I’m constantly amazed by the lack of understanding there is between what each healthcare professional actually does in their individual roles.
I’m marrying a nurse, but when I spent a day on placement on her ward, I was amazed at how much she did that I genuinely didn’t know about – not because I don’t take an interest in what she does, I should add – but because there is such a difference between our practice.
A prime example follows:
Sat on station in the city during a night shift (a rarity) when a broadcast sounds over the radio for a Rapid Response Vehicle (RRV) Paramedic on scene at a confirmed Cardiac Arrest, requesting Priority 1 backup. We called up control on the radio as we both ran to the ambulance.
Empty city roads make for a very quick drive (there is always a bit of pleasure doing 60mph through a city usually heavily congested with traffic), and we’re there in 6 minutes. We are shown in by the patient’s wife and pointed upstairs.
“Hello?!” we hollar.
“In here lads!!” Came the reply.
This is what we see:
A male, in his 70’s led on the bedroom floor with his legs up on the bed. He was unresponsive and a rather unhealthy purple colour. He had an OP airway fitted (a smallish plastic pipe inserted into the throat of an unconscious casualty to stop the tongue from flopping over the windpipe) and had chest leads fitted in readiness for a 12 lead ECG. He also had defib pads on in readiness to deliver a shock to correct the VF heart rhythm we were seeing on the monitor. We saw our colleague knelt by his side performing basic life support.
However, although this man was clearly in cardiac arrest, that is to say that his heart was not beating, he was breathing!! Not only that, he was inhaling a little, then screaming as though he was in pain.
Here’s the story: He was woken from sleep complaining of chest pain. His wife called him an ambulance. Our RRV arrived, the patient was conscious and breathing and sat on the edge of his bed. The RRV took a brief history and began attaching the necessary wires to conduct an ECG to see if his pain was caused by a cardiac cause i.e. a Heart Attack. As he attached the last lead, the patient appeared to faint. Our colleague dragged him onto the floor, leaving his legs on the bed. Looking at the monitor, he noted the rhythm was a cardiac arrest rhythm and applied defibrillator pads. Then we arrived.
So, between the three of us, we started advanced life support. I took over chest compressions as the RRV ventilated him with a bag valve mask, and my crew mate looked for IV access. With every compression he was wailing in agony but he was completely unresponsive. Even before my colleague was ventilating I could feel his chest rise and he took a breath. This man was clinically dead (as his heart wasn’t beating) but he was breathing!
We persevered and gave him two shocks with our defibrillator. That alongside some CPR, regained a pulse. We had got his heart beating again. He was still making respiratory effort but was still unresponsive. Still very very unwell!
We set up some IV fluids to maintain his blood pressure, we assisted with his ventilations, we conducted an ECG and we thought about how on earth we were going to get him downstairs and out of the house while keeping him flat!
I called control to see if there was anyone in the area that could lend a pair of hands – there wasn’t. So I got the stretcher outside the front door and grabbed a scoop stretcher. During which time, his ECG showed that his cardiac arrest was indeed caused by a heart attack.
Then we encountered another problem. He started waking up.
Now, when I say waking up, I don’t mean he sat up and said “Oh, hello chaps, thanks ever-so for saving my life. Cup of tea, perhaps?”
No, I mean he was incredibly agitated through lack of oxygen to the brain and was screaming, flailing around, pulling wires off and punching out at us. His poor wife was beside herself watching her otherwise well husband turn into something from a nightmare.
We had no choice but to tie him to the scoop stretcher for his, and our safety, as we then had to get him down the stairs.
Between three of us, we slid the 15 stone man along the bedroom, round a door frame, along the landing, negotiated the right angles and corners, then lifted him down the stairs. All the while maintaining his airway, checking his breathing and making sure he didn’t lose a pulse. We sweated and struggled with his writhing body until we reached the waiting stretcher, not before squeezing through two doorways.
So, wheeling him to the ambulance, down a bloody steep hill, while reattaching all of the monitoring we had to remove before lifting him down the stairs.
So, into the ambulance, and he vomits. He vomits everything he’s eaten in the last 70 years!! Of course, because he’s not fully alert, he doesn’t know he’s vomiting and doesn’t turn his head to spit it out and he seriously risks breathing it in – which would be fatal. I fight with our suction unit as quickly as I can and begin suctioning his airway. His confused state means he starts biting the suction tube. I fight to release it and carry on suctioning, splashing a not inconsiderable amount on my uniform!
As the cause of his arrest was a heart attack, and as it was out of hours, we were indicated to drive to the next city’s hospital that has 24 hour cardiac care, bypassing the nearest A&E. However, we couldn’t safely manage him in this state to spoke to the nearest A&E and asked to come to them first to stabilise him before transferring him to the next city. They agree to accept the patient and we blue light to them.
On arrival, he was still screaming and fighting, covered in blood and vomit. We are also sweaty, bloody and vomitty. It’s not a glamorous job.
We handover to the waiting team of Nurses, Doctors and Anaesthetists who set about sedating him, a process that takes about 30 minutes. In that time, we cleaned ourselves up, cleaned the stretcher and ambulance of all the fluids and got ready to transfer him to the next hospital.
Once he was stabilised, we were ready to transfer him. We slid him onto our stretcher and took with us the hospital monitor (far more advanced than ours), the ventilator, an oxygen cylinder, the drug syringe driver, the catheter bag, the anaesthetics bag, an anaesthetist and a charge nurse – all squeezed into the back of an ambulance 10′ x 5′.
Once we were set up, I blued us to the next city. 12 miles but the hour of the day meant no traffic, so it doesn’t take long.
During the journey, his heart went into some peculiar rhythms and his blood pressure was up and down like a yo-yo, meaning the team in the back had to work hard to keep him stable. When I opened the door at the other end, they were all sweating a bit.
We wheeled him into the department and into the cardiac catheterisation labs were the cardiologists were all waiting for us.
The anaesthetist handed over to their team and we slid him across to their bed in readiness for them to perform a procedure to unblock the coronary artery that caused the heart attack and in turn the cardiac arrest.
All of this, from the time the 999 call had been placed, was nearly 3 hours! We had worked our backsides off to first bring this man back to life, then keep him alive to deliver him to the next hospital. We had faced several challenges from start to finish; we’d twisted and graunched our backs getting him out the house, been covered in vomit, performed advance life support, driven hard and fast all while keeping his family informed of what was going on.
And what did the cardiologist say to us with distain…”Your stretcher’s in the way, are you going to move it?!”
Amazing. With absolutely no respect for what we had been through, we delivered a stable, sedated, clean and neatly packaged patient to an air conditioned, well light room with plenty of space and a massive team, and we are made to feel that we are in the way!
We cleaned our stretcher, tidied the ambulance, made a list of the many many items we needed to restock and headed home.
Sometimes, not always, but sometimes there is no professional courtesy. Sometimes it’s arrogance, sometimes it’s ignorance. Either way, we saved a life. I hope he makes a good recovery and I hope his wife is OK.