(What I'm going to post about might come across as being heartless, or myself being lazy – I don't think I'm either of them, but if you disagree with this post, as always feel free to leave a comment)
Tonight we got called to a residential home for an 87 year old female with 'difficulty in breathing', once again it was way out of our area of coverage, but we made good time to get there. I've been to this home before, and it is one of the better homes I've visited – the residents are always clean, and appear well looked after. The care staff know their 'charges', and are always friendly, helpful and courteous towards ambulance crews.
I knew there was something wrong from the face of the member of staff who met us, she had a look of total concern, and I don't like to see that look on someones face – it never bodes well. We went through the clean corridors and busy lounge of the home into one of the residents rooms. There were three nurses there, one of which was crying (something I don't think I've ever seen before) – laying in the bed was a little old lady who was extremely close to death. Her pulse was weak, and thready, something I could have guessed by the patients colour. I very quickly told the staff that, yes, she was extremely ill and that she would have to go to hospital unless she had a 'Do Not Resuscitate' order. The staff said that it would be best to take her to hospital. We scooped her up, and her heart and breathing stopped in the lift to the ground floor.
I don't believe in a 'slow blue' (where CPR is performed by 'going through the motions' knowing that the patient will not survive and that the CPR is for the benefit of the relatives), so I started active, aggressive treatment while my crewmate drove us the five minutes to hospital. The patient remained in Asystole (no heart activity at all) and on reaching hospital the doctors there declared her dead.
I may have previously mentioned the study that showed that “out of'185 patients presenting with out of hospital Asystole arrests, none survived to be discharged“. Both my crewmate and myself, and the hospital staff knew that this patient had no chance of survival – and that the reason we started CPR was because of our policy to commence resuscitation except in certain tightly defined circumstances.
If we had got there a minute later, the patient would already have died – in her bed surrounded by people that cared for her (although not her family) as opposed to being hoisted out onto a chair and then suffering the indignities of CPR in the back of an ambulance. While trying to resuscitate her during the transit to hospital I found myself looking into her dead blue eyes, apologising to her and hoping that she couldn't feel anything that I was doing to her.
I don't know if it is because I've had one and a half hours sleep in the past thirty eight, but it made me feel bad to put her through the indignity of pointless CPR. I know the policies are there to protect us (and members of the public), but sometimes I wish we could use some discretion.
Now I'll see if I can get some sleep.