Tag Archives: Cardiac Arrest

New skills

As I’ve mentioned before, I am a Student Paramedic studying part time through the Open University. This means that unlike full time students, I don’t do placement blocks as an extra person on an Ambulance, I work full time for the Service as a crew of (usually) two on a Double Crewed Ambulance (DCA).

Studying this way – I feel – gives me better exposure to lots of different types of emergencies and how to manage them with just the two of you (having a 3rd person there does make a massive difference in critical situations). It does mean that it takes longer (1 year probation plus 4 years study as a apposed to 3 years through University) and I have to study in and around my shifts – including hospital placements which have to be done in my own time, but I think that learning ‘on the job’ is a much better option. You can’t learn how to simply talk to people or reassure them at university, that’s evident from some of the young newly qualified Paramedics I’ve seen.

Studying this way also means that I am taught new skills as I progress and allowed to perform procedures on my patients. I’ve recently been given all of the Paramedic skill to add to my arsenal.

If you want to Google them, they are:

Cannulation

Intra-oseos (IO) access

Intubation

Needle Cricothyroidotomy

Needle Thoracocentesis and

Advanced Life Support (my assessment for this one is during my final year).

Cannulation is our most often practiced skill. It involves putting a small plastic tube into a vein using a needle (IV access). This allows us to give fluids, drugs and now in certain situations with help from our Air Ambulance Critical Care Paramedics, blood.

IO access is only used in truly life threatening situations, when the patient is so ‘shut down’ that you can’t get IV access, or if they’ve suffered amputations. It’s also the first line of access in paediatric cardiac arrest (no pulse and not breathing). It involves a much larger, longer needle which we attach to a special drill and drill into the bone marrow. Seriously, that’s what we do! I’ve seen it done three times and only once on a conscious casualty. It really is our last line of access because it’s so aggressive, apart from paediatric cardiac arrest – just think on that for a minute!

Intubation is only used in cardiac arrest. It involves using a curved metal blade to lift the tongue and jaw out of the way to visualise the vocal cords. We then pass a plastic tube through the cords into the main windpipe leading to the lungs, thereby blocking off the oesophagus to reduce the chance of vomit getting into the lungs. We then attach it to a ventilator of some sort to breathe for the patient.

Needle Cricothyroidotomy or Needle Cric’ (pronounced cryke) for short is when the shit really hits the fan. If you’re pulling this out of the bag, it really is do or die! We only use this when a patient has a complete upper airway obstruction that cannot be removed by the heimlich manoeuvre or by using the intubation blade to find and some special pliers to remove the blockage. This patient will die if you don’t perform this technique. It involves using the largest cannula we have (like a bloody scaffolding pole) and pushing it through the throat into the windpipe, attaching an oxygen tube to it and turning it on and off to emulate breathing. Once this is done, you have 20 minutes to get the patient to definitive care of they die. This will be a bad day at work.

Needle Thoracocentesis is used when a patient has a collapsed lung which is ‘tensioning’. This is when the lung collapses and then gets smaller and smaller until it compresses agains the heart impeding its ability to beat. Again, this is fatal if untreated. So all we do is get that massive cannula and push it between the ribs to allow the air that’s outside the lung to escape and the lung to re-inflate. Scary stuff.

Advanced life support is pretty much a combination of all of the above with a cocktail of different drugs used in the management of cardiac arrest. With all of this, we are able to offer the same treatment for cardiac arrest in someone’s living room that would be offered in an A&E resus’ room.

 

So far, I’ve cannulated plenty of actual human beings, but none of the other stuff. The time will come for me to use these skills *gulp* and it’ll be fine.

This is actual grown up stuff now…wish me luck! I’ll report back with tales of how I’ve used these skills to save hundreds and hundreds of lives!

 

 

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Morale

At this moment in time, morale is low in the ambulance service. This is evident as more and more articles are appearing in mainstream news raising concerns about how busy our crews are, fewer breaks being taken because there is so much outstanding work and finishing late at the end of every shift.

For decades, the ambulance service was quite a secretive organisation. Problems such as the above never made it to the papers because it was bad press for the NHS’ ambulance service, and crews didn’t want the public thinking they couldn’t cope with the job.

But here is the reality from the front line. The shift length of 12 hours is acceptable and is generally well liked in the service. It means we work fewer days per week and allows better 24 hour cover with less people. In my opinion, this is not the issue. The issue is not being able to take our breaks, and perpetual late finishes.

Years ago, the rules were; if you get back to your station, you are protected from being sent an emergency call until you’ve had your legal 30 minute break. However, while driving back to your station, you’re fair game. As workload increased, the likelihood of getting back to your station decreased – especially for remote, satellite stations like mine (we’re not stationed at hospitals as is popular belief). Crews would be sometimes 9 hours into their shift without a break and have to book unfit for duty until they’d had their break.

To rectify this, the Unions worked with our trust to introduce protected meal break windows. 5 hours into our shift, we cannot be sent an emergency call until we’ve driven back to our station and had a 30 minute break.

“Madness!” I hear you cry! You may think it ludicrous that crews, no matter where they are in their area (we could be 30 miles or more from our base stations) are driving all the way back to their station fully protected from emergency calls.

There’s two things to remember here, well, three if you think about the reason we ended up so far away from our station in the first place (lack of cover); Firstly. The front of an ambulance is like the front of a van except we have a computer terminal on which we receive calls and navigation details. What we don’t have, is a cool box or fridge. That delicious Chicken sandwich that’s been sat in a hot, sweaty cab of an ambulance for 8 hours, perspiring onto the now soggy bread doesn’t seem so appetising anymore! The trust will not install cool boxes as they consider it a health and safety risk if it is not cleaned. And we are not allowed to bring our own as we are not allowed to plug devices into the already overloaded vehicle electronics. This means our food is on our station. Also, on a winter’s night at -5, is it unreasonable to want a hot meal?

Secondly, we are never truly ‘protected’ from calls. What the trust took to doing was ‘general broadcasts’. Our radios are closed channel, so our dispatcher talks to one crew and nobody else, as is required by law for patient confidentiality. However, if there is an outstanding call that has been triaged as a “life threatening” emergency, they will broadcast it on open speech, thusly:

“Control to all mobiles, general broadcast. There is currently an outstanding Red call for a 60 year old male with chest pain in [town]. Currently responding a crew from [a town far away]. Anyone able to assist or render aid, please call up. Control standing by.”

So what do we do? We’re a mile away from a patient possibly having a heart attack. We do what we signed up for an answer the call. Even while legally protected, we can ‘volunteer’ to take an emergency.

“What a relief” I now hear you say. Perhaps. But the frequency of these general broadcasts is alarming. Such is the frequency and lack of cover, we might never get a rest break for answering them. So sometimes – very selectively mind you – we don’t answer them, so we may actually have a break. Let me elaborate before you faint.

If a broadcast goes out “child in cardiac arrest” control will be inundated with volunteers. Crews for miles and miles in any direction will be calling up to help.

If a broadcast goes out “25 year old male, tummy pain for 3 weeks”. What would you do? (The fact that triages as ‘life threatening’ is the subject for another post). If he’s had it 3 weeks, it can probably wait 30 minutes while I raise my blood sugar levels from 0.0!

Also, there is the subject of late finishes. We can be sent an emergency call any distance (sometimes we travel 35 miles to emergencies) minutes before the end of our shift. Looking back over last month, I worked 15 shifts and finished on time on 3 occasions! Lateness ranging from only 15 minutes to two hours! This overrun is enforced as we cannot turn down an emergency just because we’re due to finish in 10 minutes.

I know this post may seem a bit ‘moany’, and this is ‘the job we signed up for’ and please don’t misunderstand – I love my job, but don’t forget; we’re only human. Simple, fragile flesh and bone the same as the patients whom we help. After all the horrors and stresses we encounter, we only ask for a break and a reasonable finish time. It’s not too much to ask. But it is, apparently, and that’s why morale is currently lower than the shadow of shark shit!

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The Unknown History

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.

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Heroin Overdose

Much to my Mum’s delight (not!!), we often attend patients who have overdosed on one kind of drug or another. Sometimes accidentally – as in the case of a diabetic lady who mis-read her insulin packaging meaning she’d taken too much., potentially life threatening if left untreated for ay length of time – but mostly intentional.

Many people take overdoses as a cry for help, others as they genuinely want to end their lives. People overdose on a range of drugs: antidepressants, pain killers, sleeping tablets, herbal remedies and once on eucalyptus oil (particularly dangerous believe it or not).

Heroin overdoses (generally) fall into the accidental category.

Heroin is an Opiate based drug and its affect, aside from the ‘high’, is respiratory depression. If one has too much of any opiate, one will eventually stop breathing. If they stop breathing but still have a pulse it’s called ‘respiratory arrest’, if not rapidly and aggressively treated, their heart will stop and they will be in ‘cardiac arrest’.

Today, while in a public toilet in the city, one young man had apparently taken a quantity of heroin. A member of the public was rather surprised to see a man flaked out in a cubicle, quite blue in colour through lack of oxygen, so called 999. Quite right, too!

We arrived within a minute or so (we were really close by) to find him half propped up against the wall unconscious. My regular crew mate and I have a young student paramedic out on placement at the moment and we let him take the lead for a moment.

Our ‘Primary Survey’ is as follows:

D – Danger

C – Catastrophic Haemorrhage

R – Response

A – Airway

c – C-spine protection

B – Breathing

C – Circulation

D – Disability

E – Expose and Examine / Environmental Factors

A little different from DR.ABC taught in First Aid.

There was danger present in the form of used hyperdermic needles, we all spotted them and were careful not to kneel on them (that’s the bit my Mum’s going to hate!). There was no Haemorrhage at all, let alone a Catastrophic one, so the he moved on in his primary survey.

The next bit is ‘Response’. A patient is either fully alert, responsive to voice, responsive to painful stimuli or unresponsive (AVPU). Now, our student is was a little delicate with this bit and his painful stimuli weren’t quite enough to cut through this man’s heroin haze.

Now, you’ll remember I said that we aggressively treat respiratory/cardiac arrest, to prevent death…so, as he was seemingly unresponsive, I grabbed his legs and slid him along the toilet floor to lay him flat with a view to commencing advanced life support. Well, he woke up! He work up and was most annoyed to have been dragged flat onto his back and was rather annoyed that we ruined his high!

He spoke to us clearly enough but was obviously under the influence of something as he was slurring and was wobbling all over the place. He denied the use of anything other than alcohol and asked us politely to leave, which, once we were happy he could walk, we did.

We stood down the Police and the Ambulance Officer that was on his way and cleared from the scene.

Thankfully, this is a fairly rare occurrence, but, does happen. If he wasn’t breathing, we carry a very clever drug which reverses the opiate affects on the respiratory system and brings them ‘back to life’.

Our student learnt not to be so delicate with his primary survey, and I learnt to have a quick check myself before flattening some poor unsuspecting soul to the floor.

Everyday’s a school day!

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A Typical Day

I wanted this blog to give an insight into daily Ambulance life for an English Ambulance Service, but I’m aware that I tend to concentrate on specific cases of interest. So, I thought I’d write about today – a typical day.

Arrive at work 06:45 to relieve the night crew.

We say hello, ask how their night has been then set to checking the vehicle over for our shift. The night Paramedic signs over the Morphine to the day Paramedic and advises of any issues with the vehicle, any problems at local hospitals or any incidents requiring intervention from an Officer.

We are supposed to have 20 minutes to complete a Vehicle Daily Inspection (VDI), but such is the nature of the beast that if an emergency comes in at 1 minute passed starting time, we have to go.

Today however, we remained undisturbed for 20 minutes. We check that the defibrillator is functioning, that we have full cylinders of oxygen, all of the drugs we need to carry are fully stocked and in date, that our response bag has all of the diagnostic equipment we need, that we have all of the paper work that we need, that the heater works, that all the blue lights work, that all of the vehicle lights (headlights, brake lights etc) are functioning, that we have fuel and lots of other things. Quite a lot to squeeze into 20 minutes.

Anyway, here’s a run down of today’s emergencies:

1st call was to a male who had collapsed in the bathroom after having a shower. He had no recollection of fainting and awoke on the floor covered in blood. He had a nasty cut to the head which had bled heavily – he also took blood thinners which didn’t help! He alerted his wife who had called 999. We dressed the wound, fully assessed him and took him to A&E as he needed stitching and further assessment as to why he collapsed. Also, as he took blood thinners and had suffered a head injury, we wanted to check that he did not have a bleed on the brain as a result of the trauma.

Our second call was while we were heading back to our base station, a lorry driver parked in a lay-by flagged us down as his colleague had hit his head on part of the lorry causing it to bleed. By the way he was frantically waving we thought it was bad, but, it was a small nick the size of the nib of a pencil. We gave him a plaster, completed all of the other checks that we need to do, filled out our paperwork and let him back to work with instructions to see his own Doctor to check his Tetanus status.

As soon as we cleared from that call, we were sent details of a male who was possibly having a heart attack. It was a patient I had seen about 4 months ago when he had his first heart attack. He was at his Doctor’s surgery with atypical pain. His doctor was concerned that the pain he was experiencing in his shoulder was referred pain from his heart. One of our Rapid Response cars arrived shortly before us and conducted an ECG which showed no abnormalities. His Doctor had booked him directly into a medical assessment ward to bypass A&E so the car took him in as it was unlikely he would deteriorate.

We just got back to station for some lunch, and no sooner had I put my baked beans on the hob that we got sent to a nearby town for a male who had fallen more 8 feet from a crane and was unconscious. We were asked to provide an early update of the air ambulance. We arrived to find that the he was in fact fully conscious and alert with no serious injuries, so stood the helicopter down. He had been knocked out for less than a minute and sustained a relatively minor head injury and a probable broken wrist. We took him to A&E giving him some good pain relief on the way.

5th call was an urgent case (normal road speed admission) for a lady with a looooooong medical history of just about every ailment you can imagine. A recent blood test revealed that her kidney function had reduced so she needed to be admitted to a ward for treatment. The Doctor felt it appropriate to book an ambulance to transport her so she could receive a full set of medical observations and and ECG so we might correct any problems we encounter. Everything checked out fine and it was an uneventful transport.

Our final emergency was at a Doctor’s surgery for a lady who possibly had pneumonia. A middle-aged lady who had a 2 day history of a cough with shortness of breath. Her Oxygen levels were reduced below normal limits so she needed admission to A&E. We took a quick hand over from a very busy Doctor and took her to the ambulance. We listened to her chest and heard a pronounced wheeze, so we set up a nebuliser (oxygen mask with a drug to help with the breathing) which worked a treat. We performed an ECG to rule out a cardiac cause of the shortness of breath – it revealed no abnormalities. We did, however, note that she had a temperature and her blood sugars were slightly raised. That along with a fast heart rate (tachycardia) and increased respiratory rate meant it was possible she was septic following a chest infection, so we took her to A&E where they will perform blood tests and chest X-rays to diagnose the problem and treat as appropriate.

120 miles covered, 6 patients and 3 cups of tea. Not a bad day overall, even managed to eat my beans on toast in the end!

Hopefully this highlights how we have to be learned in a wide range of things, from life threatening trauma to routine medical problems. All part of the enjoyment of the job – you really never know what you’ll see next!

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ANOTHER public arrest.

Very much on the theme of my post last month, we were sent to another public cardiac arrest.

My crew mate, myself and a University Student on placement had just discharged a patient on scene; a baby who had diarrhoea the day before and her dad called 111. 111 had decided that this was immediately life threatening and actually passed the job to us a an ‘Unresponsive Baby’, which we were very glad to discover she was not.

I digress. We made ourselves available and immediately received details of an emergency in the city about 7 miles away. We were told that an elderly male had collapsed in the street and wasn’t breathing.  This is normally a 20 minute drive with traffic but I got there in 9.

We arrived to find a Rapid Response Vehicle (RRV) Paramedic doing chest compressions and one of our Officers who had also been dispatched, breathing for a patient with a Bag Valve Mask (BVM).

Between the three of us, we had already decided what our plan would be. My crew mate would jump out and help with advanced skills such as IV access or advanced airway management, the Student would take over chest compressions (because he is not allowed to perform any other skills yet, and it’s good experience to do so when the opportunity presents) and I would manage getting the patient off of the pavement and into the relative privacy of our ambulance.

I overheard that they had already delivered 2 defibrillator shocks prior to our arrival, and as I prepared our scoop stretcher, they delivered a third. Between myself and one other, we ‘scooped’ the man onto our stretcher and, while the student continued CPR, wheeled him into the ambulance.

There were Police on scene as well, who had been very proactive and closed the busy road. I was blocking it with my ambulance anyway. Sometimes that’s the only option.

A 4th shock was delivered in the back of the ambulance. For the 4th time, we had been unsuccessful in restarting his heart. But the battle continued.

We were informed that the Air Ambulance had landed in a nearby field and we were to drive round to meet them. I jumped in the front, and with the Police stopping traffic, made my way the half mile or so the the helicopter, where we were met by a Critical Care Doctor and a Critical Care Paramedic.

After a further 25 minutes of quick thinking and hard work, the man regained his pulse – something we call ROSC (Return Of Spontaneous Circulation), however, his heart rhythm was one which would not sustain life and another shock was given to ‘revert’ it back to a normal sinus rhythm. The Doctor, with agreement from all those involved, decided the ‘likely‘ cause – we never really know in these situations – was a Heart Attack which had caused the Cardiac Arrest. There is a specialist hospital that deals with this sort of emergency and it was decided that as the man was too unstable to fly, we would travel by road to this hospital in the next major city.

When everyone was ready, I began the 30 minute blue light drive. It’s a funny feeling up there in the cab on your own. You have a huge responsibility to deliver precious cargo there safely but quickly. The drive must be progressive but smooth. You need to look far into the distance to pick a route through traffic that will cause the least amount of movement in the back of the ambulance and have a 360 degree awareness. It is knackering!

30 minutes later, we arrived and I opened the back doors to lower the tail lift to unload the patient. I’m met by the Doctor who said “that was superb!” High praise indeed! I thanked him and continued to assist with unloading. The patient had maintained ROSC and was making respiratory effort but was unconscious and still very unwell.

We wheeled him in to the resus’ bay and the Doctor handed over to the lead hospital clinician where they set to work attaching leads, taking blood, checking the airway, listening to his chest, arranging scans and a host of other things.

We then were left with the mammoth job of clearing up.

He was alone shopping when he collapsed, but the Officer and I had found his wallet and ID so had his name and address, he also had his next of kin details which we passed to the Police.

I have no idea what happened to the man after we left, but I do hope he survived. If it was not to be, I hope his family were able to come and be by his side before he passed away. Either way, he had been given every chance of survival.

When reflecting on the job, I realised that was the first Cardiac Arrest I had attended where I had not done a single chest compression! Many hands and all that.

The following day, I attended an incident in Bath with my other Crew mate. I don’t like putting city names in my posts but this is important.

We were first on scene at a horrendous incident that made national news on the 9th February 2015 where 4 people were killed in a dreadful accident. I just want you to know that yes, I was there. Yes, it was horrific. And no, I will never be posting it on here.  My trust has been superb in supporting all ambulance staff involved and I have had lots of support from colleagues, friends and of course my beautiful fiancé.

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Straight into the action! *warning, graphic content*

It’s been a long while since my last post, and with good reason – I’ve been on leave.

Normally during leave when I’m not actually going away, I’ll try to squeeze in some overtime around whatever I’m doing in my time off, but this 2 weeks, I did nothing remotely ‘ambulancey’. It was great!

It’s very easy to get wrapped up in this job, even when you’re not sat in your uniform, you may well be thinking about a job or discussing work with a friend. It’s hard to escape but I managed it (all bar a couple of emails to officers about 1 or 2 important things).

So, back to it yesterday. My favourite crew mate (I have to say that as he reads this blog) at my base station – should be a nice way to return after a relaxing break.

Wrong.

First shout was at a Doctor’s Surgery given as “7 year old, unconscious, fitting”. That gets the adrenaline pumping when you’ve had no exposure to emergencies for a while!

This child had stopped fitting in the 3 minutes it took us to get there, and was being seen to by the GP who had given him Oxygen. The child still had a reduced level of consciousness so my crew mate went immediately to get the stretcher from the ambulance. Once aboard, we gave him a thorough check which revealed a very high temperature (of unknown origin), which could’ve brought on the seizure. Either way, he was going to A&E for assessment.

That job was nice and tame compared to the rest of the day.

Next job was a public cardiac arrest. Cardiac Arrests can be (organised) chaos at the best of times and this was no different.

An elderly male walking to a car and collapsed. His heart had stopped and he was not breathing. We arrived in under 5 minutes to find a member of the public performing good quality CPR as instructed by our 999 Emergency Medical Dispatcher over the phone.

Always a tricky situation this. Protocol dictates a certain order of things that need to happen. CPR was initiated and continued by my crew mate while I cut the man’s clothes off to apply the defibrillator pads to his chest. His heart rhythm was Pulseless Electrical Activity (PEA). This means that the electrical component of his heart was working, but the muscle (the bit that physically pumps the blood around) had failed and stopped. This is not a rhythm we can shock back to life.

From here, the airway should be secured and ventilations should begin to breathe for the patient. However, this was a very public arrest so we needed to get him into the ambulance before any of this could really take place – for dignity more than anything. Also as he was wedged between two parked cars, it was not the ideal location to perform Advanced Life Support (ALS).

My crew mate continued CPR and even managed ventilations while I called for Priority backup on the radio for another pair of hands and grabbed the trolley and a special scoop stretcher that splits into two and allows us to literally ‘scoop’ a patient off the floor keeping them flat.

The patient was large. And heavy. This meant that the lift with just the two of us was a challenge. But at times like this, you draw from the adrenaline and get it done.

As we loaded him onto the ambulance, our backup arrived. Out of public view, and with three of us, we could begin ALS. Gaining IV access to give a cocktail of drugs to try to ‘jumpstart’ the heart, while performing CPR. However, we had a pretty big problem. We struggled to secure his airway (by this I mean maintain an open and clear airway so that we can ‘breathe’ for the patient without occlusion from vomit, blood etc).

He was losing large quantities of blood through his airway. Despite using our suction machine to clear it, it just kept pumping out with every compression off the chest. We have various pieces of equipment to try to secure an airway, and none of them were working. We tried everything in our arsenal but this man had a catastrophic internal bleed which made it very difficult.

We were very close to our local A&E, so a very quick phone call to ensure they were ready for us, and we ‘blued’ him in.

It’s the first time I’ve done CPR in the back of a 5 ton ambulance doing 50mph through a city – it’s not easy!

We arrived at A&E in a little under 10 minutes, continuing ALS the whole time, including while walking into the department.

For another 10 or so minutes, the Doctors and Nurses fought to save this man’s life, but sadly nothing further could be done. With every one’s agreement, life support was ceased. The Doctors thanked everyone for our help and thanked us for our hard work leading up to the patient’s delivery to A&E. There’s always a few seconds of quiet after death is declared. I looked at the man’s eyes, now glazed and fixed, and felt a little sad that we had no idea who he was. Later, the nurses found a wallet with his ID, so his family could be notified.

The mess after a cardiac arrest is substantial. Here’s a photo of the back of the ambulance after the call. Bear in mind that half the kit was still in the hospital. Lots of cleaning after a job like this is needed.

Ambulance Mess

Our very next job (after returning to station and restocking the mountain of kit) was a young lady who’d been found dead by her son. She’d been dead couple of days and was in quite a distressing position. There was nothing we could do, so we contacted the Police to act as coroner (standard practice in an unexpected death). I feel sorry for the son, who lived with his mum, and due to being at work and out with friends, had no idea that his mum was dead. We left him in the care of the Police, as there was nothing further for us to do.

Our final job seemed like a routine backup for a Rapid Response Car on scene with a patient who’d had a seizure. All good, until she started to have another fit in the back of the Ambulance on the way to A&E. “Put the lights on, Stu”, came my crew mate’s voice from the back. I pulled in briefly to give him a hand securing IV access and maintaining her airway then drove under emergency conditions to A&E.

A heck of day, filled with medical emergencies that really made me think and tragedies that also made me think.

I text my mum, and fiancé reminding them that I love them.

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