Wednesday, 21 May 2008

A fitting end

Eight calls; one pronounced dead on arrival and seven others by ambulance.

Duplicate calls occur every now and again – they used to occur a lot more with the old despatch system but thankfully, in my experience at least, they are now few and far between. This morning, my first call, to a hotel for a 50 year-old woman with chest pain, cost us two ambulances and myself. One of the crews had been given chest pain and the other, abdominal pain – both calls originating from the same place and for the same person but each given a separate CAD number. It was all sorted out when the woman walked out of her room with the first crew on scene. She didn’t even really need an emergency response to be honest.

I got to spend a couple of hours drinking coffee and chatting to my colleagues at one of our regular meeting points in our standby area in Soho. That’s when I noticed a building across the road with one of those blue plaques, you know, the ones that tell us all about who lived or died in a particular place. This one stated that John Logie Baird, the Scottish inventor of television, first demonstrated it in that house. Now that may not seem like a big deal until you think about just how much television has changed life on this planet; it’s one of the most significant inventions ever to have been developed and one which almost every civilisation on Earth is influenced by. What struck me was that he’d been showing off his first telly in a non-descript building in the middle of Soho.

My conversation was interrupted by a call up north for a 72 year-old female. There were no details on my screen, apart from the basics, until I was half-way there; then I was informed that the lady was ‘not breathing, was blue’ and that ‘CPR was in progress’. I raced to get to the little bungalow and I was the first to arrive.

The door to the house was already open and I parked up and grabbed all the equipment I’d need for a resus. The warden, who’s called us, appeared at the door as I made my way over and waved me in. I was directed to a small bedroom at the back of the property, where an ashen-faced woman lay on the bed, face up in her nightclothes. She wasn’t breathing and she looked like she’d suspended a while ago.

‘I’ve done about 400 chest compressions but no breaths’, the exhausted looking warden told me.
‘How long has she been like this?’ I asked him as I started going through my checks.

‘Since 9 o’clock’, he said.

It was 9.15 now and if he was to be believed, he’d given his compressions at a rate of about 25 per minute – a quarter of the rate needed. Still, I wasn’t there to judge the man and he was clearly confused, given the situation. I had to assume that his information may be incorrect and, even though I sensed the lady had been ‘down’ for a while, I decided to continue with CPR. First of all because there was legitimate doubt about the timing of arrest, secondly because the lady was warm and flaccid with no absolute physical signs of death and finally because the warden had already started the attempt and so, morally I guess, I was duty-bound to complete it.

My colleagues from the ambulance arrived just as I was attaching the defib pads and planning a way of getting her from the soft bed to the floor. She was a large, heavy woman, so it took all three of us – myself and the crew – to move her into a position where CPR would be possible. After that, it was a case of getting into a well-rehearsed routine; compressions, ventilations, IV access, drugs, intubation, attaching the automatic ventilator (which almost pulled the tube out again), more drugs, fluids...more drugs...BM checks...more drugs...and no shocks. The woman was asystolic throughout.

Twenty minutes later and we could have called it but we didn’t. We got her out of the house and into the ambulance. Her neighbour was wandering about outside and attempted to get involved in our efforts while her friend was lying lifeless on the floor. I had to walk her back out in an almost catatonic state when she realised what was happening.

‘Is she alright?’ she asked me, her eyes staring past and over my shoulder to the scene in the bedroom.

‘No, she isn’t I’m afraid’. What else could I say?

She was an awkward lift-and-carry; a lot of them are but at least we were on the ground floor, so we got her into the chair and wheeled her outside and onto the trolley bed, which couldn’t fit inside the house. She was taken into the back of the ambulance and I handed over clinical lead to the paramedic on board, who was happy to continue. More drugs, capnography and no shocks still.

We ‘blued’ her in and the efforts continued all the way to hospital but it was called within ten minutes of arrival and she was left, covered up, in Resus while a young family sat around their ill granny in the next cubicle.

After that call, I was out of action for a while, replacing equipment and cleaning up – suspended calls are messy affairs.

Then I got a call for a 25 year-old female who’d fainted at an underground station but I wasn’t required because a crew was on scene as I arrived. Well, I thought I wasn’t required but as the crew investigated the circumstances of the woman’s syncope, questions about her health began to arise and I stuck around to look at her ECG, which appeared to show a prolonged Q-T interval. She fainted a lot, apparently and so the initial thought of letting her get on with her day was abandoned in favour of caution. Her BP hadn’t fully returned to normal anyway.

A 29 year-old security guard who dialled 999 claiming that he was ‘vomiting blood’ had chucked up what I can only describe as alcohol-stained bile; a brownish, yellowish watery substance. It waited in a waste-paper basket for my inspection when I arrived at his place of work (ironically, he has a bank of CCTV monitors on the wall covering all of the outside and street area but he failed to see me at the door, so I waited for five minutes until he appeared).

‘That’s not really blood’, I told him. He actually looked disappointed.

‘It tasted like blood when it came out’, he said. Maybe he hoped he was sick enough to get off work.

‘Well, maybe you’ve vomited so hard that blood has come up from your throat’, I suggested. I was attempting to calm him but I could sense he also wanted validation for his need to call an ambulance.

The crew arrived and, after a quick handover, he was taken away. The building now sat completely unsecured.

Another sleeping drunk required an ambulance after a MOP called us because he or she thought the 55 year-old man was unconscious in the street. He was taken to hospital so that he could sober up and continue his slumber in peace.

A 40 year-old man sat outside a shop with a passer-by attending to him when I arrived on the call for ‘DIB’. In his case, it was more the sudden dizziness and palpitations that he was experiencing that concerned him. He’d had a viral infection recently and this could be the cause of his current problem because he was normally fit and well but it was prudent to check him out properly – very often cardiac problems manifest in these small, subtle ways.

Two fitting patients for the price of one next – both on the same street and both within a few minutes of each other. I was called to the first, a 26 year-old female, who’d had a seizure for the first time for a while in front of her friend. She was post ictal when I arrived and she became very, very upset and distressed when she began to realise what was happening. The MRU arrived a few minutes after I did and we waited with the woman in the busy street, as she attempted to make sense of her world. She’d lost bladder control and as soon as she realised that, she cried even more.

Some epileptics recover slowly into a frightening, confusing sea of strange faces and environments and it’s important to help them stay calm and maintain emotional stability until their brain works everything out – it’s a bit like waking up in a strange room and not knowing where the hell you are or what day it is. It was useful to have her friend there because she was the only recognisable face around for her.

The ambulance arrived after a while but when I began to give the crew a handover, they told me that their call was for a 30 year-old male, not a 26 year-old female. Even the CAD numbers were similar but it was clearly a different call. Now that they were on scene, however and given the distress of the lady in a public place, it was agreed via Control that the crew should stay put, rather than continue, which would make us all look bad.

I left them to it and ‘greened’ up so that the other epileptic call could be sent down to me. I would go there and do what I could until an ambulance arrived, so I sped off down towards the other end of the road and found the patient slumped near a doorway. A CRU paramedic was already on scene and I could hear the wail of an ambulance not too far away, so I asked if I was needed – I wasn’t. The patient was an alcoholic, so it probably wasn’t epilepsy.

Be safe.


Anonymous said...

have just read this months pole on vouluntry agencies providing frontline cover in busy periods,and was wondering what you opinion was of LAS starting up the community first responder schemes in London? i know that as a community responder myself we get a mixed reception from crews and fru pilots,

Xf said...


I wasn't aware that we were planning to operate this scheme as the argument had always been that London is not 'rural' so not suitable.

However, I'm not in any way opposed to it and it's always good to see a competent person at work on someone when I arrive. It is, after all, about the patient, right?