Fallen

'Male 56, fallen'

I turn around to the student who is working with us for this month and tell her that it's probably some bloke who is drunk – after all, that is the sort of job that I tend to get sent to.

As is traditional the call is on the other side of our patch to where we currently are, but thankfully we can whizz along the A13 to get there that much quicker. It's not even rush hour.

As we pull up outside the house my subconscious starts shouting at me, I don't know if it's the behaviour of the relatives or something else, but I yell to my crewmate that she should bring her big bag of paramedic tricks with her – I grab the oxygen bag and the defibrillator and make my way into the house.

I follow someone who I understand is the wife into the house, she leads me along the corridor telling me that she was making a cup of tea and when she came back from the kitchen her husband had fallen over.

Before I enter the living room all the alarm bells in the back of my head are ringing – I couldn't tell you why I had that feeling, but I've learnt to listen to my inner voice when it is screaming at me, it doesn't send me wrong.

Sure enough our patient is face down on the carpet, not breathing and his skin is that deeply unhealthy bluish-purple that tells me that he hasn't got a pulse.

Over my shoulder I hear the wife ask if he will be alright, another woman ask if he'll be alright for the disco tonight and a boy wailing.

I'm on my own for the minute, my crewmate and student are still gathering the kit from the ambulance. I have long legs and I tend not to hang about getting to the patient, especially when I'm getting the 'bad vibes'. Unfortunately this can put me some way ahead of my shorter-legged colleagues.

I roll the patient over and start the CPR – he looks pretty far gone to me, but you never know. The training takes over, I haven't been flustered at a cardiac arrest for years and I settle into the familiar patterns.

Crack, crack, crack, crack go four of his ribs. I always wince when I break someone's ribs, sadly it's pretty much unavoidable if you are doing CPR properly – it's worse when you feel the ribs go on the little old ladies that have bird-like bones.

I pump away and can hear my crewmate asking where I am. I think for a moment, trying to remember my route into the flat.

“Down the end of the corridor, and it's a suspended!”, I shout.

My crewmate and the student arrive, I tell the student to place the defib pads on the patient's chest which she does perfectly. Someone gets out the ambu-bag and I suggest that I 'bag' the patient (breathe for him), while our student can do the CPR and my paramedic crewmate can do all the other things like popping a needle in his veins and preparing to intubate him.

At some point I send our student back to the ambulance to call for another crew – with a cardiac arrest it's always handy to have a second ambulance to help out.

The defib tells us to stand back as it wants to analyse the heart rhythm to see if we should 'shock' the patient – I look at the screen, it's a pretty obvious case of VF, something that we do shock. For some reason the machine isn't completing it's analysis, it keeps telling us to move away from the patient even though we aren't touching him.

Just as I'm about to put the defib in manual mode and do it my own damn self it decides that yes, perhaps a shock is advisable.

Our student gets the honour of hitting the button. She checks that we aren't touching the patient, presses the button to shock him and our his body gives a shudder.

The relatives keep asking if he will be alright, one of them mentions a disco again and I think then leaves the house. I have my mind on other things, but find the time to tell them that because our patient is very sick we are pumping his heart for him and breathing for him.

I ask my crewmate if she wants to secure his airway by intubating him, she's been trying to get a line in because she knows that I can handle airway management pretty well. She throws me a cannula in it's packet and tells me to get venous access, while she starts lays out the kit she needs to pass the breathing tube.

Our student keeps up the CPR, and it's good CPR at that – training school seem to have been doing a good job in teaching CPR.

I insert the cannula and secure it while my crewmate gets the breathing tube down in one swift, smooth movement. At the hospital the anaesthetist will compliment my crewmate on her intubation skills. She won't tell the doctor that she had to tube the patient while half curled up in a tiny space half under the TV.

One lot of drugs go in through the cannula, the patient gets shocked again and would you believe it, he gets his pulse back and starts breathing.

The trolley is fetched and we continue to stabilise the patient. It's looking pretty good, he's got nice strong breathing and a very strong and regular pulse. He could be sleeping were it not for all the bits of medical kit sticking out of him.

We lift him onto the trolley and are loading him on the ambulance when two FRUs and another ambulance turn up.

“You're too late”, I tell them, “we've got it sorted – look he's even breathing for himself”.

“Sweet”, comes the reply from a FRU responder.

We plug him in to our ambulance equipment – his vital signs are all exceptionally good, better than mine at that moment I would guess.

We pre-alert the hospital and make a run for it, our student is driving while me and my crewmate monitor our patient – it's looking pretty good for him.

At the hospital our patient starts to wake up, so the doctors knock him out so that he can rest and so they can do some more diagnostic tests without him fighting them. There is no obvious reason for his cardiac arrest and some of the other tests performed are pretty hopeful for his recovery.

We later find that he was moved to another hospital as that is the nearest with an empty ITU bed. It's a bit of a shame as it means I won't be able to follow him up to see if he survives to discharge. It's a shame, I'd really like to know how it works out.

To see if he survives his 'fall'.

—–

On May the first I'll be at this event – Cory Doctorow and Charlie Stross (two of my favourite authors) will be talking about how to escape the surveillance society. Proceeds go towards the excellent Open Rights Group. Doctorow is an annoyingly effective and engaging talker and, while I've never heard Stross talk in public, I would imagine that it will be an very entertaining and educational evening.

You can register for tickets at eventbrite. Well worth £10 of anyone's money, or if you are feeling particularly wonderful, for the cost of a subscription to the ORG. If you come along do say hello.

15 thoughts on “Fallen”

  1. Well Done! Can I ask why you don't use the defib in manual mode all the time? I'm sure you can interpret a rhythm (especially VF/VT) much quicker than the machine.

  2. Nicely done. Reminds me a bit of when my Dad had his first major angina attact; Mum thought he'd “had a funny turn”, my two younger sisters were hopeless. Thankfully Dad wasn't as bad as your patient though.I'm guessing the woman going on about the disco was just in denial, trying to tell herself it wasn't as bad as it looked rather than just simply clueless.

  3. It's default setting is to be automatic, I'm guessing as an anti-litigation measure. Normally it's fine, but yes, it does take a few more seconds.What it is good for is timing when shocks are due – when you are doing a one or two person resus not having to watch the clock is one less thing you have to do.

    (Of course, if I could programme an iPhone, that'd be my first application, an automatic timer for resus that jogs your memory as to when to give what drug and then logs what you did at what time.)

  4. Great to hear about some “real” ambulance work. If I ever have a “fall” I hope you guys get the call!Hopefully episodes like this one go some way towards compensating for all the shite you have to contend with.

  5. Wow, that was genuinely tense. Congratulations.As for breaking ribs, my wife who worked in a care home was told that unless a rib broke, you really were not doing it hard enough. Strangely this is something that never comes up during first aid courses for the public!

  6. Are techs cannulating in London now? Is that part of the extra to get to EMT4? I have never quite got my head round that! lol

  7. *Technically* no, but I can cannulate under 'Paramedic supervision' – as it's something that I used to do as a nurse it's something that my crewmate is happy for me to do.To be honest I have much more experience sticking needles in people than she does and so she saves me for the awkward cannulas…

  8. Years ago when I did my offshore certificate the chap teaching the first-aid course said that unless you broke a rib, you weren't doing it hard enough too. He went on to say that if you're doing it on an old person it will feel like beating up a packet of breadsticks. Charming.

  9. Strangely this is something that never comes up during first aid courses for the public!“I'm guessing because people have selective hearing, and would be concentrating on breaking ribs INSTEAD of actual CPR…?

    That whole Milgram experiment thing, and so on.

    Or maybe I'm just talking out my fundament! :o)

  10. Just out of interest, do you have uniform algorithms for treatment of asystolic arrest/PEA ? If so, what are they ? Here in the US, everybody uses the American Heart Association ACLS algorithm.

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