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Dr Phil: Don't be too shy to dial 999

Dr PhilI've just come back from my annual resuscitation training course, where the paramedic in charge talked about a cardiac arrest that had happened in a nearby GP surgery. When he arrived, there were four GPs milling about with three nurses, two receptionists and half a dozen patients. Lots of people were mumbling about what they might do next, but no-one was keen to take charge and the patient was lying in the middle of them all, untouched. Shall we start again? said our friendly paramedic after establishing that the patient wasn't breathing. He selected three helpers and cleared everyone else out of the room. 'I want you to give me thirty good chest compressions. When she's done thirty, I want you to give two good breaths through the mask. And I want you to use the portable defibrillator.'
'I can't.'
'It's locked in the cupboard and we can't find the key.'
'You'd better use mine then.'

Miraculously, the resuscitation was successful and the patient (an elderly lady), was sitting up and chatting by the time she reached hospital, but she only survived because the paramedic was just round the corner. The GP team should have been able to resuscitate her successfully, and they'd all been on a course like I had, but when confronted with a real emergency one that most hadn't witnessed for ten years, if at all they went to pieces and no-one took charge.
The paramedic visited the surgery a few weeks later and asked those who'd been present why when they knew what they should do they weren't able to do it. Part of the reason was panic, particularly when they realized they couldn't unlock the defibrillator cupboard. But the main reason was that too many people were crowded around the patient and people were too shy either to put themselves forward as the person in charge or to nominate a leader who they though would do the job well. In all this confusion, they forgot that when your heart stops, you have 10 minutes to get it going again or the chance of survival is virtually nil. At least someone (a receptionist) had dialled 999.
As well as keeping the defibrillator unlocked, the paramedic issued a set of four cards to be kept with it that told everyone exactly what to do at a cardiac arrest. The leader (black card) diagnoses the cardiac arrest, recruits three helpers, tells someone to dial 999 and clears the room. They get the patient onto a hard surface. Green card does chest compressions, red card operates the defibrillator and blue card is in charge of breathing. We tried this method in our training programme and it seemed to work very well. Of course, in real life you need to know where you keep the cards. Inside the (unlocked) defibrillator case would seem a good place.
If a large group of health professionals can get in such a muddle about what to do in an emergency, what hope is there for a member of the public, alone at home with Granny when she collapses? No defibrillator, no coloured cards, no-one telling you what to do. Just Granny going very pale in front of you and the dog yapping around your heels. The answer is to get help early. People collapse for all sorts of reasons and often we just stand there doing nothing and thinking is it a faint?. A heart is most likely to stop after a heart attack, and although not everyone has clear-cut symptoms, you should dial 999 quickly for anyone who looks very ill (white as a sheet, possibly sweating) and feels very poorly (possibly with chest pain that can go up to the jaw or down the arms). When you've done that, you should give her an aspirin to chew or swallow if you can find one and she isn't allergic (it can halve the size of the damage to the heart).
Far too many people wait until someone collapses before they call for help, but it's far easier to keep a heart going than restart it when it's stopped, and paramedics now carry drugs that dissolve the blood clot causing the heart attack and dramatically increase the chance of survival, even more so when given as soon as possible.
If Granny collapses before the ambulance arrives and she won't wake up, it's most likely that her heart has stopped and she needs thirty good chest compressions to do the work of the heart and keep oxygen pumped around the body. It's easy to learn how to do these on a life support course. You put one hand over the other, lock the fingers together and compress with the heel of your hand over the breast bone in the centre of the chest, at the level of the top of the armpits. You can either do this from the top end by kneeling over the head (my preferred position but it looks a bit peculiar) or from the side. You rock in with your body to do the compression, pushing down by a few centimetres, and then relax to allow the blood to pump out.
If you know how to give mouth to mouth, you should give two breaths after thirty chest compressions, and keep repeating this cycle. But if you don't know how or you just don't want to do it, keep going with the chest compressions at the rate of about a 100 a minute until the ambulance arrives. The speed can be hard to judge, but it goes at the rate of Nelly the Elephant or the theme from the Archers.
In my village, it often takes an emergency ambulance more than the target of eight minutes to get here, so a charity has installed a portable defibrillator outside the post office. It's locked, but if you call 999 you're given the code to unlock it and it's unbelievably easy to use, even if you've never used one before. You plug it in, make sure the chest is bare, put the sticky pads on as directed and listen to the instructions (particularly the one that tells you to stand back when a shock is delivered). The defibrillator only shocks when the heart might benefit, so you can't do any harm and you may well save a life. Brain cells start to die within 3-4 minutes of a cardiac arrest, so the sooner the shock, the better. If Granny recovers, well done. But you still need the emergency ambulance to take her to hospital in case it happens again.
If all this sounds a bit much, just remember the bottom line and call 999 if you think a patient might have had a heart attack (chest pain or just looks and feels ghastly fairly quickly) or a stroke (sudden face droop, loss of sensation or movement in one side, difficulty speaking). Both of these conditions are usually caused by blood clots and if you dissolve them quickly with drugs, the damage is much less. There have been some amazing advances in emergency care in the last few years, but they only work if we spot the emergencies and ask for help. The British are often too shy or embarrassed to do this. Don't phone your neighbour or your GP or NHS direct. Dial 999.
Dr Phil Hammond is a medical doctor, comedian and commentator on health issues. 

Written by: Dr Phil Hammond
Edited by: Dr Phil Hammond
Last updated: Friday, August 13th 2010

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Comments on this article

Posted by Rick on 23/05/2011 at 02:33

Nice article. I will certainly remember the 30 compressions now.