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!
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.