I always wonder why a ventilator run always takes for ever. I now present the story of how a simply transport can go horribly wrong.
Medic 23 dispatched to St. Respiratory Hospital for a patient transport to County General across the river. Our information stated that the patient was a male with IV medications thus requiring a paramedic. We went to the CCU and immediatly the nurse started talking to us, not so nicely. I couldn’t hear what he was saying from the back of the nurse station so I walked closer as my partner went to check out our patient. The nurse was trying to tell me that the patient would not fit on our stretcher. My partner agreed from downthe hall. The patient was also on a ventilator and cardiac monitor (useful information that SHOULD have been provided to us on dispatch).
My partner called for a bariatric truck, the nurse offered us some soda to drink and the waiting game began. We left our equipment on the CCU and went down to move our ambulance. I noticed the puddle of oil that leaked from the engine (see photo below). Our ambulance leaks about 1 quart ever 3 days.
We like to keep the truck idling during cold and hot months. The air bag warning light flicked on, as did the seat belt light. We decided to just turn the truck off since it had already been 30 minutes since we asked for the bariatric truck. 20 minutes later our charriot arrived. I tried to start our ambulance to no avail. The battery was working fine, the starter never tried to turn over. We are now 1 hour into this run and it’s going to hell quick.
I devise a plan. I will transport the patient in the bariatric truck, leave one member of that crew with my truck, take my partner with me and have the fourth guy drive. Dispatch was notified of my plan (which included returning to jump my ambulance after the transport) and we moved forward.
The nurses disconnected all IV drips, took the patient off the cardiac monitor as we dressed in our BSI for MRSA of “everywhere” (per hospital nurses) including sputum. We moved the patiet to our stretcher. We decided to swich to our vent after the move. I set my ventilator as dictated by the nurse. The respiratory therapist told me she changed a few settings. I reset to the RT recomendation. We switched vent tubing (called circut). The patient had a SpO2 of 94% on their vent (FiO2 80% Peep 5). He was now down to 88%. I increased FiO2 to 100%. No change. The RT reviewed my settings on my vent and concurred that it was all ok. The patient could nod his head (and he had and ET rather than trach). I asked if he was doing ok, he nodded yes. Our protocols say we have to wait 10 minutes before transporting a vent patient to see if they are acclimated to our vent. I waited 5. Patient says he is ok and I’m hitting the road. Double check my lifepak 12, vent and we roll out.
My partner (who is testing for his medic license) will ride in back with me. He did all his ride time with F&B and has more expirence with these vents than I so I will use him if I need help. New EMT, our driver, does not know how to get to County General across the river. Luckily my partner does and will guide new boy to our destination.
Arrival at destination. Enter through the ER (ask ER RNs for directions to their ICU) and find the elevators. Upstairs the ICU is expecting us, and we are greeted by a grumpy skinny Santa clause looking RN. The floor tech brings a slide board, St. Nick rales on how roller boards are better. Respiratory is not here yet, I suggest that we leave the patient on my vent until they get one. St. Nick says he’ll just bag the patient with a BVM until RTs get there. So we move the patient over to the hospital bed, they promptly remove my vent and commence bagging the patient. I’m tired and just want to leave. I ignore the snarky remarks from St. Nick and finish paperwork. Respiratory arrives and connect their vent, his sats go back to low 90s.
In the end St. Nick was nicer after the moving process. I tried anything I could think of to increase the patients SpO2 but nothing worked. The patient was in no distress and I kept a close eye on him. Three hours later we return to my ambulance, jump it and promptly return to the station for a new truck.
This is why vent runs take so long.