Dr Phil Hammond, broadcaster and GP returner in Bristol

When did you last witness a cardiac arrest?
 

This was the ice-breaking question at my annual course on resuscitation training, and none of us had been called into action for over 5 years. My last experience of a person in cardiac arrest was in 2001, when I was filming with the Staffordshire Ambulance Service for a BBC programme to show the importance of dialling 999 for chest pain. When we arrived, the patient had all but expired, his wife mistaking his blue colour for coldness. He was covered in blankets but no one had even thought about attempting cardiopulmonary resuscitation.

So are doctors any better in rare emergencies? Clive, the paramedic taking our course, talked about a cardiac arrest that had happened in a nearby GP surgery. When he arrived, four GPs, three nurses, two receptionists, and half a dozen patients surrounded the person who was having a cardiac arrest. Lots of people were mumbling about what they might do next, but no one was keen to take charge. An intravenous cannula was in site, the odd drug had been given, but they had given up on the basics. ‘Shall we start again?’ asked Clive, 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.’

‘Why?’

‘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 the doctors had all been on their annual training course, but when confronted with a real emergency—one that most hadn’t witnessed for years—it all went pear shaped because no one took control.

Clive visited the surgery a few weeks later and asked those who had 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 realised 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 thought would do the job well. In all the 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 ensuring that the defibrillator was kept unlocked, Clive issued a set of four colour-coded cards that instruct people on exactly what to do in the event of a cardiac arrest:

  • black card (denotes the leader)—he or she diagnoses the cardiac arrest, recruits three helpers, tells someone to dial 999, hands out the other cards, and clears the room; the patient is then moved to a hard surface
  • green card—carries out the chest compressions
  • red card—operates the defibrillator
  • blue card—is in charge of the airway breathing.

Each card sets out very clearly what to do, and in what order. When you get tired from all those chest compressions (or find yourself farting uncontrollably after a three-bean salad), you can swap cards. 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 you would like your own set of cards (£15, which includes a set for children in respiratory arrest and anaphylaxis drug doses), contact: clive@firstresponse.org.ukG