Throughout my first year I had been anticipating my first placement with great eagerness - I would finally travelling in the ambulance as part of the crew (or more like a third wheel at times 😂. I didn’t really know what to expect but I was excited! The first job I attended was paged as a neonate arrest, but it ended up being a blocked nose causing some transient apnoea.
After the neonate job my cases were predominately medical for the rest of my placement block. These were really interesting, and I learnt so much more through these cases in addition to in class. But where was that classic, holy grail of pre-hospital cases which everyone tends to define paramedics by? – aside from road traffic accidents – where was the cardiac arrest!...
I went through another block and my first shift back on ended up being a night shift. The crew and I went down to the usual coffee shop by the beach to get the unquestionable night-shift coffee, and we were just chatting about hiking a particular mountain when BLEEP the tones drop!
We are paged to a Priority 0 (just incase it’s not intuitive, that’s the highest priority) – cardiac arrest. En route my preceptors are talking me through our plan, telling me to make sure I have safety glasses, my stethoscope, spare gloves in my pockets, and that I’ll need to carry the resus and drug bag while they take the O2 and monitor. It turns out the case was 5-minutes away which of course allowed us to check the first box in the Chain of Survival – just! We arrive to a rather large two-story brick home overlooking the sea and are called up the stairs by the patient’s wife.
Bear in mind that at this point the worst I’d seen was some septic cellulitis on a woman’s leg I don’t think I had even seen any blood during my placement. I had only ever done compressions on a cold and firm mannequin before. I ran up the stairs behind my crew and my senior preceptor tells me to commence compressions as he cuts off the patient’s shirt and gains IV access. I get to the top of the stairs not knowing what to expect.
I see a man close to 60 years old lying supine in the hall. As he is lying across the doorway from the stairs my preceptors step over him. He has blood all over and around his face, as well as what looks like broken teeth and tuna – yep, tuna (I couldn't look at canned tuna for 4 weeks after this job).
Nevertheless, before me is a human with a heart that is not beating, and it is up to me to fix that. I wasn't ready for what I saw, but that was the best part - it meant that I didn't have time to overthink and analyze just what I'm seeing. Without really thinking I begin compressions. Squashing someone's chest - it felt, and looked, more violent than I expected. My preceptor had finished cutting the man's shirt off and placed a sensor on the chest where I was doing compressions. It told me to push harder. I did. CRACK. No one had told me how common rib fractures were during chest compressions; but I noted it verbally and kept going. Meanwhile my other preceptor was having a hard time suctioning chunks of bloody tuna from the patient’s mouth. By this time a back-up crew had arrived, and my senior had administered adrenaline.
During this whole time the patient’s wife was looking on. I’ve since down multiple cardiac arrests, traumas, death notifications etc. It is no longer something new and horrible to see such things. But I can’t imagine what it would be like to see one of my family or close friends motionless and unresponsive, undergoing chest compressions. Meanwhile, the patient’s Labrador was also looking completely aloof of the situation – tail wagging and having to be held back by the poor wife.
CRACK – there goes rib no. 2; 2 down, 22 to go.
Ventilation began and I then saw the ETCO2 trace coming down from 75mmHg to 45mmHg, affirming my compressions. 6 minutes had passed, and we re-assessed the patient’s status. There was spontaneous electrical activity being traced by the monitor, which looked like sinus tachycardia. I checked for a pulse and felt a strong radius (I also thought to myself that this must be the coldest human arm I’ve ever felt). We had ROSC! Hooray! The 6 minutes felt like at least 20. I felt so alert and energised from the adrenaline.
As he was loaded into the ambulance I spoke briefly to the patient’s wife, explaining what condition her husband is currently in and what will happen to him at hospital. Once we arrived the receiving team of nurses and doctors received our handover and carried on with his care.
So, what did I learn from my first cardiac arrest? First of all, don’t eat tuna when you’re drunk. It turns the patient was an alcoholic and must have suffered a choking arrest, which would account for the tuna in his airway and head wounds probably subsequent to falling. Secondly, the case confirmed how important team effort and communication is in ‘bringing back the dead’. Without our three separate roles of airway management, chest compressions, pharmacology and case supervision being completely in harmony, the job would have taken longer, and we would not have achieved such a quick and optimal result. Thirdly, it was nothing like I expected - in fact it was nothing like the paramedics expected either - getting ROSC so quickly and successfully is a rarity. The fact that we were so close and arrived within 5 minutes (first step in the Chain of Survival) contributed to this. See image below. Also, the job confirmed that I chose the right career. Incidentally, so did the first job on the next shift – another cardiac arrest.
So, don’t be too anxious on getting experience with cardiac arrests! They will inevitably come to you. Focus on the development of your social and clinical reasoning in medical and low acuity cases – especially mental health. These are where most of you work come from and cardiac arrests, while flashy and exciting, are really only a minority of cases you will attend. Having said that though, be sure to know your management protocols! So that when they come, you will be all over it! 🙌
Theodore is practicing Paramedic living in Australia and runs @studentparamedics on Instagram.
DanSun Photo Art - big thanks for allowing us to use his art. Follow him on Instagram @dansunphotoart
Reynolds etal., 2013. Duration of Resuscitation Efforts and Functional Outcome After Out-of-Hospital Cardiac Arrest. When Should We Change to Novel Therapies? Circulation, 128 (23), 2488-2494