Wednesday, 8 October 2008

Climate change

HEMS has a new recruit!

Day shift: Six calls; all by ambulance.

Stats: 1 Stabbing; 1 unresponsive person; 1 Broken hip; 1 Cardiac arrest; 1 anaphylactic reaction; 1 Non-cardiac chest pain.

The weather is turning cold now and the week has been busy with ‘proper’ calls – the kind of jobs you get when the winter depression sets in.

Police arrived after the ambulance and me to a 21 year-old man who’d been stabbed in the hand during a robbery at his hostel. The injury wasn’t serious but the assault was and the cops started looking for the assailant as soon as they had a description. It was very early in the morning and I wondered at the mentality of someone who goes around stealing people’s stuff then stabbing them before breakfast.

Lying on the ground in a park was a 30 year-old man who’d been found by the police. The crew was on scene just ahead of me and the man on the ground was conscious, although he couldn’t or wouldn’t open his eyes. It was clear he was keeping them shut deliberately – you can tell by the way the eyelids tense. Nobody knew how long he’d been there or what his problem was but we managed to establish that he was Romanian and probably homeless. He may have been using the system to get a warm bed for the day. To be honest, moan as I do about the abuse of our ‘sponger-friendly’ system, I can’t blame someone for trying to get out of this freezing weather.

I was asked to support a crew on scene with a 92 year-old woman who’d fallen at home and broken her hip. The attendant is a paramedic but is not yet registered, so can’t give drugs or perform invasive procedures without supervision, so I took myself up to the estate where they were and simply showed my face so that the paramedic could get on with her job. It can take weeks or even months for a newly qualified paramedic to get registered and during that time they cannot practice, even though they are perfectly capable.

I had just been cancelled on a Red1, ‘Cardiac arrest’ call because a nearer vehicle had become available when I received a Red2, ‘ineffective breathing’. These calls usually convert to Red1 cardiac arrest and this one followed that pattern a few seconds before I arrived on scene. The ambulance was pulling up with me but the crew hadn’t received the update, so I let them know that it was now a suspended.

Upstairs in the building, a 66 year-old man lay on his back where he’d fallen six or seven minutes earlier after struggling to breathe. Nobody had carried out CPR but there were at least half a dozen people around in the room, which was some kind of office.

I worked with this crew on the hotel cardiac arrest – the one we saved – and I have worked with one of the crew on at least three of these in the past, so we knew the routine and settled into it very quickly. Shocks were delivered, drugs were given and his airway was sorted out when it became difficult to manage, although nowadays my brief is to concentrate on the defib, drugs and fluids. The airway is not as important as it used to be.

A second crew was requested early on but nobody appeared until we were preparing to move the man and he was strapped into the chair. A hysterical relative suddenly appeared and had to be gently moved away and no matter how many times the people around us were told to leave the room, they persisted and hung around the doorway, causing obstruction for us when we wanted to get the patient out quickly.

The second crew helped us to get the man down to the ambulance and we continued CPR all the way to hospital, at one point with me on the floor after I’d been thrown there by the movement of the vehicle.

The patient arrived at hospital in the same condition in which we’d found him and after a few more minutes of CPR, the doctors called it.

If you come across a cardiac arrest and you have any idea about CPR (you don’t have to be trained formally) – please try. If you leave someone lying on the ground for six minutes before anything is done, then don’t expect a survivor. Any CPR is better than none and mouth-to-mouth isn’t necessarily that important (recent research has shown), so start pumping the chest until we get there. I would never forgive you if you let my mother lie there without help for so long.

A car pulled into the pavement just outside the Houses of Parliament and the security people got nervous. Inside was a 51 year-old cancer patient who was having a severe allergic reaction to something she’d eaten. She had a history of anaphylaxis and now she was scratching so much that her arms and neck were grazed and gouged. Her throat was closing and she was panicking when I got to her.

I started her on a nebuliser and was about to give her an injection of adrenaline when the ambulance pulled up alongside. The drug was given a few minutes later when she’d been moved to the trolley bed. Then off she went on blue lights to hospital.

I ended my shift at a restaurant in Leicester Square, where a 25 year-old member of staff was complaining of chest pain. A couple of questions about the nature of the pain and a few basic checks convinced me that the discomfort was probably not cardiac-related. His age and demeanour helped confirm that but once the crew was on scene an ECG was carried out, just in case.

This job was behind my usual stand-by location in this area. I only had to move the car from one corner to another – another ORCON buster. I expect my medal’s in the post.

Be safe.


Anonymous said...

"The airway is not as important as it used to be."

Really? Is this a case of the other interventions are deemed to be more affective or that the priorities have changed?

Just curious as during training the phrase "If you don't have an airway everything else is useless" was drummed in pretty hard!!

James said...

Is the airway less important because delivering shocks and getting the heart going again must be done before you can even think about them breathing?

And what is this ORCON?

Fiz said...

Is that Scruffs, your cat, Xf? Pretty puss-cat! i have the kitten from hell. She loves the Internet and my hands, feet and legs are covered in scratches where she snatches the mouse and swinging up to my lap claws inserted for most purchase wherever she needs it on my legs! :-(

nikki said...

Agree totally with this you should always have a go - compression only CPR is effective for the first few minutes after an arrest, if no one does anything for the first few minutes the person is definately going to die.
the British heart foundation run what they call bystander CPR classes (thats CPR without the mouth to mouth part) follow this link and click on heartstart schemes to find one in your area.

Sarah said...

when i did my first aid training (and for the record i totally appreciate that its a million miles from doing your job) we were told that mouth-to-mouth wasn't as high a priority as it used to be because the action of CPR will naturally move air and and out of the airway.

and that kitty is appallingly cute! i have two lazy fat mogcats whom i adore completely, and might be getting a third kitty in november.

take care

Anonymous said...

when I attended my FAW refresher course they said the airway wasn't as important. Research showing that in a cardiac case the px has enough oxygen in the blood stream already, which is why CPR got changed to 30 chest compressions to 2 breaths, and forget the rescue breaths. (It was also found that the general public were less likely to do CPR because they didn't want to do the mouth to mouth resusitation, so they just didn't do anything at all)

Now, I know that FAW ain't exactly brain surgury, but I imagine that the research carries over, and is what Stuart is talking about.

That's a very cute cat. What have they called it? And how come you visited HEMS?

Anonymous said...

Hi Scruffs and xf,
Well you look well chuffed with your new job! no offence scruffs but i would have 2 decline treatment by you, owing to the fact im allergic to you!
Hope they payin you well with good quality cat food!
Take care both
joan :-)

Kat said...

Louise...the importance of airway was absolutly drilled into us on all first aid courses I've done. The dead in 3-4 minutes without breathing logic.

However, I remember doing CPR training when the 15:2 ratio was new (about 2000 possibly) and since 2005 its been 30:2 hasn't it?!

But emphasis is on compressions then breaths whereas before it was always breaths first then messing around finding the correct place with the finger measurement and everything.

I'm waffling but compressions is better than nothing and I reckon that should be drilled into ppl who are too scared of cpr because they don't want to do mouth to mouth so do nothing!

Scott H said...

I think in this context he was comparing spending time on securing the best possible airway versus working on getting the defib on and drugs in. If the patient had a reasonably open airway anyway then spending more time there might not be worth it. That's just my interpretation, an official response would be great.

As for the role of bystanders in basic CPR and whether to perform mouth-to-mouth or not, take a look at this relatively recent article from the Resus Council (it's a bit wordy) - compression only CPR

James, ORCON is the ambulance monitoring system - this is an example of how much it is loved.

Anonymous said...


Compressions relies on the idea that you are pumping oxygen to the tissues.

The emphasis on compressions works on the theory that air will be sucked in via negative pressure in the thoracic cavity.............

this wont happen without a viable airway............. therefore A still comes first.

Whichever way I work it I still get A before B and C

Xf said...

scott h

Thanks. That's what I was saying. Paramedics have a different brief these days. A clear, patent airway is always going to be vital but if suctioning and manual management is working, then intubation is no longer as important.

If only I had the time to write things carefully enough for everyone's interpretation... :-)

Xf said...

fiz and anon

That's not Scruffs, I'm afraid. That's a kitten that a colleague of mine rescued. Scruffs is 18 months old now and a wee bit bigger these days!

The HEMS connection is coincidental; the kitten doesn't actually fly the helicopter.

He treats the patients.


Fiz said...

Thank you, Xf. I think you ought to let the kitten to have a chance to fly! He's lovely. Do you think schizophrenia exists in animals? Half the time my kitten is a sweetheart and the rest of time she's the cat from hell!

Xf said...


cats INVENTED schitzophrenia...

Fiz said...

Ahhh - so I guess homeopathy is a no-no then?!

mac said...

Oh yeah cheers for sticking my blog on your list. Keep up the good work up in the big smoke.

PCSO Bloggs said...

How cute is that cat!!