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If someone suffers any kind of chest pain or has collapsed or drowned, then the first thing to do is to make a 999 call for an ambulance. Chest pain can be the beginning of a coronary attack and it is always safest to do something rather than nothing. Ambulance Control will ask for patient details- Age, Gender, Condition and Address with Postcode then they will immediately dispatch an ambulance and a page goes out to alert the nearest First Response Team. When our pagers go off, we spring into action because we are all going about our daily lives. This can be at any time of the day or night; we've had calls at The information given to us is Location, Condition, i.e. - collapse, chest pains etc. Type of Incident- always "e" for emergency, Age and Gender of Patient.
We grab our equipment bags that contain Nitrile Gloves, CPR Mask, and Torch and put on our High Visibility Jackets, which identify us to the patient, their relatives, and the Ambulance Personnel. Depending on the location, some of us will go to pick up the Defibrillator and others will go directly to the patient. We don't have sirens or flashing blue lights but we usually put on our headlights during the day and we also display a sign in our car windscreen to identify ourselves as being on callout. On arrival at the scene we introduce ourselves and put the patient/relatives at ease by confirming that an ambulance is on its way and will arrive shortly and we will immediately assess the situation for any signs of danger. There may have been an electrocution or drowning or someone may have collapsed in a field of cows, and the danger has to be removed.( Electrical item switched off, patient removed from the wet or carried out of field or cows removed.) There are many things to be aware of concerning safety for example if a patient is defibrillated when wet, the electrical shock will arc and may stop someone who is helping's heart. If the patient is sitting up in bed and talking, we ask them what has happened, how they feel and write down their details on a patient report form to hand over to the ambulance staff on arrival. But if there has been a collapse, we follow a set protocol.
A .B .C A is for AIRWAY. B is for BREATHING C is for CIRCULATION.
A We look inside the patient's mouth to see if there is an obstruction, they may have choked on something and if it is easily removable it can be taken out. The head is then tilted backwards to open the airway by holding the forehead with one hand and placing the other on the chin. We then listen and feel with our cheek and ear close to the patient's face for signs of breathing whilst placing a hand on the chest and looking down the body for signs of the chest rising. This is done for ten seconds, which appears to be a long time but breaths can be a long way apart and you don't want to miss one. B If there are no signs of breathing then two rescue breaths are given by placing a CPR mask over the patients face and blowing firmly for two seconds, letting the breath come back out and giving one more breath. Then the same checks for signs for breathing are made for another ten seconds. If there are signs of life i.e. flickering eyelids, twitching, coughing, then the patient can be put in the recovery position and monitored until a healthcare professional arrives. C If there are still no signs then Cardio Pulmonary Resuscitation (CPR) is begun. Fifteen chest compressions are given and then two rescue breaths and this carries on until either the patient shows signs of life, a healthcare professional arrives to take over or you are physically too tired to carry on. When the Defibrillator arrives with another Responder, it is attached during step B and will assess the electrical activity in the patient's heart and the need for Defibrillation. All resuscitation attempts stop whilst the AED makes its assessment and if there is a need to shock the patient it will say so. It prompts the user by voice i.e. "attach the pads", "assessing heart", etc. Everyone has to stay clear of the patient whilst the shock is delivered because of the risk of arcing. So when someone shouts "STAY CLEAR, SHOCKING PATIENT" they mean it! It's a pretty hefty whack of energy that's used which is why the body will convulse. When the heart goes into fibrillation the electrical activity that regulates the beat goes haywire and it begins to wobble like a jelly. The blood cannot get round the body and oxygen cannot get to the brain and major organs. If this carries on for several minutes without any intervention the patient will soon die. However, if the patient is treated quickly then their chance of survival and recovery vastly increases.
As Responders, we always know that an ambulance is on its way and the crew will take over from us. But it is those few early minutes that are so vital to help the patient survive and we are trained to deal with that situation. We may only be out of our house on call for half an hour, but that is all it takes to provide basic life support, defibrillate a patient , save their life and hand over to the Ambulance crew. |