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Patient Care

The Patient-Provider Experience: I Guess This Is How It Feels to Die

Have you ever been a patient in an ambulance, before or after becoming an EMS provider? Have you witnessed a loved one become a patient? How did it alter your perception of patient care? EMS World’s newest series, “The Patient-Provider Experience,” shares the stories of both patients and providers who have been impacted by their respective experiences with EMS—on or off the cot—and how these experiences changed the way they provide care.

 

“I guess this is how it feels to die. Sure hope it’s quick.”

In a split second on the morning of May 6, 2006, this was the thought that flooded my mind. I was in the first 15 miles of a planned 50-mile bicycle ride with two companions. We were briskly descending a steep, 900-foot elevation on our road bikes when, approaching a sharp left curve, I felt a small wobble in a wheel that very quickly devolved into a complete loss of control. 

At 40 mph, whatever was going to happen next was going to happen fast.

Negotiating the curve wasn’t possible. The road was going left, but the laws of physics said I was going straight. In front of me was nothing but trees and rocks. I distinctly remember thinking that one of those trees probably had my name on it, and even if I avoided a tree, the rocks along the side of the mountain weren’t going to be much more forgiving. I decided that a rapid deceleration from 40 to zero wouldn’t end well either way. 

As soon as my bike left the road, it started falling to its right, my body following along the vectors Sir Isaac Newton’s first law of motion set out for me. As a relatively new cyclist in 2006 (and one who had not yet had any experience crashing), I reflexively put my right arm out to brace my fall. I somehow—so very fortunately—missed all the trees but hit the ground hard on my right side and rolled onto the rocks.  After a few more rolls, I came to a stop, oddly in a semi-seated position on my butt with my feet stretched out in front of me.

“Am I dead?”

I quickly realized I wasn’t. As a bonus, I was pleasantly surprised to find that, initially, nothing seemed to hurt. 

That didn’t last long.

Within a few seconds, pain set in. I couldn’t catch my breath. I remember feeling like I had the wind knocked out of me, but it wouldn’t come back.

My EMS training and provider instincts kicked in. My first thought was that someone better get EMS rolling. We were in the middle of nowhere and we didn’t have any cell coverage at the scene, so I sent one of my companions off on his bike to call for help. The other stayed with me.

Instinctively, the next step was to conduct a patient assessment. It was weird being both the provider doing the assessment and the patient being assessed. My level of consciousness was A&Ox4 and my GCS was 15—fortunately, my helmet flawlessly fulfilled its one function. My feet worked. My legs worked.  My right arm, not so much. When I palpated it with my left hand, I felt the pointy end of a clavicle sticking up, completely displaced from the rest of the bone. Well, that explains that.

The right side of my thorax wasn’t feeling swell either, either anteriorly or posteriorly. It wasn’t long before I connected the mechanism of injury sequence in my mind: I figured that the same forces which broke my clavicle also broke ribs, and if I still can’t catch my breath, my broken ribs must have popped a lung. So, this is what a pneumothorax feels like.

I knew I wouldn’t die from the pneumo—what worried me was that those sharp ribs may have gotten my spleen or liver. 

The next thought that populated my still-cogent mind: “I wonder what it feels like to bleed out internally.” I wondered if I would get cold, feel tired, or just drift off into eternity. Having never died before, I just wasn’t sure. So, in the middle of nowhere, without even the distant sound of sirens yet to offer comfort, I waited. I occasionally took a pulse, figuring that tachycardia might at least give me a heads-up of impending hypovolemic shock. 

After 10, 20, 30 minutes went by, and shock hadn’t set in, I thought, “So far, so good.”

Turns out that the first-due EMS unit for that area was already on a call, as was the second-due unit. Until the third-due unit, a BLS volunteer service, mustered a crew and responded to the remote scene after 35 to 40 minutes had elapsed. This was reassuring. I thought that if I was going to die, I either would have done so by now, or at least I’d know it was coming. It didn’t feel like it was coming.

As the EMT approached with a long spine board, I told him, “No, thanks.” Little did I know at the time that I was refusing a procedure that in another decade would fall out of favor as yet another EMS standard of care that failed to withstand the scrutiny of evidence-based medicine. I asked the EMT to help me to my feet, and I shuffled, very slowly, to the ambulance. I knew which seat was mine, and directed myself gingerly to the cot. I welcomed the supplemental oxygen as I was still sucking wind.

Off to the ED we went. 

During transport, the EMT asked my name.

“Doug Wolfberg,” I said, with all the breath I could gather. 

A pause.

“The lawyer?” he asked. 

“Yes,” I replied between shallow respirations. 

Another pause. 

“I’m going to need you to sign this refusal form for the backboard,” he said. 

“Good for him,” I thought. Damn sure I’d want the lawyer to sign a refusal form, too.

The receiving facility to which I was transported is now a Level II trauma center. In 2006, it was a community hospital that everyone made jokes about avoiding. And there I was. I remember the ED physician seeming a bit overwhelmed at first. I was guessing trauma wasn’t often on the menu at that time. 

“You should rule out a pneumo,” I suggested. It seems that those words conveyed enough of a sense of credibility that the ED doc took my advice and wheeled in a portable x-ray. A few minutes later the verdict came: “You’re right, you have a pneumo.” 

At this point I thought it was high time to get myself transferred to a trauma center, but the ED doc said that a surgeon happened to be in-house and would put in a chest tube for me. Now I had seen plenty of them put in, but never had been on the receiving end of one. Ouch. Enough said.

Things started getting hazy as narcotic analgesics did their work, but after the tube went in, I vividly recall the nurses reading the directions on how to connect the pleur-evac to the tube. For some reason, likely pharmacological, this amused rather than bothered me. 

After a few days in the hospital, the final score was seven rib fractures, a displaced fracture of the right clavicle, a sprained left hand (no idea how the hell that happened), colorfully battered and bruised, and a pneumo in a pear tree. 

I went on to recover fully (except for a nasty bulge on my right clavicle that prevents suit jackets from fitting properly to this day) and I still ride my bike about 5,000 miles a year. But that day I had experienced an ambulance transport from the horizontal side instead of the vertical one I had experienced thousands of times before. It was a new perspective. Though I ceased being an active EMS practitioner after becoming an EMS attorney, my trauma transport reminded me of the role EMS plays in our everyday lives. It starkly reminded me how important it is that the EMS system be vibrant and sustainable so that it’s there when we need it. My experience showed me that one second, someone is living his life, and in the next second, he may be fighting for it, and EMS professionals are the ones he’ll call to help in that fight. 

Having been brought up in EMS since I was a kid, I never needed much convincing that EMS held substantial value to society and was a necessary emergency resource in every community. However, after being on the other side as an accident patient, it made me redouble my efforts to help EMS agencies and EMS systems across the country, which I’ve been fortunate to be able to do my entire professional career. 

EMS, thanks for being there for me when I needed you. 

 

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