This happened a few years ago now. I dont know the details of the patient nor family. I cant even remember the day nor month anymore. Perhaps with the telling of the case, you will understand why I have little hard details in my memory.
I was at a major airport. On my way home after spending a week or so relieving at a remote RFDS base. It was mid afternoon, I think. It was certainly daytime. I had just come off one flight and was making my way to board my final flight home.
I was walking past some escalators when noticed a small group huddled at the base of one of them. I immediately recognised some were wearing firefighters uniforms. Some were kneeling
As I walked close past the group I could see what was happening.
There was an infant lying on the ground, actively convulsing with its head grossly extended, arcing its back. One of the firefighters had an portable oxygen cylinder out and a woman was holding the mask to the infant’s face which was pale blue. There was a man who must have been the infant’s father, crying and holding onto child’s legs. I walked up , introduced myself as a flying doctor and put my carryon bag down. I had no medical gear with me at all.
The woman with the oxygen mask told me she was a general practitioner who had found the father with the convulsing child at the bottom of the escalators. They called for help and the airport security called the firefighter first responders who came with oxygen gear and a portable automatic defibrillator. Ambulance were called and evidently were stuck in evening traffic.
“How long has the fitting lasted ?” I asked.
“About 30 minutes..” replied the female GP.
I felt helpless. No drugs, no airway gear, no monitoring. In fact I felt naked!
Then the female doctor passed me the oxygen mask and said ” I need to catch my flight, can you take over ?”
What was I going to say but “Yes of course”, but felt like saying ” So do I!”
Anyway this infant was about same age as one of my own at the time and I sympathised with the crying father. The history was that the 8 month old had been febrile a few hours prior and during the flight here, had become increasingly unwell with vomiting. Then she started fitting and had not stopped for 30 minutes now. This was no simple febrile seizure!
No obvious significant past medical history.
Off went the female GP. The wait for the ambulance was agonisingly slow. Believe it or not, a couple of other doctors stopped and asked what was going on. When I told them they both promptly said ” good luck” and left!
I asked the firefighters if there was any other emergency medical gear at the airport. NO! NOTHING! I did not have the presence of mind to ask if any of the onboard medical kits on the several airplanes parked outside could be brought!
I did my best to position her airway and keep it patent but in reality needed to know the priority was to stop the fitting.
Finally the ambulance crew arrived..a man and woman pushing a stretcher with gear !
I quickly told them the situation and asked if they had midazolam. We calculated a dose and I managed to get an IV in. After the first dose the fitting stopped, they loaded her onto stretcher and then asked ” Hey Doc, do you mind coming with us ? sure could use your help in the back of the ambulance , in case we get caught in traffic!”
What would you do?
Despite knowing I would miss my plane, I did not hesitate to say yes. The father was looking desperate, so were the paramedics who looked scared having never treated an 8month old with severe status epilepticus before. So I grabbed my bag, and got into the back of the ambulance.
As often happens in prehospital care, we lost the IV soon after setting off, lights and sirens . The patient started fitting again, so I ordered a second IMI dose of midazolam. This did nothing.
I tried to get another IV in but have you ever tried to do that in the back of a speeding ambulance?
We had some monitoring on at least and the pulse oximetry of 88% was not reassuring but better than 44%. I asked the paramedic if they had any airway gear and he told me they only had oral, nasal airways and LMAs. We inserted an oral airway and gave a third IMI dose of midazolam which seemed to stop the fitting. Now the infant was not breathing too well! Oh great!
The paramedic and I gave face mask ventilation and all of a sudden the doors opened and we were at an ED!
I was met by a paediatric EM consultant who basically grabbed the infant in her arms and ran back into the resus area. I quickly followed to give my handover.
They tubed the girl and you know what ? I still to this day do not know the outcome..if it was good or bad. Is she all grown up now and wants to be a doctor? Or is she disabled from hypoxic brain injury? Or is she dead ?
I walked back out to get my bag from the ambulance. The paramedics were cleaning up and I asked them for a ride back to airport. I still had 20 minutes to catch my flight!
You know what?
They refused, claiming service protocol to not provide free rides!
So I caught a taxi and guess what, never made it to my flight. I stayed in a hotel that night and got home the next day.
So you know what? THis case to me was the essence of prehospital care and why I do what I do.
If you have no gear, the wrong drugs, no bed, no monitoring, you dont give up. You use your mind, knowledge, your hands, all your senses. If there is no resus team, you form one. Think one step ahead. Keep trying to get the result that you know needs to happen.
because at the end of it all, everyone deserves the chance to make it home safe and sound.