I have been asked several times by fellow patrollers to write about my first experience as an OEC tech. I didn't feel comfortable writing about it at first, but I realize how important it is that my OEC instructors get the credit they deserve. It had only been about two weeks since my final exam and certification. The Paoli Peaks OEC instructors devoted several nights a week of their time grinding "SAMPLE" into our heads. Over and over again they would drill us until it became automatic. I am very thankful they did. I was traveling home late in the evening after work. The highway was somewhat crowded when I noticed a large tractor trailer begin to swerve. The truck veered to the right shoulder than back across both lanes into the grassy median. It had only been a year or two since the highway department placed a cable barricade between the north and south bound lanes. Didn't think much of it at first, but it held up pretty well when this eighteen wheeler plowed into it at about 75mph. I wonder if the drivers going the other way realize how lucky they were that this cable stopped several tons of steel heading straight for them.
Scene safety ran through my mind as I turned on my emergency flashers and pulled up behind the vehicle. I was hoping I gave enough space for the other drivers to notice and slow down. My heart was already racing as I reached into the back seat and grabbed my NSP first aid pouch. I got out of my car and could feel my adrenaline pumping as I ran toward the front of the truck. Another driver had also stopped and was heading in the same direction. I remember shouting at him to call 911 and keep others away as I climbed onto the passenger side of the tractor.
In the back of my mind I had thought that the driver had fallen asleep at the wheel and only needed minor attention. It was a bit of a jolt to find him motionless and wedged between the seats. His eyes were wide open and seemed to be staring straight at me. For a split second I froze as I thought, "whoa, this isn't a practice dummy and I have no instructor looking over my shoulder". I quickly snapped out of it and my training just kicked into gear. I shook him and shouted, "Sir, sir, can you hear me", no response. I administered a little pain, no response. I thought for a second that maybe it wasn't hard enough and did it again, still no response, not even a twitch of a muscle. I placed my fingers on his main artery in his neck and could feel a rapid, strong pulse. I placed my hand on his chest, it wasn't moving, he wasn't getting air. My next thought was "maybe he was eating something and it was lodged in his throat" so I opened his mouth and noticed his tongue was blocking his air way. My first reaction was to try and move it out of the way with my fingers, and then I remembered Rick warning us in class "Don't ever do that, unless you want your fingers bitten off". I knew I needed to perform a head tilt chin lift to open his air way but his body, head, and neck were not in a good position for that. I was afraid to move him at first fearing possible spinal damage but remembered what Bruce had taught in "Rescue Basics", that stopping bleeding and opening the air way were our top priorities. I positioned myself under him, cradled his head into my arm, and tried to lift him a little. As I began to move him I noticed his hand and arm begin to spasm then his whole body began to violently twitch. I remember hearing a bystander repeating, "Push him up, push him up". As I lifted him into an upright sitting position I could hear him take a deep breath just as he went into a full blown seizure.
I had never witnessed a seizure before and quickly searched the OEC classes in my mind. I remembered one of our instructors telling us that there was little we could do for a patient during a seizure other than try to keep them from hurting themselves. So I did my best to prevent him from hitting anything as his arms and body were whaling all over the cab. After about a minute or two he began to calm down and gave me this look as though I had just scared him out of a bad dream (I later learned that was a common response from a patient coming out of a seizure). It was then that I remember our class on altered mental status and began asking him, "Sir, Sir...do you know where you are, can you tell me your name", he was able to mutter who he was, but had no clue where he was or what time of day it was which let me know he wasn't completely cognitive.
Things had calmed down a bit and I realized the truck was still running. Thinking of scene safety I found the key and turned it to the left, but the engine did not turn off. I had never been in a big rig before so I asked the driver how to shut it down. What happened next caught me completely off guard. I understand now that the driver was still in an altered mental state when I asked that question. He placed one hand on the wheel, the other on the gear shift and hit the gas. The truck lurched forward and again my mind rushed to scene safety. I yelled at a small crowd of bystanders to get away from the truck and found myself wrestling with the driver to get his leg off of the gas and hand off of the gear shift. After a moment or two I realized that wasn't working so I placed my hands on either side of his head made him look at me and began to tell him to breathe slowly and deeply. He focused on me instead of the truck and after several breaths was able to relax back into his seat. I still had no idea how to shut the truck down but wasn't about to ask him again. I started going thru "SAMPLE" with him since he was talking. I asked him if he knew what had happen, if he was on any medicine, had any previous medical problems (he had never had a seizure before), the last time he had eaten or drank anything. He was finally starting to come to himself when the police and EMS arrived.
Not knowing what had happened, one of the officers jumped up on the truck and began yelling at the driver thru his window. "What the heck are you doing tearing up a half mile of my cable" he said. I quickly stopped him, informing him that the driver just had a seizure and wasn't in his right mine yet. I then asked the officer if he knew how to shut the engine off. He didn't know but brought a fireman over who talked me through shutting the truck down. I shared with the fireman that I was a new first responder, had just been trained, and this was my first patient. He called EMS over and I was a little surprised when they starting going through "SAMPLE" with the driver just as I had.
The way the truck was sitting, it was a long way down from the cab to the ground. As EMS were chatting on how to get him down, I remembered that Kevin, another OEC instructor, always told us to allow the patient to help if they could and felt comfortable doing so. I had already done a head to toe assessment and could not find any other injuries. I motioned for other responders to lend a hand and we helped the driver to slowly lower himself to the ground. There EMS put him onto a gurney as I briefed them on what had happen. At that point I had handed my patient over to a higher level of care.
My adrenaline was still pumping pretty hard as I gathered my things and headed for my car. My mind relived each moment for days after it was over. I kept going thru everything I did step by step. Did I do this right, did I handle that properly, and did I complete each step. It bothered me enough that I called Rick, my Patrol Director. He was very understanding and began to debrief me and help me coup with it all. While I was in the moment there really wasn't much time to think, I simple reacted to my training. Did I do everything right? I'll be the first to tell you I did not,(completely forgot to put my gloves on). Were there things I could have done better, probably? Even though I was second guessing myself, Rick reminded me, I got in the truck, no one got hurt, and my patient walked away from the scene. Thank you Rick and a big thank you to all my OEC instructors who gave up their time and devoted themselves to sharing what they knew with a hand full of Ski Patrol Candidates. I would have never even thought about getting into that truck had it not been for you, and even if I had, I would have been completely lost.
A very thankful Paoli Peaks candidate