If someone is to survive a cardiac arrest then certain interventions need to happen as quickly as possible. The two main procedures in this instance are early CPR and defibrillation. Of course, actually being able to get to your patient in the first place is probably just as important . . .
We were just helping our patient move across to the hospital bed at the [tippy title=”London Chest” URL=””] The London Chest Hospital is a Cath Lab. A specific hospital specialising in cardiology. Some hospitals have Cath Labs attached to them. Either way, if our patients are confirmed having a heart attack or we are able to get them back from a cardiac arrest and they are still presenting with a heart attack then this is where we take them. Even if we have to pass several hospitals en route to get there this is where we go – as this is where their best chances of survival lie. [/tippy]. He was fully alert and had been talking with us all the way to hospital. As he hopped across, his face winced and he clutched at his ribs.
“Oh-oh-ouch! My chest really hurts”
I raised my hand in the air and felt wave of embarrassment spread over me.
“Erm . . . yep. That would have been me. I sort of ‘cracked’ your ribs whilst I was doing chest compressions on you . . .” I mimed the process of CPR thinking it would make it all seem better, “um . . . sorry.”
He smiled . . . I think.
This was the first time I’d been part of a resuss where a patient had come back to fully alert AND talking. Normally, if a patient is brought back from the proverbial light at the end of the tunnel then the best we usually get out of them is a heart beat. And possibly some form of breathing. And a bad back – for us. But never talking.
As arrests go this was pretty straight forward. A little bit of CPR, three shocks on the defib and bam! – one alive and kicking patient!
Well, almost. The alive bit was right. And so too was the kicking. But ‘alive and kicking’ in the metaphorical sense was pushing it. He was literally just alive and kicking. His brain had been starved of oxygen so when he eventually began making efforts to breath for himself his body went into survival mode and started thrashing about violently gasping for air. At this stage he wasn’t with it at all and appeared more like a gold fish flapping on the floor.
Thankfully, by now there were six of us on scene which meant it was possible to hold our patient down whilst he punched out with two arms and kicked with one leg . . . . . ah, yes, let me explain – in our efforts to pull our patient into the middle of the room, (to have more space to work) I had inadvertently ‘yanked’ off a prosthetic leg. And in doing so I was propelled across the room landing on my back. I still had the leg held out in front of me as I lay staring up at the ceiling . . . there was much mirth.
The trouble now was that we had to get this patient to the Cath Lab as soon as we could. At this stage under normal circumstances, the patient would be stabilised in one position and egress would be sought by the most careful way possible. Unfortunately though, we currently had several of us lying in various positions across our patient desperately trying to hold him down whilst at the same hoping he would stay alive. It was, sadly comical. At any second he could revert back into cardiac arrest . . . which, if I had to be brutally honest, would prove a lot easier to manage than where we were at this present stage. But I believe the saying goes, ‘you play that hand you’re dealt with’.
It was decided to call [tippy title=”HEMS” URL=””] “Helicopter Emergency Medical Services”. These guys will get to calls quickly and deal with extreme trauma cases. Great idea as the team consists of an emergency Doctor and a couple of advanced paramedics so their clinical skills are far superior to those of an ordinary ambulance crew. They also operate from a fast car – and they all wear bright orange jump suits . . . which don’t always fit properly! [/tippy]. This way they would be able to “sedate” our patient . . . ie knock him out . . . and then we’d be able to transport him safely to hospital. But typically, by the time the orange jump suit clad super heroes walked in, whipping off mirrored aviators and revealing super sparkling white smiles – our patient had already calmed down to the point of talking with us. But, at least they were kind enough to stick around and give us a hand moving our patient down to the ambulance.
And so, here we were, helping our patient move across to the hospital bed where he was about to receive some life saving angioplasty, his hands still nursing his broken ribs. And, as we sat in the ambulance afterwards it occurred to us that albeit the process of dealing with our patient’s cardiac arrest was reasonably straight forward, the motions in how we got to him were not.
He had been lucky. Very lucky. Lucky that we were able to randomly pick out his unmarked block of flats straight away amongst the dozens of other unmarked tower blocks that were stacked haphazardly all about the place. Lucky that one of us were flukily carrying a non-issue personal LFB ‘skeleton’ key that gained us entrance into his block. And lucky that our patient had managed to leave his front door open before collapsing. Because, if just one of those events were different he would most likely be dead by the time we actually got to him.
I think its safe to say the LAS are at their best when it comes to cardiac arrests. This is cocky I know, but in the pre-hospital environment we have some of the best skills in dealing with this and arguably the most experience too. But, at the end of the day, no expertise in the world can replace good old fashioned luck. And that’s what ultimately saved our patient’s life I reckon – luck.