Chain of Survival…who looks after the links?

November 15, 2006

 Chain of Survival

A couple of busy shifts on the RRV doing 12 hour stints. Most jobs were very minor with the occasional chest pain and a few kiddies with infections leading to febrile convulsions.

Towards the back end of the second shift I was tasked to respond to a “cardiac arrest in the street outside a health centre…”.  I arrived almost the same time as the crew and I saw that CPR was being carried out by two members of the public. With my defib and resus bag I approached the scene and saw that the patient was attached to an automatic advisory defibrillator (basically a shock box which delivers electric shocks to the patients heart via adhesive pads on the chest with assessment of the underlying heart rhythm done by computer). 

It was then that I noticed that they were nurses from the health centre and a G.P. The pads had been taken off the patients chest and I was told that he had been shocked twice….CPR was still been carried out (mouth to mouth and chest compressions). The G.P. was after “calling it” (ceasing the resus). But in a quick conflab with the crew we took over and started “bagging” using a bag and mask with O2 attached, and took over chest compressions. This was due to the fact that it was a witnessed arrest and that good CPR had been initiated with initial defibrillation all within about the last 10 minutes.

I intubated the patient on the ground while my colleague gained venous access and started administrating cardiac drugs. Checking our monitor showed that the patient was displaying a rhythm. A regular pulse could be seen on the screen but on checking the patient at carotid and femoral arteries we knew that he was in PEA (pulseless electrical activity…meaning that the electrical stimulus was firing in the heart but the actual heart muscle was not responding). We then moved the patient to the stretcher and onto the vehicle continuing CPR all the way. Further cardiac drugs were given and the crew set off for the resus room at the local A/E putting in a pre-alert for the hospital via control.

I stayed behind to sort out my kit and clear up the normal rubbish left after a resus (syringes, paper, wrappers etc.). I spoke to the health centre staff and thanked them for their efforts and they appeared pleased to have been of some help.

It was then that I noticed a young man stood at the side of the road visibly upset. He was close to tears and shaking. (For members of the public to witness us carrying out a full resus in the street is not that common and it can be distressing to watch).

I asked him if he was okay and he asked if the gentleman who had collapsed was going to be alright? This is where you need to be careful as I thought the young man may have been a relative…turned out that he was not. So I said that everything was been done to help the chap, to which the young man replied that he had witnessed the patient walking along and then he saw him suddenly grasp his chest and then collapse to the floor! 

The young man had rushed over and realised that he had arrested and started CPR straight away, sending someone in to the health centre to get help. It was then that the young man explained to me that no-one would come out of the health centre to help as they believed that he may be drunk (the collapsed gent) and that they were not covered for insurance purposes off the premises. (This is what the young man told me).

As he was still quite shaken up and upset I told him that he had done a terrific job and that he should not feel downhearted. It was reassuring for me that this lad had helped rather than walk on by. But I felt that it was a shame that no one had bothered to talk to him during our resus efforts. It then became obvious that he was stuck in a loop. He seemed to be venting his anger or frustration towards the health centre for not coming out sooner. Again I tried to explain the reasoning/rationale behind their initial reluctance to attend. Before I left scene to follow the crew to hospital to retrieve some of my kit, I again thanked him for his efforts.

At the hospital I collected my kit and was talking to the crew at the reception area when I overheard the receptionist talking on the phone trying to calm someone down who was after info on the chap that had been brought in. It was the young man….one of the crew took the call and again reassured him and thanked him.

For us it was part of our job. We attended the patient, treated and transported to the hospital and filled in the relevant paperwork. Re-kitted our vehicles and called clear for the next job. We had spoken briefly about the arrest knowing that the patients prognosis was poor. We also talked about the next staff night out and the local football club.

Its difficult at times to put peoples minds at rest especially after they have been involved in a traumatic event, but usually we are long gone either with the patient to hospital or onto the next job. I just hope that the young man who helped out will see the positive aspects of what he did and not dwell on the circumstances that he found himself in before we arrived.

For us closure is simple (apart from the real bad jobs involving kids or multiple fatalities).  And if we should need help we can always talk to each other using dark humour etc. Members of the public dont.

I just hope that the young man is okay……