The most dreaded call

On my way to work tonight, it hits me somewhere on the highway. I start thinking about all the stress I'm going through Precepting, the downfalls I've had so far, and I start wondering am I made out for this job?? Do I really want to be a Paramedic, do I really want that responsibility in my hands, how will I react when I have a critical patient in my hands where everyone is looking at me to call the shots. I start to panic and call my girlfriend, she attempts to calm me and reassures me that I'll be just fine, I hope shes right I say to myself as I pull into the parking lot. I punch in and head to my truck to begin checking out my ALS gear. I hear the radio come to life, dispatch is sending a BLS truck to a call in the city, its for a Pediatric Seizure possibly not breathing, I roll my eyes and say under my breath "yeah right, another febrile seizure" but I know what to expect next, I hear my preceptor key up the radio form the other side of the ambulance bay "216 we're sliding on that". The dispatcher responds and tells us that we'll be primary on the call, and she'll cancel the BLS truck, we're a crew of 3 we should be able to handle a pediatric seizure.

As we race across the city, still 4 minutes out from the call we get the update from Hartford Fire Dept, Pediatric Cardiac Arrest, my heart sinks into my stomach as I feel the ambulance accelerate even faster, driven harder, I look forward to see all 3 of us have the same fear in our eyes, its the most dreaded call in EMS, the Pedi Code. We come to a stop on the street outside the house, my preceptor yells out "They're coming to us" I go to open the back door thinking I can get out and give them a hand, instead as soon as the door opens I am faced with a Hartford Fire Fighter literally throwing this child into my arms. I sit on the bench seat looking down for what felt like minutes, staring into the open eyes of a small 2 year old child's eyes, my worst fears are meet, this child is gone. As I go to place the child down on the stretcher I see his tongue looks swollen, he has frothy bloody sputum, the kind you see from an elderly Pt taking their last breaths as they cling to life battling Heart Failure, but why is this coming from the mouth and nose of a 2 year old? I immediately recognize this will be a difficult intubation and make that known to my preceptor as I place the child down on the stretcher with his head and airway closest to him. I wrap my hands around him and start doing compressions until our partner places him on the monitor with the pads and takes over, I look at the monitor and see only a flat line, this poor guy has nothing, Asystole. I grab the IO Kit and get it set up, after reassuring myself of the proper placement I sink the needle into his leg and in 2 seconds I'm in, I'm amazed at how easy and quick it was, I have fluid running within seconds. I'm handed the Epi, I assure its the right concentration I do the math in my head quickly and push the Epi. I watch my preceptor struggle with the airway, I watch copious amounts of this bloody frothy sputum poor out and I help suction it away. There is no chance of getting an airway, his jaw is clenched, he's Trismus. We start transporting to the local children's hospital, before we move a few feet we notice bruising around his eyes, we question if this child has been abused, and now believe maybe this is a traumatic injury, C-Spine precautions are taken and we change our destination to the local Trauma Center. We arrive to have the doors opened by the charge nurse, attempting to give us a hand, a Paramedic I know from another service jumps in to help us, we bring the child into the Pediatric Trauma Room and let the team take over, attempting to give him a chance. I stand in the side of the room and watch the effort they put into giving life back to this little boy, they bring mom in and I was the Assistant Director of Trauma hold her in his arms and let her know they're doing everything, I have to leave the room. Minutes later everyone faces the fact, there is nothing more anyone can do for this child, he is pronounced dead.