My first save

[911lady]

At our service, we are able to respond from home, if we live in the city. (We are a small town.) Night had come, so I went home to listen up for our calls. Then we got a seizure call with a 3 yr boy. My partner and I are both basics, the call seemed to be a basic call. We had a first responder show up on scene with us. I am thankful my partner asked him to drive for us. The father of the child sat in the front and we allowed the mother to sit on the side seat next to the child. The child was unresponsive. He was just twitching. As I was attempting to get vitals, he started frothing at the mouth, the mother started to panic somewhat. My partner trying to keep the father calm and helping with mother. I started suctioning. Then attempted to get blood pressure and other vitals. His Glascoe was a 3. I became very concerned at this point. The mother noticed the frothing again, so I suctioned again. At this point, I was wishing the mother wasnt in the back with us, too late for that now. Then I noticed my patient had become cyanotic, then I asked my partner for the pedi BVM and get him hooked up on the heart monitor. I started using the BVM, the mother is in a panic, partner is trying to get information for me. and told the driver to go code 3 and radio in for us. I was scared to death at this point, but I never lost my focus on the child. He started getting his color back and I thanked God. Then we arrived at the hospital. After releasing the patient to them, I went outside and just lost it. I thank God for helping me keep it together enroute. My partners gave me a pat on the back and said it was a good save. After returning to our EMS office, we were congratulated on the call. I was still a little shaky and nervous from it. Although this call was not the worst call I had been on; it was certainly the most satisfying at the time. I had only been a Basic about 3 months after being an ECA.

[Coach Hohman]

A couple things to address

- Great job keeping your cool, I know especially if you're a mother these calls can be difficult the first time (not that they're ever easy).

- If you have a child in this condition, transporting parents with you is NEVER a good idea. They will be too much of a hinderence. I know they want to be there, but you need to explain the need for them to follow behind (and not chase the squad).

- From the get-go this isn't a "basic call". If a child of 3 y/o is seizing, there is a serious reason why. Is ALS available in your area? This child needed much more than you could provide him.

- Good pick-up on the cyanosis. It's easy to pick up on, but a lot of people (myself included in my first few months) would either a) panic, get distracted by the mother (see point No. 2), c) have tunnel vision on the foaming

- O2 sats will regularly drop with a seizing pt. during the seizure itself, did you have the pt. on o2 prior to the BVM? just a little food for thought

Don't feel like I'm jumping all over you, just offering some advice as I seem to be a pedi-magnet and have been in your shoes. Best of luck in this field, it can be as rewarding as it is challenging if you allow it to be.

[Just Plain Ruff]

I don't understand, do you have medic backup in your area?

If you do why did you not request ALS intercept for this child that was obviously in real big trouble? A glasgow of three?

I'm also concerned that you became very concerned at the point that he started to froth at the mouth, I think you should have been concerned much much sooner than you were.

Any time a 3 year old is having a seizure is more than a basic call. There are some very very serious reasons a child would sieze and as a basic it's hard to keep an eye on the big picture.

Not trying to beat you up on your "save" but I'd like some more info on why you thought that a seizure call for a 3 year old was "just a basic call" If you only have emt's available then yes it's just a "basic call" but if you have medics available for intercept then someone on this call dropped the ball.

I'm glad the kiddo did ok.

I think we are missing some important points?

[Coach Hohman]

I don't understand, do you have medic backup in your area?

If you do why did you not request ALS intercept for this child that was obviously in real big trouble? A glasgow of three?

I'm also concerned that you became very concerned at the point that he started to froth at the mouth, I think you should have been concerned much much sooner than you were.

Any time a 3 year old is having a seizure is more than a basic call. There are some very very serious reasons a child would sieze and as a basic it's hard to keep an eye on the big picture.

Not trying to beat you up on your "save" but I'd like some more info on why you thought that a seizure call for a 3 year old was "just a basic call" If you only have emt's available then yes it's just a "basic call" but if you have medics available for intercept then someone on this call dropped the ball.

I'm glad the kiddo did ok.

I think we are missing some important points?

Ruff also covered something else I wanted to say...I didn't know a way to say it without jumping all over over the OP...I didn't want to be on my soap box :wink:

911, what was the nature of this seizure?

[Just Plain Ruff]

Yes unfortunately this call was fraught with issues and pitfalls and I don't want to jump all over the OP because if all she had available to her was a Basic level of provider then there is not much she could have done differently but....

I would bet that her pats on the back would not be so enthusiastic if they read what she wrote to us on her post.

Lady, we'd like to hear more about this call.

[Just Plain Ruff]

Then I noticed my patient had become cyanotic, then I asked my partner for the pedi BVM and get him hooked up on the heart monitor.

Heart monitor? are you a basic or a medic?

[dougd]

I'd like to hear some more about this call. What did dispatch tell you - that the patient was post-seizure or that they were still actively seizing? What kind of Hx did the family provide? How long had the patient been seizing for?

Nothing about this call sounds like it should have been handled BLS to me. 3yo actively seizing... probably now long enough that you could classify it as a 3yo in status epilepticus... that's a basic call???

Why are you messing around with the monitor and putting the leads on when your now supine (I assume) patient is compromising his airway - as evidenced by the need for suction? First of all, am I the only one who figures you're going to have plenty of artifacts if the patient is still "twitching?" Secondly, how is what is displayed on the monitor going to change what interventions you provide at all as a basic? It's not.

It sounds like you did a good job in that the kid did ok, I don't mean to take away from that. I'm just curious what your thought process was because, from one basic to another, I want NOTHING to do with this call beyond getting the call upgraded to ALS and maintaining an airway until we can get to an intercept point or to the ED, whichever is first. That said, if that's all you have in your system, that's all you have. (But the way you worded your original post, I suspect it isn't.)

[Just Plain Ruff]

Great answer Dougd. those are all questions that should be answered before any of us go on to chastise or post negatively on this provider.

I love pediatric patients but they still scare the crapola out of me especially the ones who are critical.

I'm not sure what an EMT is doing going for a heart monitor other than it being an AED and then I'm suspect. As far as I'm concerned the primary cause of this patients frothing and cyanosis is respiratory and that needed to be corrected which it was by the BVM. (good call).

I'm also curious as to how long this patient had been seizing? did the first responder notify you that he was actively seizing or was that activity from the call to your arrival?

[911lady]

It looks as though some things need to be cleared up on my post. I got into this field because I wanted to be able to help those that cant help themselves in the time of need. I lost my husband because, I didnt know how to help him if at all. Now my experience is not as lengthy as some would like; but I give it my best shot to do the best care with the training I have.

Now for some of the issues at hand. First of all, there were no ALS available that night. And I never meant to say I undermined the seriousness of the call. As always I take all our calls very serious, this is not a game to me. As far as the pats on the back; my partners knew how hard I worked on this call, and they knew how scared I was for that child, thats why they patted me on my back. Back at the station, they knew how new I was at this, and never let me forget what the big picture is, and gave me a few pointers afterwards. Although I understood the reply posts, were not meant to beat me up, they sounded harsh. And yes, I did have the patient on O2 with a NRB. Now for the monitor, I merely wanted to get a strip for the ER. And no, I am not a medic, but have aspirations to become one. But after reading these posts, maybe I need to rethink this.

I don't understand, do you have medic backup in your area?

If you do why did you not request ALS intercept for this child that was obviously in real big trouble? A glasgow of three?

I'm also concerned that you became very concerned at the point that he started to froth at the mouth, I think you should have been concerned much much sooner than you were.

Any time a 3 year old is having a seizure is more than a basic call. There are some very very serious reasons a child would sieze and as a basic it's hard to keep an eye on the big picture.

Not trying to beat you up on your "save" but I'd like some more info on why you thought that a seizure call for a 3 year old was "just a basic call" If you only have emt's available then yes it's just a "basic call" but if you have medics available for intercept then someone on this call dropped the ball.

I'm glad the kiddo did ok.

I think we are missing some important points?

[dougd]

Although I understood the reply posts, were not meant to beat me up, they sounded harsh.

Sorry if it sounded harsh. Thank you for explaining why you took the interventions that you did. My partner and I usuall run through all of our calls after and discuss what we think we did right, did wrong, didn't do... sometimes it's a bit harsh. But I find I get a lot out of it.

And no, I am not a medic, but have aspirations to become one. But after reading these posts, maybe I need to rethink this.

It's the best thing you could do to help your patients. That's my plan.