Nee Naw

Elderly people are always falling — out of bed, off the commode, out their wheelchairs, in the street, on the floor — and their equally elderly partners are always getting in a flap about it, so when an elderly lady’s panicked voice came down the line telling me her husband had fallen on the stairs, the “Serious Call” sensor in my head failed to be activated. Mental alarm bells only started to ring when she reported that her husband was not responding to her at all. By the time she reported that her husband had started “snoring”, the metaphorical sound was deafening. Within seconds, my perception of the call had gone from run-of-the-mill to a highly unusual suspended trauma call. I guess that, as it is unusual for someone to curl up for a doze after taking a six foot tumble, the “snoring” was actually agonal breathing – the rattly, ineffective, intermittent breaths a dying patient takes as their body shuts down.

I’ve read several articles (example) that mention that many dispatchers fail to recognise agonal breathing, and that if we did so more often, some lives could be saved. I know there were some calls early on in my career where I was in two minds as to whether to start resus because the caller was unsure if the patient was breathing, and in retrospect I realise the source of their confusion was that the breathing was agonal. Now, if there’s any doubt, I start CPR. CPR can be harmful to patients who are not really suspended, mainly due to the likelihood of broken ribs, but not nearly as harmful as not doing CPR if they are suspended.

Using the “breath timer” gadget on the computer system, I determined that the breathing pattern was indeed most likely agonal, and gave CPR instructions to the old lady. This wasn’t easy at first — she was, understandably, panicking, and as with many elderly callers, she didn’t understand that the ambulances are sent out by computer and kept telling me to “just sendthe ambulance!” I sometimes think it would help in situations like this if you could play a soundtrack of an engine and nee naw sirens starting up and fading into the distance so you could prove that an ambulance had been dispatched. It’s very frustrating for me when I’m trying to give someone life saving instructions and all they do is tell you “hurry up!” It makes me want to point out that the ambulance is already on way at 70mph on lights and sirens and if it hurries up any more it’ll probably crash or burn out its engine and not get there at all. Also, some elderly people think they are actually speaking to the ambulance crew and that when you hang up you are going to jump in the ambulance and come and see them.

Anyway, I managed to get the old lady to comply by speaking those forbidden words “the ambulance is on its way” and even telling her approximately how long it would be (highly forbidden). Once she started the CPR, she didn’t mention the ambulance once and did it perfectly for the four minutes or so until the ambulance arrived. I was very careful not to imply that he was dying or “not breathing” as that would have freaked her out more, but instead told her he wasn’t breathing as often as he should, so she would have to give him some extra breaths. She did it brilliantly and I was very impressed — a lot of elderly people refuse to give CPR because they can’t physically do it, not to mention being scared. Fortunately, she didn’t have to wait long before the crew burst in like the heroes they are.

Unfortunately, the outlook was not good — the patient was still not breathing when he was rushed in to hospital, although I suppose the fact they took him in must have meant they thought he had some sort of chance. In general, though, once someone has stopped breathing from trauma their chances are not good anyway, and his age and the fact that he had stopped breathing within a minute of the accident, indicating a very serious injury — maybe a broken neck? — all counted against him.

This call made me think about how strange and fragile life is — this man was in his seventies, and that morning, as far as I know, he’d been perfectly healthy, despite facing all the diseases and dangers the average person would come across in seventy-five years, and was probably expecting to enjoy many years of retirement with his wife before fading out gradually from some kind of age related illness. And yet, one false step, one piece of loose carpet, one instant not looking at his feet, and his life was over, just like that, in the space of ten minutes.