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First aid

Updated 23 July 2014

A night on call with the 911 crew

On the front line of the battle between life and death it's the paramedic who has to stay calm and think fast, making sure every second counts.

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On the front line of the battle between life and death it's the paramedic who has to stay calm and think fast, making sure every second counts, says Rob Whitaker.

It's shift change and the Netcare 911 base is full of activity when my phone beeps with a dispatch message.

I'd been hoping for a quick cup of coffee but the dispatch leaves me in no doubt about the urgency of the call. A woman has been stabbed then set alight. As an advanced life support paramedic (ALS) my job is to attend to ''priority'' calls - life-threatening illnesses or injuries. The SAPS has cordoned off the scene by the time we arrive.

The patient is lying in a café entrance covered with a blanket in such a way it appears someone has already left her for dead.

She's conscious but not writhing in agony. The burns across her torso, neck and face are deep enough to have severed the complicated network of nerves that transmit pain.

While one of the crew searches for a site to give her intravenous fluids, another gives her oxygen and rips open packets of Burn Shield. A powerful concoction of sedatives and morphine is administered through the only vein we can find, one in her foot, so we can protect her airway by inserting a tube into her lungs.

When the patient has been handed over to the hospital we get ready for the next call. It's a Friday night, typically one of the busiest times if you work in emergency services.

It's after midnight when I experience the first lull in the night's tempo; time for coffee and food.

There's a basic lesson everyone in the emergency services learns: ''Eat when you can, sleep when you can.'' I've just finished my coffee when my phone beeps: ''Cardiac arrest - CPR in progress.''

Responding with lights and sirens is always fraught with hazards, even at 1am on a deserted highway. While checking to see intersections are clear we're also receiving updates on the call and running through a mental emergency checklist. The gate to the house is closed and I spend precious seconds trying to locate the buzzer.

The patient's heart shows no electrical activity. His pupils are dilated and unresponsive, starved of oxygen for too long. Now comes the hard part - breaking the news to the family.

Three years of studying may teach you to deal with any emergency but nothing can prepare you for having to tell someone a loved one is dead. There never is a ''right'' thing to say, you can only try to avoid saying the wrong thing and watch as their emotions swing from anguish and denial to acceptance and grief.

It's just after 5am when I'm woken by the control room after a blissful 45 minutes' sleep. ''MVA (motor vehicle accident) on the N1. Patients entrapped.''

The devastation is immense. Rescue crews have secured the scene and the remnants of a small car are strewn everywhere. Four people were in the car. Three escaped injury and are huddled together next to a rescue vehicle.

The driver is still in the car, groaning, his chest wedged against the steering wheel, his legs pinned down by the dashboard.

In the cramped, dark space I immobilise his neck, give him oxygen and find a vein in his arm to give him fluids. With the roof removed we manoeuvre him out from the concertinaed vehicle onto a spine board and into the ambulance.

The monitoring equipment tells me his blood pressure is free-falling and his oxygen saturation dropping. He's bleeding from somewhere. I double-check to see if I can find any external wounds. Nothing.

The bleeding is internal. En route to the hospital I hasten to secure his airway and stabilise his blood pressure, ensuring his brain will get the oxygen it needs.

It's a multidisciplinary chain: getting the patient from the roadside, into casualty and onto a surgeon's table within the ''golden hour''. Everyone is ready for us in the resuscitation unit. By the time we've finished cleaning our gear the patient has already been wheeled off to theatre.

The patient's family is in the casualty corridor, weeping quietly. One of them thanks us for everything we did. A surgeon has spoken to them and said the prognosis isn't good.

They're just grateful they've been able to see him while he's still alive. I'll find out later the patient died in theatre. His injuries, all internal, were simply too severe.

I look at my watch. I still have 12 hours of my shift left. Taking a slow drive back to the base I use the time to reflect. People often ask the question: how do we cope with what we do - the blood, the guts, the tragic loss of life?

For me the answer is simple. At the end of every shift can I turn around and say I've made a positive difference? Sometimes, as much as I'd like it to be, that difference isn't whether the patients lived or we improved their condition.

It could be keeping them alive long enough so their family can say goodbye. Sometimes that's enough. And if I can say I've done everything I could then that is enough for me.

 

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