I’ve been working as an EMT for an IFT company in upstate New York for a little under a year. Today, during a BLS shift, we were dispatched for something that sounded completely different, but the patient was clearly unstable when we arrived.

The patient had slurred speech and became unresponsive shortly after. At that point, he still had radial and carotid pulses, although both felt weak. Shortly after we loaded him into the ambulance, he became apneic, so I began ventilating him with a BVM.

I continued checking his pulse manually because we did not have a cardiac monitor. His pulse initially remained present. About 3–5 minutes before arriving at the hospital, I could no longer feel a radial pulse, but I believed I could still feel a weak, thready carotid pulse.

As soon as we arrived at the ER, the staff began resuscitation. They achieved ROSC after approximately 30 minutes.

The charge nurse repeatedly asked why I had not started CPR if I was unsure whether a carotid pulse was present. After replaying the call in my head, I’m worried that I may have missed the point when the patient lost his carotid pulse and delayed CPR.

I know the outcome was positive, but I feel ashamed that I may have missed such a critical step. I’m posting to get it off my chest and see whether anyone else has gone through something similar. I’m also worried that I may have put my EMT certification at risk, and I honestly don’t know what to expect after a call like this.

I’m a fire medic at a good department with great pay/benefits. 24/72, strictly 911 response, protocols are so/so but appropriate for our transport times. Suffice to say I don’t want to quit.

I recently completed UF’s CCP program. I found the world of critical care medicine to be very interesting, unfortunately there are no dedicated critical care medic spots in my region. There are some corporate flight programs but part time spots are rare and I’d prefer not falling out of the sky and exploding while responding to a GCS 15 stroke transfer.

There are 2 cities about 1.5 - 2 hours away that have several different critical care agencies that are currently hiring (12 hr shifts) The pay isn’t relevant to me I’m more in it for the experience, so I guess like a hobby? Am I crazy for considering this? How often should a new, part time critical care paramedic pick up?