Why ED nursing? Why volunteer as an EMT?

Well, the short answer, the one I say most often when asked, is to prepare me for (hopefully) becoming an ED nurse when I return to nursing this fall and to serve the community. Both of which are 100% true, but neither are the whole story.

I recently had to write a service learning project paper for my Anatomy & Physiology (A&P) II class on what personal value volunteering had to us. I'll share a part of what I wrote because it answers the questions above pretty well.

In answer to the questions above - for me it’s very personal. Eight years ago, I watched my Dad die in front of me of a heart attack with no warning in a small community ER after being taken there by ambulance. It was the day before Father’s Day. There was nothing they could do. At that time I had been out of nursing for over 5 years to be home caring for my children and doing daycare in my home. I had been out of nursing for some time and didn’t hardly know what questions to ask and what the current protocols were for an MI (heart attack). I didn’t like that feeling. I’m glad I at least had the chance to be with him and talk to him during his last hour on this earth and was there to try to comfort my mom. I’m a firm believer in when God says it’s time to go, it’s time to go. It was still tough though. I think right then and there I made an unconscious decision that when I returned to nursing I wanted to be in emergency medicine and work in the emergency department.

Last year I started actively preparing for a return to the nursing field taking refresher classes in anatomy & physiology, and pharmacology. And since I had a strong interest in working in the emergency department I also took EMT-Basic to gain emergency medicine experience. Even though I had worked before as a nurse in the hospital, I wondered if I could do emergency medicine and if I could handle the trauma cases and even more how I would handle my first heart attack patient. I didn’t have to wait long to find out.

My very first clinical during EMT class I arrived at the local ED (emergency department) to find a very busy ED staff delivering care to a man having a heart attack. He was about my dad’s age when my dad had his heart attack. I helped the ED staff get him ready for transport to a Level 1 ED and more specifically to their hospital's cath lab. I handled it just fine. In the heat of the moment you really do go on automatic pilot and just do what you are trained to do. I believe the man ended up doing ok. His heart attack was fortunately caught very early.

I was also a little worried about how I would handle my first full cardiac arrest and CPR since my dad’s heart attack. Again, I didn’t have long to wait. My very next clinical was at a Level 1 Trauma ED. During the clinical the preceptor I was working with told me to come with her because they were about to call a “code”. Most know what that means, but basically that’s when a person stops breathing and their heart stops. Calling a code in an ED gets a whole lot of people in the room real quick. On the way to the room in the back of my mind I thought of my dad. I had seen him undergoing CPR compressions in the ED in an unsuccessful attempt to save his life.

When we entered the room they had indeed called a code. The ER doc was there directing the action. The respiratory therapist was bagging the patient (providing artificial respiration with an ambu bag). A medical resident was inserting a femoral central line. Nurses were administering emergency medications from the crash cart, and monitoring the ECG. And a medical tech was doing CPR compressions on the patient’s chest. My preceptor asked if I had ever done compressions and I said no but I’m CPR trained and allowed to do them. She told the tech that was doing compressions to switch places with me and let me do the compressions. And so I did CPR compressions on a real person for the first time in my life.

I learned later she was a healthy 85 year old and had come to the ED after a fall to be sure she hadn't broken her pelvis. She had just gotten back from X-ray and went downhill fast. Even though I had been a nurse for 5 years before leaving nursing to be home with my kids I had never actually done compressions. I did compressions for a while before switching with someone else so they could take over. One thing they don't tell you in CPR class - you're going to break ribs even if you do compressions perfectly and don't be surprised when you hear cracking. Doing compressions can be exhausting and it’s good to switch often if personnel are available to ensure adequate compressions are being given. Again, you go on automatic pilot and don’t even think about all the emotions. You just look at the patient in front of you and do all you can. Unfortunately, the patient ended up dying after about 20 minutes of CPR and many doses of epinephrine and other emergency medication. I said a little prayer for the patient and the family silently in my mind when it was all over. I know what it’s like to suddenly lose a family member in the ED. I was glad I could be there to at least try to help the patient.

My other worry was would I be able to handle seeing a major trauma. Again I didn't have long to wait. The very next clinical I found out as a medivac helicopter was en route with a Level 1 trauma....

More of that in the next post...
----Jen