Wednesday, 8 May 2013

B.O.G.O.F

"88 year old female, DIB"

For those that read my blog regularly, you will be able to tell the mood I was in by the following three pieces on information:

1) It was 06:55
2) I'd had no coffee
3) It was raining

Not a good day thus far! I was tired, grouchy and awful company. Luckily for me, the crew mate is also not a morning person and we know each other well enough, not to have to make small talk. We communicated with nods and grunts until such a time we are awake enough to function! Getting a job tends to wake us up so being sent to a local care home woke us slightly.

If we were still struggling with being alert, the update we received to say the patient was now in cardiac arrest snapped us out of it. We made our battle plan, we knew who was doing what, so when we arrived we each grabbed our designated kit and went in. As the driver, I was about 20 seconds behind my crew mate as I had to get some of the heavier stuff out the back of the ambulance. As I entered the room, he was starting CPR.

We started going through the routine, I took over compressions while he attached the pads, checked the rhythm and began to secure an airway. Once that was done, he took over compressions whilst I started to look for IV access. Still no second crew or FRU but it was shift change over time to that was little surprise! Then 7 words were spoken by one of the careers....

"We have another patient in cardiac arrest."

This wasn't part of our battle plan! We starred at each other for a few seconds then my crew mate just said "GO!". I pressed 'priority' on my radio, I grabbed the spare defibrillator, ran (yes, I actually ran) to the ambulance, grabbed more oxygen and ventilating bag, more drugs and the spare paramedic bag and ran (ambulance walk now) back inside and up the stairs!

Sure enough, lying on the floor was another patient with a carer doing CPR! My radio started ringing whilst I was asking the carer to continue!

"Red base, we now have 2 patients in cardiac arrest, we require at least 3 more resources on scene."

"Rog, understood, you have an FRU about 3 minutes away."

I attached the pads whilst the carer continued compressions then I started oxygenating the patient. I couldn't think straight! I couldn't really comprehend what was going on! I hadn't a clue what was going on downstairs! How was my crews mate doing? How was our patient?! You need more hands than what we had available too us. There is something very unnerving about being put in situations you are not prepared for. I've often spoken about how the journey to a job is crucial for gathering thought and getting mentally prepared for the worst case scenario you may walk into. THIS, neither of us were prepared for. I couldn't help my mind wondering to the patient down stairs.

The history of my current patient was vague, she had been seen this morning but then found not to be breathing. CPR was being done so I carried it on until I had some help and a chance to step back and think! Within 5 minutes the cavalry arrived, a total of 3 ambulance and 3 FRUs all descended on the care home! As it was student season most of them had a student too! The 12 of us got split between the two rooms and eventually I was able to return to my original patient!

Unfortunately, despite our best efforts, we terminated the resus of patient 1 after 20 minutes of advanced life support. We cleared up our kit and headed out to the ambulance car park to request the police for an unexpected death. 5 minutes later everyone else from upstairs appeared. Patient 2 had also passed away despite being given the best chance. All that was left was a mass of paperwork.

This job will always throw curveballs at you, generally when you least expect them. Today the grim reaper won, tomorrow we will win. It was going to be one of those days.

14 comments:

  1. Care homes and CPR??? Mmmm, all you needed was to set Billy Bass off. Don't worry, be happy! ;-)

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  2. Bloody hell, no other words.

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  3. But you can only do your best . Thank you and your colleagues .

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  4. .....a SPARE defibrillator......!

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    1. Until I moved trusts I would have thought that but yes, around here we carry a lifepack 15 and a (LP1000 or FR2) AED with manual mode and monitoring leads.

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    2. YES! We have an FR2 AED and a Lifepack 15 with built in defib!

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  5. Bless you and your partner for the work you did on that day (and always). Your honesty in writing shows me the side of EMS that often escapes nurses in a long term facility. Not sure what State you are in. In California, we have POLST forms - similar to DNR forms but much more complete. Do you have them? Being a supervisor, I am extremely cautious that every resident have one in order for the EMS to know what the residents end of life wishes are. They are on pink paper as to find it in the chart immediately. I know only some states have them, but the paramedics appreciate the forms so they know how to handle these emergencies. Linda, LVN, CA

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    1. Thank you! We do have DNR forms, sadly care homes are notoriously bad at producing them when needed!

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  6. Ouch, rough morning, hope your day went better. I think this just makes me appreciate it more and more that when we go for something that sounds even vaguely serious the fire department sends an engine and the police usually send an officer too, gives us lots of man-power on scene.

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  7. Sorry for such a dreadful start to the day but welcome to the world of a CFR. Try being on your own every time. I've had two deaths at care homes and each time I was on my own for at least 5 mins. Just me and a defib. Last time I kept going with CPR for around 20 mins. Defib never found enough to shock so I knew it was probably a waste of time but I kept going. Later analysis shows I nearly got enough to shock but at least both were in their 90s and at least I never got two together. I'd be shafted then. :-)

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