Code Blue

I am used to code blues being chaotic. In training, there would always be too many people in the room: nurses, respiratory therapists, residents, medical students, interns, consultants. As the ICU fellow who should be running the code, I often had trouble squeezing in, making sense of the din, and commanding the situation. I learned a lot in the first few months as a fellow about crisis management: how to quickly evaluate a situation, take control of it, and manage large groups of people. I quickly identified a lot of problems in these chaotic code blues: no clear leader or too many cooks in the kitchen, too many bodies in the room not contributing to the care, multiple people making decisions without communicating to each other. Eventually, I became proficient at running that sort of code.

In a community setting, the code blue is totally different. In many ways, it was better. On arrival, I noted three people cycling through compressions in an organized and cooperative fashion. There was a physician leader, but when he noted who I was, he quickly handed over responsibility to me. It was quiet; anyone could talk and be heard. I could quickly gather the story and make decisions. Everyone knew their role and performed it automatically; the respiratory therapist bagged the patient while the anesthesia tech set up the ventilator. A recorder and timer counted off minutes between epinephrine pushes. The other physician present, a proceduralist, put in arterial and central lines so we could send labs. I could easily settle into the role of running advanced cardiac life support, figuring out problems that could be reversed, and planning ahead. In the end, I was surprised on how well the code ran.

It makes sense. In a small hospital, everyone knows each other; most people present had been working there for years. There were no extra people (like medical students); everyone who showed up belonged there and had a function. Yet, compared to the residency setting, there are downsides. I wondered what would happen if there was a second code since all the major players were at this one (in residency, there would be enough redundant people that you could allocate resources to another crisis). We don't have last-ditch salvage interventions like ECMO. I don't know if response times are as fast. But I was impressed with how things actually played out.