The second and final shift for my week on placement started with a bang. Red Base (control room) buzzed us up on the radio for a Red 1 in progress around the corner.
We were occupied with the vehicle and equipment checks so were not available to go. Thankfully other units made themselves available to cover it; we were able to take a little more time waking up…
Almost an hour into booking on as available we had been driving around town when our MDT lit up with a Red 1 to a lady found by a carer to be unconscious and not breathing. We swiftly made it to scene, which wasn’t too far away, within four minutes of the 999 call being made to the ambulance service.
On arrival I entered the property first with the Lifepack 15 device and suction unit, followed behind by my mentor with the paramedic and primary response bag. Unfortunately there was nothing we could do, the patient had collapsed the previous evening and had been deceased for some time due to the rigor mortis present. Despite being in her late years, she did not take any medication and was able to mobilise with minimal walking aids at home. It was a great testament to her health. However tragedies like these do occur, and we supported the family for a few hours until the police turned up and took over the scene. Despite the outcome, I was confident in my practice and primary survey and recognition that there were no signs of life.
A little later in shift and we found ourselves in the all-day rush hour traffic that London has, when the next job was dispatched: "Forty-year-old male, fallen down 13 steps, 80kg washing machine crushed patient”.
Immediately we recognised the serious nature of the mechanism, and made it to the scene very quickly. On arrival I saw the patient was lying on the ground floor upright against the stairs, clutching his chest in pain and had his eyes closed. I established his vital signs to be stable and conducted a full secondary survey to find bruising to the chest, fractured digit and fractured ankle. Our main concern were the chest pain, so focused a lot on a trauma-respiratory examination. Thankfully he remained stable throughout, however, we were waiting a long time (what felt like) for an ambulance to back us up. In that time, we established 360-degree access, treated the symptoms and provided pain relief. I cannulated him as the crew arrived and gave a concise and clear handover to two paramedics that had many years in the service.
A few more patients later, and we were on the final hour of our last shift for the week. Whilst driving back to station another Red 1 was dispatched to us. We were first on scene and found the patient in cardiac arrest up a small flight of stairs in a bedroom with little space to manoeuvre. I confirmed she was not breathing and had no pulse so initiated basic life support with our priority before to establish 360-degree access to the patient. The distraught son of the patient composed himself and helped my mentor create space in the hallway. Upon arrival of the ambulance crew we all moved the patient into the hallway and continued treatment.
I positioned myself half in a room and half in the hallway and started to manage the patient's airway. My mentor became airway assistant and handed me the equipment. It was my first time using the equipment, and I felt confident that it was in situ, as we were getting a good box wave form and bi-lateral chest rise on inflation using the bag valve mask. With the airway secure, chest compressions continuing, the arrest was becoming well established, each with assigned roles. At this stage more of the family began to arrive to the property. We moved the patient to be in sight of the ground floor front door, where the family walked in.
A daughter of the patient ran towards us, whilst hysterically crying, and was shouting, 'Don’t stop, whatever you do, don’t stop!' on repeat, whilst making eye contact with me. I couldn’t help but then start to feel the soaring emotions in the house, which I left aside and provided comfort to her before changing positions to go back on the chest. I think those words really stuck with me for the rest of the job, and my mentor took over in discussing the situation with the family downstairs. The decision was made to transport to the nearest hospital as an ongoing cardiac arrest. The patient was pronounced dead a short time after handover.
It wasn’t until after the debrief, restocking and cleaning of equipment, and leaving the ambulance station two hours after our 12-hour shift was due to finish that I started asking myself a million and one questions. And it was only when driving back late that I looked up and saw one truly appropriate full moon ascending on London.
It’s been an incredible return to placement: one that has seriously challenged my clinical practice but also decision making, ability to work under pressure and resilience. I am so grateful to have such a rich support system in place within the London Ambulance Service and Anglia Ruskin University.
See also: Full moon, chapter 2, part 1