Pedi Arrest

My partner and I raced northbound for the confirmed cardiac arrest. The phone rings and I answer, its a friend in another ambulance who has been listening to the fire radios. "It's a kid," he says. "2 years old."

We're on scene a few minutes later, finding the address already saturated with police officers and firefighters waving franticly as they yell and point the way. We park and grab our gear, just the monitor and the ALS bag. No need for a stretcher to carry a 2 year old.

We find our patient by following the sounds of an anguished mother's screams. She is upstairs, getting dressed as she cries, her hair still wet from the shower she took while her baby stopped breathing. Later we would learn that 15 minutes ago she put her child down for a nap and decided to take the opportunity to shower. Walking in afterwards to check on the crib, she found that her child would not wake up.

The 2 year old was on the wooden floor surrounded by giant firefighters in dirty yellow jackets. Arms outstretched and mouth slightly open, she looked positively motionless. Absolutely still. Her skin was an ashen gray, only a memory of warmth remained.

We dropped the gear and got on our knees to work. I ripped the bag open and found a pediatric sized BVM, throwing it to one of the firefighters to set up. My partner confirmed there was no pulse and the patient was not breathing, quickly reaching for the intubation kit. We work smoothly despite the tremor in our voices as we call out commands. Get that oxygen in here. We need the suction. Find out how long she's been down.

The room is so small.

On the monitor is an apparent v-fib that to our dismay smooths out to asystole when all hands pull away from the lifeless body. Get back to work, my partner says. Good CPR. We try for the tube and the patient vomits. The mother is still screaming from the hallway outside, the room feeling smaller by the minute. My partner looks at the monitor, then back at me. "We need to just go."

We scoop up the baby in our arms and rush back to the ambulance. Behind us is a trail of firefighters and police, each grabbing a piece of equipment as they follow in toe. My partner gives CPR with two fingers and delivers ventilations as she climbs down stairs, over snow banks, and into the back of the ambulance. Another crew and a paramedic supervisor are there to help.

We do what we can. The ride to the hospital is harsh but fast, the three of us supporting ourselves against the stretcher while we give CPR and work on the airway. The baby is still ashen gray and motionless except for its lifeless jostling against the city streets. We're at the hospital within three minutes, and they are ready for us.

Room four! Room four!" They yell as we rush the stretcher down the hallways of the emergency department. Shocked patients, sitting upwards in their beds, forget their own troubles for a moment to see what all the commotion is about. Inside the brightly lit emergency room, doctors and nurses await us next to a hospital cot. We give a report and the patient is theirs. New pairs of hands with fresh gloves reach downward towards the gray child.


***

We all gather around the parked ambulances in the hospital loading dock. Each provider handles the call in their own way. Some tell jokes, some are silent. More than one person turned away with reddened eyes, tasking themselves with cleanup chores in order to keep busy. Just leave me alone for a few, they say.

Our supervisor walks from person to person, shaking hands and speaking softly. You did a good job, he said. The best we could have done. He asks if there is anything he can do, anything we need. Take your time, he says. You guys come first.

Back in the emergency department, they get pulses back. The pressure remains stable with vasopressors running into multiple IV lines. Warm air is pumped into the child's lungs via a respirator machine programmed to compensate for a gross metabolic acidosis. The pupils remain fixed and nonreactive to light.

Hearing the news, my partner's jaw tightens. She doesn’t say a word. I'm not sure what to say either. We head back to the office to clean up and restock, attempt to refresh ourselves. Our supervisor is more than accommodating. Anything we need, he offers again.

My partner insists that we go back out onto the road to finish the day. She'd rather work, she says.

We go through the motions of the rest of our shift, trying to talk about something else.