The Intersection of Skill and Fate: A Code Save Under Unusual Circumstances

A tendril of black-grey smoke—a smudge on an otherwise clear, March, Arizona sky—catches the attention of the crew of Rural Metro Fire Engine 833. They are heading back to base after a previous call. No one has reported this sighting of smoke. It’s a rural area, 30 miles west of Phoenix, and farmers burning off scrub in their fields is a common occurrence. Captain Jason Henry makes the call to investigate: better safe than sorry. This is the first of several interventions of fate that will lead to a life being saved—but not from a fire. 

E-833 is now heading east on Olive Avenue, which bisects fields on its way to the greater Phoenix area. The soil here is nourishing and lush—surprising, given that it edges a desert—and recently tilled deeply for spring planting. Behind the two-foot-diameter steering wheel, Engineer/EMT Zach Dayton barely notices. His eyes are fixed on the road ahead. There’s almost no traffic in either direction and the Engine is a lonely flash of green and blue on the desolate roadway. Dayton’s attention doesn’t wander, but soon something does catch his eye.

At first, it seems innocuous: The only other car on the road, coming the opposite direction on Olive, is not holding its lane. Dayton points out the small SUV to his three crewmates: Captain Henry, Firefighter/Paramedic Brendan McCormack and Firefighter/EMT Antoine Berenger. “We thought it might just be a distracted driver or some careless teenagers joy riding,” said Captain Henry. “Then the driving became more erratic, and we said, `they’re going to cause an accident’.”

Erratic turns to dangerous; dangerous to deadly. The SUV swerves hard into the far curb, barely missing some heavy road-construction equipment, then jumps the median into E-833’s lane. Dayton reacts quickly applying the brakes to slow the approximately 25-ton fire engine and avoid a fatal, head-on collision. The SUV is not slowing or correcting at all, but now cuts violently across the road, jumps the irrigation canal that separates pavement from field, and lands hard in the black earth beyond.

For the crew of E-833, there is no time to contemplate what has happened. Action is required, and it’s action for which they are trained. “When dispatched, we generally have time in route to think about how we are going to approach a situation, what will be required of each team member, and what roles can be assigned” said Captain Henry. “In this case, we had none of that. It was go, now.”

Their vehicle, lights flashing, is now angled on the road and shoulder to secure an area from which they can work safely and through which any traffic can slowly pass. After alerting dispatch, Captain Henry sends Berenger to assess the SUV’s driver, triage any injuries and report back. 

“The car had less damage than I expected,” said Berenger. “The soil was soft and hard to get through to approach the vehicle, but that’s probably what cushioned the impact and kept the driver from being ejected.”

A quick check tells Berenger that the driver is unresponsive, has no pulse and appears to be in cardiac arrest. He indicates as much to the rest of the crew who grab their medical boxes and rush to the site of the crash. Removing the driver, they quickly realize that the same fresh soil that has saved his life for now, is an impediment to beginning compression CPR, which requires a harder surface. 

“For any cardiac event, time is of the essence. Seconds literally count,” said Henry. “You don’t generally want to move the patient too far, but sometimes you have no choice. Delaying care to provide the best care was the decision here.”

Together they hoist the driver—each on an arm or a leg—and run to the best of their ability through the field's boggy terrrain, traverse the meters-deep and wide irrigation ditch, and set their patient down supine on the hard, compact dirt beside the road. Now CPR begins in earnest and Berenger and McCormack take turns applying compressions. 

“We switch off so we can perform consistently good CPR,” said McCormack. “You have to go down two inches into the chest. If you don’t, you’re not performing it right. As you tire, you’re less likely to reach that depth and you need someone else to step in.” 

Clear of the field and on solid ground, the crew now employs advanced cardiac life support protocols, as well. Later, they will marvel at the sheer improbability of a driver going into cardiac arrest, surviving a violent crash, and doing all of this directly in front of the very professionals who can save the driver’s life. Out-of-hospital cardiac arrest generally has a survival rate of about 10 percent. 

The patient is defibrillated and intubated. The team is working seamlessly together, efficient as a single entity. Now others are arriving on scene: the Sheriff’s department manages traffic support, American Medical Response stands by for transport to a nearby hospital, and the crew’s Battalion Chief, Ryan Travis, is coordinating with these other agencies and ensuring his team has everything they need. 

“The amazing thing about all of this is that the crew was never supposed to be together in the first place,” said Chief Travis. “Captain Henry was the only one dedicated to that shift. The others were `rovers,’ bumping up a shift, filling in for others. McCormack was a brand new paramedic. Yet, even never having worked together, and with little warning, they were operating smoothly, with continuity and their lifesaving actions were incredibly effective.”

A faint pulse. A wisp of breath. Now, the patient’s heart beats on its own and its rhythm permeates the body. Quickly the patient is moved to the waiting ambulance and transported to West Valley Hospital where severe multi-vessel cardiac disease is diagnosed and an emergency coronary artery bypass is performed. Two weeks later, the patient returns home for recovery with no neurological side-effects, which can often accompany a loss of blood flow to the brain in a coronary event.

The “if’s” that changed this patient’s life are amazing to ponder. If the crew hadn’t decided to check out routine field smoke. If they had passed the patient’s vehicle mere seconds earlier. If the field hadn’t been freshly tilled. If the crash didn’t occur in front of medical clinicians. If. If. If.

“If the driver had been in any other situation, where we were called after the crash, things could have been very different,” said Captain Henry. “You can wipe out three-to-eight minutes of the heart dying, just by us being right there. The heart got treatment fast and that saved a life. It’s really an incredible moment.” 

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