Wednesday 22 May 2013

A Bridge Over Troubled Water

"29 year old male, cardiac arrest"

Even before we got this job I had a strange feeling. I can't describe it, something just didn't seem right! I was on edge like I was waiting for something to happen.  Well,  a 29 year old in cardiac arrest was enough to snap me out of my odd state! Generally the cardiac arrests we do are on the elderly. In fact, I'd say at least 95% are over 65, maybe even higher than that. I'm not saying it's any easier doing a resus on a 80 year old but on some one younger it seems a lot more of a waste. Initially we only had a road to go by, so headed off in the general direction.

"UPDATE: Patient on a boat"

A boat. Of course he's on a boat. It's a big city, where else is he going to be?! The actually location we had been given was to an incredibly narrow, slippery concrete staircase, leading down to an canal footpath. Only problem was there are two sides to a canal and boats lines both sides. There was also two staircases to chose from and we had a lot of kit to carry! Oh, and obviously it was dark.

With all the kit you can envisage for a resus we headed down the stairs that were nearest us and started looking / shouting speculatively for a response. After about 100ft we got on! On the other side of the canal.....

So, about turn, and back we went, up the stairs, across the bridge, down the other stairs and along the footpath to the boat. Now, the boat. The clue is in the name, a 'narrow boat'. There isn't going to be much room to work, nor will there be room to stand or  move around. Once I'd taken a step of faith over the gap to the water I felt a tad safer. My crew mate passed me the kit and then followed me over. Then it was a case of squeeze down a tiny, shallow stair case into the heart of the boat and there was our patient, lying lifeless on the floor.

I quick primary survey showed that luckily he wasn't in cardiac arrest. He was however on the verge of respiratory arrest so I got ventilating him while my crewmate started doing 'other stuff'. His pupils were pinpoint and there was plenty of evidence to suggest a drug overdose to we treated as such. We have a wonderful drug called Narcan that reverses the effect opioid drugs pretty rapidly so we loaded him up with that. After about 8 minutes he started to respond and began breathing effectively himself. 

By now, the FRU had arrived, unfortunately, owing to the fact that it was a narrow boat he was made pretty redundant by the lack of space. He decided to go and fetch our carry chair! Good call! Although the patient wasn't conscious enough to talk in sentences our walk he was opening his eyes and thrashing around slightly which was kind of what we expected. He had already been cannulated by the time the chair arrived back so we got him strapped in and started the the arduous process of extraction! 

Up the stairs we went and on the stern (?) of the boat. Now the plan of how to safety get him, us and our kit across the gap of water to the foot path! Scrap that.....he started fitting. Full blown seizure and pretty violent at that. BALLS! We got him out the chair and onto the deck. This job was really going from bad to worse. We waited a few minutes to see if the seizure would stop. It didn't. We gave Diazepam and waited some more. Still fitting and we are getting pretty desperate now. More Diazepam. Still fitting......aaaaaand stop. A quick ABC check and he was up, on the chair and across the back faster than you can imagine! Sure enough, the second we got him on board the truck the fitting started again and this time it didn't stop. 

You'd think after all of that, the hospital would be appreciative of what we'd been through, but no, the Dr was just plain rude! He interrupted my handover with:

"Well he's probably still fitting because you waited 5 minutes to give him Diazepam"

He then ignored the rest of the handover and talked over me. He looked at us like we'd dropped a baby and spoke to us as if we were naughty children. He criticised and questioned why we waited to give diazepam despite showing him our guidelines. He wasn't interested. Professional courtesy and respect works both ways and today both were distinctly lacking from the doctor. It was a sour end to what had been a challenging and difficult job.

In hospitals you have every level of experienced medical professional at your finger tips. You have every drug, lots of expertise and the patient is on a bed. Pre-hospital you have 3 of us, one of which is a paramedic, one is a student paramedic and the other a technician, a patient not breathing and then seizing uncontrollably, on a narrow boat, in the dark. We are not miracle workers. We are not giving a gold standard of care that the hospitals are capable of. We are simply making the best of a bad situation. And as far as situations go, this was pretty dam bad!


  1. That could have been my drug taking, booze consuming brother that lives in the sticks on a narrow boat. You did your best, and I hope if, next time it IS him, YOU turn up!

  2. The police equivalent are CID - you go to a stabbing at 3am on a NIGHT shift when your area has teh fewest resources available at a time when you've started to run out of resources anyway and do the best you can, in the cold and dark with intoxicated or tired or reluctant witnesses. You do the scene preservation, the forensic stuff, you start what statements you can and when dawn breaks and the context of that job is irrelevant to everyone, the main query is around why more wasn't done ...... to which the answer is:

    If you'd wanted it done differently, you should have stayed up all night and done it yourself. That was the best that could be done in the circumstances and it's now time for the hindsight squad to get their pens out and police something. Good night! zzzzzzzz

  3. Maybe it should be compulsory for A&E doctors to have to do one shift a month with an ambulance crew.

  4. The bow is the pointy end, which often has a cover over it (and probably a plank to help you get on and off, if you didn't see one at the stern).
    The stern is the rounded/squared end with the controls sticking up above the deck and a big propellor (for chopping up anything that gets in its way) under it.

    If you have another narrowboat adventure, most will have a plank somewhere (I keep mine on the roof by the stern, between two plant pots) and I doubt that anyone on any of the neighbouring boats would object if you helped yourself to theirs.

  5. Ella, in my lined work i met two different crews last night. They were both clearly overworked and tired. But they remained professional, friendly and caring. Despite this, i also witnessed the negative attitude of the public as mentioned in some of your previous posts. I am always pleased to see you guys. Keep up the good work!

  6. I would send this blog into the department with the name of the doctor concerned! Obviously lacking insight and common sense..feel sad for his patients x

  7. The man's a prick, even if he IS a doctor. Can you imagine what he;s like with patients and relatives? Complain, you might just save his career!



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