code 4

code 4: firefighter radio slang for cpr in progress.

it's outdated slang. and the only ones who still use it are the old dinosaurs, like me, or the newer firefighters who like to carry on the tradition and heritage. i also still tell dispatch to "start me a card" when we have walk-in aid calls at the station. i know that dispatch has not been using time-stamp cards for almost 20 years now, using instead computer-driven dispatch systems that automatically record times and addresses from the moment the 911 call is received to the time a vehicle is back in service ready to respond to the next call.

but it's muscle memory in my brain. all of the dispatchers know what i mean and respond back "received, cpr in progress."

it's just after 4 a.m., 0409 hours by the time on my pager. the lights in my room come on and the station alarm is sounding, or at least they should be, telling us that somebody is having a bad day and expecting us to make it better. for some reason the lights and alarm aren't on -- which is unusual -- usually the system works. but my pager is making enough racket to wake me.

"female, unconscious, not breathing." we'll empty the station on this call.

within moments we're all up and heading to our rigs. i have a two-man engine company, a two-man aid unit, a three-man medic unit (including our rookie), and me on the battalion car, at our station. i also have another station east of town with three personnel ready to respond if we need the manpower.

the call is close to the station and we arrive in just a few minutes and find police doing a pretty good job of cpr in the bedroom. i think we have a great relationship with our police department. they help us out a lot and i hope they feel we return the favor when it's needed.

overall, the call doesn't look good. the patient is mid-50's, somewhat overweight, and obviously has an underlying medical history. fifty-year-olds don't just suddenly collapse and quit breathing. but we go to work. doing our best. always expecting a good outcome.

we move the furniture around to give us some working room. there's never enough room or enough light. the medic gets the monitor hooked up and his meds out while the emts get an airway in place so that they can breath for the patient and then start compressions. the cops move out of our way. asystole -- no heart beat.

the patient has poor veins, so after a few attempts at the arm, an iv is started in the patient's leg using an io gun. this line will feed directly into the inner space of the patient's bone -- where the blood cells are made. the medic gets a good line, and it flows freely. this is where the meds will be injected.

the emts are doing a good job of cpr. compressions are a lot of work and i make sure that the personnel rotate out before tiring. thankfully we have a lot of people on this call. i send somebody out for additional oxygen bottles and also call dispatch to request a chaplain to our scene. the medic drops a tube down the patient's throat to make breathing for the patient, with our bag-valve-mask, easier and more efficient. we are ventilating the patient with 100% oxygen, giving her the best chance of survival.

the person who called 911 is not giving us as much medical information about our patient as we would hope. we're not sure of her previous medical history and have no idea what prescribed meds she may be taking. this is not unusual. often family members and friends are too grief-stricken to talk with us, or simply just don't know. if only everybody wrote this information down (like the vial-of-life program), and put it where we could find it -- the refrigerator is where we always look -- valuable time would be saved.

finally a chaplain arrives and i feel much better. our chaplains are trained in caring for the family members and always seem to be able to get the info we need for patient care.

now the team is working like the proverbial well-oiled machine and the medical magic is starting to happen. but after a few rounds of meds things aren't looking all that good. the patient is not responding as hoped. we just can't seem to get a heart rhythm going and the medic is considering calling medical control at the hospital and asking for guidance. after another round of meds and a change to a fresh bottle of oxygen he makes the call to the on-line medical control doc.

it's been a long call. we've been on-scene now for 30+ minutes, which is the norm for a cpr call. we're starting to run low on meds. we're starting to wear out. we carry the same meds in our medic unit that the hospital uses during cardiac arrests -- epi, atropine, bicarb, and more. if this incident had occurred in the hospital the timing and application of meds and procedures would be the same.

the medic is on the phone with the doc discussing the call. we stop cpr again to check for a heartbeat -- what? we've got a rhythm on the monitor. not a life-sustaining rhythm, but one that we can work with. the medic tells the doc "looks like i got work to do" and hangs up. our pace quickens and our mood brightens. the patient is still not breathing on her own so we continue to use our bag-valve-mask and oxygen.

as the medic goes to work the heart rhythm gets stronger and better. we load her up on the stretcher and get her into the ambulance. i assign personnel to accompany the medic in the back of the ambulance for compressions, ventilations, and charting. once again i'm glad we have enough well-trained people on the call. the rig speeds away with lights and siren for the 15 minute ride to the hospital. she continues to improve on the way in.

it's an hour later and the crew pulls back into the station. the medic still has to complete his paperwork and enter the call into the computer. our patient is still critical, but has been admitted to the hospital for further treatment and observation. we discuss the call and talk about what went right and what we could have done better. all in all, we're pretty satisfied with how it went and how she's doing.

my dad died of a heart attack eight years ago. he lived in another town. i know many of the firefighter/emts and medics who worked his call. the scenario was similar, but unfortunately with a different outcome. i was in seattle when he collapsed and mom called 911. during the incident i received a call from the captain of the crew, a friend of mine, that was working his code. as i was driving to mom and dad's house he explained everything to me that was happening. i could actually see what was taking place. i knew they were doing everything that could be done. and i knew what the outcome would be. and also that they would feel bad, for me and themselves, for not being able to bring dad back to life.

since dad's death, every time i go on a cpr call i can see my dad lying there with the crew working on him. and it makes me want to work that much harder and push the crew that much harder too. it's not a sad thing, it's just a vision, a reminder of what you expect of us and how hard we train and work to make it happen. sometimes the magic works, sometimes it's just smoke and mirrors.

one of the things i've realized, after 25 years of doing this, is that we -- or maybe just me -- see way too many dead people. and it can make us indifferent, hardened, soft, emotional, a bit nutty, and combinations of all of these and more. it's kinda like a multiple-choice question with the correct answer being "d - all of the above." but my hope is that it gives us the respect for life -- in those around us and in ourselves -- that we deserve. and it reminds me that life is not forever. that i need to make the most of it.

and that i need to remind those around me of that too.