Calling it

One of the most difficult decisions we can make is whether or not to continue a resuscitation. It may not be in the best interests of the patient or their family to continue the almost barbaric activity we call CPR, especially when there is little evidence of a recovery. Calling a resus is an emotional bridge to cross for any paramedic.

I didn't sleep well at all today and I set off for my last night shift with a heavy heart after my previous job. This one affected me a lot I think and so I found it difficult to set my wheels in motion for any crisis that may arise tonight. Unfortunately, as is usually the case, God rolled me another loaded dice.

My second call of the shift was to an elderly woman 'believed to be dead'. I asked Control to clarify this. Was I going to carry out a ROLE (Recognition of Life Extinct), or was I facing a resuscitation? The latter applied. A crew were just about on scene and I was a couple of minutes behind them.

I went into the house and up to the bedroom where she lay in bed. She certainly looked as if she had passed on but she wasn't cold and the family confirmed that she had been seen alive within ten minutes of the 999 call being made. We had to begin resus and so we set about laying her on the floor and getting our respective jobs sorted out. I prepared my drugs and I&I kits but I also wrote down the start time for the CPR; I was preparing myself for a decision in the near future. Nobody else was coming and so it was up to me this time.

The crew I was working with were excellent. We went through the appropriate protocols and we spent 20 minutes attempting to save this woman but her airway was full of blood and that meant she had a serious underlying problem - the one that killed her probably. Apparently (and allegedly) her GP had been told by her family that she was having back pains and couldn't move. She was listless all the time and had no energy. So he telephoned the relatives back later on with a diagnosis (UTI) and a prescription to be collected at their convenience! How the hell does that work?

After 20 minutes and a serious attempt to save her (the crew worked til they sweated on those compressions), I stopped the drugs and called it. I gave a time and asked the crew if they agreed. They did. We could have taken this lady to hospital, resuscitating her all the way but it was agreed among us that dignity was important here and she should be left at home with her family. It was the right thing to do and I am glad that the guys I worked with suggested and supported this decision. It was also the hardest thing I have done for a long time. Now the husband and son had to be told. One of the EMT's broke the news and I spoke to the husband.

"We did all we could, I'm sorry". I don't know how that sounds from their perspective.

Both men had their quiet moments and we began clearing up our mess and preparing the lady for viewing by the relatives and the police, who would now have to be called. I removed the endotracheal tube that I had inserted and I took out the cannula from her arm. She was cleaned with a damp cloth and we replaced her body in the bed, with pillows under her head and a quilt over her. I closed her eyes and left the room to do the necessary paperwork.

I left the scene about an hour later. The crew stayed on to liaise with the police, who had arrived shortly before I went. I completed my PRF and drove off, Green Mobile.

The FRU desk sent me on a couple of routine errands. I collected a colleague and took her back to the station as her shift had ended (a minor injury) and I got some diesel for an ambulance that had run out (!) - shouldn't happen but sometimes does. I think they were trying to give me some time off from 'heavy' jobs. Last night and tonight were beginning to take their toll so the change in pace helped me a lot. Thanks guys.

I also attended a couple of routine jobs; a regular with leg and arm pain and a need for hospital company at 3am and a febrile baby boy who recovered completely by the time I arrived at his home. He didn't appreciate the thermometer in his ear one little bit. I decided that was pretty much the end of my obs. as far he was concerned! Now he was waving and smiling at me. You should be in bed asleep young man!

Earlier, an obnoxious and unco-operative polish man gave me and the attending crew a hard time by not speaking any English but fully understanding it when it suited him and generally being obstructive when we tried to help him. Language Line was used to establish as much information in a three-way conversation as possible but he simply lolled about feigning chest pain and groaning (in Polish). He was homeless and he needed a hospital bed for the night. Why didn't he just ask? Incidentally, his chest pain disappeared when he spoke Polish to the person on the phone from Language Line. It only ever re-appeared when we spoke to him. I can spot a kidder a mile off and he was only a few feet away. I wasn't really in the mood for him to be honest.

I promise I will catch up with all the other stuff I'm due to report but I can tell you that the young woman who was hit by the car is in Intensive Care. I believe she is still in a serious condition but she had surgery so that may be a good sign. I'll keep you posted.

Be safe.