Discussion
Former EMS worker here: It's interesting to compare the EMS responses to Graham and McConnell. Both were reportedly "cardiac arrests", but the similarity ends there.
In McConnell's case, the 911 caller REPORTED a cardiac arrest, but that's all but meaningless. People often call any heart thing a cardiac arrest.
In Graham's case, the EMS workers reported doing CPR, meaning he was actually in cardiac arrest, which has a very low survival rate if CPR hadn't already started before EMS got there.
@mattblaze the other problem and I don’t wanna sound overly critical Is that bad bystander CPR is just that bad CPR.
Our hospital and many others and some EMS systems have moved to RQI. Which basically means quarterly we take scenario test online and then we physically go to an adult pediatric infant mannequins and we actually do rounds of CPR where we’re actually graded by the computer. We basically are refreshing our CPR education and physical check off quarterly. It makes a huge difference. Also many EMS systems and hospitals now have feedback patches where the monitor will actually tell you if you’re compressing too slow or not deep enough or releasing
The computer measures rate depth, making sure you’re releasing at the top of the stroke quality CPR is difficult to perform and exhausting.
@cvvhrn I remember back in the day we had the mannequins with the mechanical strip chart showing you the depth and timing of the compressions.
@mattblaze @cvvhrn I trained on one of those! Although it wasn’t a paper strip chart is was a tablet type display. It also showed the volume of air you blew into their mouth.
@ChuckMcManis @cvvhrn Interesting - mine were definitely in the pre-tablet days. It also had a trace for the air volume, all printed on an EKG-style strip with time marks.
@mattblaze oh yeah I can remember those two now it’s high Fidelity SIM and you don’t have to fake check in the pulse. The mannequin will actually have a pulse and you can hear breath sounds etc
We actually take it a step further and we’ll actually do on the road in an ambulance live simulations and the rest of the team is actually watching the cam up ambulance in real time and it’s stressful to watch and when you’re in the rig, you know it’s a simulation and it’s still stressful
@cvvhrn That sounds like a really terrific training aid.
I remember feeling very well prepared to do a code; you trained on the protocols all the time, and you did it for real often enough that it was often fresh. I could probably still do it (with decades out of date protocols) 40 years later.
What kept me up fretting was worrying about slipping and paralyzing a trauma patient.
@mattblaze a point I'm curious about: Graham's door was reported to have been dead bolted, so the EMS workers had to break through.
Which makes me wonder: why was the caller not there to open the door and let them in?
@Shunra I think the caller may have been in another city, and had been communicating with Graham by phone.
@mattblaze Thank you! I had been fretting over that detail all day.
Given that McConnell survived, and is reportedly awake and alert, I think it's extremely unlikely that he was actually in cardiac arrest at any time prior to getting to the hospital. If he had been, the paramedics would have spent considerable time resuscitating him on the scene, and gone lights and sirens to the hospital, which reportedly they did not do in McConnell's case.
@mattblaze I would agree with that because at his age if he had significant cardiac arrest, he’s not sitting up in bed, smiling.
The silence is a bit baffling though, but it now makes sense why his wife didn’t rush home
@cvvhrn Yeah, why his team isn't doing a better job communicating is baffling.
@mattblaze @cvvhrn And who sits in a hospital bed in their regular clothes? While a picture is nice I would be much more comfortable if it was video and he turned his head to both sides while talking. I am just that cynical given all the stuff the current administration has done.
A useful thing to remember if you ever need to call an ambulance for a potentially life-threatening emergency, especially if you're alone: After you call 911, UNLOCK YOUR FRONT DOOR SO THEY CAN REACH YOU QUICKLY. If they have to do a forced entry, that will cost precious minutes, possibly more if the fire department isn't already there.
@mattblaze Same goes for front gates, especially electric ones.
@mattblaze It could also cost you several thousand dollars to repair! Getting a pro to replace an entry door that's been rammed starts around $2K where I am.
@mattblaze
Also remember to secure any pets for their safety, as well as the safety of the responding crew. Pets will already have picked up on your stress, and they may flee or attempt to protect you when strangers enter the house.
NB: about ten years ago, I lost a dear friend of mine under remarkably similar circumstances to Graham's. I was on the phone with him and he suddenly started to suffer severe pain. I convinced him to call EMS, but apparently immediately after he did he collapsed, and they had to break down his door, costing precious time. He had had an aortic aneurism, and while he made it to the hospital, he didn't survive the surgery.
Anyway, whatever you may think of Graham, perhaps his death is a useful opportunity to reinforce what to do in similar emergencies.
@mattblaze As a volunteer fireman, I had to help perform CPR on a friend who it turned out had an aortic aneurism. He didn't even make it to the hospital even though we were there two minutes after the call came in.
We performed CPR until the ambulance arrived 10 minutes later, but he was declared dead on the floor.
One of the worst days of my 15 year career. It was also another reminder that CPR rarely ends up with a success like it does on TV.
@mattblaze they rarely do. Dissection vs ruptured aneurysm matters a lot here as well, but a freely ruptured AAA in the field is lethal, and the wrong kind of dissection also carries terrible mortality. One of those rare “can’t miss” diagnoses that keeps us up at night.
@mattblaze that’s rough, Matt. Sorry for your friend, and for your loss.
@mattblaze i’m sorry for your loss
This is the same thing that got John Ritter. Even if you were on the operating room table and already opened up and the dissection started, you still don’t have good odds of survival. It is really a brutal condition
We don’t see it very often in pediatrics we will get a tornado order from a high impact collision or a fall from height or something and it’s bad
@mattblaze Sorry about your friend, I can only imagine that phone call would haunt me.
@mattblaze I can’t imagine “aortic dissection” has a very good survival rate even if care is administered right away … no? I mean it sounds pretty dire.
@fivetonsflax Yeah, you die quickly from that.
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