite questions to ask that new rider early in the ride along is, “So what is epinephrine anyway?” (For the record, this is an extremely fair question.) I’ve found this to be a telling conversation because the scope of the question gives the student a lot of rope. This is a question where the student can choose to be shockingly simple or impressively complex. The choice is theirs.

I ask this question regardless of the students experience or training. I’ve had brand new EMT students knock the question out of the park and I’ve had experienced paramedics strike out miserably. All baseball metaphors aside, it’s a telling question. It speaks to a care givers understanding of the drugs we are able to administer. (Yes, all of us.) It’s revealing about ones understanding of the autonomic nervous system and it exposes an individuals understanding of basic pathophysiology.

When I ask the question, the answer I’m looking for is something like this:

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