Working in the ambulance service you are presented with all manner of problems and conditions.  Some are outright ridiculous (of which I am sure to write about at some point), others are way beyond our meagre training.  And then there’s the ones that fall within our skill range but don’t quite present in a “standard” way.  But, no matter what the job is or how it is presented, we are the front line staff that have to deal with it.  And deal with it we must – and sadly, we can’t always deal with things in a conventional way . . .

I recall one of my first cardiac arrests and remember it falling into the catagory of the latter points above.  I was working off complex and wasn’t long out of training.  To make matters more interesting, we were using an old run down LDV for an ambulance.

We had been called to a seventy year old gentleman who had chest pain.  Arriving at the same time as the FRU (even more satisfying in an LDV) we approached the front door which was being held open by a little old woman on crutches.

“He’s just in the back room – but he’s not talking now”  She told us as we edged passed, kit bags in hands.  I could see the man in the back room sitting with his back to us on the edge of the bed.  The flat was tiny and full of bits and pieces of personal belongings that had been accumulated over the decades.  I could barely move through the hallway so god knows how the little old lady managed on crutches!

We picked our way through to the bedroom where I placed the kit bags down and edged my way round to stand in front of him.  He looked sick.  Big sick.  His eyes were shut, sweat was pouring from him and he had a deathly pallor.

“Hello sir, can you hear me”
I went straight for the carotid pulse on his neck and as I touched him he drew in one last deep breath and released it slowly – almost typically like you’d expect in a film.  And then nothing.  No pulse and no breathing.  I quickly glanced passed the patient to the others and shook my head.
“Is he going to be ok?”  The little old lady asked looking round from behind the FRU.
“Come with me love and lets get some bits and pieces together to go . . . ”  The FRU led  her through into another room and out of the way.

The room was tiny.  There was barely twelve inches between the end of the bed and the wall and the only reason the patient was sitting up was due to the ridiculous softness of the bed. There was no chance of starting CPR here let alone doing advanced life support with three of us round the patient.  In that split second we knew what we had to do . . . we had to get him to the ambulance to work on as quickly as possible!

Moving a patient who weighs over 16 stone with no muscle tone, covered in sweat is no easy task.  Throw into the equation a bed seemingly made from jelly and a home full of clutter and your task becomes bordering hysterical.  With arms and legs trailing we managed to get the patient onto the chair and out of the flat. Racing to the ambulance, one of the patient’s feet slipped off the foot bar and jammed between the pavement and the chair almost catapulting him into the road.  Thankfully, we’d buckled him in and I was able to spin around in one fluid motion and drag him backward to the ambulance.

At the same time, a relative arrived and was able to take over looking after the little old lady.  This was a god send to us because once we got the patient onto our bed things quickly went from bad – to worse.

I yanked the BVM from the the oxygen bag in an attempt to do manual breathing for the patient, but the tubing got caught on the wheel of the bed, ripping the back of the BVM off in one swift motion.  In an instinctive action I reached up above me and opened a cupboard to get another one. My crewmate’s frantic driving had caused everything in the cupboards to pile up against the back of the door so when I did open it everything fell on top of me and the patient.

I connected the new BVM to the mainline oxygen and started “bagging” the patient.  Within seconds the oxygen stopped flowing!  Desperately I looked at the gauge and saw that it was empty.  Ok – all I need to do is switch onto a new bottle by pulling the lever.  I did this so violently the lever broke off in my hand.  Holding it aloft I stared at it, whimpering.
“Get a new bottle!”
“Where?” I sobbed.
My crew mate pointed to another cupboard and pulling it open I was able to retrieve another bottle.  Whilst I did this my crewmate and the FRU were busy dealing with their own mini disasters.  In his efforts to intubate the patient the FRU had spilled the contents of his bag across the ambulance floor and was frantically trying to organise himself.  My crew mate had started compressions but the de-fib machine had fallen off the patient down behind the bed yanking one of the wires off the pads.  He was now trying to peel off the old pads so he could put new ones on.

Eventually the patient was intubated and we were able to administer oxygen.  And, miraculously, the patient was in VF – a shockable ryhythm.  My crew mate held his hand up to us both.

“Stand clear! Oxygen away, top, middle, bottom, shocking patient”

When my crewmate pressed the “shock” button two things happened at once.  Firstly, the de-fib machine was flipped off the patient dropping behind the bed, again ripping off the leads to one of the pads.  Secondly, the patient’s arm flung upwards knocking the BVM out of my hand and onto the floor.  Instinctively, both the FRU and myself went to pick it up and bashed our heads together.  There was much cursing all round.

“Right!  I’ll drive!”  The FRU jumped out the back and into the drivers seat and got us going.

He didn’t hold back in getting us there quickly either.  By the time we arrived at the hospital, the contents of half our cupboards lay strewn across the floor and the patient.  We rushed him into resuss where the FRU gave the briefest of handovers and then we stood back to catch our breath and let the hospital do their job.

We were knackered!  But stood on to watch for the outcome.  The patient remained in VF for a long while and the consultant ended up recruiting a group of trainee doctors to take turns in doing CPR.  The first did fantastic compressions and appeared really keen.  Sadly, he was wearing a shirt, tie, cardigan and a jacket and within seconds was covered in sweat.  The FRU started chuckling and called over to him.
“Good compressions there son – but I bet you won’t be wearing all that clobber next time you come in eh!”

Next up was a short young round lady who had to stand on bed steps to reach over the patient.  The moment she started her compressions we all cringed.  Three ribs went in one go and it almost appeared as if the patient was folding in half with each compression.  She was practically jumping up and down on the poor man’s chest and the fierce look of determination suggested years of pent up aggression.

The FRU turned to us and whispered, “If he wasn’t dead before – he is now”.

We stayed in resuss to help in anyway we could but sadly the patient was pronounced dead about ten minutes later.  Afterwards we went back to the ambulance to complete our paper work.  Opening the back door an empty oxygen bottle rolled off and onto the ground.  We stared momentarily at the carnage laid before us and as one, burst out laughing.

A little later I handed some sweets round.  They accepted but took them cautiously, being mindful not to come into contact with me.  I looked at them quizzically and the FRU chuckled again.

“We saw what happened when you touched that patient.  You’re the Grim Reaper.  We ain’t touching you.”