Author Question: Hockey and Head Injuries


Elaine asks
:

A hockey player gets knocked down in a fight and hits his head (with his helmet in place) on the ice. Could he be unconscious? I know the trainer would come out on the ice and possibly a doctor, but if he is unconscious, I’m assuming they’d call for the stretcher and put him in the ambulance as a precaution.

I was going to have him regain consciousness in the ambulance on the way to the hospital, but wonder what would the paramedics/EMT (which/who would it be) be doing in the ambulance? What would they do if he “came to”? And what would happen when they reached the hospital?


Jordyn Says:

Yes, it would be possible for a hockey player to be knocked unconscious with a fall on the ice even with his helmet on. If he stays unconscious, then he’s going to need to be transported to a hospital. Baseline treatment would be C-spine precautions (C-collar, back board), supplemental oxygen even if he is breathing adequately on his own, and likely an IV.

If he wakes up in the ambulance, they’ll first orient him to what happened. “Hey Mike, my name’s Roy and I’m a paramedic taking care of you. You took quite a hit on the ice and you were knocked out. To be safe, we put a c-collar on you and put you on a backboard to protect your back. We’re on the way to Swedish Medical Center to get you checked out.”

Then they’ll assess him. Can he move everything? Can he feel everything? Does he know his middle name? Does he know the month? Does he remember any part of the accident? Does he know what city he’s in?

At the hosptial in the adult world– you’re more likely to get a CT of the head for this type of injury. So upon arrival to the ER– the nurse would check his vital signs, do a neuro exam (as described above), and make sure the IV is patent.

The doctor will likely order plain x-rays of his neck and spine and a CT of his head. If all that checks out– he would probably be discharged home.

Trauma Call/Domestic Violence: Dianna T. Benson, EMT

I am pleased to welcome back award-winning novelist Dianna T. Benson. I love how she writes these scenes fictionally but conveys a host of medical details along with it. 

Welcome back, Dianna!
EMS 6, Stabbing, TAC Channel 12”
     Responding to a domestic disturbance call, my partner and I park our ambulance in front of an upscale home over a million dollars. Not atypical – EMS is too often called out to the rich on domestic violence.
     “Did you know the power company turns off this zip code for lack of pay more than any other in the state?” I ask my new partner.
     “Yep. Idiots living beyond their means. No wonder they’re so stressed out and hurt each other.”
     At the front door, we join a fire crew, as three cops enter the house, all three with weapons drawn.
     “Scene isn’t safe?” I ask.
     “Not sure,” the last cop answers then trails his two buddies.
     The fire crew of four hangs back with me and my partner.  
     “Was the door unlocked?”
     “Yup,” one of the firefighters answers me.
     After five long and boring minutes of standing around on the lawn in the dark of night, I radio in to dispatch. “EMS 6. Standing by outside residence. Any updates from PD on scene?”
     “Yes. Scene is secure. PD is with victim.”
     “Copy that.” I roll the front of our loaded stretcher into the house.
     In the family room, I find one officer bent over a body, the other two talking with an agitated man.
     I kneel at the woman’s other side. She’s supine on the carpet, her lapped hands pressed to her lower abdomen and covered in blood.
     “Ma’am?” I touch her shoulder in comfort.
     My patient blinks at me then flutters her eyes closed.
     “Can you tell me your name?”
     “Judy,” she whispered in a pained voice.
     I brush my hand over hers. “Judy, are you hurt anywhere other than here?”
     “Don’t know,” she mumbles.
     “Judy?” I stare into her eyes, mascara smudged underneath them. “Can you move your arms down at your sides?”
     She does.
     My partner hands me trauma scissors, a stack of 5X9 sterile gauze pads, and an occlusive dressing. As I rip open the gauze packages, my partner hooks up the patient to our cardiac monitor and focuses on assessing and monitoring vital signs.  
     “How can I help?” one of the firefighters asks me.
     “Perform a rapid trauma assessment.”
     “You got it.” He starts at the head.
     With the trauma scissors, I cut Judy’s shirt, exposing the wound. Noting no debris other than blood, I cover the gushing horizontal wound—thin but long—with one sterile gauze pad after another, and apply direct pressure with my palms. “Did a knife do this, Judy?”
     “He did.”
     “With a knife?”
     “Steak knife.”
     “I see nothing else,” the firefighter informs me at the patient’s feet.
     I nod. “Thanks.”
     I glance at the monitor screen for Judy’s vital signs. Her heart rhythm is normal, but her blood pressure is too low, pulse too high, indicating she’s headed to shock due to blood loss. My guess is she’s bleeding internally, the knife blade sliced an organ or two, maybe the abdominal aorta. Regardless of what’s injury, she needs a surgical team.
     I look at my partner. “We gotta go. Now.” 
       
     “Give me the switchblade,” one of the cops says, alarm in his tone. “Sir, you’re just making things worse for yourself.”  
     “Past time to go,” I whisper to my partner, a rush of panic clogging my throat.
     “No kidding,” he whispers back, wide-eyed.
     “Get out of here,” one of the cops says to us.
     “What’d you say to them?” the agitated man shouts.
     “You don’t want a murder charge, do you? The EMS crew needs to get her to the hospital.”

     The cops deal with the perpetrator, as my partner readies the stretcher. I blanket the dozen or so bloody gauze pads with a towel.
     Inside the moving ambulance, I raise the foot of the stretcher to treat for shock. I cover Judy’s mouth and nose with a non-rebreather oxygen mask and turn on the O2 to 15 lpm. Since none of her organs eviscerated, I do not apply an occlusive dressing. Instead, I add additional 5X9s and a fresh towel and instruct the one firefighter who joined us en route to press his hands over it for direct pressure. I insert an IV saline bolus and consider administering morphine or fentanyl for pain.
  
     “More cops dispatched to scene,” my partner yells back from the driver’s seat. “Guy stabbed one of the cops and fled the scene on foot.”
     I look down at my patient. She doesn’t indicate she heard those disturbing words.
  
     “We’re ten minutes out,” my partner yells back at me.
     I pick up the radio. “Wake Med ED, this is EMS 6.”
     “Go ahead EMS 6.”
     “We are enroute with a thirty-eight year old female. Left lower quadrant adnominal stab wound. No evisceration. BP 82 over 56. Heart rate 173. Non-rebreather at 15 liters per minute. Legs elevated for shock treatment. Place OR on stand by. ETA 10 minutes.”
     “See you in 10. Wake Med out.”
     “EMS 6 out.”  
**********************************************************************
Dianna Torscher Benson is a 2014 Selah Award Winner, a 2011 Genesis Winner, a 2011 Genesis double Semi-Finalist, a 2010 Daphne de Maurier Finalist, and a 2007 Golden Palm Finalist. In 2012, she signed a nine-book contract with Ellechor Publishing House. She’s the author of The Hidden Son, her debut novel. Final Trimester is her second release. After majoring in communications and a ten-year career as a travel agent, Dianna left the travel industry to earn her EMS degree. An EMT and a Haz-Mat and FEMA Operative since 2005, she loves the adrenaline rush of responding to medical emergencies and helping people in need. Dianna lives in North Carolina with her husband and their three children. You can connect with Dianna via her website.
 
   
          

Dianna T. Benson: A Son’s Tale of Traumatic Brain Injury


The term concussion is well known. The medical field refers to a concussion as a TBI – Traumatic Brain Injury. Contact sports are one of the top causes of a TBI, another are MVCs – Motor Vehicle Collisions.
My teenaged son has endured four concussions. The first two as a goalie for the Junior Hurricanes and the third in a MVC. The first one took him out of school for a month and hockey for three months. The second, a year later, was more mild, which is unusual. Typically, a patient suffers a more severe TBI the second time. In the MVC, a classmate was driving them to school when another car struck them. This third TBI ended my son’s hockey career, preventing him from attending the Junior Hockey draft in Canada Spring of 2013.
The problem wasn’t simply that this was his third concussion, although that in itself is a strong reason to end a contact sport career. With this third TBI, a neurologist evaluated him versus just the concussion clinic MDs who’d treated him with the first two. Not only was it his third TBI, but his symptoms were extremely severe, which didn’t make sense to me – the details of the MVC didn’t suggest such injuries for my son: 1) None of the others involved in the crash suffered any injuries 2) No air bags deployed 3) Vehicle damage was minor. As an EMT for nearly a decade, I wondered about underlining health conditions in my son. I also considered he had not fully recovered from the first two concussions and was in denial about his symptoms in order to play hockey.
Sure enough, the neurologist diagnosed my son with hyper-mobile joints (something I already knew but wasn’t aware of the danger with contact sports.) The MD also diagnosed him with mild CP (cerebral palsy), a diagnosis that made sense to me since my son was born in respiratory arrest and was non-verbal and had spasticity until over age two. Both diagnosis are a recipe for injury, especially in contact sports. The MD gently told my son he was done playing goalie forever – it was devastating and crushed him. Understanding his hockey career was over, he admitted he’d ignored symptoms because he had a shot to play Junior Hockey, college hockey, and possibly professional hockey. A life-long athletic competitor myself, I completely understood the denial that led him to ignore his body.
Hyper-mobile joints, while creating an incredibly athletic body, are highly susceptible to any musculoskeletal injury in that individual. For my son, after two TBIs in a contact sport, his hyper-mobile neck was easily and severely whip-lashed in the MVC, jostling his brain fiercely, causing all his concussion symptoms to return and more heightened than ever.
Ten months after the car accident, the fourth TBI occurred December 2013 just days after the neurologist cleared my son to return to his life minus contact sports. The neurologist gave my son the green light to snowboard. That December day on the mountain, my son didn’t even hit his head and he sustained no head trauma – simply snowboarding jostled his brain enough to cause another TBI.   
Even though he’s extremely athletic, my son’s body shouldn’t do what it can to do. The risk of permanent brain damage and partial or full paralysis is too high for him– something he now understands. I described it to him as this: When Cam Ward (the goalie for the NHL team Carolina Hurricanes) is playing goalie, his body is naturally like a SUV of protection in a MVC. Whereas, for my son, his body is like a motorcycle in a MVC – no protection.
Until Spring 2015, my son is restricted from doing anything with speed, wheels, height or repetition (basically everything fun.) This next year his brain will heal, then little by little he can attempt things (no contact sports ever, though) to see how his body responds. At 6’7” in height and extremely athletic, he appears a medically sound seventeen-year-old, but inside his body tells a different story. 

    

God works in amazing ways and this is my son’s blessing. Since cerebral palsy only affects motor function, and none of the four TBIs caused him any loss of cognitive abilities, he’s still as annoyingly brilliant as ever and is anxious to head off to college this fall. For now, his goal is to graduate medical school with a degree in neurology and become a neurosurgeon since he feels (understandably so) he can relate to patients’ symptoms with head trauma. 
***********************************************************************


 Dianna Torscher Benson is a 2014 Selah Award Finalist (winners not yet announced), a 2011 Genesis Winner, a 2011 Genesis double Semi-Finalist, a 2010 Daphne de Maurier Finalist, and a 2007 Golden Palm Finalist. In 2012, she signed a nine-book contract with Ellechor Publishing House. She’s the author of The Hidden Son, her debut novel. Final Trimester is her second release.
After majoring in communications and a ten-year career as a travel agent, Dianna left the travel industry to earn her EMS degree. An EMT and a Haz-Mat and FEMA Operative since 2005, she loves the adrenaline rush of responding to medical emergencies and helping people in need.
Dianna lives in North Carolina with her husband and their three children. 
Her releases are available wherever books are sold. Below are the links to Final Trimester at the three largest booksellers:

 

Fall Call: Dianna Benson, EMT


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I love these posts from author and EMS expert Dianna Benson where she weaves medical detail into a fictional piece. 
Welcome back, Dianna!
I shake my head to full awake from my cat-nap, and gear up for the trauma call less than a minute drive away. Once my partner and I roll on scene, I note the three cop cars arriving.
Additional information regarding the call flashes across our ambulance laptop screen.
Proceed with caution. Law enforcement dispatched.
“What’s the deal?” my partner yells out the driver window at a cop rushing toward the building.
“Another worker pushed the guy.”
“Ah,” I say with a nod. “Attempted homicide.”
“Or homicide, but if the guy’s not already dead, he’s gonna need us.” My partner jumps out of our ambulance.
We grab a C-collar (cervical collar) and a backboard, and toss it onto our stretcher already loaded with EMS equipment and supplies.
“Remember caution?” I remind my partner.
“Yeah, yeah. Guy was pushed not shot or stabbed. Let’s go.”
I really didn’t want to hang back either. Our patient’s life may be over if we wait.
Inside the building, we push through a crowd of gawkers. I notice three cops drawing their guns at a man choke-holding some young woman, her wide eyes glossed-over.
“Let her go,” the cop at the left yells out. “Now.”
I’m hoping the guy follows the demand or we’ll have more than one patient. As I rest my hand on my radio in case I need to request additional EMS crews, I scan the area for an injured man on the ground. I spot our patient on the other side lying supine and lifeless in a pool of blood on the cement, his attacker in the middle and blocking us from our patient. I glance up and see the catwalk and assume our patient was pushed off of the suspended walkway about twenty feet above.  
The guy fell twenty feet? I think to myself.  If he’s alive over there, he’s in critical condition.
“Clear out,” the cop to the right shouts. “Everyone. Out of this room. Now.”
The crowd scampers away. My partner and I hold our position behind the cops. The perpetrator doesn’t have a weapon, so there’s no danger to us.
After a few drawn-out minutes of the cops warning the perp to let the woman go, and our patient remaining lifeless and out of my reach on the ground in the near distance, I somehow dig up my most gentle tone and interject, “Sir, I don’t think you want to hurt her. Do you?”
The perp jerks his head in my direction. Ten seconds tick by with him just staring at me as if pleading me to help him out of this. “Ah…no. No, not really.”
“I didn’t think so. How about letting her go and we’ll talk?” Stop blocking me from my patient. If he’s not already dead, he needs me now. Needed me minutes ago.
 “Talk? Yeah, yeah,” he nods, “I just need to talk.” Chest panting, arms shaking, the perpetrator shoves the woman aside and drops on the ground. All three cops pounce on him and drag his arms behind his back.
I roll the front of the stretcher around the chaos on the ground; my partner pushes from the back. As I pass the perp, I ignore his insistent yells to talk with me since my focus is on my patient.
“Sir?” I say to the lifeless man as we approach him.
No answer. No movement of any kind.
I slide my fingers to his neck and find a thready carotid pulse. His chest is rising and falling in steady rhythm bi-laterally.
My partner holds his head in an in-line spinal stabilization position as I strap the C-collar around his neck. I slip a towel underneath his head for hemorrhage control and feel for trauma. I find an open skull wound, crepitus bone, and flesh.
Two firefighters appear at our side and assist me with log rolling the unconscious patient onto a spine board and strapping his body down. I secure the man’s c-collared head to the backboard with head blocks, straps and tape, allowing my partner to finally release the manual c-spine stabilization.  
“What do you need from me?” some guy asks. “I’m his supervisor.”
“How old is he?”
The manger answers that pertinent question as well as all my others, as I connect my patient to our cardiac monitor. Less than a minute later, I’ve assessed all vital signs and the heart rhythm, as my partner performs a rapid trauma examination. Our patient remains unconscious. I’m thinking internal bleeding is the main cause and he’s headed to hypovolemic shock, and if that’s the case, surgical interventions are vital. No more time to waste on scene.
“Femur fracture,” my partner says.
“Among other things,” I say. “Let’s go.”
All of us lift the backboarded man onto the stretcher, and roll it out to my ambulance.
As one of the firefighters drive, my partner and I attend to our trauma patient in the back with the assistance of another firefighter. Our patient remains unconscious. In order to protect his airway, I slide a lubricated oropharyngeal airway down his throat. With a curved laryngoscope, I lift the epiglottis and gain a visual of the glottic opening and white vocal cords. I drop the orotrachael tube between the cords, down the trachea. I connect a bag valve mask over the tube opening. To keep him oxygenated, I squeeze the football-size bulb every five seconds.  
“Take over bagging,” I say to the firefighter, and he grabs the bag valve mask from my hands.  
I spike an IV bag as my partner slides in an eighteen-gauge IV needle into our patients left arm. Since the patient is unconscious, there’s no point to administer pain meds.
I grab the radio mic. “Wake Med ED, this is EMS 16.”
“Go ahead EMS 16.”
“We are en route with a thirty-three year old male. Trauma patient. Twenty-foot plus fall onto concrete. Unconscious. Intubated. Open head trauma posterior. Fractured femur.  Normal sinus cardiac rhythm. BP 95/52 and falling. 182 heart rate. ETA 5 minutes.
Even if this man’s body survives, his brain will probably never be the same. I swallow the sadness clogging my throat, hoping he doesn’t have any children, and I re-focus on finishing my job on this trauma call.
*************************************************************************
 

Dianna T. Benson is a 2011 Genesis Winner, a 2011 Genesis double Semi-Finalist, a 2010 Daphne de Maurier Finalist, and a 2007 Golden Palm Finalist. In 2012, she signed a nine-book contract with Ellechor Publishing House. Her first book, The Hidden Son, released in print world-wide March 1, 2013. 

After majoring in communications and a ten-year career as a travel agent, Dianna left the travel industry to earn her EMS degree. An EMT and a Haz-Mat and FEMA Operative since 2005, she loves the adrenaline rush of responding to medical emergencies and helping people in need. Her suspense novels about adventurous characters thrown into tremendous circumstances provide readers with a similar kind of rush. Dianna lives in North Carolina with her husband and their three athletic children. Learn more about Dianna at www.diannatbenson.com.

Author Question: Death by Food Allergy

Sally asks:

My villain is going to kill his wife. She has a severe peanut allergy. My initial plan was for him to put peanut oil in a salad dressing, one that needs to be shaken to combine the oil and other ingredients. He also damages her epi pen. He does this right before he leaves town for business in order to give himself an alibi.

Using Epi Pen

He’s a professional athlete so news of his wife’s death will make media outlets like ESPN. I want initial news reports to say that it doesn’t seem to be foul play, even though it is.

Does that work?

Jordyn Says:

The cause of death would be anaphylaxis. That’s how the person would die. Basically, an allergy causes a huge histamine release that can lead to cardiovascular collapse– difficulty breathing, low blood pressure, increased heart rate (tachycardia.) The reaction can get to the point where it can lead to death.

This is what your character would die from. So– the ME would be able to determine that the patient had an anaphylactic reaction. How easy it would be to pinpoint the exact cause of the reaction may be harder.

My follow-up question to Sally was: What’s to prevent the character from calling 911?

Death by allergic reaction does take a while. There is not set amount of time and my guess is it could be fairly expedient– perhaps 30 minutes for a person who is highly sensitive.

This is where the setting would come into play. In a city– the EMS response time should be 2-6 minutes. However, in the country where there may be only volunteer response, it feasibly could take 30 or more minutes.

The photo from this piece comes from a great article about whether or not to use epi pens.

Some free nursing advice for you here today– if you are a parent or adult and the thought comes to your mind– “Hmm– should I use the epi-pen?” Then yes, you should. Don’t wait. Don’t question it. Give it and either call 911 or go straight to the ER.

The issue with anaphylaxis is that it can spiral to a point where we cannot reverse the reaction and you may die. However, I’ve not yet seen a person die from giving themselves a single epi injection when perhaps they didn’t need it.

We’d rather monitor you alive for several hours than tell your family you’ll no longer be with them. 

**************************************************************************

Sally Bradley has worked for two publishers, writing sales and marketing materials, sorting through the slush pile, and proofreading and editing fiction. She has a BA in English and a love for perfecting novels, whether it’s her work or the work of others. A judge in fiction contests, Sally is a member of ACFW, The Christian PEN, and the Christian Editor Network. She runs Bradley Writing and Editing Services from her home outside Kansas City. A mother of three, Sally is married to a pastor who moonlights as a small-town cop.

Author Question: Treatment of Car Accident Victims



Taylor asks the following regarding treatment of multiple victims of a car accident. 
SCENARIO: Serious MVC involving two cars and multiple victims. All passengers were wearing seatbelts, and airbags deployed, but the crash was serious enough that victims are still severely injured.
Jordyn: When writing about the car crash—I’d have it be pretty visual that the car is near ruin. Particularly if someone has died on scene. Having the car rollover several times would accomplish this.

Taylor: Three girls (friends) were in one car together, on the way to a Christian concert. Drunk driver character had an argument with his wife about his drinking, denying that he has a drinking problem, then got angry, left the house and went out for drinks (doing the very thing they just argued about, partly to spite her and partly “to calm down”). He causes a crash with the girls.
CAR ONE: This vehicle contains only the driver.
DRIVER:The driver is a male in his early thirties. He is slumped forward in his seat, initially unresponsive, but rouses when medics address him. There is a strong smell of alcohol on his breath, and although he is responsive, he is displaying obvious signs that he is intoxicated. Upon seeing the crash scene in front of him, he becomes upset, crying and saying things like, “I didn’t mean to”, “My wife is going to kill me”, and “What have I done?” He has a bleeding laceration on his forehead and minor scrapes and bruises on his face (from the impact of the crash and airbags), and bruising from his seatbelt. Aside from these, he is uninjured. Vital signs are elevated, but within normal limits.
Jordyn: This patient would be placed in C-spine precautions. An IV/fluids started. Usually, when EMS starts an IV—they’ll grab several tubes of blood that the hospital can send to the lab. They’ll dress the laceration on his forehead and not likely worry about the minor cuts and scrapes. Whenever there is seatbelt bruising, we always worry about what would be injured underneath.
In the ER: Since he’s intoxicated, he’s not a reliable informant about his pain. So, he’ll get automatic C-spine films to rule out neck/back fracture. They might even consider a CT of his chest and abdomen (they’ll take vital signs into consideration). Law enforcement will be involved and they’ll want blood alcohol levels and if your book is in a specific/real location—I would figure out what the procedure is in that town/city. After major stuff is ruled out—his cuts will be cleaned. The laceration to his forehead would be irrigated and stitched. Tetanus shot if none in the last five years. Once he’s medically cleared, I’m guessing he would be off to jail.
CAR TWO:This vehicle contains a driver and two passengers.
DRIVER:The driver is a female, age 18. She has no detectable pulse or respirations. Apparent DOA, killed on impact in the crash.
Jordyn: She may be declared dead at the scene. That would probably be the easiest way to manage this patient.
PASSENGER ONE:Female, age 17. Managed to free herself from the car after the crash, and is sitting in the grass a short distance away. She is displaying signs of shock. Respirations are slightly shallow and rapid, skin is pale and clammy, and pulse and heart rate are elevated but still within normal limits. She is mostly responsive, but groggy/drowsy and complaining of severe headache, nausea, and dizziness. Chest and neck are bruised from her seatbelt, and she has several other bruises and superficial bleeding cuts on her body. Her right arm is bruised, swollen, and oddly angled, and she is cradling it against her chest and complaining of pain.
Jordyn: Since she is shocky, she’ll get an IV/fluids and tubes drawn for labs at the ER. Considering the mechanism of injury (the fact that one of the occupants of the crash has died) she’ll be placed in C-spine precautions as well. All surviving patients (including the drunk) will also be give oxygen (as it is treatment for shock as well). Her arm will be splinted in a position of comfort. It’s hard to know if they would give her pain medication or not—her c/o of headache, nausea and dizziness could signify head injury and giving a narcotic could complicate that assessment. So, she may just have to tough it out until she’s in the ED.
ER: Vital signs. X-rays of neck, back and deformed arm. Possible CT of the head, chest and abdomen. Often times, deformed extremities need to be reduced either in the OR or can be done under conscious sedation while in the ED. Depends on how you want to go. This patient may be able to go home if her arm can be set in the ED and no other significant injuries are noted.

PASSENGER TWO:Female, age 17. Pinned in her seat inside the car, unable to free herself. Conscious and responsive, but clearly very frightened, and displaying signs of shock. She is complaining of some pain in her neck, numbness and lack of sensation below the waist, and inability to feel or move her legs. Chest and neck are bruised from her seatbelt, and she also has several bruises and cuts on her face, arms, and legs. There is a large, deep bleeding laceration on her right lower leg.
Jordyn: Same: C-spine/back board. IV, fluids, oxygen. Get blood for labs. Laceration of right lower leg will be bandaged to control bleeding. 

ED: Largest concern for this patient is her sign of C-spine injury. So, not only would she get C-spine films. She’ll likely get CT of her neck, spine, chest and abdomen. Probably would x-ray the leg with the laceration to look for foreign bodies before closing it up. Stuff like the leg laceration can wait until a medical game plan is decided upon after they figure out what her neck injury is.

Near Death Experiences: A Paramedic’s Perspective

I’m pleased to host Tim Casey as he shares some of his patient experiences with near death.

Welcome, Tim!

Over my 30 plus years as a firefighter/paramedic I witnessed many souls depart this world, but also had the privilege to participate in the resuscitation of hundreds of patients. I developed a habit over the years of asking the previously lifeless about what they had experienced while dead.

As I was generally the very first face they saw upon rejoining the living, once I knew their physical well being was stable, I would simply ask them what they experienced. Some had a story and some had no memory of what had happened.

But first let me take you through the process of resuscitation in the field as a paramedic. We generally had advanced notice from our dispatch center that we were responding to a possible cardiac arrest, and a description of what was happening at the scene we were approaching. We would be advised if CPR had been initiated and if the patient was believed to be pulseless and not breathing (apneic).
This gave us time to mentally prepare for what procedures would be needed to begin as soon as we arrived. If in fact we found a dead human being defined as a person not breathing and without a heartbeat, the first thing to do is determine if there was any kind of heart rhythm we could treat. The patient was attached to a cardiac monitor to access what kind of electrical activity was occurring with the heart.
There are many heart rhythms that we can treat with electricity, but one quick note; we don’t shock what is colloquially known as a flatline. This rhythm is asystole and no amount of electricity will convert this rhythm back to a functional heartbeat. If a treatable rhythm is present we will “shock” the patient and in successful cases (cardio version) this will bring the heart beat back to a functional condition.

Many other things can happen following this first procedure including intubation of the airway, administration of drugs to assist life and other supportive care. Not all patients regain consciousness but in the rare case they did and they were not intubated, I felt compelled to question them about their experience.

Almost all these cases occurred in the back of an ambulance while transporting the patient emergent (lights and siren) to the hospital. I only had a handful of cognitive patients that could talk to me and describe what had happened.
All were profoundly at peace and their former life threatening condition seemed to become more stable. I must add a quick note, when I was on scene with a conscious patient that was on the verge of a heart attack but had not yet become unconscious; one of my primary questions was if the person felt an impending sense of doom. All said they did. They knew on a base level deep within themselves that their life was about to slip away.
The patients that had survived and regained consciousness had lost that feeling of doom. There was a noticeable change I could see right before my eyes. Now was this due to the treatment I had administered? The drugs and electricity that I had applied to a lifeless body?
I was told by these people it was not because of my efforts, it was in fact they felt that they had been sent back by someone or something. Many had complete memory of the whole event including what I had said. I always talked to my patients and encouraged them to help me, to stay alive. A common phrase in emergency medicine is this, “The last thing to go is the hearing.” and my experiences confirmed this for me.
On one occasion in a remote location where the ambulance was very far away I had the experience of resuscitating a gentleman in his bedroom. My engine crew was with me but because of his improved condition I had asked them to gather equipment to prepackage the patient for transport.
The gentleman and I were alone for a few moments. He had changed from ghostly white soaked in sweat to pink and dry, he smiled and thanked me. I had to ask.
“Did you see anything while you were gone?”
“I don’t believe I was gone. I was here. I watched you.” He said. “But there was another person here with us. I guess you could say, not a person, but God I believe. He told me it wasn’t my time and said I had to go back.”
“Did you see Him?” I was very excited.
“Not really, more felt Him, felt surrounded by Him I guess I would call it.” 
“And then what?” I asked.
“And then I was looking at you.” He said.
These experiences gave me a sense of my own spirituality. Maybe I wasn’t such a big deal as a paramedic after all. Maybe it was all predetermined and out of my hands. Or maybe God worked through me. Either way I guess I will never know until it is my time.
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Tim Casey is a retired firefighter/paramedic with more than 30 years on the streets caring for the sick and injured. He has also written a memoir: Dangers, Toils, and Snares: Confessions of a Firefighter which has been number one on Amazon in the Kindle Store many times. Tim now
is a full time author and his new book on how to date a firefighter will be out later this year,