Team Work

Cardiac Arrest.

The words strike fear and excitement into the core of any medic. The adrenaline courses through the veins, the heart quickens, breaths deepen, this is it. This is what you've trained for. The chance to save a life and of all our life saving skills, this one probably gets used the most. You are the only thing standing between a patient and the coroner. The important thing to remember is, to reverse a cardiac arrest, teamwork. Obviously there are the underlying medical causes to address, but none of it makes a difference if the rescuers can't work together.

I'm going to tell a tale of teamwork, hard work and good work.

David is a businessman. An important man? I don't know, perhaps we will never know, all I do know is he is about to experience Team NHS at its best. David has just arrived at work. He walks into the office, a little sweaty, quite breathless, a lot pale. He looks up at his colleague and tries to speak as he collapses to the floor. A hush fills the room and after what feels like a eternity the cries of "Call an Ambulance!!" break the silence.

"Ambulance Emergency..." The call taker answers "What's the problem."
"He's not Breathing!!" stutters the secretary, her voice quivering...
"OK, I'll tell you what to do, the Ambulance is on its way..."

The call handler talks David's colleagues through CPR. It's 2 minutes since he collapsed, already bystanders are forcing blood around David's body, keeping his brain oxygenated, giving him every chance.

Simultaneously a First Responder, seconds from David's office is dispatched, as is my ambulance, a second from the next town and our HEMS team.

4 minutes, the responder is by David's side.
Defibrillator on.
One shock
CPR

12 minutes after his collapse we arrive. Grabbing all the kit we can can my crew mate and I run to David. We arrive at a scene of utter calm and disbelief. The responder has everything under control and a good history ready. He carries on with CPR, whilst with a glance and a nod my crew mate and I assume our roles, one on Airway and Breathing, the other on IV access and drugs.

15 minutes after his collapse David is Intubated, ventilated, has patent IV access and begins to receive life saving drugs. We swap. I take the CPR, the responder squeezes the bag, delivering oxygen to David and my colleague looks at the reversible causes.

20 minutes Post arrest - we pause...."rhythm check"

David's got a pulse, it weak, but its there. The second crew arrive with stretcher and scoop. David is stabilised, fluids to correct low blood pressure, cooling packs to reduce brain injury, he is carefully lifted onto the stretcher and carried out to the ambulance.

35 minutes.

Our HEMS service has landed a short distance away. It's too far to walk, so he is driven to the waiting helicopter. As we pull up next to it, his heart stops again.
More drugs, more CPR. A needle is inserted into David's bone, it's brutal, but stronger, the intravenous access already damaged from all the movements.

45 minutes after his collapse, David is now in the Helicopter. The noise of the engines and smell of aviation fuel fills the air. The downdraft throws up leaves and mud as the small aircraft lifts off and disappears over the houses. The hospital know he is coming, they are waiting.

60 minutes. 1hour later. David is now in the Emergency Department Resuscitation room. He is surrounded by Doctors, Nurses, Anaesthetists, all trying to keep him alive. His heart started to beat again in the helicopter, so now the team had to keep it that way. Bloods were taken, scans done all trying to piece together what had happened...
Meanwhile, my crew mate and I are staring at the devastation that is our ambulance. It was like someone had turned it upside down. We simply close the doors and drive back to the ambulance station and only there do we sit back and reflect.

We managed to find out what happened to David. Sadly, despite everyone's valiant efforts, the damage to his heart was too great and it finally stopped. It's a sad outcome, but I know that the whole NHS team did everything possible to try and save him. I'm proud to work for such a team, in such a team and with such a team.