Today, I had a harrowing 911 call. The caller advised that a man he didn't know pulled up at the local farm supply center, got out of his truck and began to vomit blood. Within seconds of answering the call, I knew it was going to be one those calls that become etched in memory. I knew I was going to have to calm this man down, as he was rather hysterical. Not that I blame him, mind you.
Initially, the patient was conscious and breathing, though with the vomiting, he was having a bit of difficulty. In a situation such as that, we're to instruct the caller to have the patient roll onto their side, so as to prevent asphyxiation. So, we had the patient on his side, his airway was clear, and the ambulance was en route. I thought we were doing okay. The caller was still frantic, but I convinced him to stay on the line and monitor the situation. He even started to calm down a bit.
As the call progressed, however, the situation began to worsen. The caller again became hysterical. The patient's breathing became incredibly labored and abnormal. In steps agonal respiration. At this point, I know it's bad, as agonal respiration usually heralds death.
While I inform my EMS of the new developments, the initial caller decides he can't take it any longer and passes the phone to another customer. In the background, I hear the initial caller saying he has to do something, but he doesn't know what to do so he's just going to try something. I spend precious seconds questioning this new caller as to what the initial caller is doing. This caller is even more hysterical than the first. I calm him down enough to get a basic idea of what's going on, but then he begins screaming incoherently, as the patient loses consciousness. Getting information out of the caller now is almost impossible. In an effort to get his attention, I use the value of shock. It gets his attention for a brief second, but immediately, he begins wailing that the patient is gone. By gone, he meant that the patient was now not only unconscious, but he was no longer breathing.
His life is now completely in my hands. I know that in order to give this man the best possible chance, I have to calm the callers down enough so that I can instruct them in CPR. The seconds tick by as I bring the caller back to earth. "Okay, Sir. We're going to do this together. I need you to roll him on his back. Place one hand on his forehead and one on the back of his neck and gently tilt his head back. With me so far?"
"How am I supposed to tilt his head back? Won't that hurt him?"
"No, Sir. It's not going to hurt him. His head has to be tilted back so we can perform CPR. All you have to do is place one hand on his forehead and one on the back of his neck and gently tilt his head back. His chin should be somewhat lifted into the air. Do you have his head tilted back yet?"
"Yes, but I don't know..."
"It's okay, Sir. Pinch his nose with your index finger and your thumb."
"Why? I just don't know..."
"Sir, I know it's a scary situation, but if you'll pinch his nose with your index finger and your thumb, we can begin giving him mouth to mouth. Just pinch his nose and cover his mouth with yours..."
"What? I can't do that. He has blood all over his mouth and it's just everywhere."
"Sir, I understand, but we need to perform CPR until the ambulance arrives."
"I just can't."
"Is there anyone else who can?"
"No. We just can't. You don't understand. His mouth just has blood all in it."
"Okay, Sir. You have the right to refuse. Are you sure no one else is willing to perform mouth to mouth?"
"No, there's no one who can. There's just too much blood. We can't even look at it."
"Okay, Sir. Stay on the line with me and let me know when the ambulance arrives."
Helplessly, I sit and wait, knowing that this man is going to die. I hope and pray that he doesn't, but it's been so long since he stopped breathing and lost consciousness. Maybe I should try again to convince the caller to perform CPR, but no, we're not supposed to "force" the callers...
"Oh, I think they're here now."
"Can you see them, Sir?"
"Yes, they're here now. Bye."
After what seemed to be an eternity, my rescue unit advises they're en route to the ER, code 4. Code 4 is almost as bad as it gets. Seconds turn into minutes. Rescue advises they've arrived at the hospital.
Now we wait. And wait. And wait some more. The phone rings. Confirmation. DOA.
