Congratulations! Your Patient Survived

By Binder Smiff, Paramedic

I opened my work tray the other day to find an envelope.  Inside was a letter.  A standard letter suggesting with all integrity that I (amongst others) had managed NOT to kill someone.

thank-you-300x65

Now, these letters don’t come often, but they do come.  In fact, I have a few now.  And I wager that anyone working in the job long enough will end up receiving at least one at some point.

I remember the job too . . . well, by process of elimination it’d be hard not to.  Of the five cardiac arrests I’ve done this year so far, only one of them wasn’t called on scene!

I would normally prefer to write about jobs that are either farcical in nature or tend to have some form of Frank Spencer-esque feeling about them.  So, it’s a bit weird (and rare) to write about something that . . . without trying to sound arrogant . . . went, um, so smooth.  Well, sort of.

Job simply came down as 70 year old male, unresponsive – red 2.  And, upon arrival I was presented with a venue that appeared perfect for the presentation of a cardiac arrest.  It was a large, empty, well lit room with a couple of chairs.  Near enough in the middle of the room lay my patient, on his back.  Quite possibly the best 360 degree access you could wish for.  Most people had left the room or were in the process of leaving and the only remaining folk were a couple of witnesses and friends of the patient.

As I was dumping my kit onto the floor I got the history . . .

“He said he felt a bit sick then just slumped to the floor”

Ah, short and sweet.  The way I like it!  Looking down at my patient I could see his fingers twitching and thought I could see some facial movement.  Therefore, thinking this was initially fake I leant down and went through the motions of DRABC.

D – Well, unless I’d missed a huge piano about to fall on my head or was about to be presented with an opening chest with teeth – like that scene in the film The Thing, where the chest opens and bites off the Dr’s hands when he performs CPR – I’m pretty sure I was free from danger.
R – I attempted the LAS’s preferred method of approach, calling out the patient’s name loudly and squeezing hard on the shoulder/neck region.  Nothing.  Oh, I thought, playing games are we?  I then flicked the eyelashes for a reaction.  Nothing.  Ah, I thought, that’s odd . . . in fact, is – is he breathing?
A – I quickly opened the patient’s airway for a quick check.  No resistance and clear.
B & C – Leaning down I watched his chest and instinctively went for both the patient’s carotid and radial pulses.  Nothing. Nothing and Nothing.

Well, what do you know.  I thought. You AREN’T faking it.

And just like that, I stepped up a gear.  And to be honest, as it always is, the rest is a bit of a blur . . .

Priority button.  Cardiac arrest confirmed. 
Help required?  Yes please!
Patient’s shirt ripped open. 
Start CPR.
Employ use of patient’s friend into taking over CPR.
Instructions to count them loud.  Thank you.
Airway secured temporarily with OP.
BVM fitted to O2 bottle.
Good chest rise with BVM.
Get other friend to act as a scribe and note times.
Lifepak switched on. 
Pads applied.
Metronome on.
Compressions in time with that please.  Thank you.

Rhythm check – VF. 
Charge button pressed.
Continue compressions.
Stand clear!  Shock administered.
Back on the chest.  Thank you.
Times noted please.
More questions on medical history.
Cut off remainder of shirt.
Second round CPR.
Open ALS airway roll to my right.
Open IV bag below.
Tourniquet applied ready to go.
Third round CPR.
Prepare iGel and all corresponding attachments ready to go.
Fourth round CPR.
Instruct another friend to stand by for CPR.
Double check advanced airway procedures.
Fifth round CPR.
OP out.  iGel in.  EtCo2 attached.  Printout confirmed.
Times noted.  Thank you.
Rhythm check – VF. 
Charge button pressed.
Back on the chest please.  Thank you.
Stand clear!  Shock administered.
New friend on CPR.  Thanks.
Times noted please.
Second FRU arrives.
Formal intros.  “Hello. So glad to see you” etc.
Quick hand over.
FRU begins IV access.
Second round CPR.
Lung fields listened to.  Good.
Rise in EtCo2.  Excellent.
Rhythm change noted on Lifepak.  Good.
Third round CPR
IV access gained.  Fluids run up.
Times noted.  Thank you.
Fourth round CPR.
Other drugs prepared.
Fifth round CPR.
BM and Temperature – normal.
Rhythm check – Sinus rhythm.
Pulses checked.  Good carotid.  Good radial.
ROSC time noted.  Excellent cheers.
Crew and Team Leader arrive.
Formal intros.  “Hello. So glad to see you” etc.
Hand over to current point.
Team Leader goes through cardiac arrest reminder card.
Cover all H’s and T’s
Blood pressure good
ECG – ?inferior MI.
Good Sats and EtCo2.
Scoop and bed got by crew. 
Kit cleaned up.
EtCo2 monitored and printouts got.
Pt to scoop then to bed. 
Pt stable ROSC.
Friends congratulated on potentially saving their friend’s life.
Pt handed to crew and team leader to continue to heart attack center.
Imaginary hi 5’s all round.

Ambulance leaves.

Aaaaand breath.

I remained on scene to finish tidying up, write paper work and sort kit.  There were enough people on the truck to be able to sort any problems so I didn’t need to travel.  And in fairness, the patient appeared as stable as they were ever going to be.

Pretty soon I was done.  I said my goodbyes to all other friends and relatives on scene and left to continue my shift.

I knew this was a “good” arrest.  It felt good.  And had a good ROSC too.  There were no egos present and everyone did whatever was expected of them.  No complaints.  No moans.  No clashes.  It was all calm and methodical.  The way it should be.

Now comes the reason, I guess, that I chose to write this entry.

I don’t believe for a second that our actions were the sole reason our patient made it alive to the hospital.  Nor do I believe it the sole reason they eventually walked out of the hospital – alive.  The main reason I believe, that our patient walked out alive – and like so many like them – is that early CPR and shocking was available to them.

I arrived on scene within two minutes of the call being made, which was pure fluke as I was only a few roads away.  And I recall EVERYONE miraculously getting out of my way en route – something that rarely happens!  But because of this, early interventions were able to be made.  And because the patient’s friends were proficient enough in CPR, other procedures were able to progress rapidly and shocks were applied.  Without any of those early interventions the outcome would undoubtedly of been a different story.

Therefore, I know I can attribute all of the “congratulations, your patient walked out of hospital” letters I’ve received down to the simple fact that someone, somewhere, had administered early or immediate CPR to the patient.  And by doing so, halted Death in his tracks and bought the patient some valuable time.

So, what’s the lesson from all this?  Well, there’s at least two here . . .

  1.  Learn CPR.  Please!  LEARN CPR.  It COULD save a life.
  1. When you see an ambulance or an FRU driving up behind you on blue lights – please, get out of OUR way – not the other way round.

Remember – every second counts.

Reprinted with permission from not-on-my-shift.org: a paramedic blog.

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