Its Not Pretty…!!!

People outside the job seem to have lots of misconceptions about resuscitation. On the TV or in books its portrayed usually in a sanitised manner keeping to the basics of it what entails. This is usually CPR…CardioPulmonaryReusucitaion…Cardio = heart…pulmonary = lungs…resuscitation = the act of reviving someone who was previously dead (ie no heartbeat and no breathing).

Occasionally the process of defibrillation, the electric shock, may be chucked in (and paras/techs/nurses/docs up and down the land will cast a critical eye over the proceedings to see if its done right!).

But most active resuscitation’s, either in the street or in a persons home, can be brutal, messy affairs. We need to ‘get down to skin’ so off come the patients clothes either by use of scissors/tuffcuts or simply ripping them off.

We need to secure the airway and the Gold Standard is intubation where a very large tube is passed down the throat and into the lungs. We need to get venous access so a needle is inserted either into the hand or arm or even the neck. We need a drug route.

This is on top the basic stuff ie artificial respiration by way of a ‘bag & mask’, chest compressions by pumping the sternum sufficiently deeply enough to squeeze the heart and any ‘plugging’ of major bleeds if the patient is in arrest due to severe trauma.

It is hard work which brings a sweat on regardless of the ambient temperature. And bear in mind there is usually only two of us working away in the corner of a room trying to move furniture without interrupting compressions and often in poor light. Sometimes we are lying on the floor in piss, shit and blood (it happens although we try to avoid it).

Then add the arrival of relatives who get obviously distressed at the scene before them. We can multi task like no bodies business…cracking on with the resuscitation and giving orders to others/relatives/bystanders and grab the next piece of kit/drug ready for use and looking at the patient and the monitor deciding if and when to ‘shock’.

Then throw in the variables…is there a DNR order (do not resuscitate) in place? Will the patients relatives object to what we are doing on the grounds of religion. (I have been vociferously asked what the constituents were in a fluid I was giving to a Jehovah’s Witness by her brother whilst she was being resuscitated.)

Sometimes the bedside manner can change from ‘pink & fluffy’ to downright ‘bite yer bollocks off’ if someone gets in the way of us. But that’s the nature of the job. East Mids Ambulance Service have started a course showing different people from different backgrounds how, and more importantly, why we need to do what we do. Click on link below.

East Mids Ambulance Service Resuscitation

The other thing which is never shown on TV or written in books is the extrication from someones house. I have lifted, carried, dragged people through doors, windows, fences, walls etc. We have had to carry people down umpteen flights of stairs due to the lifts being broken, and still having to carry on resuscitating the patient. 

15 Responses to Its Not Pretty…!!!

  1. Wild Cat says:

    I have the upmost respect for you all! x

  2. AnneDroid says:

    What Wild Cat said.

    To Mrs Squeamish here, you are total heroes!

  3. Louise says:

    TV programmes drive me nuts, family have banned me from watching Casualty or Holby with them as I sit and correct everything or just tut from time to time muttering “Well thats bollocks” under my breath.

    As well as the carrying/dragging out of the property add in the accured skill of CPR in a fast moving vehicle. Have found the optimum position, wedge one leg down side of stretcher and put other as far across as possible without doing the splits for a good base…………… then develop the illusion of a second pair of hands as you, ventilate, compress, suction, check monitor and not fall over!

  4. Caroline says:

    Believe me, those of us who have seen you in action know just what you do and why and how dedicated the people who stick the job are. As for the media – pfft! what do they know? If the way they portray Social Workers is anything to go by, it’s a wonder they show you working on the right end!

  5. Any of us that worked in EMS/ED for any length of time invariably encounter the “that’s not the way they do it on “ER” crowd. They are the polar opposite of the “Uh, oh” squad; the crowd at an accident scene, or other situation that stand around and go “uh, oh, uh, oh” instead of actually trying to be helpful.

    That said, I remember all too well responding to a cardiac arrest in one of the numerous African-American Methodist churches that dotted Bedford-Stuyvesant in Brooklyn. These were the type of churches where the spirit moved people – though in this case, this woman was moved right to the floor.

    We were working her up, the BLS doing CPR and ventilations, my partner and I doing our paramedic thing, when there came the point where we had to call the doc for more orders, as we ran the gamut of standing orders. We had our trusty Motorola radio/telemetry unit to call the doc, (this was before the era of cell phones as standard equip.) and I had trouble hearing the doc on the other end. Radio interference? Nope. The church service was still in progress, with the choir belting out a beautiful gospel hymn, but was doing no good on our part. I actually had to scream at the pastor to please stop the service, as I could not hear the doc on the other end.

    He obliged, (grudgingly) and just as we were hanging a Lidocaine drip, (we did get a rhythm back) he leaned over my shoulder and asked, quite seriously, “You gonna be taking her to the Kings County (Hospital) morgue?” I’m sure the look of astonishment on my face was quite palpable, so I just said the first thing that came into my brain:

    “Have a little faith.” I replied.

  6. kingmagic says:

    Wild Cat…thanks Wild Cat. Hope it didnt put you off too much?

    AnneDroid…we do what we do. Mostly it goes to plan, sometimes it gets messy. And we try to protect the patients modesty best we can.

    Louise…when I’m in the back of a moving vehicle doing CPR I always try to maintain 5 points of contact for stability! Feet on floor, hands holding onto something and my arse gripping the seat!!!

    Caroline…the media try their best in most cases, but sometimes you might a lazy researcher or producer who sticks to the old stereo types. I always check that I am resuscitating the right end as I do not want to have to explain in a disciplinary why I was trying to inflate their lungs via their arse!

    Mr. Nighttime…Good reply to the preacher! I,ve been in clubs/pubs/discos etc where the music has been deafening and it has taken a mighty effort to get them to turn it off! Also been fighting to save a woman in cardiac arrest when the pub kicked off..it was like something out of the Wild West! As it was some time ago I may do a post on it.

  7. Emma says:

    I don’t know how you do it, I wouldn’t have the patience to deal with everyone around aswell.

    Big respect to all of you…xx

  8. As a ‘bystander’ who has done CPR, (a gent who had been knocked down by a car) I can vouch for the fact it is extremely hard work and very, very intense, if you have ever done a first aid course, you will have done a couple of mins of compressions, but in reality, it goes on and on, time enters another dimension and when the medics arrive they want you to keep going, with the compressions, so they can do all of the above. I couldn’t walk or stand straight for days afterwards, I was so stiff, and my knees were grazed from kneeling in the road. I remember thinking as they cut through his collar and tie, ‘oh no his tie, some one will have bought him that for Christmas’ how silly of me, in the circumstances. But I came away in no doubt that everything that could have been done to help him was, with as much dignity as the circumstances allowed and that was a comfort.

  9. john WH says:

    Re – ‘public attitude’ to resus – A friend of mine was in (voluntary) first aid attendance at the local theatre, when a gent in the Circle collapsed in cardiac arrest. Whilst she was doing CPR, nearby members of the audience complained that she was blocking their view of the stage and spoiling their enjoyment.

  10. kingmagic says:

    john WH…sometimes the people who complain are just totally oblivious to their surroundings and what is going on. Once they wake up and realise the seriousness of the event most of them switch on.
    But some are just downright ignorant, selfish t**ts who would not p**s on you if you was on fire!

  11. kingmagic says:

    Mr. Nighttime…I followed your link and read the story about the Paramedic refusing to cut short his break.

    What it does not say is that if the Paramedic knew that it was a heart attack patient then he would most likely have attended the scene.

    We now have ‘Call Connect’ in this country which means the ambulance is sent before we even know what we are going to. This means invaribly getting sent on ‘Blues & Twos’ to every call whether it is life threatening or not. And most cases are not life threatening.

    Some crews have opted out of the availability breaks because they were either not getting a break at all or having their break disturbed by having to attend a needless call.

    It all comes down to getting the right info at the time of call…something that Call Connect does not do.

    As I said earlier if the Paramedic knew it was a heart attack patient I’m sure he would have responded. But sometimes control have their hands tied with not being allowed to contact the crew on their break.

    My solution…Get rid of Call Connect and get the right info off the caller and get the right response to the right patient at the right time.

    Common sense is becoming a rare commodity in the NHS at the moment!

  12. That must put you at risk more often than is necessary, driving on ‘blues and twos’ must be more dangerous than ‘regular driving?

  13. John R. says:

    Where I work, we at least get some idea of what we’re rolling on when we’re dispatched. Any drug/ETOH overdose or suicide attempt call gets law enforcement and they secure the scene BEFORE we go in. Unless the responding crew has their heads up their arse and doesn’t wait. The larger services often use something called “systems status management” and are also dispatched using codes like “thirty-two-bravo” or “sixteen-delta” (which is Greek to me, we don’t use them).

  14. kingmagic says:

    UHDD…Blues & Twos can be okay but it adds that other dimension of speed and lack of speed of thought from other drivers to shift.

    John R…we used to run on American based systems which took some getting used to but at least we had most of the important info required. This system of Call Connect is all about ‘Times’ meeting government targets set out by the great God ‘ORCON’

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