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Check Your Own Pulse First

Posted Jul 11 2008 7:11am

“Someone please get a pulse ox and a non-rebreather!”

My urgent voice sent two medical assistants running.

I walked into the room and the patient was working hard to breathe. He needed more oxygen and a monitor so we could see how much oxygen was circulating in his blood. The nurse on the medical-surgical floor knew her patient was not doing well, but even with her eight years of experience, froze in place.

“I can’t find anything on her!”

The Army medic was panicked. The woman was in the middle of the street, not breathing.

“Check for a pulse again, and start CPR!” I hollered, as I moved on to triage the other six victims of the horrible head-on collision.

————————

“Jag!”

“Yes Sergeant Rod?” I answered quickly, automatically turning to the non-commissioned officer, who was my supervisor and mentor.

“You get called out to a gun shot wound to the chest. Training accident. That is all you know. GO!”

This was a game we played. A very serious game. He had taken it upon himself to help mentally and physically prepare me for a chance at a flight medic slot. We ran scenarios verbally when we had a few minutes between patients in the clinic, before formation, or during down time out in the field.

“Is my scene safe, perimeter secure?” I automatically ask.

“Yes!”

“BSI! I’m approaching my patient, what do I see?”

“You see a bunch of freaked out infantry soldiers screaming at you to help their buddy who is on his back in the dirt gurgling for breath.”

“I’m approaching my patient, and I ask his name. Can he talk to me?”

“WRONG!” Sergeant Rod yells.

I look at him dumbfounded.

He tries to keep a straight face. He waits for me to process the scenario.

I finally give up. Nothing frustrates me more than being stumped. Although I’m getting flustered, I ask instead of guessing. Guessing had gotten me into much more trouble than simply admitting I didn’t know.

“Jag, I’m only gonna tell you this once, so listen up.”

My brain went on record. This was not going to simply be important, it was going to be profound.

“Always, always, ALWAYS check your own pulse first.”

I stayed silent, intent on his words.

He went on, “It doesn’t matter how ugly the situation is, it doesn’t matter how chaotic or how crazy everyone around you is. If you don’t check your own pulse, have your own wits about you, you will not be able to keep yourself, or your crew safe. You must have control or you will lose the big picture. Losing that focus will narrow your view and you will miss something. It will kill your patient faster than his injuries will. In our line of work, it will get you killed as well.”

That advice has served me well.

When we are on final approach landing on an accident scene and the patient report has my adrenaline working I will still, to this day, find my fingers on my carotid, feeling my pulse. The simple act of palpating my heartbeat, feeling the pulsation against my fingertips, centers my mind. It calms my breathing, and usually makes me smile once I realize that old habits remain.

I know Sergeant Rod didn’t mean for me to physically check my pulse. He wanted my mind aware, my eyes open, and my focus to be on the basics. He wanted me to think about the safety of myself and my crew and airway, breathing, circulation of my patient.

Sergeant Rod—-I listened up.

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