Working with a new guy again. Slimm took the day off for his monthly mani/pedi can haircut. Call is for a late 50s man who dropped dead in a crowded restaurant. Fire reports asystole when they arrived, about 5 minutes after the 911 call. Bystander CPR was performed and the AED advised “no shock.” Patient is loaded and we are now enroute to the hospital, about 12 minutes away, when NG throws me against the wall with a violent turn out of the parking lot, and activates the siren.
CCC: Hey, you can turn off the lights and sirens. Just give us a nice, smooth ride to the hospital, okay?
Newguy: But this is a cardiac arrest, we have to go emergency!
CCC: No, we don’t ‘have to’ go emergency. Turn off the lights and siren, and give us a smooth ride to the hospital. We have everything under control back here.
Newguy: Uh, okay. If you say so. [keying up the radio] ‘Show us downgrading per the paramedic.’
Dispatch: Teenfoe, Medic Ateen
CCC: Thanks, buddy!
And later on, at the hospital, after the requisite patient transfer and pronouncement of death…
Newguy: So why did you make me turn off the lights and siren? Aren’t we supposed to go emergency to the hospital with cardiac arrest?
CCC: I didn’t make you turn off the lights and siren. I asked you to turn them off. And no, we aren’t supposed to go to the hospital in any certain fashion. We are supposed to get there safely.
NG: But why didn’t you want the lights on? Wasn’t that an emergency?
C: No, it wasn’t. Everything was completely under control.
NG: But the guy wasn’t breathing!
C: You are right. He wasn’t breathing. But he had a secured airway thanks to the fire department, he was receiving ventilations from the BVM, and he was getting fantastic chest compressions as shown by our capnography.
NG: I think we should have gone emergency. My regular partner goes emergency all the time.
C: Well, I’m not your regular partner, and I respectfully disagree.
NG: So do you ever go emergency to the hospital?
C: Rarely, but occasionally. When there is an unstable airway, or a complicated labor with an abnormal presentation, or when surgery would be needed really quick.
NG: Didn’t that patient need surgery?
C: Surgeons don’t operate on patients who are in asystole and are receiving chest compressions. Plus, we don’t know why he dropped dead. It could have been a PE, an MI, a stroke, or any other thing, and how would the hospital know which surgeon to call?
NG: I guess that makes sense.
C: The last thing we need in a cardiac arrest is to be thrown around by a fast-moving ambulance, or to have a difficult time focusing. Lights and sirens make things more stressful.
NG: But don’t the lights and sirens save time and get us there quicker?
C: I would rather perform better CPR and be able to focus on my patient, and know that everyone is going to get to the hospital safely than get there two minutes faster.
NG: So it’s not like, a rule that we have to drive emergency?
C: Not as far as I know. But your partner can do whatever she wants to.
NG: You ready to go in service?
C: Yeah. Let’s go get us a Coke or something.