MedEvac'd

Today I finally got to go on a MedEvac!  (Being on an island, we have to transfer anything remotely serious by boat or plane.) I wasn't on call, I just happened to be walking by the ER when the patient came in. The doctor and most of the staff were in administrative meetings, so I was the first to respond to and diagnose AFib with RVR (fast and irregular heart rate). The patient also had a weak pulse, chest pain, and some suspicious ST elevations (can mean a heart attack) on EKG. He had been having symptoms for many hours before coming in, and was still looking pretty well, so it was an "urgent" situation rather than an "emergent" one. I semi-successfully placed an IV while under pressure (I did it right on the first try but it happened to be in a freaking valve), pushed dilt, which slowed heart rate for awhile but didn't stop the afib, and we loaded the patient up in an ambulance, drove to the dock, transferred to a boat, and sped off to Ketchikan, where we put the pt in another ambulance and transferred to the ER, where I gave pass-off (describe the patient's situation and what we've done so far) to staff there. The MedEvac boat takes only 30 min instead of an hr and a half like the ferry. The ER in Ketchikan was also super-dead, with no patients or staff in sight, even though I think they were expecting us (and as the Ketchikan EMS pointed out, they just heard "AFib with RVR" and had no idea whether the patient was stable or crashing or had even received any treatment). Definitely different from a trauma team accept at Mass General where a whole team of 10+ people are crowded around the bed waiting to take immediate action.