Warning: this is a grim post with a tragic ending – some of you may find it distressing (I do).
Tony and I were on a day shift. We were in good spirits; it was our last day shift before our shift break so we were both looking forward to a few days rest. We cleared from a job at one of the local hospitals, time was passing and it was nearly the end of our shift. We still hadn’t had our rest break and were ‘out of the system’ meaning control had to return us to our base for twenty minutes. The radio bleeped which tells us control are about to speak to us. I expected it to be them telling us to return for our rest. I was wrong.
“Guys, I know you’ve not had a rest break and I hate to ask, but, I’ve got a 3 year old child in cardiac arrest. I’ve got another ambulance running but we need to use you too…”
One of the improvements to the ambulance service recently is our management of cardiac arrests. When I first started, a single crew would be sent to a cardiac arrest and would be expected to perform CPR, Advanced life support then transport to a local ED – too much for a single crew to achieve properly. Now the service sends at least two ambulances to each cardiac arrest. When it’s a child they send at least two ambulances and normally senior staff in cars to help too. A child cardiac arrest as well as being more emotionally taxing is more complex. Drug doses and fluid volumes have to be reduced according to the weight of the child.
We arrived onto the street a few minutes later. As I pulled onto the street another ambulance was already parked outside the address. A senior paramedic, Joe, arrived in a car just behind me.
I saw the paramedic, Andy, from the ambulance carrying a child onto his ambulance. I went straight onto his ambulance and saw that Andy had already connected the defibrillator and was doing chest compressions. He quickly told us what had happened when he went in the house; the child was lying on the floor in cardiac arrest (no breathing and no pulse) in a pool of vomit. Mum and auntie were obviously distraught and screaming – Andy made the decision to move straight to the ambulance so we could treat the child, Naz, more quickly.
I went to Naz’s head to clear his airway and start to ventilate his lungs. His mouth was full of vomit so we quickly turned Naz to his side to empty his mouth. Then I inserted a small tube to keep his tongue free of his airway, but his mouth immediately filled with vomit again. I used the suction machine to clear his mouth and decided to intubate. This involves inserting a plastic endotracheal tube (ET) tube into the patient’s mouth and through the vocal chords into the top part of the trachea. Once in place vomit can no longer block the airway or sink into the lungs. I connected a bag ventilator to the protruding end of the tube and was able to breath for Naz. While I was doing this Andy was continuing with chest compressions. Part of the procedure for resuscitation involves regular doses of adrenaline (epinephrine) into the blood stream. With a child it is quicker and easier to get intra-osseous (IO) access than intra-venous (IV) access. This sounds brutal but is quick and effective – a drill is used to drill into a long bone in the leg or arm and a cannula is left giving access to the marrow space within the bone. This leads directly into the blood stream for drugs and fluids. While I was intubating, Joe was getting IO access and started the drug therapy. Tony was assisting each of us as we needed and trying to reassure Naz’s mum while at the same time getting some details and general medical history.
We were ready to go to hospital. We all decided to travel in the ambulance to assist with on-going resuscitation on the drive to the ED. This meant leaving our ambulance and Joe’s response car on the street to be collected later. We just had to hope they would still be there and not vandalised when we got back later.
The journey to the ED seemed to pass very quickly with me ventilating Naz, Andy compressing his chest and Joe periodically giving a dose of adrenaline (epinephrine). Tony was in the back with us too trying to comfort Naz’s mum and get some basic details for us for when we arrived at the ED. Andy’s mate, Jack was driving.
When we arrived at the ED Andy scooped Naz up in his arms to carry him into the resuscitation room (much quicker than using the tail lift and wheeling the stretcher in). I followed a step behind with the bag-and-mask ventilator still attached to the end of the ET tube protruding from Naz’s mouth. The resuscitation room was crowded with the receiving medical team – anaesthetist, consultant ED doctors and several junior doctors plus a range of ED nurses – they were pulling out all the stops for little Naz. The team listened to our handover as they took over the resuscitation. We stayed a while to watch. It may seem a bit strange that we hung around just watching but that type of job is hard to just walk away from – we wanted to see if the medical staff could pull off the miracle that we hadn’t been able to and restore life to Naz.
Sadly after nearly an hour of effort they had to tell Naz’s mum (and dad who had arrived at the hospital now) that they weren’t able to resuscitate Naz.
A few days have passed and I’ve managed to process things. Typically with me for a couple of days I tend to ruminate on jobs, playing them over and over again in my mind wondering if I could have done anything differently. I can’t imagine the pain and suffering that the family are going through now and feel for them. I don’t suppose mum and dad will ever forget or get over that day.