My shifts on call taking are generally limited to two every five weeks these days, on the part of my rota called “relief week” which is when we work with other watches. Consequently, I’m a bit rusty with it and tend to forget how exasperating a lot of the calls are and how exhausting a day on call taking is. Thank god I don’t have to do it four days in a row any more.
One call reminded me of just how close to incidents we really do get as call takers. It was a call from an elderly lady who was a carer for her even more elderly friend. Her friend had suddenly started vomiting a lot of bright red blood, which as you can imagine is not a good sign. The call came out as a category A, which would usually have meant an ambulance in about five minutes, but unfortunately, they lived in one of those pesky “rural” places that I talked about before. (Incidentally, some of the commenters had a good laugh at me describing a place 5 miles from the nearest ambulance station as rural. Apparently there are plenty of properly rural places where you are 45 mins or more from the nearest ambulance station and the poor call takers have to stay on line all that time and the callers STILL expect you to be there in five seconds flat! I bet people don’t take this into account when buying big mansions in the countryside…) The nearest ambulance and FRU were sent. They weren’t very near at all - five miles and seven miles respectively.
While I was asking the triage questions, I could hear the patient groaning and vomiting in the background. She sounded in a bad way and I prayed the traffic would be on our side and that the FRU would get there quicker than the computer’s estimate of 10 minutes. Of course, there is one thing worse than a patient sounding really ill in the background, and that’s a patient who you can’t hear at all. And that’s precisely what happened next. Just as I was telling the caller to put her dogs away and open the door, everything went quiet.
“Doris? Doris! She’s gone unconscious! Help!”
My poor caller, who up until this point sounded calm and as if she had been calling ambulances for Doris on a regular basis, totally panicked. After having the usual “where’s the ambulance/hurry up/why’s it taking so long?” conversation, I tried to move on to the instructions for an unconscious person. But it was no good. Doris, who was in her late 80s, had collapsed in an armchair with her head lolling to one side. Joan, the caller, sounded a little younger, but not much and was totally unable to lift her unconscious friend from the chair to the floor. Their nearest neighbour was a few minutes’ walk away and Joan told me she couldn’t walk very fast, so there was no point going for help. It’s always a difficult judgement to make whether you should encourage or even pressurise a caller into moving a patient when they feel unable to do so. On one hand, it might only be fear of making things worse (Joan started off by saying she couldn’t put Doris on the floor, Doris had a bad hip, it could hurt her… but of course alive with a broken hip is better than dead without…) that is stopping them, on the other hand, they really might be physically incapable and could injure themselves trying, and then we’d end up with two patients instead of one! So I didn’t push Joan any further, and instead concentrated on getting her to try to open Doris’s airway whilst she was still in the armchair, clean the blood away from her mouth, talk to her and generally make her comfortable.
I decided to use the “breath timer” gadget on the computer. Normally we use this for a patient with abnormal breathing to determine whether they are going into cardiac arrest and whether CPR needed to be started. On this occasion, I already knew that CPR wouldn’t be possible, but I thought it would do it anyway, partly to give Joan a “job” to make her feel she was doing something, and partly so I could convey this information to the FRU and ambulance to better prepare them if she did stop breathing.
The first time I used the gadget, Doris’s breathing was a nice, regular pattern. A little slow, but acceptable. Joan reassured Doris that she was going to be fine. Doris was silent.
The second time I did it, Doris’s breathing had slowed down a lot. The gagdet told me this was possibly an agonal pattern and to start CPR or recheck. I rechecked. This time, Doris’s breathing was irregular, alternating between shallow and rattling gasps with long gaps in between. I had no doubt that she was arresting.
Just as I was changing the “breathing?” answer from “yes” to “agonal” on the ticket, the FRU burst through the door. I heard him talk to Joan briefly and look at Doris before picking up and speaking to me. I already guessed what he was going to say.
“She’s suspended, can you ask sector for a second vehicle please? Thanks.”
And then they were gone. Sector got the second vehicle there and Doris was blued into hospital in cardiac arrest, but didn’t make it.
You could spend a lot of time worrying about a call like this and how it could have been done differently. If Doris and Joan had lived closer to town, or if we’d had an ambulance on standby in their village, would we have reached them quicker? And would that have made any difference? If I’d sent Joan to fetch the neighbour or been a bit more pushy with her, would they have started CPR earlier and saved her life? Or would Doris have died alone while Joan was fetching the neighbour? Would Joan have hurt her back and been unable to comfort Doris as she took her dying breaths? I’ll never know, but I hope I did the right thing. Sometimes making someone’s death more comfortable is better than trying to save their life.
September 15th, 2007 at 1:28 pm
It sounds like you made the right judgement. It doesn’t sound as if the poor woman who was ill was going to make it and the friend probably wouldn’t have been able to do very much for her anyway but being with her at the last will have been a comfort, to both of them.
September 15th, 2007 at 4:44 pm
Definitely, You did the right thing.
In my opinion, even one minute away from a hospital it sounds to me that Doris´ last minute had already arrived. In that cases trying Joan to feel useful is the best you can do. I do like someone like you “at the other side” if I ot to call LAS
Al
September 15th, 2007 at 6:24 pm
It’s a shame that Doris had to die in such a traumatising way, vomiting blood and the like, and couldn’t just pass away in her sleep. A least she had someone there in her last moments, and it sounds like you did the right thing for the situation. I almost think call taking and dispatching would be a lot harder then actually responding in the ambulance, emotionally anyway. How often do you get to follow up on bad calls, and find out what happened to the patients?
Rural calls are difficult, at least where I live. Our area stretches a 20 minutes drive north, 30 minutes south, 10 minutes east, and 30 minutes west, however if the ambulance is out in another town, we could be at least 50 minutes away. That and when the direction we are given are “near where the big tree used to be” can make it very hard.
September 15th, 2007 at 6:39 pm
I guess “near where the big tree used to be is the rural equivalent” of “on the high street, near tescos”! The only way we can follow up on a call is by ringing the crew who took it when they get back to station. We rarely get to hear what happens after the crew leave the hospital, unless they happen to go back there later in the shift and ask after them.
September 15th, 2007 at 6:54 pm
My ex-girlfriend’s father, 81 years and a large 6 foot 3, arrested in front of her and her mother. The dispatcher asked them to get him out of his armchair - which they were unable to do. He had been without oxygen for too long by the time the ambulance arrived and passed away. It has always haunted me that I wasn’t there to suggest tilting the chair backwards until the back of it was on the ground, and then sliding the big fella out.
Do you think that would have been possible in this case too? Is it something you would suggest? I think, as soon as you suggest “lifting”, people just start thinking “how do I lift them?” but the goal is really to get them on the floor. The question “how do I get them on the floor?” returns a much more flexible reponse.
September 15th, 2007 at 7:02 pm
Hmm, that’s a very good suggestion. I suspect it would be very difficult for a elderly person to tip up an armchair with someone in it on their own, but it’s certainly worth a go and something I might suggest next time. Thank you.
September 15th, 2007 at 9:10 pm
Sometimes one has to recognise that, even with the full facilities of a big city’s A&E at your disposal, there is nothing you can do. From the brief details given, this may well have been one of those situations. Nevertheless, it sounds like you did just the right thing in deciding not to pressurise the caller into attempting to move the lady from her chair and I would like to commend you for this.
I hope that when my time comes, I will die quickly and not be subject to the brutal treatment that so many elderly people suffer at the hands of well-wishers and public servants following ‘protocols’ that insist on removing one from the company of those we love most to spend our last few minutes being rushed to a trauma suite and subjected to a whole barriage of chemicals being flushed into my bloodstream. But, of course, this is purely my personal view…
September 15th, 2007 at 9:14 pm
Sometimes there is no right or wrong, just tough.
There are only seconds, to react and cope, but soooooo much longer for family friends to question thier actions and what might have been
Don’t be to tough on your self Pan.
Mark, I can’t imagine what it is like to try and help direct over the phone, I am sure I would want to scream with frustration.
(Sorry to bang on the ‘rural’ drum again, but we don’t all live in stately homes or country mansions with sweeping drives! The countryside is where we live and work, as the Scots say ‘It’s not where we stay but where we belong’
September 15th, 2007 at 10:28 pm
Reminds me of this post from Tom Reynolds a couple weeks ago:
http://randomreality.blogware.com/blog/_archives/2007/9/3/3204056.html
September 15th, 2007 at 10:59 pm
Hey there Mark
I have just taken a job as a call taker and I would like to know more about you prepare yourself for awkward calls and how you deal with awkward calls?
Any tips would be greatly appreciated
September 15th, 2007 at 11:02 pm
IMHO you did the right thing, no question, although I am sure there are plenty of calls where the decisions are much less clear cut.
If this rural area had had a Responder scheme then a local responder may have been able to get to Doris quickly, recognise what was happening, call you with an update, and start oxygen therapy and defib or cpr if necessary in those crucial minutes before the FRU arrived. Even if this didn’t make any difference to Doris’ eventual outcome, Joan (and you) wouldn’t be left agonising over whether quicker care would have made a difference, and Joan would have had someone local to take care of her while her friend was being treated and whisked off to hospital. I knwo some people are anti-responders, but this is the kind of case Responders were invented to help with.
September 16th, 2007 at 6:10 pm
We don’t have responders in London. As others have pointed out, what I consider to be rural is not rural at all compared with Properly Rural Places!
KyleG: a post you might find helpful. Good luck with your new job!
September 17th, 2007 at 5:38 pm
You did the right thing - you know as well as I do that for some people it’s their time to die, and to make that passing as ‘good’ as possible is the only thing left to do.
You also know as well as I do patient CPR survival rates.
September 17th, 2007 at 7:21 pm
It sounds like everyone did the best they were able. I think Tom said it well above.
I hope your day today goes smoothly and is peaceful.
Take good care of yourself and thanks for what you do.
-Zipperhead
http://chiarian.blogspot.com
November 4th, 2007 at 11:13 am
We’re proper rural and it does take 40 minutes, sometimes more, for ambulances to reach us. In fact, sometimes it’s better to bundle the patient into the car and head for the city as the nearest A&E (in either direction) is 60-70 minutes away.
We have a lot of RTAs to deal with - bad bend, even worse drivers - so we keep a crash bag just inside the back door with hi-viz jackets, beacons, tools, first aid kit, blankets etc. Myself and the farmer’s wife across the road are trained first aiders, so when there’s a crash we just get to work.
We check the safety of the scene, get in and assess how many patients we’ve got and their obvious injuries, call 999 with the details, then triage the patients and get on with it. 999 is third because I don’t have a mobile and mobile reception is poor here anyway, so it’s better to have basic details first then head for the house and phone.
If you’re on your own - often the case for me as the four neighbouring houses are empty on weekdays with people at work - then it’s bloody hard work and you have to accept that you will lose someone at some point. A woman died here in 2001 when her boyfriend rolled his car through the gateway and she was ejected through the rear window.
But with more people on scene, we can treat patients, close the roads, mark the accident scene with beacons, set up halogen work lights, make the scene more safe (disconnect car batteries etc), etc etc. All before help arrives.
Usually it’s 20 minutes for police to arrive, 15-35 minutes for fire service (local retained fire crew if there are enough of them is quickest) and 40-45 for ambulance. Latter is very dependent on jobs - we have one ambulance in the nearest town. Their shifts are 10-hour day, 14-hour on call call overnight, for four days and they’re spread thin.
A multiple vehicle RTA at the same time or just after another RTA elsewhere in the region on a Friday night is our worst case scenario.
Oh, and unless there are more than three people available, we can’t stay on the phone. So, it’s incident details, number of casualties and obvious injuries, address (including OS reference) and off the phone, then back out to deal with the incident.
But it’s still nothing like as isolated as parts of Australia - where I’m from originally.
A friend of mine once had to do a tracheotomy with a penknife and straw at an RTA in the middle of nowhere. She was given instructions over HF radio by the Royal Flying Doctor Service and managed to save the man’s life. Help arrived about two hours later.
Oh, and if you have someone in a chair - think leverage. A stout walking stick under the front or side of the chair, use a stool, low table or even a couple of books as a fulcrum, keep the distance between the fulcrum and the chair short, keep the distance between the fulcrum and the person doing the leverage long, and get them to lean on the stick with as much weight as they have.
I know of a couple of instances where that’s been used to good effect.
Finally, you did the right thing with the two old ladies. Its’ much, much better that the old lady had someone with her when she went and that her friend believed she was of some use.