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When It Became Real

My unit was dispatched to an Echo call: cardiac arrest in progress. All the pieces seemed to be in place. The 9-1-1 dispatcher was giving prearrival instructions on the phone to a relative who reported his elderly aunt was seen talking a few minutes before. The police arrived in less than a minute with an AED and CPR help. Our BLS ambulance was out the door in less than a minute and on scene in less than four. A second BLS ambulance arrived moments later to back us up. An ALS unit from the local hospital was dispatched and had an eight-minute ETA.

My partner on the ambulance was a brand-new EMT who’d had her card less than a month. With five EMTs and two police officers in the cramped kitchen of the home, we worked as a team. Hard and fast chest compressions, 100 a minute, no interruptions. Both oral and nasal airways in place. High-flow nasal cannula at 15 liters per minute in addition to ventilation with a BVM attached to a PEEP valve. One person held a two-handed mask seal and the other slowly compressed half the bag every 25 seconds or so. AED in place, still not advising shocks after several cycles.

ALS arrived, and we gave a status report. Intraosseous line into the shoulder for epi, i-gel airway inserted. Lifepak 15 hooked up, showing excellent compressions over an asystole rhythm. Medical control consulting on the phone. Conversation with the family. CPR ceased, and patient pronounced. Family members came to the kitchen for a hand-holding good-bye. A request to cover the patient with a sheet. We shared condolences. Family members gave each of us a hug and said, “Thank you for trying.”

As we drove back to the station, I complimented my young partner on the way she conducted herself and noted that her skills were excellent. I told her she worked very well as part of the team. I asked if she was OK. She said yes—then paused. “I was fine throughout the call, doing all the skills I’ve been taught,” she said. “It didn’t seem like a person I was working on but more a skill I was doing. Then we put the sheet on the patient. And that’s when it became real for me.”

Not all our calls will be life-threatening, and not all of our life-threatening calls will result in lives saved. This conversation was a good reminder that some skills, though practiced, refined, and honed, can still go on autopilot for a while when you’re working hard. In the end, if you’ve done your best, used the best available skills, knowledge, personnel, and equipment, you can still always add your humanity to that list. Treat your patients and their families with compassion and respect. Look after your crew. Look after yourself. Keep it real.

Barry A. Bachenheimer, EdD, FF/EMT, is a frequent contributor to EMS World. He is a career educator and university professor with more than 30 years in EMS and fire suppression. He is currently an EMT with the South Orange (N.J.) Rescue Squad, a firefighter with the Roseland (N.J.) Fire Department, and an instructor at the National Center for Homeland Security and Preparedness in New York. Reach him at


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