Lucky times and nuggets

Sometimes you just and end up in the right place at the right time.  If you are especially lucky, you have a set of highly trained and experienced paramedics there too. This is a story of one of the proudest moments of my life and how , without working within a team, things may be been very different.  A few days ago I was part of a team that saved a young man’s life.

After a long day of work and writing I felt like some macdonalds before my evening gym, little did I know I’d soon be getting some free food.

I came across paramedics working on a young man who had lost consciousness for an unknown reason. I offered my help, and as soon as it became apparent I was a doctor, they looked to me to lead. This was a difficult task, and I felt it clear that this should be a team effort and was happy to be questioned. In the end it was about accepting responsibility for immediate management, whether I liked it or not.

This fellow was very unwell and in severe danger. It became quickly evident that he was not able to breathe for himself, and quick examination using ALS protocols indicated that he had lost his upper airway.  This was likely due to either the effects of atypical medications, seizure or loss of upper airway muscle tone. I was very concerned about his oxygenation, and by instucting the highly skilled team was able to assess and address the issue.

By using adjunctive kits we were able to keep his airway open. We had repeated instances of him regaining and  then losing his breathing, but it soon became clear how to  fix things. After the administration of some medication he was whisked off to hospital, lucky to have survived.

I am less inclined to talk about the cause of this mans collapse and respiratory arrest, but more the beneficial aspects of team work and how these are integral to his medical care.  My role within this gentlemans management was within a leader role, but this role was only a small part of something much greater. The work of a well oiled team is integral to saving lives in modern medicine.

Delivery of a potentially life saving intervention requires a number of skills used appropriately in time and technique.  By acting calmly and establishing team roles early, myself and the paramedics were able to create an efficient and directed team. Each member kept a real time monitor on a specific facet of care, be it airway, breathing or circulation. Arriving healthcare staff were assigned, after a quick verbal handover, to new tasks involving medication management and bedside tests.

One of the most successful parts of this case was the method of communication employed. The team would use closed loop communication, often repeating information and establishing a timeline to ensure that tasks were done. By creating a timeline we were better able to measure the effects of our interventions, helping better our treatment.

The combination of early recognition of issues, established group roles and real time coherent and thorough communication meant that things went very smoothly. Any concerns were raised and dealt with quickly.  It became evident that the most effective part of our intervention was the deft interaction between the ambulance crew, which spoke of experience and forward thinking.

It is fair to say that although my role was more senior (much to my dismay), it was the team effort that saved the day. Although the experience was terrifying, and I spent a while shaking afterwards, I went home that night having made a difference.

Sometimes we get a win. And now I get free nuggets.





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