Once they have transferred Edward to the Accident & Emergency Department, the ambulance crew are dispatched straight out on another emergency call. Alistair would have liked an opportunity to talk through what happened at the OHCA with his qualified mentor but there was no opportunity for this.
Instead, Alistair uses the event when he is asked to reflect on a critical incident as part of his clinical learning portfolio, using a structured model of reflection.
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Description (what happened?)
I am a student ambulance technician. On Friday, I was working with my paramedic mentor when our ambulance team was despatched to an out of hospital cardiac arrest (OHCA) event in a local shopping mall. When we arrived at the scene, a security guard had performed CPR on a middle-aged gentleman and had successfully established Return of Spontaneous Circulation (ROSC). While the two attending paramedics concentrated on stabilising the patient and preparing him for transfer to the nearest Accident & Emergency department, I was tasked with dealing with the gentleman’s wife and the bystanders. The wife was clearly very distressed. None of the bystanders had participated in the resuscitation attempt and one man appeared to be filming everything on his mobile phone, until I asked him to stop and to respect the privacy of the patient and his wife.
Once we had transported the patient and his wife to hospital, we were immediately dispatched to another emergency call, so there was no time for the team to debrief or discuss how the event had gone.
Feelings (what were you thinking or feeling?)
I felt a number of different emotions at the time:
- Excitement. This was the first OHCA I had been involved in and, although I appreciated that this would be a life or death situation for some unfortunate individual, I still felt an adrenaline rush at the thought of being involved in it.
- Disappointment. I would have preferred to have helped with the more technical aspects of stabilising the patient, rather than being asked to deal with his wife and the bystanders.
- Inadequacy. The wife was very upset and quite inconsolable. I felt very helpless as I did not really know what to say or do, in order to calm her down and reassure her.
- Anger. I was angry about two aspects of the event. One was that, despite the number of people watching the cardiac arrest, nobody had stepped forward to help the security guard. I was also very angry with the man who was filming on his mobile phone.
- Unresolved. Although the gentleman was successfully resuscitated and stabilised, there were a number of aspects of the event that I would have liked to have had the opportunity to discuss with the other, more experienced, members of the team. The fact we were immediately sent out to another emergency meant that this did not happen. I found that I was still mulling over the situation that evening, once I had gone off shift.
Evaluation (what was good/bad about the event)
The event was good in that the patient was successfully resuscitated, stabilised and transported to hospital. The SAS team was well organised, with one paramedic acting very effectively as team leader, and the team worked efficiently together.
On a more negative note, I do not feel that I dealt particularly well with the distressed wife. The fact that her husband regained consciousness helped alleviate her distress levels, rather than any specific interventions that I had instigated.
The privacy of both the patient and those responding to the cardiac arrest was compromised by the individual who filmed the event.
The final negative aspect of the event was the lack of time for any sort of debrief (formal or informal) with the other members of the ambulance team.
Analysis (what sense can you make of the situation?)
- I have a tendency to value technical skills over softer skills, such as communication, and I need to understand that the softer skills are equally important.
- I have a lack of training in dealing with distressed relatives and this left me feeling indadequate.
- I didn”t fully appreciate the effect of witnessing a relative being resuscitated would have on an indivdual.
- Issues of privacy and dignity in OHCA need to be considered. These are compounded by use of social media.
- Value of debriefing in supporting staff should not be underestimated.
Conclusion (what else could you have done?)
Whilst the outcome for the patient was positive, his wife still had to deal with a very traumatic and distressing event. If I had been more skilled in dealing with emotional distress, I might have been able to offer her more support. Lack of time to debrief is a difficult issue to overcome, as it is very dependent on call demands. I could, perhaps have been more vocal and assertive in requesting some sort of debrief with my mentor.
Action Plan (if situation arose again what would you do?)
I could prepare myself for dealing with a similar situation in future by:
- Negotiating time to attend training/study days on dealing with distressed relatives.
- Accessing and reviewing literature/research/guidelines on preserving the privacy and dignity of patients being resuscitated after OHCA, particularly in terms of social media exposure.
- Requesting regular debriefing support sessions with my paramedic mentor.
