Watching The Crash

'Cardiac Arrest – Mental Health Unit'

My regular crewmate was sunning herself in France and I had someone working with me who'd only been out of training school for her first practical experience for the last two weeks. I'd already done one job with her and she seemed totally sensible.

“We'd better take all the kit in”, I told her while buckling my seatbelt, “this could be anything from a cardiac arrest to a blocked nose”.

It is somewhat telling that when we get sent to a mental health unit, no matter what they have called us for, we never quite know what to expect. It's one thing to accept that a member of the public can't tell 'chest pain' from 'bellyache', it's quite another to have such mix-ups from a healthcare professional.

We arrived at the unit to discover an ambulance already there – it would seem that we were being sent as a second pair of hands. Sure that the first crew would have all their kit we still took ours in, you can never be too careful.

The door to the unit was locked, so I leant on the buzzer and one of the nurses came towards the door with the normal foot-dragging shuffle that I see a lot in these sorts of unit. She opened the door and stood there with her mouth open.

“Cardiac arrest?”, I asked striding past her.

“In”, was all she said.

I kept walking, obviously the patient was 'in' the unit, but where?

As we reached the end of the corridor I saw a group of people, all wearing unit ID badges standing around with their arms crossed watching two of my fellow ambulance staff working the resus. I relaxed somewhat when I saw who it was, the crew who were already there are one of the good ones ('I'd trust them to treat my mother' as we say in the service). The medic was passing a breathing tube while the other was doing CPR.

So, my crewmate and I bundled in and gave our assistance, it was a fairly straightforward resuscitation to be honest, CPR, breathing tube, IV access, drugs, more CPR.

What annoyed me was that the 'crash team'* from this unit were standing around watching us work – no offers to help, no-one suggesting that they get IV access, no-one offering to take over the CPR from EMT who started some minutes ago**

No help, no talking – just standing there watching. Doctors and nurses seemingly not knowing what to do at a cardiac arrest, yet still on the 'crash team', watching four stretcher-monkeys getting on with it, making the decisions, performing the interventions. We are lower status, are on lower pay, and yet we were the ones having to take charge.

I wondered what they were doing while they were waiting for the ambulance to arrive.

We took the patient to hospital, where they sadly died.

I mention this, not to celebrate ambulance crews, but more to show my concern that the hospital unit staff seemed so aimless. The scary thing is that this sort of occurrence doesn't seem all that unusual. At least where I work.


*A Crash team is a group of doctors and nurses that come running in the event of a cardiac arrest

**I understand that the latest guidelines, in America at least, is that you swap whoever is doing CPR every two minutes because it's too tiring.

15 thoughts on “Watching The Crash”

  1. I have to say, it really does happen here in the US where people switch out every round… only if they want to of course. Lots of our firefighters and police like to do 2 or 3 rounds before they switch out. And yes, they usually do our compressions for us while we deal with airway and IV access and meds and whatnot. Or they make great IV poles. Either way, they're very helpful.

  2. Hello Tom, I performed CPR a few days ago on a stranger in the street. I was the only person there (aside from some sobbing waitresses who did nothing) & did it alone for 6 minutes until someone else came by & at 8 minutes, the ambulances both arrived. We carried on whilst the crew got an airway & IV access. It was exhausting. For the first 6 minutes I was also trying to answer ambulance control's questions, propping the phone on my shoulder. It was a complete nightmare. The stranger was dead, we all knew it. They didn't even have a shockable rythum.I have a question I wonder if you can answer… when I got through to ambulance control I said 'I need an ambulance' control then asked where I was (I didn't know, I was lost in a city I do not know well) so the howling/sobbing waitress nearby told her. It was the only English she knew.

    She did not even know to call 999.

    I then spoke to control again… I said that I was with a collapsed person, that the airway was open, there was no breathing and they had no pulse – not even a femoral one. I said that I was starting chest compressions & she told me to wait, to be sure they weren't breathing. I checked again – using a makeup mirror to be sure & I explained my job (I am NHS too) & then started CPR. She asked me 3 times if I was declaring a cardiac arrest & I replied 3 times that yes, I was. Was this because she was going to commit 2 crews to the call? I just wondered really, as it seemed like the longest phone call of my life.

    We carried on CPR for 26 minutes on the street.

  3. Well, I live in Italy and I've been volunteering on the ambulances for about three years now (we have no paramedics and almost all rescuers are volunteers in Italy – that's also why I'm going to apply with the LAS as a student paramedic asap).Following a ratio of 2 lung inflations every 30 chest compression, we're trained to swap places every 5 compression-inflation cycles. The medic who trained me claimed that it's because after so many compressions your cpr becomes ineffective, so you need to do something less tiring for a while before you compress again.

  4. Well, I live in Italy and I've been volunteering on the ambulances for about three years now (we have no paramedics and almost all rescuers are volunteers in Italy – that's also why I'm going to apply with the LAS as a student paramedic asap).Following a ratio of 2 lung inflations every 30 chest compressions, we're trained to swap places every 5 compression-inflation cycles. The medic who trained me claimed that it's because after so many compressions your cpr becomes ineffective, so you need to do something less tiring for a while before you compress again.

  5. Contrary to Tom's view, when Iworked in Epsom in the 1981's, we were given occasionally accurate infromation. I say this now, because what I understand of mental health sevices now and then have absolutely no relation.The printer chirrped, and the 'bells went down' to a call at a local institution which simply read, “male, penis cut off”.

    Great! Better take the kitchen sink then, because lord knows what we'll need.

    On arrival, we got the story. Patient passess unlocked office and see's a glass ashtray. Patient breaks ashtray on the desk, and is in the process of 'sawing' off his giblet when a member of staff intervenes.

    Crew attend, and see 'willy' wearing a lovely bandage more in keeping with a bow tie. But, the appendage is not bleeding as bad as we thought. Staff watch listlessly as the 'carpenter' is removed.

    Moral. Nothings changed then. But I will add. CPR is 'KNACKERING.'

  6. Well… yes.Out in the community it's often a little different.

    (Of course, I remember being able to do 5:1 *forever*. Of course, all our patients died…)

  7. I would imagine that Control have a protocol to follow when there is someone who sounds like a professional on scene – I'm not sure, NeeNaw would be best placed to answer this.Any emergency phonecall feels like a long time, I've turned up at an arrest one minute after the call was made and the relatives have told me that it seemed like forever before we turned up.

    Others have commented that they turned around and we were there – people are funny like that…

  8. The evidence says two minutes – which ties in nicely with the ALS timings.Just one question, do MHUs have 'crash teams' as such? The one's I've worked in certainly didn't – the most the emergency team could offer at an emergency is a strong arm and a shot of 'ten 'n' two'.

    Although it's frankly shit that they're standing watching, you're almost certainly far better trained and certainly far more experienced when it comes to ALS and the practical skills.

  9. What this post tells me is that there is a critical piece of training that ambulance drivers get drummed into them that doctors do not: how to take charge and otherwise respond in an emergency situation.I suspect that the typical doctor is trained to think slowly, thoroughly and ponderously about things before deciding on a course of action, because in every non-emergency situation that's the right thing to do.

    If it were me, and other people were handling the problem, I'd be standing nearby, displaying my badge clearly, and waiting to be asked for anything the ambulance people needed, but not getting in the way or otherwise distracting them. That's the common sense thing to do, and if everyone else is doing it too, it would feel like the *right* thing to do.

    Another factor might be politics: the junior doctors present wouldn't want to step forward to volunteer if the senior ones didn't, since they'll be following the lead of the senior ones. The senior ones wouldn't step forward, because to be rebuffed by an ambulanceman would be a huge loss of face in front of the junior ones. So everyone just makes themselves available and waits to be called upon.

    Never been in that situation, am not a doctor, but that's how it feels to me that people would react in that situation. Once a “take charge” person arrives, everyone else tends to default into “watch and obey” mode.

  10. Dewi Morgan does make a very good point.Ambulance personnel are told, and trained how to manage a crisis. And in my experience, both in the military, and ambulance service, when such a person attends, it appears natural for those (bystanders) to defer to the 'alpha' responder.

    It is a good point, very well made.

  11. SJA training tells us to swap every 2 minutes if possible because you get knackered and CPR becomes inneficient as previously stated. I find two cycles on 'Annie' knackering……………… Though in real life you will have adrenaline running!I too have witnessed doctors and other HCPs not being able to help in an emergency, though it was when they were out of their comfort zone with no de-fib or drugs to hand.


  12. I agree that Dewi makes a good point about letting 'Alpha' responders get on with what they're good at – they are likely to be much better practised at what needs to be done. However, the guys standing around gawping included the Crash team and other so called professionals which begs the question what are they doing rubber necking? These guys surely have a more useful role doing their best to ensure the privacy and dignity (such as it is) of the patient being resussed as well as taking care of other patients on the ward, some of whom will undoubtedly have been distressed at the incident occuring in their midst.

  13. Can i just say as a member of staff who works in a mental health unit (private) that we are trained in first aid but personally I would feel that if an ambulance turned up that the people who work there are more medically trained and therefore better off carrying out CPR etc. I would feel more confident in the abilities of EMT's/Paramedics who carry out things like that on a daily basis compared to me who has been trained to use it but no matter what our lovely patients do to try and kill themselves?DSH (pen swallowing is a big thing) the actual chance of us using first aid is very very unlikely! That is my personal opinion anyway. Oh and we are MASSIVELY underpaid…. 6.75per hour to be attacked and assaulted on nearly a daily basis and they still say we can't use “control” and restraint only management of violence and agression.

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