Back at Last!

For a variety of reasons I’ve not posted for nearly a year. I intend to post a little now & again, then more from October.

One of the reasons I’ve not posted was that I’ve temporarily stopped being a CFR. I managed to cock up my annual retest. I received one alert, forgot about it and got a mail saying that I’d get another date that I’D BETTER NOT MISS!!! Unfortunately I then never got any more mail from HQ. Our Unit had virtually ceased to exist some time before this so I was acting as a solo responder.

I’ll redo the whole course in October and then should be back on the road. My old unit has now re-formed with some new faces I can look forward to working alongside.

CPR

I’ve been a CFR for a couple of years now (OK, underestimate), but I’ve rarely had to do CPR.

CPR, for the uninitiated, is not similar to a CFR (Community First Responder), though we sometimes do it. It’s Cardio-Pumonary Resuscitation – chest compressions and breathing for the patient. It’s used only when the patient has no pulse.

I’ve now done it for real twice in the last month. Before this, I doubt if I’ve needed to do it more than once a year. Unfortunately it didn’t work either time.

The first one was for a bloke of about 75. I arrived to find the Community Paramedic (CP) already performing CPR. She shouted to me to take over so I did, whilst she gave various drugs. She’d already checked to see if she could use a defibrillator, but no joy. I really gave it my best and continued when the ambulance crew arrived.

Unfortunately, this time my best, and the professionals’ too, wasn’t good enough. We had to accept that the poor chap was dead.

Walking away from the scene, the CP said to me “Your chest compressions are damn good. You did them as if you meant it.”

She may have simply been making nice comments, but she’s not like that. Her “nice comments” would have been more general, so I believed her. I felt I’d done the CPR as well as most professionals could – I’ve been practising for over 40 years, after all!

The other day, I had to do it again. This time I was first on scene to find an old lady trying to do CPR on her equally aged husband – and not making a particularly good job of it. Like most caring people, she was being too gentle.

I felt for a pulse in his neck and couldn’t find one. His neck felt a little stiff too.

Giving a couple of rounds of CPR, I then tried the defibrillator. No joy – no shockable pulse. Back to the CPR.

I was on my own for a few minutes and then the CP (different one) turned up about 45 seconds before the ambulance crew. They attached the leads to do an ECG and got a flat line. Well, first of all they got my compressions (as I don’t stop until I’m told to), and then the flat line. Checking the time since the patient first stopped breathing, the CP asked me to stop – we’d done all we could.

OK, two cases and no result in either. Will it stop me from using CPR again? Of course not. Our problem is that, by the time we get on scene, some time has passed since the original stopping of the heart. The longer it’s been stopped, without good CPR, the harder it is to get it going again.

I feel that EVERY citizen should be trained in CPR, at least every three years. Not being trained would result in you losing every benefit you get from the State. OK, there would be exemptions for those who physically couldn’t do it or who had a genuine religious or ethical reason for not learning the technique. Having said that, all the major religious groups support CPR.

My heart goes out to the people in the two cases mentioned who lost a loved one;I just wish that CPR hadn’t been necessary, or that it had resulted in their loved ones survivals.

What do YOU think?

Textbook Response

As a CFR, I know my place in the pecking order (just off it!). However, I also know the order people should arrive at the scene.

In theory, I should be the first there as I’m “local”, followed by the Community Paramedic (a solo ambulance service, highly qualified practitioner in an estate car) followed by the truck. That is, of course, theory only. I don’t have blue lights and the CP or the truck could be anywhere from the other side of the area (or even at the hospital), or right next door.

Yesterday we actually had a textbook case.

A 70+ patient with difficulty in breathing. I got the call, and whilst he was hardly on my doorstep he was at least on the right side of town.

I set out and arrived. There was no sign of any yellow vehicles, so I went in through the open door to find the patient sat (slumped?) in an armchair.

The chap was looking a bit peaky to say the least – greyish skin, seeming fatigued and a bit breathless.

I got out the pulse oximeter, a brilliant piece of kit (see below). The patient had a bit over 80% of the oxygen he should have had. Anything under 80%, and sometimes over that, can result in respiratory arrest. His pulse was going like the clappers – 138 beats per minute. (The only time mine approaches that is on Budget Day, when the Chancellor gets around to the tax on booze.)

The oxygen cylinder and a mask were in my hands before I even realised. Putting him on 6 l/min I was soon watching the pulse rate drop as the O2 level rose, as did the patient’s colour.

About a minute later the CP arrived. Asking me about what I’d found, he checked the patient and asked a couple of questions. Yes, the patient was a smoker – but not very much these days. Using a stethoscope, he found a non-standard sound in the patient’s chest. The patient said that he’d had a problem some years ago but it had been all right for quite a while.

Just as we’d heard this, and only about five minutes after my arrival, the truck turned up with the crew. The ambulance paramedic and the CP had a chat with the patient. Result? The patient was going in. I’m sure he would have had an uneventful trip to hospital as his oxygen levels had come up to where they would sustain life for a while and his pulse rate was back in the bounds of reality. His face was looking healthy too.

It was only later that I realised that this was just about a textbook case. I go there first (tick). We actually had a CP on duty and available (tick) who arrived before the ambulance (tick). The ambulance still arrived within good time (tick). Whilst the patient was recovering (tick and gold star), he had no problems going into hospital to geet checked out properly (tick).

These are rare!

Pulse oximeter.

The pulse-ox is a terrific bit of kit. Every ambulance carries at least one, as part of the defibrillator extras. Not all CFRs carry them, as you often have to buy your own.

By popping one of these on a patient’s finger, it will electronically check the pulse rate (thank goodness, as I lose count too easily) and the oxygen level (sats) in the blood, giving this as a percentage of the perfect amount.

These stats are essential in many circumstances.

Police Attending!

Nah, I wasn’t having a barney with an akward patient.

I got a call saying that there was a 60++ male “collapsed” at an address. “Police notified – they will attend”.

This is unusual for me, as we’re not normally sent to cases where there is any chance of violence (unless we really cock up!). However, it turns out that the patient lives on his own and the door was locked.

On arrival, there were two PCs having a go at the door with a large crowbar whilst trying not to cause too much damage. We did think about shoving the crowbar through a small glass pane in the door and opening the Yale lock, but the bigger of the two PCs (who was holding the crowbar!) thought differently.

After a relatively short time the door was opened – though it wasn’t in quite the same state of health it had been before it met the large PC. They invited me to precede them into the house, and go into the living room. (Incidentally, why is only one room for living in? What are we supposed to do in the other rooms – the opposite of living?)

There was a chap – 80+ I’d say – in the armchair looking like he was having a good nap. He hadn’t gone particularly pale, and just looked reasonably peaceful. The carotid pulse was non-existant and there was a stiffness to his neck that was very unusual, though his arms were still very flexible, having no muscle tone.

Although I can’t carry a thermometer (don’t ask me!), I thought the patient was a bit cooler than I’d expect from someone with a pulse who hasn’t been out in the cold for a while.

Essentially the patient was K13 – dead. Although I can’t actually say this, in such a situation I’m not going to dive in with all guns blazing.

Very shortly a crew arrived and I told them what I’d found. After a short check, the Paramedic agreed with my thoughts and called it.

It was a shame, but the chap looked as if he simply fell asleep and died in his sleep. Forget the “60++”, I’d have put him in his late 80s to early 90s. Not a bad age, and not a bad way to go – though that probably won’t help his relatives much.

?MI

Had an unusual call recently. It came through as a “Chest Pains”, which is normally an MI (heart attack for those not medically inclined).

The bloke involved was less than half my age, and looked more worried than ill. His face was a good colour and he was coherent. (Essentially, he appeared much fitter than I either looked or felt!) The pain, in the centre of his chest, was not constant. He had a little discomfort most of the time and then he’d experience a sharp pain. These were coming about every 30-60 seconds.

His sats were fine at 97-99% but his pulse was variable. It would be at 98bpm and slowly reduce in rate until it was about 78-82, for a while. It would then jump back up to the high 90s or even as high as 106, then slowly reduce. Just by looking at his pulse rate I could tell when he had a new spasm.

Other than when he had the sharp pain, he only had mild to moderate discomfort.

Unfortunately, this chap picked the wrong time to be ill! Not only was it shift change (and our local crew have 7-8 miles to go back to the station from their standby point), but there were a few calls at the same time and there was more traffic congestion than is usual at that time.

I was alone with him for about 30 minutes. Normally, with chest pains, this would concern me greatly. In this case, he was not apparently getting worse so I wasn’t too worried (well, not THAT much, honest). I was more puzzled than anything.

The crew didn’t seem to have much more idea of what was happening than I did, so they decided to take him in.

I’d love to know what the outcome was, but I’ll probably never find out (confidentiality must be observed).

Has anyone any ideas?

Thanks

As I mentioned a bit back, I’ve been made redundant from the day job. This means that I’m signing on with our Control more than I used to. (NB I get so few calls in a day that I still have plenty of job-search time. Unlike some, I DO want a job.) As a result, I’m seeing some of the professional staff more often than before.

One thing I’ve noticed is that some of them, just one or two, have been treating me as more of a colleague than as a helpful Amateur. You can guess how good that makes me feel!

I’ve been asked to do minor things like take a BM, or attach the leads for a four-lead ECG. (“Ride Your Green Bike”; learned that one a bit back.) I’m being included even more than I used to be.

You can only imagine how good this makes me feel. Having been chucked out of my (albeit crap) job, I’ve now got real professionals actually encouraging me to help more. In none of these situations was the professional involved swamped with things to do. They watched what I did, just to make sure their confidence wasn’t misplaced. They needn’t worry; if I don’t know, I’m not ashamed to ask. It’s how you learn.

I’m also getting more confidence in dealing with patients and their families. I have no problems asking a patient, or a spouse, what I think the crew may need to know when they arrive. Don’t get me wrong, I still don’t know all that many of the questions I need to ask.

I’ve now even got the confidence to talk to rellies to try to reassure them, once the crew has arrived. This has never been my strong point. Whilst I’ve never been too bad at ressuring the patient, they were my sole focus and their rellies didn’t really get a look-in. Now, when the professionals arrive, I have the confidence to talk to the spouse/partner/kids etc.

All this is down to the obvious trust the regularly-seen professionals show in me, and the incredibly supportive comments they make.

Thanks Guys! You sometimes make my day with a single request.

CPR 2!!

It’s like waiting for buses; none come for ages, then you get two at once.

I’ve just had another call where I needed to do CPR. Until recently, I’d done CPR about – er – once in the (nearly) four years I’ve been a Responder, and that wasn’t for long. I exclude the few pushes I may have given whilst the Paramedic was attaching the electrodes.

That’s two in a month, and one in the previous 46!

I was called to a gentleman who had collapsed – ? not breathing. He was at a local rural pursuits area and was an angler. He’d gone into his bivvy and sparked out.

First on scene, I checked for a pulse – not expecting to find one. I wasn’t wrong. I straight away started CPR. After a short while, I tried the defib – “No shock advised”. Back to the CPR.

I was probably going for about 5 minutes before I saw the crew arrive, and was I glad. I’m not usually one for hard work! I carried on whilst they got sorted and then took a spell. The Paramedic took over from me whilst her partner went and got some more kit. When he came back, I did CPR again whilst they did professional-type stuff.

When they’d been there 10 minutes, we had to give it best. This was one we weren’t going to get back.

Just to make matters worse, the patient’s 13yo granddaughter was there all the time. She was in a state of disbelief – shocked, upset but too stunned to cry. Grandma called her whilst we were just finishing and the poor lass tried to explain. The Paramedic took the phone and explained to Gran what had happened. She told Gran that they’d take the young ‘un to the hospital with them, as Gran was going there.

A sad outcome, but I think we all worked to the best professional standards.

Mind you, without wishing to seem to be bragging, I am amazed at how I work in these situations. I’m a bit prone to depression. I had a bad time of it about 7-8 years ago, and some more minor ones since. I’ve been feeling quite down for the last 5-6 weeks, but I do sometimes have a good period.

However, when I’m on a call – particularly a more serious one – any depression simply lifts. I can only think about the patient and how I’m going to treat them. I feel like I’m doing something genuinely useful for a change that is actually appreciated by other people. Even when, like on this call, the outcome is not what we’d want, I don’t feel down about it. I’d done my best, and so had the professionals. Sure, we’d have preferred a different result, but we’d done what we could.