Camden ambulance station, Friday: three crews were at base all enjoying a rare occurrence - being sent back for break! Then the call came in...
Do paramedics get breaks?
It’s not often that emergency crews with the London Ambulance Service experience such luxuries as a break. Usually the call volume and demand is high enough to go from patient to patient.
However, despite the reduction in demand, our break was interrupted in the final 15 minutes to attend a critical assistance back-up, Red 1, confirmed cardiac arrest in a public place. I’d never been to an arrest in view of the public; just the thought of it makes me a little uneasy.
Treating a cardiac arrest
We were the third resource on scene, following a FRU (Fast Response Unit) and ambulance which both had students on. The patient was still in a non-shockable rhythm and I assisted with airway management and chest compressions. Upon administering drugs, we achieved a return of spontaneous circulation (ROSC). At this exact moment an Advanced Paramedic Practitioner (APP) walked in and took over leadership of the arrest.
The patient then lost cardiac output and went into Ventricular Fibrillation (VF), a shockable rhythm. After one shock with the defibrillator we reinstated ROSC. Despite regaining a pulse, the patient kept alternating rhythms between supraventricular tachycardia (SVT) and Ventricular Tachycardia (VT). In the event of pulseless VT, you can deliver an electric shock. Or in this instance, the VT was pulsed and the APP went to cardiovert the patient in order to shock it back into a sustainable heart rhythm. Just as the APP went to cardiovert, the rhythm changed again back to SVT. The decision was made to transport the patient in this presentation, and ten days later they are still alive in intensive care.
Three emergency crews arrive for one patient
Bright and early Sunday morning, we had just booked on to start the shift and while still checking the equipment, we were sent down a Red 2 for breathing difficulties. We speedily completed our checks and went to drive out of station when the notification came down: 'Event cancellation, higher priority event'. Then it came down to our MDT: 'Ninety-year-old male, unresponsive, not breathing, CPR in progress'. Astonishingly, all three resources that were dispatched (two FRUs and an ambulance) all arrived on scene at exactly the same time. I was first to walk through the door and quickly confirmed cardiac arrest and established 360-degree access. With six pairs of hands turning up at the same time (including myself and another student), it was safe for me to take a step back at the foot of the patient and start to lead the entire arrest. Assigning tasks to each individual, we had IV access and an advanced airway in place in just minutes.
A no-treatment order
After a short time conducting Advanced Life Support, we were getting no response from the non-shockable rhythm he was in. I discussed over the phone with the APP desk in EOC (Emergency Operations Centre) about the predicted outcome, and an APP was dispatched to see if there was anything else we could do. We found that the patient had a no-treatment order in place for hospital, and respected both his and the family's wishes letting him pass away in the comfort of his own home, surrounded by loved ones. It was a sad outcome, but the family were extremely grateful to us and thanked us for trying. The grandson even went to shake my hand as I left. This was a personal moment I don’t think he’ll ever forget.
Alex studies Paramedic Science at ARU. You can find out more about this and other degree courses at one of our Open Days.