Twice

My last call for yesterday was to a “65 year old female, fall in street, possible head injury”, I was only two minutes away, and I was happy to do a nice simple job.
Falls in the street are often minor injuries, where I have to do little other than minor treatments, and give a bit of the old Reynolds chat

I pulled up on scene and saw a crowd of people standing around, looking fairly relaxed, and in the middle of them a woman lying on the floor. Someone was stroking her hand.

I walked up, looked down at my patient and said, “Hello, what seems to be the problem”.

There was no answer, and her eyes kept staring ahead.

I checked her pulse, she didn't have one, nor was she breathing.

“Oh… Bollocks”, I thought.

I quickly started our treatment for this condition. Connecting my defibrillator to her (A box that monitors heart rhythmn and can 'shock' the heart), I saw that she was in 'VF'. 'VF' is what is called a 'shockable rhythmn', which means that I can give her heart an electric shock in an effort to restart her pulse.

When you see Doctors on the telly shouting 'clear!' and then the patient's body jumping, this is what is happening.

So I 'shocked' her three times, when I wasn't shocking her, I was doing CPR (pushing on her chest to keep the blood flowing to her vital organs) and breathing for her with my ambu-bag. I'd had to cut her clothes off (so I could attach the pads through which to deliver these shocks to her chest).

All the time I was fully aware of the crowd around me, and I was hoping that none of them had a cameraphone. None of the bystanders had seen anything, and none of them knew the woman (it looked to me as if she was just popping down the local shops).

The crowd were thankfully no trouble, actually they tried to be helpful – one person offered to help me with her breathing (I refused, because in reality it's tricker than it looks). There was another person who helped me, by running into their house and getting me some paper towels.

Why paper towels?

Well, I tend not to wear gloves, and while trying to resuscitate her, the patient had vomited up her last meal. So my hands were covered in her vomit. The paper towels were so I could wipe my hands before belatedly putting some gloves on.

So the crowd were, as we say in this part of London, “As good as gold”. They didn't get in the way, they didn't annoy me by asking awkward questions while I was busy, and even the little kids who were watching were well behaved.

It took a long nine minutes for the ambulance to arrive, not their fault, they were a long way away, and the traffic at that time of the day is pretty heavy.

We continued to attempt a resuscitation, and at two points we managed to restore the patient's pulse. Unfortunately she later died in hospital.

Once more I was left thinking about the relatives, who would be sitting indoors wondering why mum/gran was taking so long to get back from the shops.

Also, a resuscitation attempt is not the most dignified thing to have happen to you. That this woman had to have me cutting her clothes off, me jumping up and down on her chest and vomiting over herself, all in full view of the crowd, is not the best way in which to leave this world.

I'm hoping I have nothing but minor calls today…

44 thoughts on “Twice”

  1. Is there a way to state that you don't want to be ressucitated ? I've read about the US surgeon who had a “do not ressucitate” tattoo on his chest, but it's rather long and doesn't travel too well.Maybe there could be an international logo tattoo for people who want to be left alone if they collapse.

  2. Well, I can't say ambulance men have ever been on my top ten list of hot-men-in-uniform, but you've always sounded pretty darn sexy to me :-)(Regular reader, first post…)

  3. not the best way in which to leave this worldWell it's better than being left there. Given the choice between having my clothes ripped off (fnarr!) and shocked in public, or simply dying I think I'd take the chance of resuscitation.

  4. i would like someone to have a good go at resusitation, than just being left for my body to shut down completly

  5. if I am witnessed collapsing by somone with a defib in their pocket then go go go, otherwise leave me alone.

  6. Hello,I've had to do CPR once, and when the casualty was whisked off by the Ambulance, I was reasonably sure that he was going to die. It didn't affect me in the slightest – I just thought “I did the best I can do, at least I gave the man a chance, I'm sure his relatives/friends will be grateful for that”.

    Something that did bother me at that collapse was that when the Tech appeared in the RRV he wasn't wearing gloves either, and wasn't wearing them whilst he was trying to get a line into the cas's arm!

    Now, as a First Aider and Lifeguard, gloves and personal protection is drummed into us – as a consequence I always have two pairs of gloves in a wallet on my person. I am amazed that professionals who do this day-in day-out are so lapse about Personal Protection. I realise it can't be very pleasant to have your hands inside a pair of gloves all day, but the HIV scare that you went through I expected that you would be more careful.

    Congratulations on a very interesting blog, I've been a longtime reader, but this is my first comment.

    Regards, Dan

  7. this, absolutely. And if I was a relative, I think I'd prefer to know that every effort was made to save granny's life regardless of whether or not her clothes were opened in the process.

  8. One question as I am a little confused. Youve often complained about “minor” calls, people who didnt actually need an ambulance etc but is this what you want? Two suspended per day?So what would be the perfect shift? Who would be the “perfect patient”???

  9. I was a lifeguard for five years and only had one person who needed recessitation (sp?). Luckily her heart was beating, so I did rescue breathing. She spat up just water and foam (thankfully) and when the ambulence came she was still unconscious but very stable.The one thing I will never forget is the color of her lips and face. When she was pulled out of the water she was white with blue lips. I was just 17 at this time and had never seen a dead person before, so I wasn't prepared for the “look” of a non-breathing person.

    Luckily she was released from the hospital the very next morning and suffered no complications. I was told that normally pnemonia sets in when there is water in the lungs like her.

    The mayor gave me, the other lifeguard who assisted me (just 16), and the shift manager certificates of honor for the rescue. The whole thing seemed a little trite, but it was cool to be recognized like that.

    I hope things get better for you…

  10. I agree that after you have had a job like this all you want to do is have a nice quiet day. Unfortunately it does not always work like that.

  11. At a guess, a single, sexy twentysomething female, with something genuinely wrong but that will be resolved fairly straightforwardly and that doesn't stop her slipping the studly EMT her phone number?

  12. To be honest… Yes 'minor' calls are easy, but annoying to go to. Serious calls are more “fun” (wrong word, but I think you know what I mean), but involve people being seriously ill, which isn't a nice thing to wish on people.So, I don't want more seriously ill people, but a nice mix would be one or two 'proper' jobs a day. More than that and you'd end up burnt out.

    But I'd like a lot less 'minor' calls, or at least less calls from people who are taking the micky in asking for an ambulance.

  13. Meh,I can't drive with gloves on, then walking up to the house/patient, I'm carrying two bags, so can't put them on then.

    Also unbroken skin is a pretty good protector against the really nasty stuff (HIV), and if there is lots of 'gunk' around then I'll stop to put them on.

    Of course, when they vomit halfway through a resus, it's a bit of a pain (but again, there isn't that much you can catch from vomit).

    Funnily enough, I nearly always have a pair of gloves in one of my pockets when out and about…

    And if anything, the HIV scare I had made me realise how tricky it is to catch via medical work.

  14. Congratulations.Just goes to show that if you get to them quickly, then there is a better chance of a good outcome.

    (Did you have a mouth shield? Because without one I wouldn't do rescue breathing on anyone I didn't personally know.)

  15. Nasty but in my experience you normally feel better after a resus that goes well but is unsuccessful than when you arrive at a doa what do you think

  16. Poor lady. At least she was in caring hands. Oh to die in bed with loved ones round – but just in case – clean undies EVERY day!Pat

  17. That reminds me of a Billy Connolly routine about wearing clean undies in case you get hit by a bus. He made the point that emergency personnel aren't likely to give a damn what your pants look like! Or are they?Reynolds, have you ever been on a call to someone and had cause to see their knickers, and found yourself shocked and appalled at the state of them? If so did this event bring great shame on the dirty-cacked person's family? I must know.

  18. Many of the Paramedics I've worked with don't use gloves, and then after they've finished treatment they saunter over to the wash stand and rinse their hands, then splash some bleach on, and rinse again.Not something I'd recommend.

    We're all volunteers, so drumming the personal protective mantra into us is a good thing. The professionals play fast and loose, but they KNOW what the risks are.

    Dean

  19. All (or at least 80%) of men in some sort of emergency services uniform are “studly” to a reasonably large proportion of twentysomething females.FACT*

    (*may be pure conjecture)

  20. Aw, he stole my idea. I swear, when I turn 65, I am going to have a DNR tattoo on my sternum. I've done CPR, I've seen what happens, especially with elderly people with other health issues. If I am young enough, with a sudden accident, sure, give it a go. But otherwise- well, there are worse ways to die. And I would not want to vomit on some poor EMT, only to die later anyway.Reynolds, I think I know what you mean about “fun”, a call that needs your skills, but everything works out?

  21. You're utterly right there. I often find myself completely torn when I see a police officer. I have this feeling I should be wary of rozzers (not sure why… never been in trouble) but at the same time I find myself drooling slightly. It is the uniforms.

  22. What if there is no time to wash your hands afterwards? Then I wouldnt wanna be your next patient, sorry

  23. Yes sure, in your dreams.Be honest, how many percent of your patients are actually female, in their twenties and additional to that pretty/good looking as well? The last time you had such a patient? *LOL*

  24. And even if theyve got all this one problem remains – theyre certainly hysterical and/or hyperventilating which means boooooring

  25. **ahem**(female, 23, no supermodel but not bad looking, collapses occasionally, but rarely hysterical or hyperventilating)

  26. So a mixture of both and seriously ill patients who can be helped, right?Another silly questions, do you actually mind how your patients look (smell) like? (If you know what I mean) E.g. if there were two 30 year old females. One is having a fit (so actually needing help) the other one is just having .. whatever.. a sort of panic attack. The first one is homeless, dirty, awfully stinky and drunk, the second one fairly “normal” (a bank clerk for example). You could actually help the first one by doing whatever and then do nothing but talk to the second one (as she doesnt wanna calm down anyway), who would you prefer??

  27. Tom, Diamond Geezer's post today made me want to come here and tell you how great you are, even if I don't often comment. I read your blog religiously, but because I'm Australian the time diffence often means that by the time I want to say something, someone has alraedy said it…Anyway a big 'Thankyou' and when my tax cheque arrives I'm going to buy you something from your wish list – so make sure it is up to date!

    Regards,

    Carolyn.

  28. Well, I've often asked a local shop, or if in a house if I can use their sink (and have never been refused). Also we do carry alcohol gel in the car – which I use religiously after every job.

  29. Young + attractive + not 'suffering' from something daft +single + has a thing for men in uniform who work 12 hour shifts, come home and either sit on a computer, or just fall asleep?Zero.

    Trust me, ambulance work does not give you great opportunities to meet members of the opposite sex.

    Which is why a lot of people go out with nurses, and hospital receptionists (apart from me, as I don't get to go into the hospital much while working on the car).

  30. Well, obviously I like my patients to be clean and smell fragrant.But.

    To be honest I care less what you look like, and more about why you have called an ambulance, and what your attitude towards me is. Unless I've had a really bad day, I'm always polite to people, and (accepting that illness/injury can affect how people react), as long as they are reasonable towards me then I don't really mind what people smell like.

    But I'll take a panic attack over a fitter anyday – much less to go wrong with a panic attack…

  31. Yep “Fun” = genuine call + use of skills + good outcome.And yes, I'll be having that tattoo myself once I reach a certain level of health.

  32. Depends on my mood.If I'm feeling lazy, then a dead body that I don't have to do anything with (especially if there are no relatives around) is preferable.

    But a proper resus does get the old endorphins rushing around the body, and again, it's a chance to use some proper skills.

  33. Oh yes……we all have cameraphones especially designed to take pictures of dirty underwear and email them to your mum.

    Actually, I can't remember ever really worrying about the state of someone's underwear – if they are ill enough for me to be cutting off clothes and seeing them, then there is a good chance they have either just pooed themselves, or I'm a bit to busy to check for skid marks.

  34. Thanks for the comment, and for the offer, but there is no need to get me something from my wish list. (It's mainly there so I can remember the DVDs and stuff that I fancy buying).

  35. What happens if DNR is the persons loved ones initials that hes had tattooed as a loving gesture!!!????

  36. Don't count on it. It's been so long I'd probably offer to clean your knee just so I can touch you up.

  37. Actually I am all of those things…. apart from attractive. So if you don't mind a whale, I'm yours.

  38. I'd be in favour of designing a logo meaning that :- to avoid confusion when your loved one is named David N. Roberts or Diana N. Reynolds.

    – to break the language barrier

    – to shorten the tatooing process, “do not ressucitate – ne pas ranimer – etc” is quite long đŸ™‚

    I wonder what should be in this logo, though…

  39. Two suspended patients in a shift or two suspended patients plus eight annoying time-wasters; you choose. (I know; I work too hard!)

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